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ABSTRACT Introduction: There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases. Objectives: To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.
RESUMO Introdução: Existem diferentes possibilidades de planejamento ortodôntico para os casos que apresentam ausência congênita de incisivos laterais superiores. Esse é um assunto que divide a opinião de ortodontistas e reabilitadores orais, devido às vantagens e desvantagens de cada uma das opções de tratamento, as quais podem envolver a abertura de espaços para futuros implantes e/ou restaurações protéticas ou o fechamento dos espaços, com posicionamento dos caninos superiores no lugar dos incisivos laterais. O correto diagnóstico e uma criteriosa avaliação de cada paciente permitem determinar a melhor abordagem terapêutica. Nesse artigo, serão discutidos os principais tópicos a serem considerados no planejamento desses casos. Objetivos: Avaliar os principais aspectos relacionados ao planejamento do tratamento ortodôntico nos casos de ausência congênita de incisivos laterais superiores, de maneira a auxiliar nas tomadas de decisão, com embasamento clínico e científico.
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ABSTRACT Objective: The purpose of this study was to determine the perception of smile esthetics among orthodontists and laypersons with respect to unilateral maxillary canine torque variations in a frontal smile analysis. Methods: Full face and close-up smile photographs of two subjects (1 man and 1 woman) were used. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to obtain a bilateral 0° torque in the maxillary canines. From this image, unilateral variations of the left canine were made with -15°, -10°, -5°, 0°, +5°, +10° and +15°. Final images were randomly assembled into an album that was given to 53 orthodontists and 53 laypersons. Each rater was asked to evaluate the attractiveness of the images using visual analog scales. Data collected were statistically analyzed with one-way analysis of variance with Tukey post-hoc test and the unpaired Student t test. Results: For orthodontists, most attractive smiles were those with 0°, -5° and -10°. For laypersons, most attractive smiles were those with 0°, -5°, -10°, -15° and + 5°. For both groups, the lowest scores were given for the smiles with +10° and +15° torque. When comparing the perceptions of the orthodontists and laypersons, they did not show statistical differences in most situations. Moreover, in general, there was no significant difference between the full-face and close-up assessments of the smiles. Conclusions: The present findings indicated that smiles with unilateral palatal (negative values) maxillary canine torque variations were more tolerated than smiles with buccal crown torque (positive values) variations.
RESUMO Objetivo: o objetivo do presente estudo foi avaliar a percepção estética do sorriso, por ortodontistas e leigos, em relação a variações unilaterais do torque do canino superior, em uma análise frontal do sorriso. Métodos: foram utilizadas fotografias de face total e de sorriso aproximado de dois indivíduos (1 homem e 1 mulher). Ambos os sorrisos exibiam dentição anterossuperior saudável. As imagens foram alteradas digitalmente para obtenção de um torque bilateral de 0° nos caninos superiores. A partir dessa imagem, variações unilaterais do canino esquerdo foram realizadas com -15°, -10°, -5°, 0°, +5°, +10° e +15°. As imagens finais foram montadas aleatoriamente em um álbum que foi entregue a 53 ortodontistas e 53 leigos. Cada avaliador foi orientado a avaliar a atratividade das imagens com escalas visuais analógicas. Os dados coletados foram analisados estatisticamente com análise de variância ANOVA com pós-teste de Tukey e teste t de Student não pareado. Resultados: para ortodontistas, os sorrisos mais atraentes foram aqueles com 0°, -5° e -10°. Para os leigos, os sorrisos mais atraentes foram aqueles com 0°, -5°, -10°, -15° e +5°. Para ambos os grupos, as pontuações mais baixas foram dadas para os sorrisos com torque de +10° e +15°. Ao comparar as percepções dos ortodontistas e leigos, não foram encontradas diferenças estatísticas na maioria das situações. Além disso, em geral, não houve diferença significativa entre as avaliações de face total e de sorriso aproximado. Conclusões: esses achados indicam que os sorrisos com variações unilaterais no torque do canino superior para palatino (valores negativos) foram mais tolerados do que os sorrisos com variações no torque da coroa para vestibular (valores positivos).
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Humans , Female , Adult , Esthetics, Dental , Orthodontists , Incisor , Smiling , Attitude of Health Personnel , Tooth Crown , Torque , Visual Analog Scale , MaxillaABSTRACT
Los pacientes de hoy exigen una sonrisa atractiva que no sea causa de vergüenza al expresarla. La sonrisa gingival excesiva es una condición clínica en la que se expone la encía (≥ 4 mm) al sonreír. Para su manejo se debe establecer un buen diagnóstico y etiología para determinar la mejor opción de tratamiento dentro de las diversas técnicas descritas en la literatura. Se describe un caso en una paciente con sonrisa gingival excesiva de 8-9 mm causada por crecimiento vertical maxilar, erupción pasiva alterada y labio superior hiperactivo. Después de explicarle los pros y los contras, decidió realizarse sólo la cirugía de reposicionamiento labial, debido a que rechazó la cirugía ortognática y el alargamiento de coronas, obteniendo un buen resultado desde el postoperatorio inmediato con una gran satisfacción de la paciente y pocas complicaciones posteriores (AU)
Today's patients demand an attractive smile and do not cause them to feel embarrassed when expressing it. Excessive gingival display smile is a condition in which the gum (≥ 4 mm) exposed when smiling. Good diagnosis and etiology should be established to determine its treatment. A case described in a patient with an excessive gingival smile of 8-9 mm, caused by vertical maxillary growth, altered passive eruption and hyperactive upper lip. Who after explaining the pros and cons, decided to perform only lip repositioning surgery, because I refuse orthognathic surgery and elongation of crowns. Obtaining a good result, from the immediate postoperative, with great patient satisfaction and few subsequent complications (AU)
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Humans , Female , Adult , Esthetics, Dental , Gingiva , Lip , Smiling , Oral Surgical Procedures , Postoperative Complications , Wound HealingABSTRACT
Objective:To investigate the effect of different crown heights of lateral incisor and canine on smile esthetics perception between orthodontists and patients.Methods:A total of 31 orthodontists and 56 patients on smile aesthetics perception were investigated.We adjusted the height of lateral incisor and canine to get 20 kinds of anterior tooth area morphology by Photoshop and asked interviewees to grade.Scores of satisfaction were recorded by Likert method.Results:Subjects in the 2 groups preferred smiles with upper anterior teeth edge parallel to lower lip.There was better acceptance for longer canines and less satisfaction at shorter lateral incisors in patients.Patients also got higher discrete degree of evaluation results and more rigorous about smile esthetics than orthodontists.Conclusion:Orthodontists and patients have different satisfaction at esthetics of anterior teeth.Esthetics preference should be considered in orthodontic treatment schedule.
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This case report illustrates the successful treatment of a patient with skeletal Class II malocclusion and an unesthetic smile involving excessive gingival display and large buccal corridors. By applying dual buccal interradicular miniscrews, total intrusion of the maxillary dentition along with distalization was induced to improve both the occlusion and smile esthetics. In addition to the conventional cephalometric superimposition, three-dimensional superimposition was performed and evaluated to validate the treatment outcome.
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Humans , Dentition , Esthetics , Malocclusion , Treatment OutcomeABSTRACT
Objective To survey aesthetics cognition for smiling beauty in young people smile. Methods Smile model was established. The middle incisor width/length ratio, lateral incisor and middle incisor width ratio, difference of lateral incisor and the middle incisor gingival level, gingiva exposure, buccal corridor width and smile line radian were used as variable values to change respectively. A total of 200 young people were selected to evaluate results. The differences in index of ideal value and acceptable range between different dender groups were calculated. Results The ideal value of middle incisor width/length ratio was 0.75, and acceptable range was 0.65-0.85. The ideal value of lateral incisor and middle incisor width ratio was 0.618, and acceptable range was 0.518-0.718. The ideal value of lateral incisor and the middle incisor gingival level difference was-0.5 mm, and the acceptable range was-1-0 mm. The ideal value of gingiva exposure was 0 mm, and the acceptable range was 0-2 mm. The ideal value of buccal corridor was 0.09, and the acceptable range was 0.05-0.21. Coordinate smile was ideal smile line (value=1), and the acceptable range was 0.5-1. There were no statistically significant differences in smile esthetics of six ideal value indicators and acceptable ranges between different gender groups. Conclusion The ideal values and acceptable ranges of six indexes of quantitative criteria can be used for clinical treatment.
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Objective To explore the related factors that might had effect on orthodontic patients' esthetic evaluation of axial dental midline angulation from three aspects which are ideal value,detectable value and tolerable value.Methods Photographs of a smiling woman was digitally manipulated to produce models with left or right maxillary axial dental midline angulations in 2° increments.These digital photographs models were used to develop an electronic questionnaire in combination with corresponding guidance for each question.The electronic questionnaire was applied to investigate the esthetic evaluation of axial dental midline angulation from 222 orthodontic patients who complied with the inclusion criteria.Esthetic evaluation included three aspects,the ideal value,the detectable value and the tolerable value,which represented the degrees of maxillary axial dental midline angulations the patients considered to be ideal,detectable and tolerable,respectively.The patients' personal information and clinical orthodontic examination results were collected as well.Results The mean detectable value and tolerable value were 4.9° and 9.7°,the median of detectable value and tolerable value were 5°and 9.5°.Logistic regression analysis was applied to explore the influence of seven factors on each evaluator's ideal value,detectable value and tolerable value.The seven factors were gender,marriage condition,education level,orthodontic treatment condition,malocclusion index,dental esthetic rating from others and from themselves.The statistical analysis indicated education level and orthodontic treatment condition were the influential factors of detectable values,while the tolerable values were influenced by the education level and gender.The ideal value converged to 0° and none of the factors had effect on it.Conclusions The education level,orthodontic treatment condition and gender are considered to be the influential factors of the esthetic evaluation of axial dental midline angulation.
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INTRODUCTION: The search for orthodontic treatment by adult patients is increasing. This demand may be explained by many reasons, but the most important was the change in the concept of normality, allowing the selection of simpler and more conservative and consistent therapeutic objectives. This conceptual evolution, combined with the technological advances allowed an improvement in orthodontic management, making it more effective, fast and comfortable. The promotion of awareness of the society on the advantages of this treatment and the increase in esthetic demands, with an increasingly longer and active social, affective and professional life, creates a context in which the need for Orthodontics is absolutely established for the adult individuals. OBJECTIVE: The objective of this article is to report the nuances in diagnosis and orthodontic treatment of an adult patient, in a different perspective. Within this approach, the objective is to recover the shape, i.e. to establish occlusal conditions that would probably be present if the patient had been assisted at the proper time, namely during growth and tooth irruption.
INTRODUÇÃO: a procura de tratamento ortodôntico por pacientes adultos é cada vez maior. Essa demanda pode ser justificada por vários fatores, mas o mais relevante foi a mudança do conceito de normal, permitindo a opção por metas terapêuticas mais conservadoras, simples e consistentes. Essa evolução conceitual, mais os avanços tecnológicos, permitiram melhora no manejo ortodôntico, tornando-o mais efetivo, rápido e confortável. A conscientização, por parte da sociedade, das vantagens desse tratamento e o aumento da exigência estética entre os adultos, com uma vida social, afetiva e profissional cada vez mais longa e ativa, cria um contexto onde fica absolutamente estabelecida a necessidade de uma Ortodontia para os indivíduos adultos. OBJETIVO: o objetivo desse artigo foi relatar as nuances de diagnóstico e tratamento ortodôntico em um paciente adulto, dentro de uma perspectiva reformadora. Nessa abordagem, o objetivo é o resgate da forma, ou seja, estabelecer condições oclusais que, provavelmente, estariam presentes se o paciente tivesse sido assistido em épocas adequadas, na fase de crescimento e erupção dentária.
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Aim: The aim of this study was to evaluate and compare the importance of amount of gingival display on smile esthetics and facial attractiveness in males and females with different facial forms by orthodontists as well as lay person. Materials and Methods: Frontal photographs of 18 male and female patients (9 male and 9 female) each, at a posed smile, seeking treatment in the Department of Orthodontics and Dentofacial Orthopedics were obtained. The photographs were divided in 3 groups based on their facial forms (Short face, Average face and Long face) and were altered by moving the dentition within the lip frame of the captured photograph to bring about different gingival display at smile. The pictures were divided into six groups with gingival exposures of 0 mm, 1 mm, 2 mm, 3 mm, 4 mm and 5 mm. The pictures were rated for attractiveness by four sets of evaluators - male and female Orthodontists and male and female lay evaluators. The statistical analysis methods used for the study included Mean score calculation, standard deviation and Analysis of variance: [test (Mono- Variance)]. The Student t test (two tailed, independent) has been used to find the significance of rating scores between lay person and orthodontist, and also between males and females evaluators. Results: No significant difference in ratings of gingival display in the 3 groups of photographs was noted by lay person and orthodontists. The results point to the fact that the influence of amount of gingival display on smile esthetics was independent of the facial form. It was also observed that gingival display of 0 mm to 2 mm was acceptable to both the lay person and the orthodontists. Conclusion: As the amount of gingival display increased, the ratings for facial attractiveness by both orthodontists and lay person decreased. Higher scores were given by both orthodontists and lay person for photographs which showed gingival display of 0-2 mm, suggesting this value to be most acceptable.
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Beauty , Dentists , Esthetics, Dental/standards , Face/anatomy & histology , Female , Gingiva/anatomy & histology , Gingival Hyperplasia , Humans , Male , SmilingABSTRACT
Purpose: This study was designed to evaluate the buccal corridor in smile esthetics and to correlate it with underlying hard tissues. Materials and Methods: Posed smiling frontal photographs, digital posterior-anterior (PA) cephalograms, and study models of 25 males and 25 females in age range of 18-25 years were taken. Photographs were evaluated for smile esthetics by eight orthodontists, eight plastic surgeons, eight beauticians and eight lay people to group them into three groups with least attractive, average and attractive smile and buccal corridor width was measured. Digital PA cephalograms were transferred on Nemo-tech software for frontal facial analysis. Intercanine and intermolar widths were measured on upper study model with the help of a digital calliper. Results: The buccal corridor width was least in attractive smile group and maximum in least attractive smile group. The buccal corridor width had a negligible correlation with hard tissues and a mild to moderate inverse correlation with intercanine and intermolar widths within the groups. Conclusion: As the amount of buccal corridor display was increased, smiling images were scored less attractive by the evaluators. The buccal corridor is not influenced by underlying skeletal hard tissues but have mild to moderate inverse correlation with the intercanine and intermolar width.