Smile attractiveness of patients treated for congenitally missing maxillary lateral incisors as rated by dentists, laypersons, and the patients themselves.

STATEMENT OF PROBLEM: Esthetic judgments can help dental professionals better understand how attentive people are to their own smiles and those of others. PURPOSE: The purpose of this study was to evaluate the smile attractiveness of patients treated for maxillary lateral incisor agenesis compared with that of individuals with a complete dentition. MATERIAL AND METHODS: Photographs were made of the smiles of patients with maxillary lateral incisor agenesis who were treated with space closure and teeth recontouring (n=26) or space opening and implants (n=20) and of a control group with a complete dentition (n=22). Both laypersons and dentists assessed smile attractiveness by using a visual analog scale. Patients and controls also assessed the level of satisfaction with their own smile. Assessments were performed twice, and the reliability of the method was determined with Cronbach α and intraclass correlation. Multifactorial and 1-way ANOVA were used to analyze smile attractiveness and participant satisfaction, followed by the Bonferroni post hoc test (α=.05). RESULTS: Attractiveness ratings by dentists and laypersons did not differ significantly among the study groups (P=.64). The ratings of male dentists and female laypersons differed significantly from those of other evaluators (P=.01). Patients with space closure and teeth recontouring were significantly more satisfied than controls (P=.002). No significant differences were found between the patients with implants and controls or between the patients with implants and those with space closure and teeth recontouring. CONCLUSIONS: The smiles of patients with maxillary lateral incisor agenesis were judged to be as attractive as those of the controls. Male dentists were the most critical raters, closely followed by female laypersons. All participants had high levels of satisfaction with their own smile; patients treated with space closure and teeth recontouring were the most satisfied.

Digital analysis of anterior dental esthetic parameters in patients with bilateral maxillary lateral incisor agenesis.

OBJECTIVE: To analyze anterior dental esthetic parameters-width/height ratio (WHR), gingival zenith (GZ), and apparent contact dimension (ACD)-in patients with maxillary lateral incisor agenesis (MLIA) bilaterally treated with space closure and recontouring of the canines, or with implant-supported prostheses. METHODS: Fifty-two participants were allocated into three groups as follows: MLIA patients (N = 18) treated with teeth recontouring (RG); MLIA patients (N = 10) treated with implants (IG); and volunteers without agenesis (N = 24), who served as controls (CG). Dental casts of all patients were obtained and electronically scanned. Digital images were analyzed with 3Shape A/S OrthoAnalyser software (Copenhagen, Denmark). Shapiro-Wilk test, Spearman correlation, and Kruskal-Wallis statistical tests (p < 0.05) were used for statistical analysis. RESULTS: Although IG presented smaller means when compared with RG and CG, no statistical differences were found for WHR among groups (p > 0.05). Concerning GZ, RG presented more discrepancies than IG and CG, with statistically significant differences (p = 0.0165). IG presented statistically significant differences for the ACD in comparison with RG and CG (p < 0.05). CONCLUSION: Based on the results of this study, patients treated with space closure and teeth recontouring (RG) were shown to be closest to patients without agenesis (CG) in relation to the anterior dental esthetic parameters evaluated. CLINICAL SIGNIFICANCE: The digital analysis of esthetic principles, such as those investigated in this study involving maxillary incisor agenesis, is paramount to successful esthetic treatment planning. The results of the present study, as well as those found in the literature, indicate that clinicians should use esthetic parameters, such as those investigated herein, when treatment planning extensive oral rehabilitation cases.

Analysis of the golden proportion and width/height ratios of maxillary anterior dentition in patients with lateral incisor agenesis.

OBJECTIVE: The purpose of this study was to assess the presence of the golden proportion (GP) in the facial view tooth-to-tooth width proportion of the six maxillary anterior teeth and to evaluate the width/height (W/H) ratios of the incisors of patients with maxillary lateral incisor (LI) agenesis treated either with implants or orthodontically (by moving canines into the position of the laterals, recontouring them, and placing composite restorations over the repositioned teeth). MATERIALS AND METHODS: Forty-eight patients with LI agenesis were divided into four experimental groups: unilateral recontouring group (N = 10), bilateral recontouring group (BRG, N = 18), unilateral implant group (UIG, N = 10), bilateral implant group (N = 10), and a control group (CG, N = 25) of patients without agenesis. GP ratios were determined on patients' dental casts placed over Levin's grids, whereas W/H ratios were measured directly on the casts and a millimeter ruler to determine these distances. Statistical analysis was performed with Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon tests (p < 0.05). RESULTS: The incidence of GP in the tooth-to-tooth width proportions was significantly different between groups and more commonly found between centrals and laterals than between laterals and canines. The GP was more likely to be observed in the BRG, UIG, and CG. The results demonstrated that the GP was not found to be present in the majority of the cases treated with maxillary agenesis, regardless of the method of treatment. The mean W/H ratios of the laterals ranged between 0.75 and 0.90. CONCLUSION: Although the GP may be a useful diagnostic guide, it was not observed in the majority of esthetic outcomes of patients treated with maxillary LI agenesis in this study. CLINICAL SIGNIFICANCE: The assessment of the golden proportion and width/height ratio of upper anterior teeth in patients with upper lateral incisor agenesis treated with either implants or tooth re-contouring may assist dentists and patients in deciding the best treatment option based on the peculiarities of each case.

The relationship between smile attractiveness and esthetic parameters of patients with lateral agenesis treated with tooth recontouring or implants.

BACKGROUND: The purpose of this study was to associate smile esthetic judgment with dentofacial attributes of patients with unilateral and bilateral agenesis of maxillary lateral incisors treated with recontouring of canines or implants and patients with no agenesis (control). MATERIAL AND METHODS: Forty-six participants were divided into two groups: those treated with recontouring (N = 26) and those treated with implants (N = 20). The participants in the control group (N = 22) were selected among dentistry students at the State University of Maringá, Brazil. Photographs of posed smiles (17 cm × 10 cm) were evaluated with a 100-mm Visual Analog Scale. Smile attractiveness was judged by two groups: laypersons and dentists (N = 20 in each group). Judgment was classified into Unpleasant and Pleasant. Measurements of 11 smile attributes were done with ImageTool Version 3.0. These measurements were correlated with the type of judgment using the Pearson correlation coefficient. RESULTS: The two groups of evaluators showed no rating difference (analysis of variance, P = 0.64), thus they were placed into a single group. No significant correlation was found between esthetic judgment and six smile attributes (incisor exposure, interlabial gap, width 3 to 3, smile index, right buccal corridor, and buccal corridor ratio). The control group showed more correlations with the unpleasant judgment type than the other groups. CONCLUSION: Some correlations between smile attributes and esthetic judgment were found, but other features of smiles not evaluated in this study may interfere in smile attractiveness.

Analysis of width/height ratio and gingival zenith in patients with bilateral agenesis of maxillary lateral incisor

OBJECTIVE: The purpose of this study was to evaluate the width/length ratio and the gingival zenith (GZ), by means of dental casts and digital caliper, in patients with missing maxillary lateral incisors after treatment. METHODS: The sample was composed of 52 subjects divided into 3 groups: BRG (n = 18), patients with bilateral agenesis treated with tooth re-contouring; BIG (n = 10) patients with agenesis treated with implants and CG (n = 24), control group. The data were analyzed using Shapiro-Wilk, Spearman correlation, Wilcoxon, Kruskal-Wallis, t test and ANOVA tests (p < 0.05). RESULTS: For the width/length ratio of the lateral incisors, BIG presented the lowest mean values (0.72 right and left), when compared with other groups. However, comparison between groups presented statistically significant differences for the right lateral incisor (BIG x CG) and for the canine (BRG x CG). GZ data evaluation showed the greatest difference for BRG (0.5 right and 0.48 left). BIG (0.95 right and 0.98 left) and CG (0.98 right and 0.8 left) presented more similar values, nevertheless, without statistical difference (p > 0.05). GZ data for the right and left sides of the smile were not considered statistically different. CONCLUSION: Although no statistical difference was found in the comparison between the groups, analysis of the descriptive values showed that group BIG showed the greatest difference in values with regard to width/length ratio. Regarding gingival zenith, BRG showed the greatest difference.

OBJETIVO: o propósito desse estudo foi analisar, por meio de modelos de estudo e paquímetro digital, a proporção largura/altura e o zênite gengival (ZG) em pacientes com agenesia bilateral do incisivo lateral superior após o tratamento. MÉTODOS: a amostra consistiu de 52 voluntários divididos em 3 grupos: GBR (n=18), pacientes com agenesia bilateral tratados com reanatomizações dentárias; GBI (n=10), pacientes com agenesia bilateral tratados com implantes; e GC (n=24), grupo controle. Os dados foram avaliados por meio dos testes de Shapiro-Wilk, Wilcoxon, Kruskal-Wallis, teste t, ANOVA (p<0,05) e correlação de Spearman. RESULTADOS: para a proporção largura/altura dos incisivos laterais, o GBI apresentou menores valores (0,72 direito e esquerdo), quando comparado aos demais. Porém, a comparação intergrupos revelou diferenças estatisticamente significativas para o incisivo lateral direito (GBI x GC) e para o canino (GBR x GC). A avaliação das medianas obtidas para o ZG demonstrou que o GBR foi o mais destoante (0,5 direito e 0,48 esquerdo), e que o GBI (0,95 direito e 0,98 esquerdo) e o GC (0,98 direito e 0,8 esquerdo) apresentaram valores semelhantes, sem diferença estatisticamente significativa (p>0,05). Os valores obtidos para os lados direito e esquerdo foram considerados iguais dentro de cada grupo. CONCLUSÃO: embora não tenham sido encontradas diferenças estatísticas na comparação entre os grupos, pela análise descritiva dos dados, o GBI foi o grupo que apresentou as medidas mais destoantes dos demais em relação à proporção largura/altura, sendo que, para o zênite gengival, a maior diferença observada foi no GBR.

Frequência da discrepância dental de Bolton em pacientes ortodônticos adultos / Frequency of bolton tooth size discrepancies among orthodontic adult patients

Objetivo: investigar a incidência das discrepâncias anterior e total de Bolton em pacientes jovens e adultos. Testou-se a hipótese de que a história odontológica (restaurações proximais) pode gerar maior prevalência de discrepâncias inter-arcos quando comparado às médias de normalidade de Bolton e em jovens sem evidentes alterações mesiodistais decorrentes de desgastes e/ou restaurações. Materiais e métodos: a amostra foi constituída por 60 modelos ortodônticos de gesso obtidos previamente ao tratamento e foram formados dois grupos: o grupo controle, de pacientes jovens, composto por trinta modelos de pacientes na faixa etária entre 12 e 18 anos de idade. O grupo adulto foi formado por trinta modelos de pacientes adultos acima de 20 anos de idade, incluindo pacientes com restaurações proximais. Foram realizadas as mensurações mesiodistais conforme preconizado por Bolton para a obtenção das proporções dentárias anterior e total por meio de um paquímetro digital. Resultados: as médias das proporções encontradas para o grupo controle e para o grupo adulto não apresentaram diferença estatisticamente significante entre si e em relação aos parâmetros determinados por Bolton. Dos modelos avaliados do grupo adulto com restaurações proximais, 21,05% da amostra considerando-se a proporção total e 31,58% considerando-se a proporção anterior, apresentaram valores maiores que mais ou menos dois desvios padrão. Conclusão: a análise de Bolton é aplicável para pacientes jovens e adultos, sem dimorfismo sexual. No entanto, foi demonstrado que a “história odontológica” pode interferir na variabilidade da discrepância inter-arcos.

Aim: to determine the incidence of anterior and overall Bolton’s ratio in young and adult Brazilian patients and evaluate the frequency of deviation from Bolton’s mean for adult patients with “dental history”. Materials and methods: the sample consisted of 60 orthodontic pre-treatment study casts from patients involved. Two groups were composed: the Control group consisted of 30 initial of patients between 12 and 18 years of age, without fixed prosthesis or restorations with mesiodistal extension, evident dental abnormalities or inter-proximal or occlusal wastage. The second group was composed by 30 initial casts of Adult patients up to 20 years of age, including patients with proximal restorations. All mesiodistal measuring was performed according to Bolton, using a digital caliper to obtain anterior and total ratios. Results: the ratios averages between groups and Bolton parameters did not differ statistically. Among adult patients with proximal restorations, 21,05% and 31,58% considering overall and anterior ratio, respectively, showed higher means than two Bolton’s standard deviations. Conclusion: Bolton standards is applicable to young and adult Brazilians patients, without sexual dimorfism. However, it was show that “dental history” interferes in inter-arch discrepancy variability, although mean values did not differ statistically.

Reprodutibilidade da posição natural da cabeça em fotografias de perfil de crianças de 8 a 12 anos, com e sem o auxílio de um cefalostato / Reproducibility of natural head position in profile photographs in children aged 8 to 12 years old, with and without an auxiliary cephalostat

OBJETIVO: este estudo avaliou a reprodutibilidade da posição natural da cabeça (PNC) em crianças. MÉTODOS: foram fotografados 25 pacientes da Clínica Infantil do Curso de Graduação em Odontologia da Universidade Estadual de Maringá com idades entre 8 e 12 anos, sendo 12 do gênero feminino e 13 do masculino. As tomadas fotográficas registraram a PNC com uma câmera digital e foram realizadas com e sem o uso de um cefalostato. Uma linha vertical (LV) foi usada como referência para as mensurações. Após um intervalo de 15 dias, as fotografias foram repetidas, respeitando-se o mesmo protocolo utilizado na primeira série de tomadas fotográficas. A reprodutibilidade da PNC entre os dois momentos das tomadas fotográficas foi avaliada utilizando-se a medida angular entre a linha vertical de referência e uma linha do perfil, passando pelo pogônio tegumentar e pelo ponto labial superior. RESULTADOS E CONCLUSÃO: embora algumas variações de posição tenham sugerido que os pacientes dessa idade devam receber orientações adicionais quanto à PNC, não foram observadas diferenças significativas quanto à reprodutibilidade das fotografias tomadas no intervalo de 15 dias, com ou sem a utilização do cefalostato auxiliar. Dessa forma, a PNC mostrou-se como um método de boa reprodutibilidade em crianças.

AIM: This study assessed the reproducibility of natural head position (NHP) in children. METHODS: 25 children, 12 female and 13 male, aged from 8 to 12 years old, patients of Dentistry School of the State University of Maringá were photographed. Photographs were taken in NHP, using a digital camera, with and without cephalostat. A vertical line (VL) was used as reference for measurements. The photographs were repeated after a 15-day interval respecting the same protocol. Reproducibility of NHP between both moments of photographs was evaluated using an angular measurement between the reference vertical line and a profile line, from soft pogonion and upper lip point. RESULTS AND CONCLUSION: Although some positional variations have suggested that patients in these ages should receive additional orientation on NHP photographs, there were no significant differences in reproducibility of NHP in this 15-day interval, with or without auxiliary cephalostat. NHP showed to be a good method of reproducibility in children.

Como trabalhar de forma integrada na reabilitação de pacientes com agenesia de incisivo lateral superior, a fim de otimizar o resultado estético, quando a opção é o fechamento de espaço e reanatomizações estéticas? / How to work an integrated manner in the rehabilitation of patients with maxillary lateral incisor agenesis, in order to optimize the aesthetic result, when the option is closing space and aesthetic re-anatomy?

A agenesia dentária é caracterizada pela ausência ou falha na formação de um dente, que pode ocorrer de forma isolada ou não, por influência genética ou ambiental. A agenesia do incisivo lateral superior ocorre entre 0,8 e 2% durante a dentição permanente, com maior frequência no sexo feminino, sendo mais comum a ausência dos incisivos laterais que a unilateral.