Esthetic paradigms in the interdisciplinary management of maxillary anterior dentition-a review.

UNLABELLED: This article reviews some commonly used esthetic proportions and paradigms in dentistry. Establishing optimal anterior esthetics frequently entails restorative, orthodontic, and periodontal treatment. Several guidelines have been purported to facilitate an esthetic outcome during the rehabilitation of the maxillary anterior teeth. The golden proportion, recurring esthetic dental proportion, tooth width : height ratios, vertical positioning of the maxillary lateral incisor, and the apparent contact dimension are examples of some such guidelines. Evaluation of these esthetic paradigms including their validity, esthetic significance, perception by laypeople, and the range of tolerance to alterations are very important considerations. CLINICAL SIGNIFICANCE: This review presents a comprehensive analysis of some selected esthetic dental paradigms and recommendations for their application in the interdisciplinary management of anterior dental esthetics.

Comparison of Intralesional Placentrex Versus Hyaluronidase and Dexamethasone Injection in the Symptomatic Management of Stage II Oral Submucous Fibrosis - a Prospective Study.

AIM: The present study aimed to compare the effectiveness of intralesional placentrex versus hyaluronidase + dexamethasone injection in the symptomatic management of stage II OSMF. MATERIALS AND METHODS: This was a non-randomized prospective study conducted over a period of 14 months at a tertiary referral center. Patients with clinical stage II OSMF were randomly grouped into A(n = 18) and B(n = 17). These patients were treated with weekly intralesional injection of placentrex and hyaluronidase + dexamethasone respectively, over a period of six weeks. Variables such as mouth opening, burning sensation and colour of mucosa were evaluated at baseline(T0), second week(T1), fourth week(T3), sixth week(T4) of follow up. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 15 patients completed the study in each group with regular follow up. The mean improvement in mouth opening was 4.3 ± 0.57 mms in group A(p-value < 0.001) and 7.2 ± 0.76 mms in group B(p-value < 0.001) which were significant at the end of six weeks. Mean change in burning sensation at the end of six weeks in group A was 1.2 ± 0.73(p-value < 0.001), and 3.6 ± 0.63(p-value < 0.001) in group B. Mean change in colour of mucosa at the end of six weeks was 1.4 in group A(p-value > 0.05) and 2 in group B(p-value > 0.05). On comparison between both groups, patients in group B exhibited better mouth opening and reduction of burning sensation than patients in group A(p-value < 0.001). CONCLUSION: Both intralesional placentrex and hyaluronidase + dexamethasone injection are effective in alleviating the symptoms of stage II OSMF. However, hyaluronidase + dexamethasone injection showed slightly better improvement in mouth opening and burning sensation after six weeks.

The apparent contact dimension and covariates among orthodontically treated and nontreated subjects.

UNLABELLED: The apparent contact dimension (ACD), a determinant of dental esthetics, has been purported to exhibit an esthetic relationship termed the "50:40:30" rule, implying that in an esthetic smile, the ACD between the central incisors, central and lateral incisors, and lateral incisor and canine would be 50, 40, and 30% of the height of a central incisor, respectively. This study assessed the existence of this proportion using casts of orthodontically treated (N = 40) and nontreated (N = 27) subjects deemed to possess excellent occlusion. Covariates studied included tooth size, tooth shape, tip, and torque. The average ACD proportions in this study, relative to the height of an ipsilateral central incisor, were found to be 49, 38, and 27% between the central incisors, central and lateral incisors, and the lateral incisor and canine, respectively. The ACD exhibited a positive correlation (p < 0.05) with the height of the clinical crown and a negative correlation (p < 0.05) with the width/height ratios of the corresponding teeth. No statistically significant correlations were evident between the ACD with the shape of the clinical crown, tip, and torque. However, the tip and torque did exhibit a statistically significant (p < 0.05) correlation with the height of the clinical crown. This study is the first to validate the existence and proportions of the ACD. CLINICAL SIGNIFICANCE: This study validates the existence of the ACD and quantifies the relationship of the ACD with tooth size, tooth shape, mesiodistal crown angulation (tip), and labiolingual crown inclination (torque) among subjects deemed to possess excellent occlusion and alignment. This quantifiable "ideal" and its correlation with the other determinants of dental esthetics may be used in conjunction with various evidence-based paradigms in the esthetic appraisal of the maxillary anterior teeth.

The National Dental Practice-Based Research Network adult anterior open bite study: A description of the practitioners and patients.

OBJECTIVES:: To describe the demographic and practice characteristics of the clinicians enrolled in a large, prospective cohort study examining recommendations and treatment for adult anterior open bite (AOB) and the relationship between these characteristics and practitioners' self-reported treatment preferences. The characteristics of the AOB patients recruited were also described. MATERIALS AND METHODS:: Practitioners were recruited from the National Dental Practice-Based Research Network. Participants in the study consisted of practitioners and their adult AOB patients in active treatment. Upon enrollment, practitioners completed questionnaires enquiring about demographics, treatment preferences for adult AOB patients, and treatment recommendations for each patient. Patients completed questionnaires on demographics and factors related to treatment. RESULTS:: Ninety-one practitioners and 347 patients were recruited. Demographic characteristics of recruited orthodontists were similar to those of American Association of Orthodontists members. The great majority of practitioners reported using fixed appliances and elastics frequently for adult AOB patients. Only a third of practitioners reported using aligners frequently for adult AOB patients, and 10% to 13% frequently recommended temporary anchorage devices (TADs) or orthognathic surgery. Seventy-four percent of the patients were female, and the mean age was 31.4 years. The mean pretreatment overbite was -2.4 mm, and the mean mandibular plane angle was 38.8°. Almost 40% of patients had undergone orthodontic treatment previously. CONCLUSIONS:: This article presents the demographic data for 91 doctors and 347 adult AOB patients, as well as the practitioners' self-reported treatment preferences.

A fatality due to an accidental methadone substitution in a dental cocktail.

A 6-year-old male child was scheduled for a dental procedure requiring conscious sedation. Prior to the procedure, the child was administered a dental cocktail containing chloral hydrate, hydroxyzine, and methadone. After returning from the dentist, the child appeared groggy and was allowed to sleep. A few hours later, he was found unresponsive, and following resuscitation attempts at a local medical center, he was pronounced dead. Toxicological analyses of femoral blood indicated the presence of hydroxyzine at less than 0.54 µg/mL, trichloroethanol (TCE) at 8.3 µg/mL, and methadone at 0.51 µg/mL. No meperidine was detected. The cause of death was reported to be due to the toxic effects of methadone. The toxicological analysis was corroborated by the analysis of the contents of the dental cocktail, which revealed the presence of hydroxyzine, chloral hydrate, and methadone. Residue from a control sample obtained from the same pharmacy, but administered to a different subject, was found to contain hydroxyzine, chloral hydrate, and meperidine. This report represents the first known fatality due to accidental substitution of methadone in a dental cocktail.