The Influence of Age and Facial Expression (Eye Open/Closed) On Maxillary Dental and Gingival Display.

PURPOSE: To assess if there are any differences in maxillary dentogingival exposure between different facial expressions (maximum smile with eyes open and eyes closed), age groups and both sexes. MATERIAL AND METHODS: Digital photographs of the lower third of the face of 120 subjects, belonging to 6 different age groups were taken. There were 20 subjects in each of the 6 age groups (20-30, 30-40, 40-50, 50-60, 60-70, and 70-80) which were comprised of 80 women and 40 men. Two standardized images of each subject were taken, one of maximum smile with eyes open, and the second of maximum smile with eyes closed. These 240 images were used to quantify a dentogingival exposure ratio (DER) for each tooth spanning the second bicuspids on either side, using standardized measurement techniques. Additionally, incidence of interdental papilla visibility was studied in a binary manner, and all data were studied with respect to various covariables of age, sex and type of facial expression using a generalized linear mixed effects model. A p-value < 0.05 was determined to be statistically significant. RESULTS: There was a statistically significant difference between the dentogingival exposure ratio (DER) for all images with eyes open and eyes closed per tooth location studied, across all age groups (p ≤ 0.001) and both sexes, suggesting that subject images of smiles with eyes closed had significantly higher dentogingival exposure. There was a decreasing trend of DER with increasing age groups when eyes were open (p = 0.005) and when eyes were closed (p = 0.042), suggesting that older subjects had lower dentogingival exposure. With respect to sex, there was no statistically significant difference in mean DER between males and females, when eyes were open (p = 0.430) and closed (p = 0.351). The incidence of interdental papilla exposure also differed significantly between images with eyes open and eyes closed across all age groups (p ≤ 0.001). However, the incidence of interdental papilla exposure decreased with age, only in images with eyes open (p < 0.001) but was not statistically significant among images with eyes closed (p = 0.127). With respect to sex, there was a significant difference in incidence of interdental papilla exposure in images with eyes open (p = 0.029) but no significant difference when eyes were closed (p = 0.782). CONCLUSIONS: Maxillary dentogingival exposure decreases with increasing age and is significantly higher when recording maximum smile with eyes closed, for all age groups and both sexes. As this is a simple and clinically reproducible facial expression, incorporating patient's maximum smiling images with eyes closed may be routinely necessary for complete and accurate data collection for prosthodontic treatment planning purposes.

Management of peripheral giant cell granuloma around complete-arch fixed implant-supported prosthesis: A case series.

Abnormal peri-implant tissue response in the form of benign reactive lesions, such as peripheral giant cell granuloma and pyogenic granuloma, is a less frequent biologic complication associated with dental implant therapy. However, these lesions can cause gingival pain, swelling, and discomfort, as well as peri-implant bone loss and possible implant failure. Few reports in the dental literature have described these lesions around complete-arch fixed implant-supported prostheses. The purpose of this clinical report was to describe 3 distinct scenarios in patients with complete-arch fixed implant-supported prostheses presenting with benign reactive lesions that were histologically diagnosed as peripheral giant cell granulomas. Each of these 3 patients had acrylic resin as one of the materials in their prosthesis. The distinctive management of each of these 3 patients encompassed surgical, prosthodontic, and pharmacologic means.