Well-aligned Teeth Research Articles

Evaluation of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental Proportion in Kenyans of African Descent.

To evaluate the validity of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental (RED) Proportion among Kenyans of African descent with naturally well-aligned teeth. Standardized frontal photographic images of the smiles of 175 participants aged 18-35 years were obtained, and Adobe Photoshop was used to analyze and measure the frontal widths of the maxillary central and lateral incisorsand canines in triplicate. The average teeth widths were calculated to determine the existence of the Golden Proportion, Golden Percentage, and RED Proportion, and their validity using independent sample t-tests to compare the differences in the mean teeth widths at α < 0.05. The number of male and female participants was 107 (61.1%) and 68 (38.9%), respectively. The Golden Proportion between the maxillary central and lateral incisors was found in 4.0% on the right and 2.8% on the left of all the participants, but between the maxillary lateral incisors and canines was found in only 0.6% on the right of male participants (p < 0.0001). The RED Proportion between the maxillary lateral and central incisors was in the range of 67%-70%, and between the canines and lateral incisors was 82%-84% (p < 0.0001). The proportion of RED was not constant, and gradually increased distally. The Golden Percentage of 15% was observed in the lateral incisors bilaterally; however, in the central incisors and the canines, the Golden Percentage was 22% and 12%, respectively. The Golden and RED Proportions were invalid determinants of anterior teeth proportions. The Golden Percentage existed only in the lateral incisors. The Golden Proportion, RED Proportion, and Golden Percentage theories may not be applicable to all populations when designing smiles. Racial and ethnic backgrounds are important considerations to establish objective quantifiable values of anterior tooth proportions that are beneficial for esthetic restorations.

Treatment and genetic analysis of multiple supernumerary and impacted teeth in an adolescent patient

BackgroundMultiple supernumerary teeth, combined with numerous impacted teeth, can lead to various malocclusions, posing significant treatment challenges. While certain genes associated with syndromic cases of multiple supernumerary and impacted teeth have been identified, the etiologies of non-syndromic cases still largely remain elusive.Case presentationHere, we report a treatment of a 12-year-old boy who presented with 10 supernumerary teeth and 6 impacted teeth, accompanied by a genetic analysis to explore the underlying etiology. During the treatment, fifteen teeth were extracted, and various skilled techniques, including the closed-eruption technique and the application of by-pass arches, were utilized. Post-treatment, traction was successful for all the impacted teeth, without any tooth mobility or reduction in gingival height. Space closure, well-aligned teeth, and excellent functional occlusion were achieved. Furthermore, comprehensive genetic analysis was conducted through whole-exome sequencing on the patient and his parents, which revealed a potential link between the patient’s numerous supernumerary teeth and abnormal mineralization. Notably, the p.Ser496Pro variant in the TCF7L2 gene was identified as a potential candidate variant in this patient.ConclusionsOverall, our findings not only report the treatment of a rare case involving multiple supernumerary and impacted teeth but also offer valuable insights into the molecular basis of supernumerary teeth.

Comparison of knowledge, self-perception about malocclusion and orthodontic treatment need amongst undergraduate dental students

ABSTRACT Introduction Perception regarding malocclusion and esthetics is affected by knowledge, age, race, gender, social background, and exposure. This study compares knowledge and awareness of undergraduate dental students regarding malocclusion, its impact on oral and mental health, and students’ self- perceived need for orthodontic treatment. Material and Methods A multi-centre cross-sectional study evaluated 424 questionnaires. They were assessed and compared on knowledge, awareness, and self-perception regarding malocclusion. Results were reported in percentages and compared using chi-square test. Results Most of the respondents were females, (82.1%). 4th year students were most aware about malocclusion’s effects on caries (86.8%), plaque (98.1%) and gingivitis (85.8%), p-value was significant, 0.000. Mostly, 3rd year students favoured well-aligned teeth, 91.5%, (p = 0.431); 2nd year students mostly, regarded aligned teeth important for esthetics (96.2%) p = 0.042; 4th year students mostly reported self-perceived need for orthodontic treatment, 43.4% (p = 0.048) and thought malocclusion affected one’s self-esteem 86.8% (p = 0.031), acceptance amongst peers 51.9% (p = 0.000) and mental health 52.8% (p = 0.000). Conclusion Knowledge and self-perception regarding malocclusion did not have a direct relation with the level of education of the dental students studied.

Perception and attitude of Mongolians on malocclusion

Background/purposeThis study assessed the perception and attitude of Mongolians on malocclusion and compared the perceptions with researchers’ perceptions on malocclusion, and this study aimed to determine factors influencing the self-perception of laypeople.Materials and methodsIn addition, we evaluated the correlation between the subjective and objective perceptions of participants. In a random sample of 133 people (39.8% men and 60.2% women) aged 18–55 years, subjective perceptions were assessed using a questionnaire (oral aesthetic subjective impact scale), and objective perceptions were assessed using 10 intraoral frontal photographs of the aesthetic component of index of orthodontic treatment need (AC-IOTN) and six intraoral lateral photographs of the aesthetic component of lateral occlusion (AC-LO).ResultsA significant association was observed between participants' self-perception and researchers' ratings (P < 0.001). The appearance of teeth was significantly correlated with participants’ self-rating by using AC-IOTN and AC-LO. Most people (74%) believed that well-aligned teeth improve the overall facial appearance. Sex, monthly income, and education level significantly influenced the self-perception of participants on malocclusion.ConclusionPatients’ perception and attitude cannot be overlooked because they are some of the crucial aspects of the entire treatment.

Periodontal support and escort for healthy orthodontic treatment

Health and support of periodontal tissue is the basis for achieving excellent, safe and efficient orthodontic treatment outcome, which also guarantees the esthetics, stability and function of treatment objectives. The support of healthy periodontal tissue contributes to the stability of teeth. Orthodontic treatment also requires adaptive periodontal reconstruction during tooth movement. Well-aligned teeth and balanced occlusion play an important role in maintaining and improving periodontal homeostasis. Healthy orthodontic treatment can improve the health of periodontal structure and functions, which has to rely on the existence and reconstruction of healthy periodontal tissue. Therefore, orthodontics and periodontal health have dialectically close association and mutual maintenance. Favorable "periodontal support and escort" is indispensable for healthy orthodontic treatment.

Orthodontists' and parents’ perception of finished occlusion and willingness to extend treatment time

Patients and parents want shorter treatment times, but it is unclear whether they would compromise outcome quality to shorten treatment. The purpose of this study was to compare orthodontists' and parents' perceptions of finished occlusion and their willingness to extend treatment time to achieve improved outcomes. The effects of elapsed treatment time and patient compliance were also investigated. Parallel surveys for orthodontists (n=1000) and parents (n=750) displayed simulated treatment outcomes of well-aligned teeth with occlusions in 1mm increments from 3mm Class III to 3mm Class II. Participants rated their preferences on a visual analogue scale (VAS; 0-100) and specified whether they would extend treatment, and for how long, to improve the occlusion. Two hundred thirty-three orthodontists (23%) and 243 parents (32%) responded. Despite differences between the scores given (P<0.0001), both groups rated Class I occlusion most acceptable (mean VAS=93.9 and 80.7, respectively) and 3mm Class III malocclusion least acceptable (mean VAS=25.9 and 40.9, respectively). Parents were willing to extend treatment more often and for a greater time than orthodontists to improve results (P<0.0001). In addition, parents were less willing to terminate treatment early (P<0.05). Both groups perceived existing outcomes as more acceptable if the patient was noncompliant (P<0.05), but elapsed time in treatment had no significant effect on ratings. For outcomes with well-aligned teeth, orthodontists and parents agreed on what the most and least acceptable occlusal relationships were. To achieve better outcomes, parents were willing to extend treatment duration more often and for a greater time than were orthodontists. In addition, parents were less willing than orthodontists to terminate treatment early.

Assessment of lip phenotype and its association with anterior tooth alignment in children

Background: Lip types are typical for every person, and there are three basic lip phenotypes in humans. Uncertainty exists as to whether a general trend follows in the classification of lip according to the dental alignment. Aim: The purpose of this study was to assess the correlation between lip phenotype and the type of anterior tooth alignment. Materials and Methods: The study sample comprised schoolchildren aged between 10 and 14 years screened before the study and equally divided (n = 50) based on lip phenotypes given by Cutbirth classification on the basis of lip form as high, moderate, and straight lip. Parameters assessed included anterior well-aligned teeth, anterior malaligned teeth, crowding, spacing, midline diastema, increased anterior maxillary overjet, anterior deep bite, and retroclined anterior teeth. Scores for each of these morphologic characteristics were determined by direct measurement. Descriptive and analytical statistics were done. Results: The Chi-square test was used to check differences in proportions. The statistical significance was set at P

Targeting the smile: why don't we aim at the lips?

The smile is more than a question of well-aligned teeth. Harmonization of the dentition with the soft tissues is the key to a beautiful smile. This abundantly illustrated article looks more closely therefore at the lips and their movements. The article begins by explicating the terminology relevant to the lips, then addresses the notions of volume, mobility and aging, and concludes by examining the orthodontic clinical dimension. Practitioners must be fully informed when assessing requests for treatment formulated by adult patients and a detailed analysis must be made of the lips at rest and during functioning. Harmony of both the teeth and the soft tissues is indispensable to a beautiful smile. A multidisciplinary approach is often necessary. Restoring the patient's smile therefore obliges the practitioner to think beyond mere problems of dental occlusion.

The Facial Aesthetic index: An additional tool for assessing treatment need.

Objectives:Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices.Materials and Methods:A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using “irr” package of R environment version 2.15.1.Results:The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P < 0.001), excellent reproducibility (kappa 0.9078), high sensitivity, and specificity (95.7%). Testing in population yielded excellent agreement among orthodontists (kappa 0.9286).Conclusions:A new Facial Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need.

Awareness of orthodontic treatment need and perceptions of dental attractiveness among school children

Aim: The study aimed at assessing awareness about their own orthodontic treatment need and their perceptions about the dental attractiveness in school children. Subjects and Methods: The random sample of 200 school children (126 boys, 74 girls), aged 9-16 years was selected and categorized into eight different groups according to their occlusion after the dental check-up. Their own orthodontic treatment need and perception of the dental attractiveness was assessed by using questionnaire and was scored by showing eight intraoral frontal photographs and assessing their responses. Statistical Analysis Used: Chi-square test. Results: About 86% of school children considered well-aligned teeth important for overall facial appearance. School children scored photos having severe crowding (95.5%), highly placed canine (86.5%), and Class II Division 2 (70.5%) as most unattractive. 69.5% students did not feel the need of orthodontic treatment and 14.5% students did not know about orthodontic treatment. Conclusion: The study concluded that after showing positive perception toward dental attractiveness, when similar malocclusion was observed in them, they did not feel the need for orthodontic treatment due to lack of awareness. The study emphasizes the need to increase awareness especially among school children about different malocclusion and importance of orthodontic treatment as it is advantageous in preventing further complications.

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

Mandibular incisor crowding in the mixed dentition is one of the most common problems presenting to the orthodontist. Asymmetry of alignment, premature loss of primary canine(s), and disruption in arch integrity are all early benchmarks of a tooth size/arch length discrepancy in the transitional dentition that can occur independent of any skeletal discrepancy. Space supervision and guidance of eruption refer to treatment interventions during the early to mid-mixed dentition periods that influence the eruption patterns and positioning of the permanent teeth during their transition. Generally considered applicable to individuals with adequate overall arch dimensions to accommodate a normal complement of permanent teeth with an acceptable esthetic and functioning occlusion, guidance of eruption involves the implementation of directed interventions to optimize the eruption and alignment patterns of the permanent teeth as part of a non-extraction protocol.

Mechanical Reaction of Facial Skeleton to Rapid Palatal Expansion Devices using Laser Holography: An in vitro Study

Introduction: Rapid palatal expansion of the midpalatal suture is an effective method for the correction of transverse malocclusions. This study was conducted to compare the reaction of circum-maxillary sutures and center of resistance of molar to the Hyrax appliance with different degrees of activations and the Spring jet appliance using laser holography on a freshly macerated skull. Materials and methods: A freshly macerated skull with well-aligned teeth and intact dental arches was used as the experimental model. The Hyrax appliance and Spring jet appliances were fabricated and analyzed qualitatively and quantitatively by using double exposure hologram. Hyrax was activated two 1⁄4 turns, four 1⁄4 turns and eight 1⁄4 turns. The Spring jet is activated and double exposure hologram was recorded. Results: Results were obtained qualitatively by observing the fringes, and quantitatively by counting the number of fringes. The Spring jet showed fringes only in the first molar area, whereas the Hyrax showed fringes along the circum-maxillary sutures and the first molar area; and the number of fringes increased with the number of turns. Conclusion: Hyrax appliance activation produced mechanical reactions on the teeth, alveolar bone, maxilla and the circum-maxillary bones and sutures. The displacement and fringes increased progressively with two, four and eight turns activation of hyrax. The pattern of the fringes was more circular around the nasomaxillary complex and zygomaticomaxillary sutures, suggesting rotational displacement of the maxilla. The number and pattern of fringes produced by the Spring jet appliances suggest that it produces only dentoalveolar changes and minimal orthopedic affects.

Factors Influencing Subjective Orthodontic Treatment Need and Culture‐related Differences among Chinese Natives and Foreign Inhabitants

AimThe aim of this survey was to compare Chinese natives and foreign inhabitants in Chengdu, China, with respect to: (1) attitudes towards dental appearance, (2) subjective orthodontic treatment need, and (3) the main factors influencing orthodontic treatment need.MethodologyA total of 522 subjects, including 227 foreign inhabitants and 295 Chinese natives in Chengdu participated in the survey. A simple random sampling method was adopted and a face-to-face interview was conducted at some public sites using a questionnaire. Data was entered by two persons synchronously using Epidata 3.0, and SPSS 13.0 was used to analyze these data.Results89.0% of foreign inhabitants were satisfied with their teeth compared to only 46.8% of Chinese natives. Females were more dissatisfied with their teeth than males. Chinese natives put improving appearance as the top priority (55.9%) for seeking orthodontic treatment; however, in foreign inhabitants, the main reason for seeking treatment was to improve masticatory function (44.1%), followed by ”to be pretty“ (35.2%). The importance of well-aligned teeth and self-perception of psycho-social impact of malocclusion were the same two main factors influencing subjective orthodontic treatment need (P<0.05) in foreign inhabitants and Chinese natives. Subjective orthodontic treatment need between the two target groups was significantly different (P<0.05).Conclusion(1) It was very common that Chinese natives were dissatisfied with their dental appearance, and their subjective orthodontic treatment needs were high. (2) There were some differences in orthodontic treatment motives between the two target groups. (3) There were differences in subjective orthodontic treatment needs between foreign inhabitants and Chinese natives. However, the prominent influential factors were almost the same. There may be benefit to understanding subjective orthodontic needs of different races.

Influence of anterior tooth alignment on peer perception in 8- to 10-year-old children

The purpose of this research was to investigate whether anterior dental alignment in 8- to 10-year-old children influences the first impressions of their peers, and to verify the validity of the tested method. From colour photographs of two attractive children, one male and one female, Adobe Photoshop 5.0 was used to alter the images and create three versions of each photograph: one with good anterior dental alignment (OK smile), a second with proclination of the upper incisors (P-type smile), and finally one with moderate-to-severe anterior crowding (C-type smile). The six different photographs were shown to 121 subjects with mean age of 9.2 years (65 females and 56 males). Each subject was asked to view one photograph and subsequently respond to a questionnaire, the 'Smile perception questionnaire for children between the ages of 8 and 10' (SPQ 8-10), composed of 13 questions with graded responses. The responses for each photograph were analysed using linear regression analysis to determine the questionnaires validity as a whole and to investigate five area of common interest (honesty, intelligence, personal happiness, pleasantness, and extroversion). The results demonstrated that the questionnaire was reliable both from an internal coherence standpoint and from a test-retest reliability perspective. Data regarding the five areas of interest showed that 8- to 10-year-olds viewed their peers with well-aligned teeth more favourably as far as honesty, personal happiness, and intelligence were concerned. However, there was no statistically significant difference with regard to pleasantness and extroversion in children with harmonious, as opposed to crowded or proclined anterior teeth.

Relationship Between Gingivitis and Anterior Teeth Irregularities Among 18 to 26 Years Age Group: A Hospital Based Study in Belgaum, Karnataka

ABSTRACT Aim To study the relationship between gingivitis and irregular teeth in the anterior segments of dental arches. Materials &amp; Methods The sample size of 120 subjects who satisfied the inclusion criteria was randomly selected for the study. These subjects were selected between the age group of 18 to 26 years and divided into two groups. The study group (cases) consists of 60 subjects with irregular teeth in the anterior segments of dental arch. The control group (controls) consists of 60 subjects with well-aligned teeth in the anterior segments of dental arches. Results The mean gingival index of cases &amp; controls were 0.9513 and 0.5959 with standard deviations of 0.7014 and 0.4909 respectively. The t-value was 3.1093 with p&lt;0.001 which was highly significant. Conclusion The mean gingival index of study group was higher than the gingival score of the control group (P&lt;0.001).

Commentary

Commentary

Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children

The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most ( P < .0005). This suggests that, from the children's point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania.

Changes of facial gingival dimensions in children

Facial gingival surfaces of maxillary and mandibular anterior teeth were monitored to evaluate changes of the width of the keratinized and attached gingiva. 96 children 6 to 12 years of age were examined 2 x with an interval of 2 years. Measurements included dental plaque, gingival inflammation, probing depth, and width of keratinized and attached gingiva. In addition, study models were used to determine the facial/lingual position of the teeth. The results of this report, evaluating well-aligned teeth only, showed that during the 2-year observation period, increases in widths of the facial keratinized and attached gingiva took place. Increases occurred for the various teeth regions examined, and for deciduous as well as permanent teeth. During transition from the deciduous to the permanent dentition, patterns of change were variable. The increase of gingival widths was greatest for sites with the smallest baseline width of attached gingiva, and smallest for sites with the greatest baseline width. It was concluded that in well-aligned teeth, a conservative, monitoring approach prior to a corrective, surgical intervention seems prudent in children of this age with a minimal zone or absence of attached gingiva.

Care of the deciduous teeth as the basis of occlusion of the permanent dentition

The most important preventive procedure in orthodontics is the maintenance of the full deciduous arch length from the distal surface of the second molar around to that of the opposite side until the teeth are replaced by their successors. The permanent first molar thus is guided in eruption to its normal position contacting the distal surface of the second deciduous molar and should be so retained until all the deciduous teeth are replaced at about the twelfth year. It is the most important of all teeth and must be kept in perpetual health and efficiency. This we recognize as the imperative factor in the development of normal occlusion of the permanent teeth. If the full length of the deciduous arch is not maintained, the permanent first molars almost invariably shift to the mesial, resulting in too little jaw area with crowding and malalignment of the premolars and cuspids as they erupt, and orthodontic treatment thus becomes a necessity. In normal cases the deciduous molars and cuspids provide sufficient anteroposterior jaw length to accommodate their permanent successors. Therefore, horizontal growth in this region is not necessary after the fourth year. In extreme cases of mesial shift of the permanent first molar, extraction of good teeth may become necessary for the attainment of a pleasing result. However, it must be regarded as a compromise. Early treatment is the best safeguard against the need for such a procedure. It should be synchronized with the normal growth of each individual child. In the buccal segments, for the correct alignment of premolars and cuspids, the jaw area should be large enough to receive these teeth in advance of their eruption, and the correct distal position of the permanent first molar assuredly provides for this. Mesial shift should be corrected as soon as detected by moving this molar to its normal distal position. Extra-oral pressure, with headcap or cervical anchorage, is often indicated. In the incisal segment, horizontal jaw growth continues after eruption. While the permanent incisors are considerably wider than their deciduous predecessors, there is some latitude in that growth of jaws forward and downward in this section continues during and after eruption. Should developmental spacing of deciduous incisors be insufficient to provide an adequate area for their eruption in alignment, the tongue and lips in function tend to guide them into alignment as growth of the jaw takes place during the two or three years following eruption, provided there is no mechanical interference, as when teeth are in-locked or in crossbite, or when supernumerary teeth are present. These conditions should be corrected without delay and should take only a short time. The appliances should then be removed and Nature given her opportunity. Quite frequently it will be necessary to align them finally during a secondary period of treatment. Protruding upper incisors should be corrected promptly to protect them against the danger of breakage. Deep overbite, when the lower incisors wound the mucous membrane of the palate, should be corrected promptly. Abnormal labial frenum should receive early treatment by appliance pressure from the distal surfaces of the upper central incisors, the frenum thus being compressed with resultant resorption due to diminished blood supply and impoverished nourishment. Open-bite, almost invariably, is due to harmful pressure habits of biting or sucking the tongue, lips, finger, or thumb. This should be corrected as early as is expedient. Relapse of well-aligned teeth will recur unless the causative habit is permanently broken. Certainly, the most harmful advice that can possibly be given the parent is that orthodontic care should be deferred until all the deciduous teeth have been replaced by their permanent successors at about the twelfth year.