The Influence of Gingival Exposure on Smile Attractiveness as Perceived by Dentists and Laypersons.

Background and Objectives: Smile is an important mark of beauty, and smile attractiveness can be influenced by various factors, one of these being the amount of gingival exposure. The aim of this research was to evaluate the perception of an ideal gingival exposure in smile in a sample of Romanian dentists and laypersons, and to find out what is the most important aspect that influences the smile perception for the respondents included in the study sample. Materials and Methods: An online survey was conducted between 3 February 2020 and 31 October 2020. The authors developed a short questionnaire consisting of 7 items. The first four items investigated the respondents' age, gender, profession and whether or not they underwent an orthodontic treatment in the past. For items 5 and 6, participants had to choose the most and the least attractive amount of gingival exposure, and for the last item they had to choose the factor that mostly influences the smile attractiveness in their opinion. Results: 235 questionnaires remained in the study. The sample consisted of 194 women and 41 men, 162 laypersons and 73 dentists. The average value for the most attractive amount of gingival exposure was −0.57 ± 2.407 mm, with a median value of 0 mm while the average value for the least attractive amount of gingival exposure was 1.43 ± 3.785 mm, with a median value of 4 mm. The differences between the most or least attractive gingival exposure perceived by the participants were not significant according to gender or professional category (p > 0.05), but, when compared between having or not having an orthodontic treatment in the past the differences were statistically significant (p < 0.05). As such, participants who had an orthodontic treatment in the past perceived a significantly higher value for the most attractive gingival exposure, and a significantly higher value for the least attractive gingival exposure (p = 0.026) than the participants who didn't have an orthodontic treatment in the past. As for the factor that mainly influences smile attractiveness, laypersons chose significantly more frequent white teeth or aligned teeth (96%, 71.7%) while dentists chose significantly more frequent a gingival exposure between 0−3 mm (70.4%) as smile factors for an aesthetic smile (p < 0.001). Conclusions: In this study sample, the respondents considered that the most attractive smile involved a covering of 0.57 mm (in average) of the upper incisors by the upper lip. Although smile attractiveness did not appear to be influenced by gender or profession in this study population, it was influenced by previous orthodontic treatment. The participants' roles of dentist or layperson influenced the factors chosen for an aesthetic smile.

Validity of the Demirjian Method for Dental Age Estimation in Romanian Children.

Dental age assessment is useful in various medical fields. The Demirjian method for dental age estimation is one of the most widely used in the field of pediatric dentistry. The aim of this study was to verify the accuracy of the Demirjian method in determining age in a sample of girls and boys from Oradea, Romania. This retrospective and radiographic study was based on the evaluation of 1006 panoramic radiographs, belonging to 1006 patients (431 boys and 575 girls) with ages between 3 and 13.9 years from the city of Oradea, Romania. They were collected from three private dental practices from Oradea and were analyzed between 1 September 2021, and 10 November 2021. The patients were distributed into 11 age groups, each group spanning over one year (e.g., 3−3.9, 4−4.9). For the assessment of dental age, the Demirjian method was used, which is based on the evaluation of the developmental stages of the lower left permanent teeth. The mean chronological age of the patients was 9.496 ± 2.218 years, and the mean dental age was 10.934 ± 2.585 years. The overestimation of dental age was obtained in all age groups for the entire sample. As such, dental age was higher than chronological age, with values varying from 0.34 years in the 3−3.9 years age group to 1.7 years in the 10−10.9 years age group. In girls, dental age was higher than chronological age, with values varying from 0.46 years in the 3−3.9 years age group to 1.73 years in the 11−11.9 years age group, while in boys, the values varied from 0.15 years in the first age group to 2.02 years in the 10−10.9 years age group. The comparison of the differences between chronological age and dental age according to the gender of the patients revealed that the distribution of the differences was nonparametric in both groups according to the Shapiro−Wilk test (p < 0.05). The differences between the groups were not significant according to the Mann−Whitney U test. However, larger differences were identified for boys (1.46 years) than girls (1.417 years), with an overestimation of the dental age. The Demirjian method overestimated the age of the children included in the investigated sample, with different values for the different age groups investigated, and requires adaptations.

Research on demographic, clinical and paraclinical aspects in pregnant women infected with Toxoplasma gondii.

Toxoplasmosis is a zoonotic disease caused by the Toxoplasma gondii protozoan parasite. The aim of this study was to determine the frequency of acute toxoplasmosis or its presence in the medical history of 240 pregnant women, depending on age and geographical background. The second purpose was to analyze several medical aspects (clinical and paraclinical) in pregnant women with acute toxoplasmosis. The study identified several serological changes including positive toxoplasma IgM, IgG, and IgA antibodies. The chemiluminescence immunoassay (CLIA) method was used to detect T. gondii-specific IgM and IgG antibodies and the enzyme immunoassay (EIA) method to detect T. gondii-specific IgA antibodies. Of the 96 pregnant women (40%) infected with T. gondii, approximately 1/3 had acquired acute infection and 2/3 had a history of prior acute infection (P<0.0001). No statistically significant differences according to age groups (P=0.9384) were found in terms of serological profile. The number of patients with negative serology was significantly higher in urban areas than in rural areas (P<0.0001). The highest incidence among the pregnant women with acute toxoplasmosis with a single chain of ganglia affected was represented by those with the involvement of cervical lymph nodes (75%), the difference compared to the involvement of other chains of ganglia being statistically significant (P=0.0087). All 35 pregnant women with acute toxoplasmosis tested positive for T. gondii-specific IgM antibodies. Most pregnant women with acute T. gondii infection (57.1%) tested negative for T. gondii-specific IgM antibody serum titres within 3-6 months of presentation. The difference compared to other intervals from the moment pregnant women sought care was statistically significant (P=00002). Only 80% of all pregnant women with acute toxoplasmosis tested positive for T. gondii-specific IgA antibodies. Pregnant women with acute toxoplasmosis have a 3.3 times higher risk of pregnancy loss.

The Influence of Age on the Development of Dental Caries in Children. A Radiographic Study.

Dental caries is a chronic disease that can be influenced by a multitude of factors. Poor oral hygiene and unhealthy eating habits are the most incriminating factors in the onset of dental caries, but age has been proven to impact the disease. The aim of this study was to find correlations between age and the evolution of dental caries in the first permanent molars in children. The retrospective study was conducted based on 400 panoramic radiographs, belonging to Romanian children between the ages of 6 and 14 years. All first permanent molars were investigated, and the carious lesions were classified according to their depth. The chronological age was calculated by subtracting the patient's date of birth from the date when the radiograph was performed, while for the assessment of dental age, the Demirjian method was used. The gender of the patients did not significantly influence the number of superficial, medium, and deep carious lesions. Most of the identified carious lesions were superficial. Regarding correlations between age and dental caries, there was an association between the decrease in the chronological age and the increase in the number of superficial carious lesions on the first permanent molars and also an association between the increase in the chronological age or dental age and the increase in the number of medium and deep carious lesions on the first permanent molars. Age can impact the development of dental caries in first permanent molars.

The Behavior of Two Types of Upper Removable Retainers-Our Clinical Experience.

The Hawley retainer (HR) and the vacuum-formed retainer (VFR) are the most common removable retainers in orthodontic treatments. The aim of this retrospective study was to comparatively analyze the behavior of two types of removable retainers-HRs and VFRs-in terms of retainer damage, loss, and the rate of installation of mild or severe relapse that required recourse to certain therapeutic interventions. The study was performed on 618 orthodontic patients aged 11-17 years, average age 13.98 ± 1.51, out of which 57% were patients having VFRs and the remaining 43% having HRs in the upper arch. We performed an analysis of the two groups of patients-HRs group and VFRs group-at 6 months (T1) and at 12 months (T2) after the application of the retainer. The results showed that 6% of all the retainers were damaged, mostly at T2 (54.1%). Seven percent of all the retainers were lost, mostly at T1 (58.1%). Of all the patients, 9.1% presented mild relapse, mostly at T1 (58.9%), while 2.6% presented severe relapse. The VFRs were significantly more frequently associated with the occurrence of damage than the HRs (p < 0.001). Severe relapse was more frequently associated with the HRs rather than with VFRs (p < 0.05).

An important morphological feature of the face: upper lip length.

The oral cavity, including the lips, is considered one of the most important features of the face, taken into consideration when people inter-relate. Upper lip, in particular, can have a great influence on the aspect of a smile, which is why its proportional length and thickness can improve a lot a persons' smile. The aim of this study was to determine the average length of the upper lip in the Caucasian population, considering age and gender. The average upper lip length determined on the lateral skull radiography was 20.25±2.555 mm. The average length of the upper lip was 19.79±1.641 mm in the age category under 12 years and 20.32±2.664 mm in the age category over 12 years. The average length of the upper lip was 19.95±2.4 mm in women and 21.18±2.79 mm in men. We can conclude that women have lower values, while men have higher values of the upper lip length, and that the younger the patient is, the shorter the length of the upper lip is. Moreover, the Caucasian population proved to have a shorter upper lip compared to the Asian or Negroid population.

Environmental Factors Associated with Malocclusion in Children Population from Mining Areas, Western Romania.

Our study is based on the hypothesis that the prevalence of malocclusions in children is higher in the mining areas from North-Western (NW) Romania than in other geographic areas. We also considered that the distribution of the different types of malocclusions can be correlated with environmental factors. Therefore, the main purpose of the current study was to assess the prevalence of malocclusions in children from the mining areas in NW Romania. Another purpose was to establish the influence of certain environmental factors such as gender, geographical area of origin, and ethnicity on the distribution of malocclusions in order to provide an epidemiological reference for the planning of preventive and treatment programs adapted to the particularity of the mining areas. This cross-sectional study was performed in 2015-2016. The study batch consisted of 960 children from the mining areas, aged 7-14 years, in the period of mixed dentition and early permanent dentition. The clinical examination was conducted by a single examiner, an orthodontic specialist (TBI), in order to avoid inter-operator bias. Occlusion was registered according to Bjoerk. Occlusal clinical signs were followed for the determination of malocclusions. Most children had malocclusions (93.5%). The percentage of anomalies was significantly higher in subjects from Rosia Montana, in girls, and in the Romanians. Data showed that Angle Class I was the most prevalent malocclusion (60.21%), followed by crowding (47.5%), midline shift (43.33%), and deep bite (28.65%). The independent association between ethnicity and total malocclusions shows that the Romanian subjects presented a 3.31 higher chance of developing malocclusions than the Romani ones. The presence of malocclusions was independently influenced by all the studied environmental factors, namely gender, geographical area, and ethnicity. Our results could be relevant for oral health policy-making, i.e., planning preventive and treatment measures of malocclusions, adapted to the peculiarity of the studied mining areas.

Correlations between morphology of cervical vertebrae and dental eruption.

The process of dental eruption is submitted to physiological and pathological variables. A series of discrepancies may occur, one of these being a disturbance between dental age and bone age. The assessment of bone age is best made with the cervical vertebral maturation (CVM) method, simplified by Baccetti et al. (2005). The sample studied consisted of 215 orthodontic patients. The dental age was assessed on the orthopantomograph radiographies and the bone age on the lateral cephalograms. For determining the bone age, CVM method was used. Considering dental age, most of the patients (50.2%) have a premature dental age compared to bone age, while patients with normal dental age (27.9%) and patients with late dental age (21.9%) have a lower frequency. The correlation between the dental age and the bone age of the patients shows that patients who have higher values of dental age also have higher values of bone age (p<0.001). The correlation between genders shows that female patients tend to have a higher average value of bone age in comparison to male patients (p<0.001). The authors conclude that assessing bone age based on the morphology of cervical vertebrae and correlating it with the dental age could be of great use in opting for a certain orthodontic treatment plan.

Application of Fuzzy Logic in Oral Cancer Risk Assessment.

BACKGROUND: The mapping of the malignization mechanism is still incomplete, but oxidative stress is strongly correlated to carcinogenesis. In our research, using fuzzy logic, we aimed to estimate the oxidative stress related-cancerization risk of the oral potentially malignant disorders. METHODS: Serum from 16 patients diagnosed (clinical and histopathological) with oral potentially malignant disorders (Dept. of Cranio-Maxillofacial Surgery and Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania) was processed fluorometric for malondialdehyde and proton donors assays (Dept. of Physiology,"Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania). The values were used as inputs, they were associated linguistic terms using MIN-MAX method and 25 IF-THEN inference rules were generated to estimate the output value, the cancerization risk appreciated on a scale from 1 to 10 - IF malondialdehyde is very high and donors protons are very low THEN the cancer risk is reaching the maximum value (Dept. of Industrial Engineering, Faculty of Managerial and Technological Engineering, University of Oradea, Oradea, Romania) (2012-2014). RESULTS: We estimated the cancerization risk of the oral potentially malignant disorders by implementing the multi-criteria decision support system based on serum malondialdehyde and proton donors' values. The risk was estimated as a concrete numerical value on a scale from 1 to 10 depending on the input numerical/linguistic value. CONCLUSION: The multi-criteria decision support system proposed by us, integrated into a more complex computerized decision support system, could be used as an important aid in oral cancer screening and establish future medical decision in oral potentially malignant disorders.

A rare case of canine anomaly - a possible algorithm for treating it.

Canine transmigration is a very rare dental anomaly in which an unerupted mandibular canine migrates, crossing the mandibular midline. This unusual condition is most often diagnosed by chance during a routine X-ray examination. The most common clinical signs announcing the presence of this anomaly are over-retention of the deciduous canine and the absence of permanent canine from the dental arch after its physiological period of eruption. In this paper, we present a clinical case, 10-year-old boy, who was diagnosed with mandibular right canine transmigration at three years after the start of orthodontic treatment, during which we were expecting the eruption of mandibular canines. The orthopantomograph revealed the mandibular right canine to be in a horizontal position under the apices of the incisors - type 2 transmigration pattern classified by Mupparapu (2002). Based on cone-beam computer tomography examination, we recommended a surgical exposure of the canine and orthodontic alignment. Due to the risk of root resorption of the mandibular right lateral incisor during orthodontic movement phase of canine transmigrated to the dental arch, we decided to align the mandibular right canine in a transposition, between the two mandibular right incisors. Then we resorted to adapting the mandibular right lateral incisor coronary morphology to simulate a canine and also to reshaping the canine coronary morphology to resemble a lateral incisor. This therapeutic approach allowed us to restore morphologically and functionally the mandibular dento-alveolar arch, preserving the entire dental system.