An EMG-based approach toward the assessment of implicit self-esteem.

An important aspect of implicit self-esteem is the positivity of peoples spontaneous affective reactions to the self. In this study, we developed and validated a physiology-based measure that captures such positive reactions. We presented participants (N = 256) self-related stimuli (i.e., pictures of themselves) and used electromyography (EMG) to record changes in facial muscular activity that are indicative of subtle smiling. EMG responses were on average positive, which matches with previous research findings on positively biased self-evaluations. Individual differences in EMG responses were moderately reliable and positively associated with explicit self-esteem and self- and peer-rated likability (but not consistently with measures of well-being and agentic behavior). The relations between the EMG responses and likability indicators largely held when we controlled for explicit self-esteem, indicating that the novel measure possessed incremental validity over self-reports. The results thus indicated that the EMG approach might be fruitful for the assessment of implicit self-esteem.

Os (des) caminhos da saúde bucal coletiva: perspectivas atuais / The (mis)paths of collective oral health: current perspectives / Los (des)caminos de la salud bucal colectiva: perspectivas actuales

Objetivo: Analisar as perspectivas atuais acerca (des) caminhos da saúde bucal coletiva no Brasil. Método:Trata-se de um estudo bibliográfico de abordagem quantitativa. A pesquisa abrange a busca de artigos publicados nos últimos dez anos, na Scientific Electronic Library Online ­Scielo. Resultados:Ao realizar a triagem desses artigos, utilizando os critérios de inclusão, têm-se para o estudo um total de dez artigos, sendo (30%) em 2015, (40%) em (2016, 2019) e 30% em (2017, 2021, 2023). Conclusão:a PNSB vem apresentando grandes avanços conforme sua sériehistórica e o programa Brasil Sorridente tem como compromisso qualificar a atenção básica, garantindo universalidade, equidade, integralidade da assistência e resolutividade, conforme os princípios doutrinários do SUS.

Objective: To analyze the current perspectives on the (mis)paths of collective oral health in Brazil. Method:This is a bibliographic study with a quantitative approach. The search includes the search for articles published in the last ten years in the Scientific Electronic Library Online ­Scielo. Results:When screening these articles, using the inclusion criteria, a total of ten articles were included in the study, (30%) in 2015, (40%) in (2016, 2019) and 30% in (2017, 2021, 2023). Conclusion:the PNSB has been showing great advances according to its historical series and the Smiling Brazil program is committed to qualifying primary care, ensuring universality, equity, comprehensiveness of care and problem-solving, according to the doctrinal principles of the SUS.

Objetivo: Analizar las perspectivas actuales sobre los (des)caminos de la salud bucal colectiva en Brasil.Método: Se trata de un estudio bibliográfico con enfoque cuantitativo. La búsqueda incluye la búsqueda de artículos publicados en los últimos diez años en la Scientific Electronic Library Online ­Scielo. Resultados:Al cribar estos artículos, utilizando los criterios de inclusión, se incluyeron en el estudio un total de diez artículos, (30%) en 2015, (40%) en (2016, 2019) y 30% en (2017, 2021, 2023).Conclusión: el PNSB viene mostrando grandes avances de acuerdo con su serie histórica y el programa Brasil Sonriente está comprometido con la calificación de la atención básica, garantizando la universalidad, la equidad, la integralidad de la atención y la resolución de problemas, de acuerdo con los principios doctrinarios del SUS.

Automated Spontaneity Assessment after Smile Reanimation: A Machine Learning Approach.

BACKGROUND: Recreation of a spontaneous, emotional smile remains a paramount goal of smile reanimation surgery. However, optimal techniques to reliably restore spontaneity remain unknown. Dual automated machine-learning tools were used to develop an objective tool to analyze spontaneous smiling. The feasibility of this tool was tested in a sample of functional free muscle transfers. METHODS: Validated humorous videos were used to elicit spontaneous smiles. Automated facial landmark recognition (Emotrics) and emotion detection software (Affdex) were used to analyze video clips of spontaneous smiling in nine normal subjects and 39 facial reanimation cases. Emotionality quotient was used to quantify the ability of spontaneous smiles to express joy. RESULTS: The software could analyze spontaneous smiling in all subjects. Spontaneous smiles of normal subjects exhibited median 100 percent joy and 0 percent negative emotion (emotional quotient score, +100/0). Spontaneous smiles of facial palsy patients after smile reanimation, using cross-facial nerve graft, masseteric nerve, and dual innervation, yielded median emotional quotient scores of +82/0, 0/-48, and +10/-24 respectively (joy, p = 0.006; negative emotion, p = 0.034). CONCLUSIONS: Computer vision software can objectively quantify spontaneous smiling outcomes. Of the retrospective sample of cases reviewed in this study, cross-facial nerve graft-innervated gracilis functional free muscle transfer achieved a greater degree of emotionality during spontaneous smiling than masseteric or dually innervated transfer. Quantification of spontaneous smiling from standard video clips could facilitate future, blinded, multicenter trials with sufficient long-term follow-up to definitively establish the rates of spontaneity from a range of reanimation procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Effect of dimensions on function: A 2-dimensional sonographic assessment to correlate facial muscle and smile type.

OBJECTIVE: The aim of this study was to measure the dimensions of the select facial muscles and correlate them with different types of smiles. METHODS: The study group included 30 South Asian adults (17 men and 13 women) aged between 24 and 30 years divided into 3 groups of 10 subjects each according to Rubin's classification of smile. The zygomaticus major, levator labii superioris, depressor anguli oris, and mentalis muscles were ultrasonographically evaluated. The length and thickness of the muscles were measured bilaterally. The data obtained were analyzed statistically. RESULTS: The maximum mean value thickness of the zygomaticus major was found in the canine smile group. The maximum mean value thickness of the depressor anguli oris and mentalis was seen in the full denture smile group. However, the thickness of the levator labii superioris muscle was similar between the different smile groups. There was no significant difference in the measurements of the length of the muscles between the right and the left sides. CONCLUSIONS: This study did not find any statistically significant correlation between the type of smiles described in Rubin's classification and the dimensions of the associated facial muscle.

Guía de evaluación estética de la sonrisa en ortodoncia / Guide of esthetic evaluation of the smile in orthodontics i: en

Introducción: El objetivo estético fundamental en los servicios de ortodoncia es conseguir una sonrisa balanceada, pues tiene una función importante en la apariencia y expresión facial. Objetivo: Confeccionar una guía de evaluación de estética de la sonrisa a partir del diagnóstico de insuficiencias detectadas en los parámetros clínicos para ello y desde las perspectivas de la satisfacción de pacientes y profesionales de ortodoncia. Métodos: Se realizó una investigación de desarrollo tecnológico, con enfoque mixto, en la Clínica Estomatológica Docente Victoria de Santa Clara de la provincia de Villa Clara, del 2017 al 2019, en una muestra no probabilística intencional que estuvo conformada por los pacientes y ortodoncistas que cumplían los criterios de inclusión establecidos a tal efecto. Resultados: Los especialistas opinaron sobre los parámetros existentes para evaluar la sonrisa y revelaron insatisfacción con la evaluación que realizaban; además, consideraron que dicha valoración es necesaria para el diagnóstico y la planificación del tratamiento. Igualmente, se determinó la percepción estética de los pacientes. Toda esta información permitió realizar el diseño de la guía, la cual fue valorada por profesores expertos en el tema, quienes estuvieron de acuerdo con los nueve parámetros propuestos, de manera que fue aceptada para su posterior aplicación clínica. Conclusiones: La guía elaborada para evaluar la estética de la sonrisa contiene parámetros clínicos que satisfacen las necesidades de pacientes y profesionales de ortodoncia.

Introduction: The fundamental esthetic objective in the orthodontics services is to get a balanced smile, because it has an important function in the appearance and facial expression. Objective: To make a guide of esthetics evaluation of the smile starting from the diagnosis of inadequacies in the clinical parameters and from perspectives of the satisfaction of patients and orthodontics professionals. Methods: An investigation of technological development, with mixed approach, was carried out in Victoria Teaching Stomatologic Clinic of Santa Clara in Villa Clara province, from 2017 to 2019, in a non probabilistic intentional sample that was conformed by the patients and orthodontists that fulfilled the established inclusion approaches to such an effect. Results: The specialists expressed an opinion on the existent parameters to evaluate the smile and revealed dissatisfaction with the evaluation that they carried out; also, they considered that this valuation is necessary for the diagnosis and planning of the treatment. Equally, the esthetic perception of the patients was determined. All this information allowed to carry out the design of the guide, which was valued by expert professors in the topic who agreed with the nine proposed parameters, so that it was accepted for its later clinical application. Conclusions: The guide elaborated to evaluate the esthetics of the smile contains clinical parameters that satisfy the necessities of patients and orthodontics professionals.

Relationship of 3 indexes of orthodontic treatment need used by Medicaid and oral health-related quality of life.

INTRODUCTION: This study aimed to assess the relationship between 3 indexes of orthodontic treatment need that are used by Medicaid, namely the Salzmann Index (SI), the handicapping labiolingual deviation (HLD) Index, and the HLD California Modification Index, and oral health-related quality of life (OHRQOL). METHODS: The orthodontic records of 100 participants aged 11-14 years were used to calculate occlusal index scores. The condition-specific oral impacts on daily performances (OIDP) index questionnaire was used to quantify OHRQOL and to identify detriments attributable to malocclusion-related conditions (MRCs). The relationship between occlusal index scores and OHRQOL was analyzed using descriptive statistics, Spearman rank-order and biserial correlations, and logistic regression. RESULTS: The mean index scores were: SI, 15.4; HLD, 13.2; and HLD California Modification, 15.8. Ninety percent of participants did not have normative orthodontic treatment need according to current index criteria. OIDP scores were not normally distributed, and the mean score was 3.1. Of those participants who reported an impact, 83% attributed at least 1 of those impacts to MRCs; however, 90% of these were of mild or moderate intensity. Smiling was the performance most impacted by MRCs. The only statistically significant correlation between an occlusal index and OIDP scores was for the SI, though this association was weak (r = 0.27). None of the variables used in the logistic regression model (age, sex, 3 index scores) were significant predictors of OHRQOL. CONCLUSIONS: No meaningful association exists between the 3 indexes studied and OHRQOL. These findings challenge the validity of current systems for the allocation of Medicaid-funded orthodontic treatment.

Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception.

AIM: To clinically assess the aesthetics of smile and the possible influencing factors. MATERIALS AND METHODS: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. RESULTS: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from -0.04 to 0.34; p = .12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p = .0342), located in the upper jaw (p = .0223), and corresponding to incisors (p < .0001) and canines (p = .0159) with respect to molars. CONCLUSIONS: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.

Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness.

AIM: To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness. MATERIALS AND METHODS: Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating. RESULTS: Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative. CONCLUSIONS: ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

El deber de actuar por la salud bucal y la felicidad / The commitment to act for oral health and happiness

La salud bucal y la felicidad requieren acción social. El buen estado de salud es uno de los principales determinantes de la felicidad, pues produce alegría y se expresa habitualmente a través de la sonrisa o risa que pudieran resultar inhibidas por afecciones bucales. La campaña "Unidos por la salud bucal", impulsada por la Federación Dental Internacional a nivel mundial, hace un llamado a decisores, profesionales y a la población para que asuman compromisos orientados a reducir la carga global de las enfermedades bucales. El establecimiento de compromisos y las acciones consecuentes pueden contribuir a mejoras en la salud bucal, aunque para ello es necesario establecer acciones sistemáticas. En el contexto cubano, es una fortaleza que la estrategia de la estomatología sea nacional y tenga un enfoque de salud pública, si bien se hace necesario reforzar el seguimiento y evaluación del impacto de las acciones, estimular la creatividad, la comunicación dialogada y revisar cuáles compromisos deben ser consolidados para contribuir a la salud bucal y, por consiguiente, a la felicidad(AU)

Oral health and happiness require social action. The good health is one of the main determinants of happiness, since it produces joy and is usually expressed through a smile or laughter that could be inhibited by oral conditions. The International Dental Federation's "United for Oral Health" Campaign in 2020 aims to make commitments for decision-makers, professionals and the population to reduce the global burden of oral diseases. Establishing commitments and consequent actions can contribute to improvements in oral health, making it necessary to establish systematic actions. In the Cuban context, it is a strength that the stomatology strategy is national and has a public health focus, although it is necessary to reinforce the monitoring and evaluation of the impact of the actions, stimulate creativity, dialogue communication, and review which commitments they must be consolidated to contribute to oral health and therefore to happiness."(AU)

The Effect of Depressor Anguli Oris Muscle Block on Facial Symmetry in Synkinetic Facial Paralysis Patients and Its Role in Preoperative Assessment.

BACKGROUND: Depressor anguli oris muscle hypertonicity in synkinetic facial paralysis patients may have an overpowering antagonistic effect on facial symmetry. Depressor anguli oris muscle block is a crucial diagnostic test before any treatment planning. Presented is the largest patient cohort analysis to date on static and dynamic facial symmetry changes after depressor anguli oris muscle block. METHODS: Unilateral synkinetic patients with depressor anguli oris muscle hypertonicity were included. Resting symmetry and smile modiolus angle, excursion, and exposure of teeth were measured on both synkinetic and healthy hemifaces before and after depressor anguli oris muscle block using Emotrics and FaceGram photographic analyses. RESULTS: Thirty-six patients were included. Before depressor anguli oris block, resting modiolus height was elevated on the synkinetic side (p = 0.047). During open-mouth smile, reduced modiolus angle (p < 0.0001), modiolus excursion (p < 0.0001), and exposure of teeth (p < 0.0001) were observed on the synkinetic hemiface. After depressor anguli oris block, resting modiolus height became symmetric (p = 0.64). During open-mouth smile, modiolus angle and exposure of teeth significantly increased (both p < 0.0001); excursion did not improve on the synkinetic side (p = 0.13) but unexpectedly improved in open-mouth smile on the healthy side (p = 0.0068). CONCLUSIONS: Depressor anguli oris muscle block improved resting symmetry and modiolus angle and exposure of teeth during smile, demonstrating the inhibitory mimetic role of a hypertonic depressor anguli oris muscle in synkinesis. It is a critical diagnostic and communication tool in the assessment and treatment planning of depressor anguli oris muscle hypertonicity, suggesting the potential effects of future depressor anguli oris myectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Esthetic assessment of celebrity smiles.

STATEMENT OF PROBLEM: Guidelines for planning esthetic outcomes are sparse. The present study evaluated the most noticeable characteristics of the celebrities with the most esthetic smiles. PURPOSE: The purpose of this observational study was to assess the smiles of celebrities based on descriptive esthetic smile criteria and to compare male and female celebrity smiles based on dentally esthetic smiles. MATERIAL AND METHODS: An internet search for the "most beautiful celebrity smile ranking" was conducted in 2019, resulting in 50 celebrities that had been voted for having the most beautiful smiles. A second search was conducted to locate images of the identified individuals with the whole face and a broad smile. RESULTS: The most frequent characteristics of the studied variables were a normal smile line (70.7%), incisal edges parallel to the lower lip (56.1%), maxillary anterior incisal edges touching the lower lip (48.8%), a smile width of 10 teeth (53.7%), a facial midline coincident with the maxillary dental midline (51.2%), and average buccal corridors (78%). Statistically significant differences between men and women were only found in the smile arch (P<.01). CONCLUSIONS: Celebrities voted as having the most beautiful smiles comply with most of the characteristics described as esthetically pleasing, except for midline deviations. The general population is influenced by factors other than the individual's smile.

Beauty Is in the Eye of the Beholder: Esthetic Outcome Assessment in Smile Reanimation Surgery in Patients With Facial Palsy.

ABSTRACT: Layperson assessments are becoming increasingly important in the evaluation of surgical procedures of the face, including smile reanimation. In this study, the authors set out to answer 3 questions: (1) are esthetic scores more dependent on the assessor or the person that is being assessed, (2) how does smile reanimation change esthetic scores, (3) do sex and age of the patient and assessor explain some of the esthetic outcomes?Thirty-five assessors scored pre and postoperative photographs of 21 facial palsy patients undergoing smile reanimation. Linear mixed-effect models were used to investigate the effects of assessor and patient factors on esthetic outcome assessments, to examine changes after smile reanimation, and to determine whether sex and age explained part of the esthetic outcomes.Fifty-eight percent of variation in the esthetic scores can be explained by some assessors being more positive in their esthetic scoring compared to other assessors. Twenty-nine percent was attributed to patient baseline esthetic scores. Overall esthetic scores improved after smile reanimation. Sex and age of the patient and assessor could not explain variation in the esthetic scores.Esthetic appearance highly depends on "who is looking." These findings are important for preoperative counseling, and for those treating and educating patients with facial palsy.

Assessment of tooth and gingival display in maxillary anterior teeth and premolars relative to gingival and interdental smile lines.

BACKGROUND: Gingival tissue circumforaneous to the maxillary anterior teeth has been known to play a crucial role in smile esthetics. Reports in the literature suggest that both tooth and gingival display in the premolar areas are relevant for a beautiful smile. The present study examines the amount of tooth and gingiva exhibited in relation to the gingival smile line (GSL) and the interdental smile line (ISL). MATERIALS AND METHODS: The study population comprised 120 periodontally healthy patients within an age range of 20 to 40 years who were equally divided into two groups based on gender. The gingival zenith position (GZP), gingival zenith level (GZL), presence or absence of interdental papillae, GSL, and ISL were determined for the maxillary anterior teeth up to the second premolars. RESULTS: The mean GZL for the second premolars was found to be highest, followed by that for the first premolars and the lateral incisors. The GZL for female patients was slightly higher than that for males. The difference between the GZL for the first and second premolars in both the males and females was statistically significant (P < 0.0001). The majority of participants - 36 (60%) of the males and 33 (55%) of the females - displayed first premolars, whereas both the premolars were visible in 18 (30%) males and 22 (36%) of the females. CONCLUSIONS: Within the smile corridor, the majority of participants exhibited tooth and gingival display in the maxillary anterior teeth and premolar region. The GZL was greatest for the second premolars and smallest for the lateral incisors, indicating a considerable amount of gingival tissue display during smile for both GSL and ISL.

Three-Dimensional Stereophotogrammetry Assessment of Facial Asymmetry in Facial Palsy.

Three-dimensional stereophotogrammetry is not much used in assessing facial palsy and a comprehensive understanding of sources of variation in these measurements is lacking. The present study assessed intra- and interobserver reliability of a novel three-dimensional stereophotogrammetry measurement of facial asymmetry and examined sources of variation in these outcomes. Three photographs (rest, closed mouth smile, and maximum smile) were made of 60 participants, 30 facial palsy patients and 30 control subjects. All images were analyzed twice by 2 observers independently, to determine intra- and interobserver reliability. Variance component analysis was performed to investigate sources of variation in the outcomes. Intraobserver reliability was good with intraclass correlation coefficients ranging from 0.715 to 0.999. Interobserver reliability ranged from 0.442 to 0.929. Reliability of the smile image measurements was not clearly different from the rest images. Variation in measurement results was largely due to the status of a participant, facial palsy versus control. When splitting the sample, the facial expression was a major source of variation. Acceptable reliability of the proposed 3D facial asymmetry measurement was found, in facial palsy patients and control subjects. Interobserver reliability was marked less compared to intraobserver reliability. For follow-up data only one observer should assess 3D stereophotogrammetry measurements.

Consistency in maternal affect and positive vocalization over the first year of life.

Consistency in parenting infants has positive developmental outcomes. Yet, the role of socioeconomic status (SES) in consistency of maternal behaviors is not well understood. We investigated individual-order continuity of maternal smile and laughter and positive vocalization from 6 to 12 months of age in 82 mother-infant dyads. Overall, individual differences in maternal smile and laughter, and positive vocalization were consistent across time. A multidimensional measure of SES moderated the association of maternal smile and laughter from 6 to 12 months, such that infants from lower SES families were vulnerable to unpredictable parenting - experiencing a lack of consistency in maternal smiles and laughter.

Three-dimensional assessment of restored smiling mobility after reanimation of unilateral facial palsy by triple innervation technique.

The aim of this study was to assess surgically restored facial mobility using an optical 3D instrument. Eleven patients (age range 42-76 years) with unilateral facial palsy, treated by triple innervation procedure (masseteric and partial hypoglossal reinnervation, plus double cross-face facial grafting), performed five facial animations: rest position, smiling by contracting the healthy side, clenching the teeth, and pushing the tongue against the lower incisors and Mona Lisa smiling. These were recorded by stereophotogrammetry. Sixty healthy subjects were also recorded. The 3D reconstruction of each facial expression was registered onto the rest position scan, and the root mean square (RMS) point-to-point distance between the two 3D surfaces was calculated automatically for the facial thirds. RMS values on the rehabilitated hemiface were 74.8% (upper third), 46.6% (middle third), and 54.1% (lower third) of those recorded in healthy subjects. RMS values were higher in the middle and lower thirds than in the upper third, and during smile provided by masseteric stimulus (P<0.05). The rehabilitated hemiface differed more from healthy subject values than the healthy hemiface did (P<0.05). On average, patients were more asymmetric than healthy subjects (P=0.004). The proposed method is non-invasive and non-contact, and it can quantify localized facial movements after surgical procedures.

Interventions of computerized psychotherapies for depression in Primary Care in Spain.

Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.

Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery.

IMPORTANCE: Surgeons have sought to optimize outcomes of smile reanimation surgery by combining inputs from nerve-to-masseter and cross-face nerve grafts. An objective assessment tool could help surgeons evaluate outcomes to determine the optimal neural sources for smile reanimation. OBJECTIVE: To evaluate the use of a novel video time-stamping method and standard outcome measurement tools to assess outcomes of facial reanimation surgery using various innervation strategies. DESIGN, SETTING, AND PARTICIPANTS: Cohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs single-source innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video time-stamping spontaneity assessment method. The statistical analyses were performed in 2018. INTERVENTIONS: Dually innervated gracilis free muscle transfers or single-source innervated gracilis transfer. MAIN OUTCOMES AND MEASURES: Spontaneous smiling was assessed by clinicians and quantified using blinded time-stamped video recordings of smiling elicited while viewing humorous video clips. RESULTS: This retrospective cohort study included 25 patients (12 men and 13 women; median [range] age, 38.4 [29.3-46.0] years) treated with dually innervated gracilis free functional muscle graft for unilateral facial palsy between 2007 and 2017. Smile spontaneity assessment was performed in 17 patients and was compared with assessment performed in 24 patients treated with single-source innervated gracilis transfer (ie, nerve-to-masseter-driven or cross-face nerve graft-driven gracilis [n = 13]) (demographic data not available for NTM and CFNG cohorts). The use of time-stamped video assessment revealed that spontaneous synchronous oral commissure movement in a median percentage of smiles was 33% in patients with dually innervated gracilis (interquartile range [IQR], 0%-71%), 20% of smiles in patients with nerve-to-masseter-driven gracilis (IQR, 0%-50%), and 75% of smiles in patients with cross-face nerve graft-driven gracilis (IQR, 0%-100%). Clinicians graded smile spontaneity in dually innervated cases as absent in 40% (n = 6 of 15), trace in 33% (n = 5 of 15) and present in 27% (n = 4 of 15). No association was demonstrated between clinician-reported spontaneity and objectively measured synchronicity. CONCLUSIONS AND RELEVANCE: Dually innervated gracilis free muscle transfers may improve smile spontaneity compared with masseteric nerve-driven transfers but not to the level of cross-face nerve graft-driven gracilis transfers. Quantifying spontaneity is notoriously difficult, and most authors rely on clinical assessment. Our results suggest that clinicians may rate presence of spontaneity higher than objective measures, highlighting the importance of standardized assessment techniques. LEVEL OF EVIDENCE: 4.