Smile dimensions in adult African American and Caucasian females and males.

OBJECTIVES: To test smile dimension variations in adult African American and Caucasian females and males. SETTING AND SAMPLE POPULATION: The University of Alabama at Birmingham School of Dentistry and Hospital. Three hundred and ninety-four participants were recruited; African American females and males distributed over five age groups: 20-30, 30-40, 40-50, 50-60 and older than 60. MATERIAL & METHODS: Three-dimensional surface imaging was used to acquire two images of each participant, one at rest and one upon smile. Landmarks were plotted on the lips and linear distances measured to assess the length of the upper and lower lips, mouth width at rest and upon smile, gingival and dental display upon smile. RESULTS: Linear dimensions are larger in males than in females, and in African Americans than in Caucasians, except for the length of the upper lip that does not differ between male African American and Caucasian males, in any given age group. Gingival display and dental display decrease with age in all groups. CONCLUSION: Norms should reflect race, age and sex in order to optimize treatment goals.

Effects of FGFR Signaling on Cell Proliferation and Differentiation of Apert Dental Cells.

The Apert syndrome is a rare congenital disorder most often arising from S252W or P253R mutations in fibroblast growth factor receptor (FGFR2). Numerous studies have focused on the regulatory role of Apert FGFR2 signaling in bone formation, whereas its functional role in tooth development is largely unknown. To investigate the role of FGFR signaling in cell proliferation and odontogenic differentiation of human dental cells in vitro, we isolated dental pulp and enamel organ epithelia (EOE) tissues from an Apert patient carrying the S252W FGFR2 mutation. Apert primary pulp and EOE cells were established and shown to exhibit normal morphology and express alkaline phosphatase under differentiation conditions. Similar to control cells, Apert dental pulp and EOE cells expressed all FGFRs, with highest levels of FGFR1 followed by FGFR2 and low levels of FGFR3 and FGFR4. However, Apert cells had increased cell growth compared with control cells. Distinct from previous findings in osteoblast cells, gain-of-function S252W FGFR2 mutation did not upregulate the expression of epidermal growth factor receptor (EGFR) and platelet-derived growth factor receptor (PDGFRα), but elevated extracellular signal-regulated kinase (ERK) signaling in cells after EGF stimulation. Unexpectedly, there was little effect of the S252W mutation on odontogenic gene expression in dental pulp and EOE cells. However, after inhibition of total FGFR signaling or ERK signaling, the expression of odontogenic genes was upregulated in both dental cell types, indicating the negative effect of whole FGFR signaling on odontogenic differentiation. This study provides novel insights on FGFR signaling and a common Apert FGFR2 mutation in the regulation of odontogenic differentiation of dental mesenchymal and epithelial cells.

Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning.

The approach to orthodontic diagnosis has changed gradually but steadily over the past 2 decades. The shift away from diagnosis based entirely on hard tissue evaluations has been a result of a broadened recognition of the importance of facial and smile appearance to our patients, and how they change over time. The purpose of this article is to describe and illustrate the integration of the new soft tissue paradigm into long-term treatment planning, with a focus on the esthetic goals of treatment.

Enameloplasty and esthetic finishing in orthodontics-identification and treatment of microesthetic features in orthodontics part 1.

Interdisciplinary treatment also has expanded to include not only soft tissue assessment of the periodontal components of the dentition and smile, but of the face as well. The next level of esthetic enhancement certainly will include facial proportionality as a key component in our patient evaluation. This paper expands the diagnostic vision of the dentist to include facial proportions and relationships of hard and soft tissues to improve diagnosis and treatment of dental and facial esthetics.

Enameloplasty and esthetic finishing in orthodontics-differential diagnosis of incisor proclination-the importance of appropriate visualization and records part 2.

The purpose of this paper is to briefly review some of the principals of ideal tooth shape and morphology and demonstrate how to use tooth reshaping through enameloplasty to treat and finish orthodontic cases to much more esthetic conclusions. This paper demonstrates the significant improvement to a smile orthodontists can achieve if they understand the principles of dental esthetics. In assessing smile design, the patient must be evaluated in three dimensions, and both dental and skeletal components must be considered. Expanded documentation in the form of frontal, profile, and oblique images taken both at rest and on dynamic smile permits the dentist to evaluate these elements without cephalometric radiography.

Growth maturation aging: how the dental team enhances facial and dental esthetics for a lifetime.

As the body of research regarding facial esthetics increases, dentists are gaining a deeper understanding of their broadening roles in defining facial characteristics. Dentists are required to advance their repertoire of diagnostic skills in order to meet patients' esthetic needs and demands. The focus has been shifting from treatment plans being based entirely on the occlusal relationships to the balance of the teeth and smile presentation as well as soft-tissue support and facial appearance. This article presents two cases illustrating these principles.

Soft tissue images from cephalograms compared with those from a 3D surface acquisition system.

OBJECTIVE: To assess whether 2D cephalometrics is comparable with 3D imaging devices and whether 3D technology could replace traditional 2D image capture in posttreatment evaluation. MATERIALS AND METHODS: The study is a prospective evaluation of superimposition techniques obtained from a cohort of 40 patients who underwent orthognathic surgery in a private practice environment. Surgical records were obtained from lateral cephalometric radiographs taken by a Kodak 8000C machine, and the 3D images were obtained from the 3dMD stereo photogrammetric camera capture system. Pre- and postlateral cephalometric records were superimposed on the cranial base (SN line) while pre- and post-3D surgical records were superimposed on the regional best-fit method. A mathematical algorithm, or best-fit calculation, was carried out on the selected surfaces. Each set of superimposed records was analyzed, and five soft tissue landmarks were plotted. The differences between the five surface points were analyzed for each set of records. RESULTS: The final sample consisted of 34 subjects with full records. A total of 680 surface landmarks were plotted and analyzed. The mean differences of the soft tissue landmarks were analyzed for each pair of data sets and were found to range between 1.06 and 8.07 mm and 1.26 and 7.34 mm for lateral cephalometric and 3D readings, respectively. Paired t-tests were carried out using the SPSS 15.0 software, and they showed that the results were not statistically significant between the superimposition techniques on the image capture systems (P > .05). CONCLUSIONS: The types of superimposition techniques used in the imaging modalities studied were comparable with one another.

Interview with an Insignia doctor: David M. Sarver.

Insignia (Ormco, Orange, Calif) offers custom-designed orthodontic appliances via fully interactive software. It is a precise, start-to-finish process that works with Damon, Inspire ICE, and conventional appliances. Insignia software incorporates the clinician's treatment plan into a virtual 3-dimensional model of each patient's ideal occlusion and delivers a complete custom solution: patient-specific brackets, precision (computer-assisted) bracket placement, and custom wires to eliminate time-consuming adjustments in all phases of treatment. Dr David Sarver, an orthodontist in Birmingham, Alabama, has treated patients with the Insignia technique since 1997.

Pitch, roll, and yaw: describing the spatial orientation of dentofacial traits.

The value of systematically enhancing the Angle classification by including transverse and vertical characteristics in addition to anteroposterior relationships for the face and the dentition is universally accepted. Three aeronautical rotational descriptors (pitch, roll, and yaw) are used here to supplement the planar terms (anteroposterior, transverse, and vertical) in describing the orientation of the line of occlusion and the esthetic line of the dentition. Each of the latter traits affects the modern clinical practice of orthodontics because of its greater focus on dentofacial traits beyond the correction of malocclusion. Consistent with the principle that every orthodontic intervention should begin with a thorough consideration of variation in a patient's dentofacial traits, this article offers further refinement of diagnostic description and classification.

Use of the 810 nm diode laser: soft tissue management and orthodontic applications of innovative technology.

Innovative technologies such as the diode laser have provided considerable benefit to dental patients and professionals. Facilitating efficient cutting of tissue and subsequent coagulation, the soft tissue laser enhances tissue healing and can reduce postsurgical complications. Due to the conservative nature of treatment accomplished with the laser this technology is very useful in orthodontic procedures. The diode laser is utilized in both esthetic enhancement of the smile, and treatment management of soft tissue issues that impede efficient orthodontic treatment. Its clinical application will be illustrated in a series of orthodontic cases.

Long-term efficacy of reverse pull headgear therapy.

OBJECTIVE: To add to the data for long-term reverse pull headgear (RPHG) outcomes and further explore possible variables that could be predictors of long-term failure. MATERIALS AND METHODS: Cephalometric radiographs of 41 Class III malocclusion children treated with RPHG (face mask) were evaluated before and immediately after treatment; at 5 years posttreatment; and, for 18 patients, at 10 years posttreatment. Patients were assigned to success or failure groups according to positive or negative overjet at the longest available recall. RESULTS: Seventy-five percent of the patients maintained positive overjet, whereas 25% outgrew the correction. In a stepwise discriminant analysis, a large mandible and vertical positioning of the maxilla and mandible so that mandibular growth would be projected more horizontally were the major indicators of unfavorable later mandibular growth. Patients who experienced downward-backward rotation of the mandible during RPHG treatment were more likely to be categorized in the failure group. The age at which treatment began had no effect on long-term success and failure for patients younger than 10 years, but the percentage of successful treatment decreased after that age. CONCLUSIONS: When RPHG treatment is used for all but the most obviously prognathic children to correct anterior cross-bite in the early mixed dentition, positive overjet is maintained long-term in 70%-75% of cases, whereas 25%-30% of cases relapse into reverse overjet mainly because of increased horizontally directed and often late mandibular growth. Up to age 10, the time at which RPHG treatment began does not appear to be a major factor in long-term success in maintaining positive overjet.