Digital dental photography.

Photography has always been an integral part of dentistry. The journey goes back to the time when film photography was used only for documentation and referral purpose which has now evolved to digital photography. Its application in dental practice is simple, fast, and extremely useful in documenting procedures of work, education of patients, and pursuing clinical investigations, thus providing many benefits to the dentists and patients. The article describes the added benefits of digital dental photography over film photography, basic armamentarium for obtaining good photographs, and how digital dental photography is beneficial in the field of prosthodontics.

Validation of assessment of intraoral digital photography for evaluation of dental restorations in clinical research.

OBJECTIVES: The aim of this study was to investigate the validity of assessment of intraoral digital photography in the evaluation of dental restorations. METHODS: Intraoral photographs of anterior and posterior restorations were classified based on FDI criteria according to the need for intervention: no intervention, repair and replacement. Evaluations were performed by an experienced expert in restorative dentistry (gold standard evaluator) and 3 trained dentists (consensus). The clinical inspection was the reference standard method. The prevalence of failures was explored. Cohen's kappa statistic was used. Validity was accessed by sensitivity, specificity, likelihood ratio and predictives values. RESULTS: Higher prevalence of failed restorations intervention was identified by the intraoral photography (17.7%) in comparison to the clinical evaluation (14.1%). Moderate agreement in the diagnosis of total failures was shown between the methods for the gold standard evaluator (kappa = 0.51) and consensus of evaluators (kappa = 0.53). Gold standard evaluator and consensus showed substantial and moderate agreement for posterior restorations (kappa = 0.61; 0.59), and fair and moderate agreement for anterior restorations (kappa = 0.36; 0.43), respectively. The accuracy was 84.8% in the assessment by intraoral photographs. Sensitivity and specificity values of 87.5% and 89.3% were found. CONCLUSIONS: Under the limits of this study, the assessment of digital photography performed by intraoral camera is an indirect diagnostic method valid for the evaluation of dental restorations, mainly in posterior teeth. This method should be employed taking into account the higher detection of defects provided by the images, which are not always clinically relevant.

Clinical Assessment of Frenum Morphology and Attachment in Malaysian Children

Objective: To determine the prevalence of various types and attachment level of maxillary frenum in Malaysian children. Material and Methods: A cross-sectional study was conducted in a total of 200 children of age ranging from 2 to 15 years. Photographs of maxillary frenum were taken and their types and level of attachment were recorded by using Placek's classification and modified Sewerin typology. Children were divided into 3 groups based on age: between 2-5, 6-11 and 12-15 years. Descriptive analysis was carried out to determine the frequency of frenum types and level of attachment. The relationship of frenal attachment with gender, and age were studied. Data collected was analyzed using descriptive statistics (frequencies, percentages, means and standard deviation). Statistical Package for Social Sciences (SPSS) version 19.0 was used to analyze the data. Results: The most common type was mucosal type of attachment (75%) and the least common was papillary penetrating (4.5%) based on Placek's classification whereas for modified Sewerin's typology, simple frenum (73%) was the most prevalent, followed by simple with nodule frenum (11.5%). There was no significant difference in the frenum attachment between the two genders. Mucosal and gingival attachment was significantly higher in older age group whereas papillary and papillary penetrating was higher in younger age group. Conclusion: This study showed that attachment of frenum in children changes according to age and whereas gender plays no role in portraying the difference. Hence, clinicians must be able to identify the different types of MMLF during dental examination to avoid any unnecessary surgical interventions particularly during the period of development.

An experimental in vivo procedure for the standardised assessment of sealants retention over time.

AIM: The elaboration of an experimental system to obtain reproducible and comparable photographs of the occlusal surface to monitor sealants retention. MATERIALS AND METHODS: An intraoral camera connected to a computer was used to obtain photos of the occlusal surfaces. A specific software was utilized to perform measurements on archived pictures. An experimental two-part system, consisting of a dental arch support and a camera support, connected to each other through holes and pins, was made to obtain a standardised and reproducible placement of the camera in the mouth. In the first part, to test the degree of reliability of the procedure and the percentage of image distortion, 120 first molars were sealed and for each molar ten photographs were taken, using the intraoral camera connected with the dental arch support, the camera support and the dedicated software. In the second part, 165 first molars were sealed and photographed, as above described, immediately after sealing (T0), 6 months (T1) and 1 year later (T2). With the software, the sealed areas were measured. The comparison of the selected sealed areas between T0 and T1, T0 and T2, T1 and T2 determined the percentage of sealant loss. RESULTS: In the first part, the experimental procedure showed a reliability of 96.85%. In the second part, the difference in the rate of lost sealant between T0-T1 and T1-T2 was statistically significant (p <0.001). STATISTICS: ANOVA analysis was made. CONCLUSIONS: Photographs, obtained through the experimental two-part system, allowing a reproducible positioning of the intraoral camera in oral cavity, could represent a standardised and useful method to monitor sealants retention over time.

Assessing the use of Quantitative Light-induced Fluorescence-Digital as a clinical plaque assessment.

BACKGROUND: The aims of this study were to compare the relationship between red fluorescent plaque (RF plaque) area by Quantitative Light-induced Fluorescence-Digital (QLF-D) and disclosed plaque area by two-tone disclosure, and to assess the bacterial composition of the RF plaque by real time-PCR. METHODS: Fifty healthy subjects were included and 600 facial surfaces of their anterior teeth were examined. QLF-D was taken on two separate occasions (before and after disclosing), and the RF plaque area was calculated based on Plaque Percent Index (PPI). After disclosing, the stained plaque area was analyzed to investigate the relationship with the RF plaque area. The relationship was evaluated using Pearson correlation and paired t-test. Then, the RF and non-red fluorescent (non-RF) plaque samples were obtained from the same subject for real-time PCR test. Total 10 plaque samples were compared the ratio of the 6 of bacteria using Wilcoxon signed rank test. RESULTS: Regarding the paired t-test, the blue-staining plaque area (9.3±9.2) showed significantly similarity with the RF plaque area (9.1±14.9, p=0.80) at ΔR20, however, the red-staining plaque area (31.6±20.9) presented difference from the RF plaque area (p<0.0001). In addition, bacterial composition of Prevotella intermedia and Streptococcus anginosus was associated with substantially more the RF plaque than the non-RF plaque (p<0.05). CONCLUSIONS: The plaque assessment method using QLF-D has potential to detect mature plaque, and the plaque area was associated with the blue-staining area using two-tone disclosure.

Validation of the digital photographic assessment to diagnose traumatic dental injuries.

INTRODUCTION: Alternatives for monitoring dental trauma in epidemiological surveys may be useful, as data collection of epidemiological investigation can be jeopardized due to several conditions. AIM: To investigate the validity of standard digital photographs to determine the occurrence of anterior dental trauma compared to the clinical examination in an epidemiological survey. METHODS: Participants were children aged 8-12 years old attending both private and public schools; children were clinically evaluated for the assessment of dental trauma, and standard photographs were taken from maxillary and mandibular permanent incisors of each child. Validity was determined by calculating the percentages and respective 95% confidence interval of sensitivity, specificity, positive predictive value, and negative predictive value. Cohen's kappa statistic was also used. RESULTS: A total of 412 children were included, totaling 3296 teeth assessed for dental trauma presence. The prevalence of dental trauma was 11.2% (95% CI 8.29-14.61) and 10.2% (95% CI 7.45-13.53), respectively, for the clinical examination and the photographic method. Agreement between the gold standard and the photographic diagnosis was good: 0.64 for the prevalence of dental trauma and 0.66 for diagnosis of dental trauma on a tooth basis. The diagnosis through the photographic method had higher specificity (96.7%) than sensitivity (65.2%). High positive likelihood ratio and low negative likelihood ratio were also observed. CONCLUSION: The photographic assessment method of dental trauma was valid and reliable as compared to the oral clinical examination.

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts.

BACKGROUND: Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. METHODS: Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. RESULTS: Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant. CONCLUSIONS: RME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the "lip bumper effects" observed in the MME protocol.

Assessment of dynamic smile and gingival contour in young Chinese people.

OBJECTIVES: This study aimed to classify the dynamic smile and to quantify the gingival line (GL), as well as apico-coronal displacement of the gingival zenith (GZ), in the maxillary anterior dentition in a young Chinese population. METHODS: Two-hundred young Chinese subjects (100 men and 100 women; 20-35 years of age) with healthy dentogingival tissue were recruited. The dynamic smile process was captured using a digital camera. The smile type, GL type, the vertical distance of the GZ between the canine and the central incisor on the same side and the GZ of the lateral incisor-GL relationship were measured using a self-developed smile-analysis method. The kappa statistics was used to examine the reliability of the data recorded by the rater. The Pearson chi-square test was used to analyse the differences between subjects regarding the frequencies of smile type and GL type at α = 0.05. RESULTS: Data revealed that 45.5% of subjects had a high smile and 45.5% had an average smile; 58.2% of the subjects presented an upwards GL. The GZ of canine teeth was 0.33 mm apical to the corresponding central incisor and no significant difference between both sides of the GZ was observed. The GZ of the lateral incisor was located coronal to the GL in 87.9% of samples. The vertical distance between the GZ of the lateral incisor and the GL was 0.59 mm and no statistically significant difference was detected. CONCLUSIONS: The most common findings were a high or average smile type, combined with an upward GL. In the majority of subjects, the GZ of the lateral incisor is coronal to the GL. The apico-coronal displacement of the GZ showed bilateral symmetry.

Photographic and videographic assessment of the smile: objective and subjective evaluations of posed and spontaneous smiles.

INTRODUCTION: Esthetic considerations play an increasingly important role in patient care, and clinicians need a methodology that includes imaging techniques to capture the dynamic nature of the smile. Photographs of the posed smile are routinely used to guide diagnosis and treatment, but there is no standardized and validated method for recording the dynamic smile. The purposes of this study were to (1) determine whether a posed smile is reproducible, (2) compare visual and verbal cues in eliciting a smile, and (3) compare the diagnostic value of videography and photography in evaluating a patient's smile. METHODS: The smiles of 22 subjects were simultaneously photographed and videotaped on 2 separate occasions. For objective comparisons, measurements of the smile were obtained from 8 × 10 color still photographs and selected digitized video images. A panel consisting of a layperson, an oral surgeon, an orthodontist, and a prosthodontist subjectively assessed the reproducibility of the smile, posed vs spontaneous smiles, and the diagnostic value of video vs still images. RESULTS: Objective measurements showed that the posed smile can be reliably reproduced, whether captured by videography or still photography. However, subjectively, the panel members detected differences between the posed smiles taken on different days 80% of the time. The clinician panel members expressed a strong preference for videography over photography and for the spontaneous over the posed smiles. CONCLUSIONS: This study emphasizes the need to continue to investigate and standardize the methods of eliciting and recording a smile of diagnostic quality.

Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children.

OBJECTIVES: A cross-sectional study was conducted to compare a visual dental examination method developed by the British Association for the Study of Community Dentistry with assessment of intra-oral photographs as means of detecting dental caries in 5-year-olds and 10- to 11-year-olds. METHOD: 130 5-year-olds and 140 10- to 11-year-olds were visually examined by five trained and calibrated examiners. The children also had intra-oral photographs of their teeth taken. The same five examiners assessed the photographs for caries. Both photographic and visual assessments were undertaken at 'caries into dentine' level. RESULTS: Weighted kappas for the outcome DMFT/dmft as a measure of intra-examiner reliability for the visual examinations ranged from 0.94 to 0.98 (median = 0.98) in the 5-year-olds and 0.80 to 1.00 (median = 0.93) in the 10- to 11-year-olds. Weighted kappas as a measure of intra-examiner reliability for the photographic assessments ranged from 0.83 to 1.00 (median = 0.93) in the 5-year-olds and 0.69 to 0.95 (median = 0.81) in the 10- to 11-year-olds. Sensitivity values for the photographic assessment method as compared to the gold standard of the visual examination scores of a benchmark examiner ranged from 87.8% to 95.8% in the 5-year-olds and 58.5% to 71.7% in the 10- to 11-year-olds. CONCLUSION: There was good intra-examiner reliability for both the visual and the photographic methods for all the examiners. There are no clinically significant differences between the photographic scores and the visual assessments using any of the metrics described. The photographic approach is therefore equivalent in diagnostic utility to the visual system and confers considerable advantages in terms of examiner bias reduction, remote scoring and archiving. These advantages must be weighed against the modest costs of the cameras and the increase time required to acquire the images.

Photographic assessment of cephalometric measurements.

OBJECTIVE: To investigate the relationship between craniofacial measurements obtained from cephalometric radiographs and analogous measurements from profile photographs. MATERIALS AND METHODS: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 123 subjects (65 girls, 58 boys; age 7-12 years). Intraclass correlation coefficients (ICCs) were calculated from repeated photographic measurements to evaluate method reliability. Analogous cephalometric and photographic measurements were compared to assess Pearson correlation coefficients. Linear regression analyses were conducted between the measurements that achieved correlation coefficients greater than r  =  0.7. RESULTS: The reliability of the photographic technique was satisfactory. Most measurements showed ICCs above 0.80 and highly significant correlations (P ≤ .001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric, mainly for female subjects (r(2)  =  0.80). The FMA' angle showed the best results for vertical assessment (r(2)  =  0.65). CONCLUSIONS: The photographic method has proven to be a repeatable and reproducible tool provided that a standardized protocol is followed. Therefore, it may be considered a feasible and practical diagnostic alternative, particularly if there is a need for a low-cost and noninvasive method.

Ultrashort echo time (UTE) MRI for the assessment of caries lesions.

OBJECTIVE: Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions. METHODS: 40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings. RESULTS: In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images. CONCLUSION: The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.

Esthetic smile preferences and the orientation of the maxillary occlusal plane.

STATEMENT OF PROBLEM: The anteroposterior orientation of the maxillary occlusal plane has an important role in the creation, assessment, and perception of an esthetic smile. However, the effect of the angle at which this plane is visualized (the viewing angle) in a broad smile has not been quantified. PURPOSE: The purpose of this study was to assess the esthetic preferences of dental professionals and nondentists by using 3 viewing angles of the anteroposterior orientation of the maxillary occlusal plane. MATERIAL AND METHODS: After Institutional Review Board approval, standardized digital photographic images of the smiles of 100 participants were recorded by simultaneously triggering 3 cameras set at different viewing angles. The top camera was positioned 10 degrees above the occlusal plane (camera #1, Top view); the center camera was positioned at the level of the occlusal plane (camera #2, Center view); and the bottom camera was located 10 degrees below the occlusal plane (camera #3, Bottom view). Forty-two dental professionals and 31 nondentists (persons from the general population) independently evaluated digital images of each participant's smile captured from the Top view, Center view, and Bottom view. The 73 evaluators were asked individually through a questionnaire to rank the 3 photographic images of each patient as 'most pleasing,' 'somewhat pleasing,' or 'least pleasing,' with most pleasing being the most esthetic view and the preferred orientation of the occlusal plane. The resulting esthetic preferences were statistically analyzed by using the Friedman test. In addition, the participants were asked to rank their own images from the 3 viewing angles as 'most pleasing,' 'somewhat pleasing,' and 'least pleasing.' RESULTS: The 73 evaluators found statistically significant differences in the esthetic preferences between the Top and Bottom views and between the Center and Bottom views (P<.001). No significant differences were found between the Top and Center views. The Top position was marginally preferred over the Center, and both were significantly preferred over the Bottom position. When the participants evaluated their own smiles, a significantly greater number (P< .001) preferred the Top view over the Center or the Bottom views. No significant differences were found in preferences based on the demographics of the evaluators when comparing age, education, gender, profession, and race. CONCLUSIONS: The esthetic preference for the maxillary occlusal plane was influenced by the viewing angle with the higher (Top) and center views preferred by both dental and nondental evaluators. The participants themselves preferred the higher view of their smile significantly more often than the center or lower angle views (P<.001).

An assessment of the relationship between cervical vertebrae maturation index and eruption of permanent maxillary canines.

AIM: The purpose of the present study was to establish the relationship between the eruption of permanent maxillary canines and cervical vertebral maturation stages (CVMs) to assess an alternative method for determining time of canine eruption in the late mixed dentition. MATERIALS AND METHODS: One hundred and twenty subjects with erupting permanent maxillary canines were observed both intraorally and radiographically with orthopantamograms. Lateral cephalograms were recorded to divide subjects according to CVM stage into prepeak (CS1 and CS2), peak (CS3 and CS4) and postpeak (CS5 and CS6) groups of puberty. STATISTICAL ANALYSIS: The differences between the prevalence rates of canine eruption in different groups of puberty were estimated using 'z test'. RESULTS: Prepeak group comprised of forty six subjects, peak group sixty eight subjects and postpeak group six subjects. The differences in prevalence rates between peak and prepeak and between peak and postpeak groups were noticed highly significant (p<0.001), while prevalence rates between peak and postpeak was found less significant ( p0 <0.01). CONCLUSION: Eruption of the permanent maxillary canine can occur at any CVM stage till end of the puberty or after puberty (CS1-CS6). Thus, an absence of maxillary canine during or after postpeak stage of puberty (CS5 or CS6) suggests delayed eruption and canine impaction.

Photographic assessment of nasal morphology following rapid maxillary expansion in children.

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64 percent of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92 percent of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56 percent of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Clinical photography vs digital video clips for the assessment of smile esthetics.

OBJECTIVE: To test the null hypothesis that there is no clinically significant difference between the post-orthodontic treatment images of smiles of subjects captured by clinical photography and the smiles of the same subjects obtained from digital video clips. MATERIALS AND METHODS: Clinical photographs and digital video captures were obtained from 48 orthodontically treated patients. An updated version of the Smile Mesh program was used to quantify and compare smile characteristics obtained with the two methods. A paired-samples t-test was performed to test for mean differences in Smile Mesh measurements generated from both smile images. The relationship between the various Smile Mesh measurements obtained from both smile images was examined by way of Pearson product-moment correlation. RESULTS: A significant difference was found between 7 of the 14 mean Smile Mesh measurements. The absolute values of all these differences, however, were smaller than 1 mm and therefore were not clinically significant. With the exception of lower lip to maxillary incisor, all measurements showed a moderate to strong relation with each other (P values ranging from .47 to .82; P < .001). CONCLUSIONS: The hypothesis cannot be rejected. A significant positive correlation was noted between Smile Mesh measurements obtained from smiles captured by clinical photography and those captured with digital video clips. This supports the conclusion that a standard digital photograph appears to be a valid tool for analysis of the posttreatment smile.

Assessment of the golden ratio in pleasing smiles.

AIMS: The golden ratio is a guideline to help harmoniously restore or replace missing teeth. However, this concept is controversial. This study assesses the validity of the golden ratio between the widths of the maxillary anterior teeth in individuals presenting with an attractive/nonattractive smile. MATERIAL AND METHODS: A double-stage random cluster sample cross-sectional study included 903 students whose ages ranged from 18 to 30 years and met the inclusion criteria. Image-measurement software was used to assess the perceived mesiodistal widths of the maxillary anterior teeth on scanned photographs. A jury of two dental professionals, a portrait photographer, and a painter, along with the respective subject as the fifth judge, determined the attractiveness of each smile on a visual analog scale. The mean value determined whether an individual was allocated to the attractive or nonattractive smile group. Finally, the prevalence of the golden ratio was investigated in these two groups. Intraobserver correlation coefficient was 0.966. Cochran's chi-square test was used for data analysis. RESULTS: According to the jury, 143 individuals had an attractive smile and 289 had a nonattractive smile. Maxillary central to lateral incisor ratio showed the golden proportion in 50.3% of the students with an attractive smile as compared to 38.1% in the nonattractive smile group (P =.014). However, the golden ratio between the maxillary lateral incisors and the canines existed in only 16.8% of the individuals with an attractive smile as compared to 12.1% in the nonattractive smile group (P =.223). CONCLUSION: The golden ratio can be useful to achieve esthetic restorations of the maxillary central and lateral incisors. However, the golden ratio between the perceived widths of the maxillary lateral incisors to the canines does not seem to be decisive for an attractive smile and other factors should be considered.

Digital dental photography. Part 2: Purposes and uses.

Although the primary purpose of using digital photography in dentistry is for recording various aspects of clinical information in the oral cavity, other benefits also accrue. Detailed here are the uses of digital images for dento-legal documentation, education, communication with patients, dental team members and colleagues and for portfolios, and marketing. These uses enhance the status of a dental practice and improve delivery of care to patients.