A conservative approach for keratinized tissue augmentation: Report of two cases.

BACKGROUND: Free gingival graft harvested from the palate is considered the most predictable method to augment the keratinized tissue (KT). However, the anatomical limitations of the palate, and associated patient morbidity and complications restrict clinicians from performing these procedures in adolescents. Color mismatch with the native tissues resulting in poor esthetic appearance is another concern. To overcome these limitations, this article reports a surgical approach known as labial gingival graft (LGG) as an alternative to palatal graft. METHODS: Two adolescent patients presenting with absence of attached gingiva and shallow gingival recession in the mandibular incisor region were treated with LGG harvested from the labial KT of teeth adjacent to those requiring KT augmentation. RESULTS: The procedure was well tolerated by the patients. At the final follow-up (3.5- and 2 years from baseline), a significant gain in KT with complete root coverage was achieved in both patients. Both professional and patient-centered esthetic evaluations revealed excellent color match making the grafted area imperceptible from the adjacent mucosa. CONCLUSIONS: The proposed technique was found to be simple and predictable, and was associated with minimal morbidity and no complications. Clinicians may consider performing LGG procedure when sufficient KT can be harvested from adjacent donor site. The selection of such techniques is of particular relevance in children who are vulnerable to complications associated with more invasive procedures. KEY POINTS: Why are these cases new information? To the best of our knowledge, this article is the first to present the use of labial gingival graft harvested from adjacent keratinized mucosa in adolescent patients. What are the keys to successful management of these cases? Proper case selection in terms of sufficient amount of keratinized tissue to harvest as labial gingival graft from adjacent teeth. Use of smaller instruments, small-sized needles, and sutures under magnification to minimize trauma to the tissues /graft. Preparation of an immobile periosteal bed and suturing protocol that minimizes the dead space and ensures revascularization of graft. What are the primary limitations to success in these cases? A prerequisite of the presence of thick gingiva and sufficient dimensions of KT around the adjacent teeth further limits its applicability in all cases.

Effects of facial forms and midline deviations and rolls on female facial beauty according to laypeople, orthodontists, and prosthodontists or restorative dentists.

No study has examined the simultaneous effect of facial forms, midline deviations and midline angulations on facial beauty. Therefore, this comprehensive study aimed to evaluate these and many other hypotheses. This psychometric study was performed on 15,042 observations. A female frontal photograph was edited to 45 perceptometric images with controlled anatomical alteration: 3 facial forms (euryprosopic [brachyfacial], mesoprosopic [mesofacial], leptoprosopic [dolichofacial]), each having either 9 bidirectional midline deviations (0, 1, 2, 3, and 4 mm deviated to the left and right) or 7 bidirectional midline angular deviations (0°, 5°, 10°, and 15° deviated to the left and right). One of the photographs were repeated. These 46 images were esthetically judged by 327 participants (243 laypeople, 49 orthodontists, and 35 'prosthodontists or restorative dentists'). Hierarchical mixed-model multiple linear regressions and post hoc tests were adopted to evaluate the simultaneous impacts of the photomodel's facial forms, midline deviations to the right or left, and midline rolls to the right or left plus sex, age, experience, and dental specialty of the referees on their perception of facial beauty as well as the tolerable zones of midline alterations. These were also done separately for each specialty group, and also for each facial face. Ideal combinations of anatomic features were determined using repeated-measures ANOVAs. Differences between esthetic preferences of different groups in terms of each image were assessed using one-way ANOVAs and t-tests (α = 0.05, α = 0.008, α = 0.001). All 5 anatomical features significantly and independently influenced perception of facial beauty. The tolerance threshold for midline deviations was 1 mm deviations to the right and left sides. For midline rolls, the only tolerable form was the no-roll ('on') midline; the judges preferred right-oriented defects over left-sided ones. The most beautiful facial form was mesoprosopic, followed by leptoprosopic. Men perceived the female face slightly more attractive than did women. The viewers' specialty (or lack of it), their age, or their experience did not affect their esthetic preferences. Predictors of esthetic preferences were all 5 anatomical features plus views' sex, but not their dental specialty, age, or experience. Zones of acceptability and also the ideal range of anatomical features were determined.

Nonextraction Treatment of Maxillary Canine and Lateral Incisor Transposition: A Case Report.

The transposition of teeth is an infrequent dental abnormality characterized by the exchange of position between two adjacent teeth. This report presents a unique case of transposition involving the maxillary right canine and lateral incisor in a 20-year-old female patient. Clinical assessment and radiographic evaluation revealed the unconventional positioning of the affected teeth. Treatment planning necessitated collaborative efforts between orthodontic specialists to achieve optimal esthetic and functional outcomes. The patient underwent a comprehensive treatment regimen, including orthodontic alignment by distal drifting of the canine and mesial shifting of the lateral incisor. Subsequent long-term follow-ups confirmed stable occlusion and satisfactory esthetics in a time period of 18 months. This case underscores the significance of precise diagnosis and a multidisciplinary approach in managing intricate dental anomalies such as tooth transposition.

Spot-etch technique and other adhesive strategies for provisional veneers.

AIM: The objective of the present study was to evaluate the influence of different adhesive strategies regarding shear bond strength (SBS) of provisional resin--based materials bonded to the enamel surface as well as on the enamel surface roughness. MATERIALS AND METHODS: Bovine incisors were randomly divided into six groups (n = 10) according to the adhesive strategy used: BRControl (bis-acrylic resin); Spot-etch+BR (spot-etch + bis-acrylic resin); Spot--etchSB2+BR (spot-etch + adhesive + bis-acrylic resin); Spot-etchZ350Flow+BR (spot-etch + flowable composite resin + bis-acrylic resin); SBU+BR (universal adhesive + bis-acrylic resin); Spot-etchSBMP+Z350 (spot-etch + adhesive + composite resin). The enamel surface roughness was determined by a surface profil-ometer. An SBS test was performed in a universal testing machine, and failure modes were classified under magnification. The SBS data were analyzed by one-way analysis of variance (ANOVA). A paired t test was used for enamel surface roughness intragroup comparisons, and the Friedman one-way repeated meas-ures analysis of variance by ranks was used for differences in enamel surface roughness between groups, with the Tukey post hoc test (a = 0.05). RESULTS: BRControl had the lowest SBS values (MPa), with a significant difference (P ≤ 0.001) from the other groups. Spot-etch+BR had the highest SBS values but with no significant differences from the other groups in which the spot-etch technique was also used. Adhesive failure mode was predominant for all groups. BRControl had the lowest surface roughness difference, significantly different (P = 0.001) from all the other groups. CONCLUSIONS: Spot-etch and other adhesive strategies could be applied to increase the SBS values of provisional restorations to enamel compared with no surface pretreatment. However, the adhesive strategy may change the enamel surface roughness, revealing the importance of cleaning the tooth surface.

Conservative Management of Uneven Anterior Teeth Spacing using Lingual Porcelain Laminate Veneers: Report of Two Cases with 2- and 6-year follow-up.

Porcelain laminate veneers (PLV) offer a conservative aesthetic solution for interdental space closure. However, space is typically not distributed symmetrically, and the mesiodistal width of the restored teeth may increase unless multiple teeth are prepared for conventional PLV to maintain appropriate individual tooth proportion. Ceramic fragments can be suggested to close the space without modifying tooth size and dental proportion. This article presents two cases where interdental gaps were closed using lingually placed porcelain laminate (LPPL). All stages of the restorative procedures, including treatment planning, temporization, tooth preparation, and cementation of these delicate restorations, are detailed. Based on the results of these clinical reports, we regard the use of LPPL as a successful treatment option in selected cases, as evidenced by 2- and 6-year follow-ups. The Modified United State Public Health Criteria is reported.

Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression.

BACKGROUND: Nasolabial fold (NLF) depression can affect the facial appearance of patients to some extent and increase their psychological burdens. In recent years, autologous fat grafting (AFG) combined with botulinum toxin A (BTX-A) injection (AFG + BTX-A injection) has been gradually applied in the treatment of patients with NLF depression. Although studies have been conducted on the efficacy and safety of AFG + BTX-A injection in treating NLF depression, the experimental design, observational indicators, and sample enrollment criteria vary remarkably, making it difficult to draw convincing and consistent conclusions. Thus, further relevant research is warranted. AIM: To assess the esthetic improvement, efficacy, and safety of AFG + BTX-A injections in patients with NLF depression. METHODS: This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021. These patients were categorized into control (n = 30) and observation (n = 30) groups. The observation group received AFG + BTX-A injection, whereas the control group underwent AFG only. All patients were evaluated using the wrinkle severity rating scale (WSRS) and global aesthetic improvement scale. The compactness of facial contours, skin evaluation indexes, adverse reactions, and satisfaction of the two groups were evaluated 3 months postoperatively. RESULTS: The WSRS scores of the observation group at 1, 3, and 6 months postoperatively were lower than those of the control group (P < 0.05). Three months postoperatively, facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group (P < 0.05). The compactness of facial contours was better in the observation group than in the control group (P < 0.05). In addition, no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness, facial asymmetry, facial bruising, and facial concavity inequality (P > 0.05). CONCLUSION: AFG + BTX-A injection is a highly safe, cost-effective, effective, and long-lasting treatment for NLF depression with high esthetic value, which should be promoted in the future.

LIMITED DATA SHOWS POTENTIAL OF FLAPLESS SURGERY FOR ENHANCED BUCCAL BONE PRESERVATION IN IMMEDIATE IMPLANT PLACEMENT.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Pitman J, Christiaens V, Callens J, Glibert M, Seyssens L, Blanco J, Cosyn J. Immediate implant placement with flap or flapless surgery: A systematic review and meta-analysis. J Clin Periodontol. 2023 Jun;50(6):755-764. doi: 10.1111/jcpe.13795. Epub 2023 Mar 5. PMID: 36843361. SOURCE OF FUNDING: The study was funded by the authors and their affiliated institutions. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

The Concept of Ideal Lips of Caucasian Female: An Anthropometric Analysis of the Lower Third of the Face.

BACKGROUND: The demand for lip-redefining procedures has been rising in recent years, thus creating the need for reliable and detailed reference sources on aesthetic female lips. This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian females. METHODS: A semi-automatic photogrammetric analysis of the faces of professional female photograph models (n=400) of the Caucasian race aged 18-39 was performed. Angular, linear, and surface area parameters were evaluated. A graphical summarization of the average facial shape of all analyzed attractive females was generated as an average body contours (ABC) image. RESULTS: The height of the lower third of the face equaled 0.32 ± 0.02 of the total facial height. The average lip width was 48.06 ± 3.34 mm. The upper vermilion height was found to be significantly lower than the lower vermilion height (6.47 ± 1.36 vs. 11.64 ± 1.46 mm, p < 0.01). The lip obliquity angle was found to be 1.05° ± 0.79°. The area surface of the upper lip vermilion was considerably smaller than the vermilion of the lower lip (p < 0.01). CONCLUSIONS: This is one of the largest studies on attractive Caucasian females' lips and lower face morphology. The data it provides, including the graphical presentation of the aesthetic lower face as an ABC image, may provide physicians with valuable guidelines for lips rejuvenation and reconstruction procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Impact of combining dental composite brushes with modeling resins on the color stability and topographic features of composites.

This study explores the effect of using dental brushes with or without metacrylate-based modeling resins on long-term color stability and surface topographies of resin-based composites. This study examined the effects of two variables: (1) the type of brush used (Art brush, Micro-brush, or Mylar strip) and (2) the application of a modeling resin (applied or not applied). The specimens were artificially aged through 10,000 cycles of thermocycling and subsequently immersed in coffee for 30 days. Measurements of color and surface roughness were taken at baseline and after the aging, using a non-contact profilometer for surface roughness and a spectrophotometer for color. Data were analyzed using paired t-tests and one-way ANOVA. Resin-based composites smoothed with dental brushes or micro brushes without modeling resins exhibited lower color change (ΔE) than other groups. Paired t-tests revealed significant differences in average surface roughness (Ra) and valley depth (Rv) for each surfacing technique before and after aging (p ⩽ 0.01). The root means square average of the profile heights (Rq) significantly increased in the control and micro-brush groups (p ⩽ 0.01). In conclusion, the use of brushes in resin-based composites placement does not increase the susceptibility to staining. Instead, the inclusion of resin modeling contributes to discoloration over time.

Esthetics in Pediatric Dentistry-BioFlx Crowns: Case Series.

Background: The crown is considered the most effective restoration for the management of dental caries. It reproduces the morphology and contour of the damaged coronal portion of the tooth while maintaining its function. The esthetic needs of children and the demands of parents bring advancement in dentistry toward a new era of esthetic crowns. In this era of esthetic crowns, the newly introduced preformed BioFlx crown seems to be an effective esthetic treatment option. Case description: In the present case series, full coverage restoration for the management of carious and pulp therapy-treated primary molars was done by esthetic and flexible BioFlx crown (Kids-e-Dental, LLP, Mumbai, India). Over a 6 months period, the crowns have demonstrated good retention and esthetic results. Conclusion: Dealing with the esthetic needs of children and managing primary molars using BioFlx crowns would be practical and successful. Clinical significance: The treatment described in the case series is a new advancement in pediatric dentistry with promising esthetic alternatives. How to cite this article: Goswami M, Jangra B, Chauhan N, et al. Esthetics in Pediatric Dentistry-BioFlx Crowns: Case Series. Int J Clin Pediatr Dent 2024;17(3):357-361.

Shared decision-making implementation status among dermatologists engaging in medical esthetics: a cross-sectional study in China.

Objective: Shared decision-making (SDM) is a collaborative process in which patients and healthcare providers jointly make a medical decision. This cross-sectional study aimed to identify the implementation status of shared decision-making among dermatologists engaging in medical esthetics in China and to identify factors associated with the good practice of SDM among them. Methods: From January to June 2023, a total of 1,287 dermatologists engaging in medical esthetics in China were recruited and completed the online interviews about their implementation of SDM based on the Shared Decision-Making Questionnaire for Doctors (SDM-Q-Doc). Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) to explore factors associated with the higher SDM score achievement among dermatologists with medical esthetic practice. Results: The median value of the total SDM score was 39, and 48% (621/1278) of dermatologists with medical esthetic practice achieved at least 40 out of 45 scores. Logistic regression indicated that dermatologists aged 40-49 or ≥ 50 years and those engaging in medical esthetic practice for ≥5 years were more likely to achieve at least 40 out of 45 scores compared to dermatologists aged <30 years with less than 5 years of medical esthetic practice. The ORs were 1.82 (95% CI: 1.13-3.12), 1.94 (95% CI: 1.13-3.61), and 1.76 (95% CI: 1.34-2.31), respectively. Conclusion: The SDM implementation level among Chinese dermatologists engaging in medical esthetics is high, especially for those who are older age and have more years of practice. Hence, it is highly recommended to promote and enhance SDM practice among younger dermatologists engaging in medical esthetics with less working experience.

Severe Discoloration of the Alveolar Bone Secondary to Long-Term Minocycline Therapy: A Case Report.

Minocycline, the synthetic derivative of the antibiotic tetracycline, has been used for a variety of medical treatments. One such use for minocycline is for acne vulgaris. Although widely used, minocycline has a common side effect of discoloration of tissues, including bone, skin, and mucosa. This case report presents a 19-year-old female patient with a history of long-term minocycline therapy for acne vulgaris who presented for periodontal esthetic crown lengthening. The initial exam revealed a blue-gray discoloration of the mucosa. Upon surgical exploration, it was discovered that the discoloration originated from the underlying alveolar bone with minimal gingival involvement. Surgical removal and recontouring of the bony exostoses revealed that the bone remained deeply stained. Although the discolored bone was not fully removed, the patient was able to obtain an acceptable esthetic result.

Influence of dental midline deviation with respect to facial flow line on smile esthetics-A cross-sectional study.

BACKGROUND/OBJECTIVE: A contemporary concept states that dental midline deviation towards the direction of facial flow line (FFL) can mask the compromised smile esthetics. This study aimed to identify a range of midline deviations that can be perceived towards or away from the FFL influencing smile esthetics. MATERIALS AND METHODS: A cross-sectional study was conducted using a frontal smile photograph of an adult female. The photograph was altered on Adobe Photoshop software into six different photographs by deviating the dental midlines towards and away from the FFL. A constant deviation of chin towards the left side was incorporated in all the photographs. Forty-three laypersons (LP) and dental professionals (DPs) evaluated those photographs. Independent t-test was used to compare the perception of dental midline deviation between LP and DPs. Simple linear regression was run to identify the factors associated with the scoring. RESULTS: A statistically significant difference was observed for picture two with 4 mm towards FFL in the perception of midline deviation between LP and DPs. LP could not perceive the midline deviations up to 4 mm while DPs were able to perceive deviations above 2 mm. The greater the age the better the scores were and female raters had a greater inclination towards poor scores. CONCLUSIONS: From 2 to 4 mm of midline deviation towards the FFL can be tolerated by LP and DPs. CLINICAL SIGNIFICANCE: These findings underscore the importance of considering facial symmetry in orthodontic and cosmetic dental treatments to optimize smile esthetics.

Laser Depigmentation: A Case Report.

The pigmented lesions of the oral cavity may be endogenous or exogenous. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary portions. After local anesthesia, we started depigmentation with a high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory results.

Enamel hypoplasia with nonsyndromic oligodontia: A rare case report.

Enamel hypoplasia is an exclusive ectodermal disturbance, related to alterations in the organic enamel matrix which can cause white flecks, narrow horizontal bands, lines of pits, grooves, and discoloration of the teeth. It can result in compromised oral health that causes physiological and psychological disturbances. Management of enamel hypoplasia not only includes esthetic and functional rehabilitation of the patient but also requires a positive rapport building with the patient due to psychosocial issues. The present case reports elucidate step-by-step management of 16-year-old female patient who presented with localized enamel hypoplasia with severely decayed anterior teeth, poor dental esthetics, and oligodontia of the lower teeth.

Management of a bulbous blunderbuss maxillary central incisor with one root and three canals in a patient with cleft lip and palate.

Unique anatomical deviations in canal structure are rare in anterior teeth, especially central incisors, and thus risk being overlooked. For successful intervention, a meticulous diagnostic procedure and treatment plan, significantly aided by cone-beam computed tomography (CBCT), are crucial. The case at hand explores the management of a maxillary left central incisor in a cleft palate patient, characterized by multiple developmental lobes, a bulbous crown, and an atypical root anatomy. The primary symptom was pain, accompanied by a history of trauma at age 8 years and ensuing tooth discoloration. Initial evaluations, augmented by CBCT, revealed pulpal necrosis in a single-rooted tooth with three distinct canals. Initial clinical examination was supplemented by electrical pulp testing, RadioVisioGraphy (RVG), and CBCT, after which the root canal therapy was initiated. Informed consent was obtained from the patient. The access cavity preparation resulted in a three-orifice cavity. Subsequently, the canals were enlarged and sufficiently debrided. Calcium-hydroxide was applied for 2 weeks before the commencement of apexification and obturation, followed by esthetic rehabilitation. This case highlights the importance of recognizing rare anatomical variations in anterior teeth and demonstrates the invaluable role of CBCT in both diagnosing and managing such complexities.

Changes in smile parameters after surgical-orthodontic treatment for skeletal Class III malocclusion.

Background/purpose: Many patients pursue attractive smiles, and surgical-orthodontic treatment is a common method. We aimed to analyze the changes in smile parameters after surgical-orthodontic treatment in patients with skeletal Class III pattern and identify factors influencing postoperative outcomes. Materials and methods: This retrospective study comprised 34 patients with skeletal Class III malocclusion and pure mandible prognathism who received surgical-orthodontic treatment. Hard and soft tissue parameters were assessed through lateral cephalometry, and smile esthetics were evaluated through extraoral photography. Postoperative changes in smile parameters and between-parameter correlations were analyzed. Random forest and decision tree deep learning models were used to identify factors influencing postoperative changes. Results: Substantial postoperative changes were observed in the buccal corridor, upper lip height, and smile index. Significant between-sex differences were noted in the upper midline and right chelion. Strong, positive correlations were found between upper lip height and upper lip ratio and between lower lip height and lower lip ratio. By contrast, strong negative correlations were observed between lower teeth exposure and smile index and between interlabial gap and smile index. The highest degrees of postoperative changes were noted in asymmetry-associated smile parameters: lower lip area, interlabial gap, smile index, buccal corridor, and arc ratio. Conclusion: Considerable changes were noted in skeletal, dental, and soft tissue parameters after surgical-orthodontic treatment. However, the changes in smile esthetics were less prominent from the frontal view. As for chin asymmetry, the most to least prominent changes were in the lower lip area, interlabial gap, smile index, buccal corridor, and arc ratio, respectively.

Dental esthetic screening index (DESI) scores among patients attending Qassim University dental clinics.

Aim: This study aimed to evaluate dental esthetic screening index (DESI) Intraoral component scores among patients attending Qassim University dental clinics and the factors affecting these scores. Materials and methods: This was a retrospective study that included 150 participants aged 18 years or older with full upper and lower anterior dentitions. Standardized intraoral frontal photographs of the patients' upper and lower dentitions were acquired from their dental records, and the mean rank DESI intraoral scores were evaluated and compared across the demographic and dental characteristics of the study patients.The mean age of the patients sampled was 33.56; 57 % were female and 43 % were male. The mean DESI Intraoral score was 15.33. DESI scores were significantly higher in patients older than 35 years compared with subjects 35 years old or younger (p = 0.015). DESI scores were increased in patients who had anterior restorations compared with those who did not (p = 0.016). Conclusions: This was the first study of its kind to use the DESI in a large clinical setting. According to the DESI, most patients attending Qassim University dental clinics had good dentofacial aesthetics. Age and the presence of anterior restorations negatively impacted patients' dentofacial aesthetics. Sex, the nature of the chief complaint, a history of orthodontic treatments, and teeth bleaching did not affect the DESI scores.