Effect of maxillary median diastema on the esthetics of a smile.

INTRODUCTION: With the increasing demand for facial esthetics, patients' expectations regarding dental treatment have increased. The treatment of maxillary median diastemas (MMDs) stands out as one of the most noticeable esthetic alterations performed on patients. The objectives of the present article were to evaluate the effects of MMD and its restorations on the esthetics of a smile and to determine the differences in esthetic perceptions among 3 different groups of patients: orthodontists, prosthodontists, and laypeople. METHODS: Printed photographic images were randomly arranged in an album that contained the original photograph of the smile, 8 photographs with digitally created diastemas (0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 4.0 mm, and 5.0 mm), and 8 with simulated restorations of these spaces. Each evaluator assigned scores to the images using a 100-mm visual analogue scale. RESULTS: Orthodontists, prosthodontists, and laypeople presented similar perceptions regarding the levels of attractiveness of the original smiles and those of smiles involving restorations of diastemas with widths of 0.5 mm and 1.0 mm. The ratings assigned to the smiles with diastemas differed significantly from those of the corresponding restored smile with the same magnitude of diastema. CONCLUSIONS: The prosthetic space closure of diastemas is better than leaving the space untreated. Restorations of MMD up to 1 mm perform similar to orthodontic closure. Larger MMDs are ideally treated with orthodontics because the restorative treatment is more invasive, leading to incremental damage to the dental tissues.

Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial.

OBJECTIVES: The aim of this study was to compare the caries-preventive effect and the retention rates of sealants prepared with a new modified and a high-viscosity glass-ionomer cement (GIC) in recently erupted first permanent molars.  MATERIALS AND METHODS: Fifty-six children (224 teeth) were included in a split-mouth randomised clinical trial. All children had their four first permanent molars sealed with either Clinpro XT Varnish (CXT) or Fuji IX GP FAST (FJ). FJ sealants were placed according to the ART protocol. Retention rates and caries-preventive effect of both materials were assessed clinically after 24 months, and survival curves were created according to the Kaplan-Meier method. For sealant retention rates, analyses were performed according to both the traditional method and modified sealant retention categorisation. RESULTS: FJ sealants were retained longer in comparison to CXT sealants (p < 0.05), regardless of the categorisation used. In relation to the caries-preventive effect, no statistically significant differences were observed between materials (p = 0.99). Sealants prepared with the high-viscosity GIC according to the ART protocol survived longer than those prepared with the modified GIC, but both materials were equally effective in preventing cavitated dentine lesions over 24 months. CONCLUSION: We concluded that GIC-based sealants are effective in preventing dentine caries lesions.

Impact of metal and ceramic fixed orthodontic appliances on judgments of beauty and other face-related attributes.

INTRODUCTION: Physical attributes, behavior, and personal ornaments exert a direct influence on how a person's beauty and personality are judged. The aim of this study was to investigate how people who wear a fixed orthodontic appliance see themselves and are seen by others in social settings. METHODS: A total of 60 adults evaluated their own smiling faces in 3 different scenarios: without a fixed orthodontic appliance, wearing a metal fixed orthodontic appliance, and wearing an esthetic fixed orthodontic appliance. Furthermore, 15 adult raters randomly assessed the same faces in standardized front-view facial photographs. Both the subjects and the raters answered a questionnaire in which they evaluated criteria on a numbered scale ranging from 0 to 10. The models judged their own beauty, and the raters assigned scores to beauty, age, intelligence, ridiculousness, extroversion, and success. RESULTS: The self-evaluations showed decreased beauty scores (P <0.0001) when a fixed orthodontic appliance, especially a metal one, was being worn. There was no statistically significant difference between the 3 situations in the 6 criteria analyzed. CONCLUSIONS: A fixed orthodontic appliance did not affect how personal attributes are assessed. However, fixed orthodontic appliances apparently changed the subjects' self-perceptions when they looked in the mirror.

Calcitonin as a pharmacological anchorage in orthodontics.

Objective: This study aimed to evaluate the effects of salmon calcitonin administration as a pharmacological anchoring agent in orthodontics and to determine the influence of locally applied calcitonin on serum calcium levels. The secondary aim was to observe the response of dental and periodontal tissues using light microscopy. Methods: Fourteen healthy male adult Wistar rats with an average weight of 250 g had their teeth moved, seven of which received a local injection of salmon calcitonin in the furcation region of the left upper first molar. Concurrently, the remaining seven were used as controls. In the control group, saline solution was injected in the bifurcation region of tooth 26 to subject these animals to the same stress level as those of the experimental group. After 14 days, a 6 mm diameter orthodontic elastic band was inserted between teeth 26 and 27 in all animals to induce the movement of these teeth. The rats were anaesthetised and exsanguinated on day 21. In both groups, tooth movement and serum calcium levels were measured. The jaws were dissected with straight scissors, and tissue blocks containing gingiva, bone and teeth were identified, fixed and demineralised. Then, the pieces were cut into semi-serial slices, stained with hematoxylin, eosin, and Mallory's trichrome, and analysed under an Axiophot light microscope. Results: There was significantly less tooth movement in the experimental group (X̄; 0,150 mm ± 0,037) than in the control group (0,236 mm ± 0,044; P = 0,003), while there was no significant difference in serum calcium levels between the two groups (controlX̄; 9,53 mg/dl ± 1,53; experimental 10,81 mg/dl ± 1,47; P = 0,15). Conclusion: While calcitonin did not completely inhibit osteoclast activity, it promoted orthodontic anchorage, apparently, by local action.

Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report.

Hartsfield syndrome is a rare and unique clinical combination of ectrodactyly and holoprosencephaly (HPE) with or without cleft lip and palate, as well as various additional characteristics. Although several genes responsible for HPE and ectrodactyly have been identified, the genetic origin of Hartsfield syndrome remains unknown, as there are few reports in the literature. The objective of this case report is to present dentofacial abnormalities in an 11-year-old boy with Hartsfield syndrome, who presented mental retardation, hearing loss, bilateral hand and foot ectrodactyly, HPE, and solitary median maxillary central incisor (SMMCI) besides 12 dental ageneses. How to cite this article: P Reis PM, Faber J, O Rosa JS, et al. Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report. Int J Clin Pediatr Dent 2023;16(1):147-152.

Does treating proximal cavities in primary molars non-restoratively affect intra-arch space and alignment of successor teeth negatively? A 4-year longitudinal study.

Background: Removing plaque with toothbrush and toothpaste from proximal cavities in primary molars without restoring them follows sound cariological principles. But does this treatment affect space for and alignment of their permanent successors negatively? Hypothesis: There is no difference in impaction and displacement of the premolars, as well as in the D+E space in quadrants with three different statuses of the proximal surface of primary molars over a 4-year period. Methods: A total of 936 quadrants (466 maxillary and 470 mandibular quadrants) in 233 children were assessed. Treatment of cavities in the proximal surfaces of the primary molars consisted of amalgam and ART restorations using high-viscosity glass-ionomer cement, and cleaning of open large- and medium-sized cavities with toothbrush and toothpaste (UCT) under supervision for 220 days per year over 3 years. Dental casts were made at baseline, and after two, three, and 4 years. The D+E spaces were measured digitally. Status of the proximal surface of the primary molars was assessed by two calibrated examiners, and quadrants were grouped into normal anatomy, defective restoration, and proximal cavity. ANCOVA, ANOVA and LSD tests were applied. Results: There was a statistically significant difference between groups (p <= 0.001) and between evaluation times (p < 0.001), for the D+E space in both the maxilla and mandible. A sex difference related to the D+E space in the maxilla was found (p = 0.007). For boys, quadrants in the maxilla of the group 'proximal cavity' showed a significant shorter D+E space when compared to quadrants of the group 'normal anatomy' at the 3- and 4-year evaluation time. For girls the difference between the two groups was only present at the 3-year evaluation time. There was no significant difference between the D+E space in quadrants with defective restorations and those with normal anatomy in the mandible and in the maxilla. Displacement and impaction of the premolars showed no significant difference between groups. Conclusion: Primary molars with open proximal cavities that are cleaned with toothbrush and toothpaste do not result in displacement and impaction of the successor teeth, neither do primary molars with defective restorations in proximal tooth surfaces.

The Caries Assessment Spectrum and Treatment (CAST) index: rational and development.

Serious difficulties in reporting results were encountered when using ICDAS II and PUFA separately in an epidemiological survey in a child population in Brazil. That necessitated the development of a comprehensive but pragmatic caries assessment index. This publication describes the rationale, development and content of a novel caries assessment index. Strengths and weaknesses of ICDAS II, PUFA and other indices were analysed. The novel caries index developed for use in epidemiological surveys is termed 'Caries Assessment Spectrum and Treatment' (CAST). 'Spectrum' indicates what is considered the main strength of the new index - its usefulness in describing the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and caries cure (restoration) to lesions in enamel and dentine, and the advanced stages of carious lesion progression in pulpal and tooth-surrounding tissue. CAST combines elements of the ICDAS II and PUFA indices, and the M- and F-components of the DMF index. A DMF score can easily be calculated from the CAST score, thereby enabling retention of the use of existing DMF scores. The CAST index for use in epidemiological surveys is very promising. It should be validated and its reliability and usefulness be tested in different age groups in different countries and cultures.

Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth.

OBJECTIVE: To compare stimulated and non-stimulated salivary flow, pH, buffering capacity and presence of signs and symptoms of hyposialie and xerostomia in elderly patients, with senile dementia using medication and healthy elderly subjects not using medication. METHODS: Forty individuals (mean age: 68.5 years) were divided into two groups, according to the use (G1) or non-use (G2) of medication and the presence (G1) or absence (G2) of senile dementia. Data with reference to the general health condition, use of medication and the patient's complaints were collected during anamnesis. Clinical examination identified signs associated with hyposialie and xerostomia. Stimulated and non-stimulated saliva flow, pH and buffering capacity were verified. RESULTS: The stimulated saliva flow in both groups was below normal parameters. The drugs used by individuals in G1 showed xerostomic potential. Individuals with a higher consumption of xerostomic medication presented with dry and cracked lips. A significant negative relationship was found between drugs consumption and the buffering capacity (p < 0.001), and the resting saliva flow rate (p = 0.002). CONCLUSION: The use of medication increases the chance that an elderly person may present signs related to xerostomia and alterations in stimulated saliva flow and buffering capacity.

Prevalence of hypodontia in orthodontic patients in Brasilia, Brazil.

The purpose of this retrospective study was to determine the prevalence of hypodontia and associated dental anomalies in patients undergoing orthodontic treatment in Brasília, Brazil, over a 2 year period (1998-2000). The records of 1049 orthodontic patients between 10 and 15.7 years of age (507 males and 542 females) from 16 orthodontic clinics were analysed. Descriptive statistics were performed for the study variables. A chi-square test was used to determine the difference in the prevalence of hypodontia between genders. The prevalence of hypodontia was 6.3 per cent (39.4 per cent males and 60.6 per cent females) with no statistically significant difference between the genders. One case of oligodontia was observed. The maxillary lateral incisor was the most frequently missing tooth, followed by the mandibular second premolar. All cases of hypodontia, except one, were associated with at least one other dental anomaly. These associated dental anomalies were retained primary teeth (30.3 per cent), ectopic canine eruption (25.8 per cent), taurodontism (21.2 per cent), and peg-shaped maxillary lateral incisors (16.7 per cent).

Impact of proximal cavities and primary molar absence on space in the dental arches.

BACKGROUND: A recently proposed treatment protocol for dental caries in primary teeth, called Ultra Conservative Treatment (UCT), keeps medium to large cavities open so that children can keep them clean with tooth brushing and fluoride toothpaste. However, carious lesions have been related to malocclusion and decrease of space for the eruption of the permanent successor. METHODS: This cross-sectional study evaluated dental casts of 235 schoolchildren, aged 6-7 years old of six public schools in deprived suburban areas, and with at least two cavitated dentin carious lesions. The casts were grouped according to the location of cavitated dentin lesions into non-proximal cavity (NPC), proximal cavity with buccal or lingual surface contact point to adjacent tooth (PCCP) and proximal cavity without contact to adjacent tooth (PCWC), as well as the absence of primary molars due carious lesions (PMA). The relationship between location of cavitated dentin lesions or absence of primary molars with C+D+E and D+E space was analyzed. RESULTS: Children with absence of primary molars exhibited the smallest C+D+E and D+E space in the maxilla (P < 0.001) and mandible (P < 0.001), followed by proximal cavity without buccal or lingual surface contact. No significant difference was observed between NPC and PCCP groups in upper and lower arches. DISCUSSION: PCWC are associated with minor (less than the leeway space) C+D+E and D+E space loss in both arches, and additional space loss is noted when primary molars are prematurely lost. These results may have implications for orthodontic and restorative dental care decisions in children.

Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

BACKGROUND: An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years. METHODS: Dental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression. RESULTS: The sample consisted of 867 pairs of casts of 272 initial 6-7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography.

AIM: The aim of this study was to apply a novel method to obtain high-quality images by cone-beam computerized tomography (CBCT) that consistently allowed the determination of the dimensions of the palatal mucosa. MATERIALS AND METHODS: Thirty-one patients participated in this study. At the time of the CBCT scanning, the patients wore a plastic lip retractor and wooden spatulas to retract soft tissues away from the teeth and gingiva. The thickness of the palatal mucosa was obtained at forty different locations on each patient. RESULTS: Retraction of the lips and cheek allowed a clear observation and measurements of the thickness of the palatal masticatory mucosa. The average thickness of the palatal mucosa was 2.92 mm in the canine area, 3.11 mm at the first pre-molar, 3.28 mm at the second pre-molar, 2.89 mm at the first molar and 3.15 mm at the second molar. Statistical differences were observed at different ages and heights of measurements. CONCLUSIONS: A new non-invasive method to consistently obtain high-quality images of the palatal masticatory mucosa is described. Measurements of this mucosa could be obtained at different locations on the palate.

Titanium miniplate as anchorage to close a premolar space by means of mesial movement of the maxillary molars.

We report the orthodontic treatment of a woman who was congenitally missing teeth 15, 47, and 48. A titanium miniplate was used as anchorage to close the space of the missing premolar by mesial movement of the maxillary posterior teeth into the space of tooth 15. Teeth 16 and 17 were moved 7.4mm mesially, until the proximal contact of tooth 16 with tooth 14 was detected clinically. Good esthetic and dental results were achieved after 34 months of active treatment. Miniplates can be used as orthodontic anchorage to move maxillary molars forward.

Esthetic effect of orthodontic appliances on a smiling face with and without a missing maxillary first premolar.

INTRODUCTION: In this study, we evaluated the effects of orthodontic appliances and an extracted maxillary first premolar on the esthetic evaluation of a smiling face according to the perceptions of orthodontists and laypeople. METHODS: Standardized oblique photographs of a young woman with a pleasing smile were taken. The photos were edited by using digital imaging software to produce 10 combinations of presence or absence of orthodontic appliances with either esthetic or metal brackets, rubber bands of different colors, and presence or absence of the maxillary first premolar. Two groups of 50 observers each, 1 of laypeople and the other of orthodontists, evaluated the images and assigned esthetic scores to the smiles according to a visual analog scale. RESULTS: The presence of orthodontic appliances and metal brackets, regardless of rubber band color, had no negative effect on the esthetic evaluation of the smile by either group. Appliances with esthetic brackets were significantly less pleasing for laypeople, whereas for orthodontists they did not affect the esthetic evaluation of the smile. The extraction space had a significantly negative effect on the evaluation of the smile, and only orthodontists thought that the appliance minimized its effect. CONCLUSIONS: The type of bracket used with the orthodontic appliances and a maxillary first premolar extraction space produced different esthetic perceptions in laypeople and orthodontists.

Obstructive sleep apnea in adults.

INTRODUCTION: Obstructive Sleep Apnea and Hypopnea Syndrome (OSAS) is a highly prevalent disease with serious consequences for the patients' lives. The treatment of the condition is mandatory for the improvement of the quality of life, as well as the life expectancy of the affected individuals. The most frequent treatments provided by dentistry are mandibular advancement devices (MAD) and orthognathic surgery with maxillomandibular advancement (MMA). This is possibly the only treatment option which offers high probability of cure. OBJECTIVE: The present article provides a narrative review of OSAS from the perspective of 25 years of OSAS treatment clinical experience. CONCLUSION: MADs are a solid treatment option for primary snoring and mild or moderate OSAS. Patients with severe apnea who are non-adherent to CPAP may also be treated with MADs. Maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS.

Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics.

BACKGROUND: One of the most controversial issues in treatment planning of class III malocclusion patients is the choice between orthodontic camouflage and orthognathic surgery. Our aim was to delineate diagnostic measures in borderline class III cases for choosing proper treatment. METHODS: The pretreatment lateral cephalograms of 65 patients exhibiting moderate skeletal class III were analyzed. The camouflage group comprised of 36 patients with the mean age of 23.5 (SD 4.8), and the surgery group comprised of 29 patients with the mean age of 24.8 years (SD 3.1). The camouflage treatment consisted of flaring of the upper incisors and retraction of the lower incisors, and the surgical group was corrected by setback of the mandible, maxillary advancement, or bimaxillary surgery. Mann-Whitney U test was used to compare the variables between the two groups. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups. RESULTS: Holdaway H angle and Wits appraisal were able to differentiate between the patients suitable for orthodontic camouflage or surgical treatment. Cases with a Holdaway angle greater than 10.3° and Wits appraisal greater than - 5.8 mm would be treated successfully by camouflage, while those with a Holdaway angle of less than 10.3° and with Wits appraisal less than - 5.8 mm can be treated surgically. Based on this model, 81.5% of our patients were properly classified. CONCLUSIONS: Holdaway H angle and Wits appraisal can be used as a critical diagnostic parameter for determining the treatment modality in class III borderline cases.

Smile prevails over other facial components of male facial esthetics.

BACKGROUND: The aim of this study was to assess whether scores assigned to the eyes, nose, mouth, and chin regions work as predictors of full smiling face scores. METHODS: In this cross-sectional study, the authors used the facial photographs of 86 smiling men. Photographs yielded 5 components: 1 of the face itself and 4 subcomponents (eyes, nose, mouth, and chin region). Raters assigned the photographs beauty scores that the authors measured morphometrically. The authors analyzed the predictive ability of the subcomponents against that of the full face. RESULTS: The subcomponents were statistically significant predictors of facial beauty (mouth: r2 = 0.38, P < .0001; eyes: r2 = 0.14, P < .0001; chin region: r2 = 0.09, P < .0001; nose: r2 = 0.02, P = .05). The more beautiful people had several statistically significant characteristics, such as narrower faces. CONCLUSIONS: Facial subcomponents are predictive factors of the male smiling face and contribute in the following descending order of importance: mouth, eyes, chin region, and nose. PRACTICAL IMPLICATIONS: The results suggest that for many people improvement in smile esthetics also likely will exert a more positive effect on facial beauty than will other procedures (for example, rhinoplasty).

Impact of dental asymmetries on the perception of smile esthetics.

INTRODUCTION: The purpose of this study was to evaluate the impact of anterior tooth asymmetries on the perception of smile esthetics. METHODS: Three pleasant female smiles were digitally altered to simulate several degrees of asymmetry of the gingival margin of a maxillary central incisor, wear of a maxillary canine cusp, and a dental midline shift. Three groups of 50 raters--laypersons, orthodontists, and prosthodontists--evaluated the original and the altered images and used a visual analog scale to score smile esthetics. RESULTS: The threshold of the orthodontists and the prosthodontists for asymmetry of the gingival margin of a maxillary central incisor was 0.5 mm; the threshold for laypersons, who were less perceptive, was 2.0 mm. Wear of a maxillary canine cusp had no esthetic impact for any group of raters. Midline shifts became perceptible when equal to or greater than 1.0 mm for orthodontists and 3.0 mm for prosthodontists; laypersons saw no alteration. CONCLUSIONS: Laypersons, orthodontists, and prosthodontists have different perceptions of attractiveness when evaluating gingival margin height of a maxillary central incisor and a dental midline shift. These findings might help dental specialists to consider the patient's esthetic expectations when planning treatment.

Writing scientific manuscripts: most common mistakes.

I have had the privilege of serving as editor-in-chief for 11 years of two scientific journals: The Dental Press Journal of Orthodontics and the Journal of the World Federation of Orthodontists. I had the opportunity to read and correct thousands of manuscripts. This experience was greatly enriching, because reading a text professionally completely differs from the perspective of readers in general. The routine practice of correcting manuscripts has made me realize that some errors recur frequently. To help authors to improve their manuscripts before submission, these problems are discussed here in the order that they appear in conventional manuscript sections.

Rapid prototyping as a tool for diagnosis and treatment planning for maxillary canine impaction.

Treating an impacted maxillary canine requires identifying its exact position; this can pose a challenge to both orthodontists and oral surgeons. The purpose of this article is to present a new method for diagnosis and treatment planning of maxillary canine impaction by using computed tomography combined with rapid prototyping. Computed tomography image files of a patient with tooth 13 impaction were edited to produce, by means of rapid prototyping, an anatomic model of the maxillary teeth and a single attachment model that was later used to fabricate a metal attachment to be bonded to the impacted tooth. The dental model was used in the diagnosis and orthodontic treatment planning, and to communicate with the patient and his parents. The model showed the exact anatomical relationship between the impacted tooth and the other teeth; it was the main aid in intraoperative navigation during surgery to expose the tooth. The metal attachment built from the prototype was bonded to tooth 13 during surgery. Prototyping could become a new tool for fabricating brackets and other precision accessories for specific needs. Dental models made with rapid prototyping could become the diagnostic procedure of choice for evaluating impacted maxillary canines.