Dento-skeletal characteristics of cleft patients with missing teeth.

OBJECTIVE: The objective of this study was to compare the cephalometric skeletal and dental characteristics of unilateral complete cleft lip and palate (UCCLP) subjects with and without missing teeth. DESIGN: A retrospective records review was conducted for patients who are being treated at the cleft lip and palate (CLP) clinics in the College of Dentistry. METHODS: Ninety-six consecutive records of non-syndromic UCCLP subjects were recruited (33 subjects without missing teeth, 50 subjects with only one missing tooth, and 13 subjects with two or more missing teeth). Skeletal and dental characteristics were assessed using lateral cephalometric radiographs in UCCLP subjects with missing teeth and compared to the group with no missing teeth. A total of 25 linear and angular measurements were analyzed and compared between the sample groups. RESULTS: Of the dental variables tested, overjet was significantly different between the three groups. The UCCLP subjects with multiple missing teeth had the smallest overjet (-3.89±2.75 mm; P=0.015) among the three groups. None of the skeletal characteristics reached statistical significance. CONCLUSION: Missing teeth influence the dental but not skeletal characteristics of UCCLP. Overjet is significantly reduced in UCCLP subjects with multiple missing teeth. Future studies with larger sample sizes are warranted.

The Influence of the Smile on the Perceived Facial Type Esthetics.

OBJECTIVE: The objective of this study was to determine if the smile would influence the facial types esthetics perception for dentists, specialists, and laypeople. The null hypotheses for this study were that the smile has no effect on the perceived facial esthetics of different facial types. MATERIALS AND METHOD: A photograph of an attractive female face with an attractive smile was captured and manipulated using computer software, which was used to produce changes in the smile and facial type of the female face. Two sets of photographs were developed. The first set is composed of three photos showing mesofacial, dolichofacial, and brachyfacial faces; on these photos the smiles were masked intentionally. On the second set, the smile was revealed in the three face types (mesofacial, dolichofacial, and brachyfacial faces); this results in three smiling photos, where each showed a facial type with the same smile. These photos (6 photos in total) were rated by the participants; two hundred participants were recruited, 50 general dentists, 50 specialist dentists, and 100 laypeople. RESULTS: The three groups (dentists, specialists, and laypeople) rated the mesofacial face as the highest (p value < 0.01) (64.48, 76.12, and 60.68, respectively), the mesofacial face was the only face that showed a significant difference between the three groups ratings (p value<0.01), and this significant difference disappeared when we compared the smiling photos for the mesofacial face (p value>0.01). CONCLUSION: Mesofacial face is considered to be the most attractive face in comparison to dolichofacial and brachyfacial faces. Facial type should not be looked at separately from the smile as the smile might influence the esthetics perception of the facial type.

Association between Ectopic Mandibular and Maxillary Canines.

AIM: The aims of the present study were (1) to assess the prevalence of ectopic mandibular canines and (2) to evaluate whether an association exists between maxillary and mandibular canine ectopia. MATERIALS AND METHODS: The records of 983 patients (males and females) were divided systematically into two groups: group I (454 patients) (control group) included patients who attended the clinic from September 2013 to August 2014, while group II (529 patients) included patients who attended the clinic from September 2014 to August 2015. Group I was used to assess the prevalence of ectopic mandibular canines in the population, while group II was used to obtain 40 radiographs of ectopic maxillary canines, which comprised group To investigate any association between maxillary and mandibular canines, the prevalence of ectopic mandibular canines was assessed in group Canine positions were assessed as follows: (1) amount of horizontal canine overlap with the adjacent lateral incisor root; (2) the angle between the canine and true vertical. RESULTS: The prevalence of ectopic mandibular canines in the population (group I) was 5.3% (24 of 454 patients); in group 22.5% (9 of 40) of maxillary canine cases exhibited ectopic mandibular canines. Group II1 had a significantly higher prevalence of ectopic mandibular canines than did the control group (group I) (p < 0.001). CONCLUSION: The prevalence of mandibular ectopic canines was 5.3%. Ectopic mandibular canines were highly associated with ectopic maxillary canines; a quarter of patients with ectopic maxillary canines are expected to have mandibular ectopia. CLINICAL SIGNIFICANCE: Dentists should be aware of all dental anomalies, particularly, impacted canines. Early and interceptive management of impacted canines increases the chance of canine eruption.

Use of Interarch Width Ratio to measure Transverse Relationship: A New Method to measure and assess Interarch Discrepancy.

AIM: The purpose of this study was to assess the arch width, transverse discrepancy, and transverse interarch ratio for class I malocclusion sample, with and without crossbite, in permanent dentition stage. MATERIALS AND METHODS: Records of class I malocclusion patients with minimal crowding and spacing with and without posterior crossbite were selected. Each group consisted of 40 pairs of dental casts (20 males and 20 females). Arch widths were measured for the canine, first, and second premolars, and first permanent molars using the buccal approach. Means and standard deviations (SDs) of dental arch widths were measured for the maxillary and mandibular arches, and the interarch width ratio was calculated. RESULTS: There was a highly significant difference between the noncrossbite and crossbite groups regarding the maxillary width, p < 0.001. However, no differences were found between groups for the mandibular widths, p > 0.01. There were also significant differences between both groups for the intercanine, first and second premolars, and first molar ratios, p < 0.001. CONCLUSION: This new simple method showed that a transverse maxillary-mandibular ratio of 1:1.1 is ideal. A ratio less than 1:0.9 will indicate the presence of crossbite. CLINICAL SIGNIFICANCE: The interarch ratio significantly aids in orthodontic treatment planning in patients requiring maxillary expansion and/or surgical cases.

Space creation for a missing central incisor using functional and fixed appliances.

Children with an overjet of more than 6 mm are three times more likely to receive trauma to their upper incisors than children with an average overjet. This could be complicated with avulsion of permanent incisor and with space loss for the tooth. Functional appliances are usually used to treat Class II skeletal pattern and increased overjet in growing patients. The following is a case in which the Twin Block functional appliance was used, while its classic design was modified to treat a Class II skeletal problem and to open a space for a missing maxillary central incisor.

The Difference in Cervical Vertebral Skeletal Maturation between Cleft Lip/Palate and Non-Cleft Lip/Palate Orthodontic Patients.

OBJECTIVE: The aim was to evaluate differences in the cervical vertebral skeletal maturity of unilateral cleft lip and palate (UCLP) and non-cleft lip/palate (non-CLP) Saudi male orthodontic patients. METHOD: This cross-sectional multicenter study took place at the dental school, King Saud University and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between October 2014 and September 2015. The records of Saudi male orthodontic patients with UCLP (n = 69) were collected. Cervical vertebral maturation was assessed using their cephalometric radiographs. The records of 138 age-matched non-CLP Saudi male orthodontic patients served as controls. RESULTS: There was a significant difference in skeletal maturity between the UCLP and non-CLP groups, as evident in the delayed skeletal development among the UCLP participants. Moreover, pubertal growth spurt onset was significantly earlier in the non-cleft participants in comparison with the UCLP participants (p = 0.009). CONCLUSIONS: There is delayed skeletal maturity among the UCLP Saudi male population in comparison with their non-CLP age-matched peers.

Cephalometric Soft Tissue Characteristics of Unilateral Cleft Lip and Palate Patients in Relation to Missing Teeth.

OBJECTIVE: This study aimed to evaluate cephalometric soft tissue characteristics in individuals with unilateral complete cleft lip and palate (UCCLP) both with and without missing teeth. DESIGN: A retrospective investigation of patient records, who are being treated at the cleft lip and palate (CLP) clinics at the College of Dentistry. Ninety-six consecutive records of nonsyndromic UCCLP subjects were recruited (33 subjects without missing teeth and 63 subjects with missing teeth). Linear and angular soft tissue measurements obtained from lateral cephalometric radiographs were evaluated and compared among the studied samples. RESULTS: Lower lip was significantly retruded and shorter (p = 0.037), p = 0.015, respectively; in addition to the fact that shallower mentolabial sulcus (p = 0.05) was found in the subjects with missing teeth, the rest of the soft tissue was not significantly different between the two groups. CONCLUSION: In subjects with a UCCLP anomaly, missing teeth have an effect on lower lip position and length, which influenced the mentolabial sulcus. Lower lip position and length differ between cleft patients who present with either multiple missing teeth or with no missing teeth, and this needs to be considered during orthodontic treatment planning and surgical management for the cleft defect.

Presurgical cleft lip and palate orthopedics: an overview.

Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.

Incisors' proportions in smile esthetics.

AIMS: To determine whether alteration of the maxillary central and lateral incisors' length and width, respectively, would affect perceived smile esthetics and to validate the most esthetic length and width, respectively, for the central and lateral incisors. MATERIALS AND METHODS: Photographic manipulation was undertaken to produce two sets of photographs, each set of four photographs showing the altered width of the lateral incisor and length of the central length. The eight produced photographs were assessed by laypeople, dentists and orthodontists. RESULTS: Alteration in the incisors' proportion affected the relative smile attractiveness for laypeople (n=124), dentists (n=115) and orthodontists (n=68); dentists and orthodontists did not accept lateral width reduction of more than 0.5 mm (P<0.01), which suggests that the lateral to central incisor width ratio ranges from 54% to 62%. However, laypeople did not accept lateral width reduction of more than 1 mm (P<0.01), widening the range to be from 48% to 62%. All groups had zero tolerance for changes in central crown length (P<0.01). CONCLUSION: All participants recognized that the central incisors' length changes. For lateral incisors, laypeople were more tolerant than dentists and orthodontists. This suggests that changing incisors' proportions affects the relative smile attractiveness.

Lip asymmetry and smile aesthetics.

Objective : To determine if lip asymmetry can affect lip aesthetics. Setting and Participants : A group of dentists (n = 40) and cleft patients (n = 40) were recruited from the dental hospital and cleft service. Interventions : Still photographic digital images of lips and teeth were manipulated to produce a computerized gradient of smile appearance with different degrees of upper-lip vertical asymmetry. These five photographs (with 0 mm representing "symmetry," and 1, 2, 2.5, and 3 mm, asymmetries) were assessed by participants using a 5-point Likert scale. Statistics : Descriptive statistics in addition to chi-square test were used to analyze the data. In order to satisfy the requirement of the chi-square test, the five smile ratings were reduced to three. Results : Lip asymmetry did affect relative smile aesthetics, as determined by dentists and cleft patients. Both the dentists and cleft patients rated the 0-mm photograph more attractive than the 2.5-mm and 3-mm smiles (P < .05). The 0-, 1-, and 2-mm smiles were indistinguishable for both dentists and cleft patients. Conclusion : Lip asymmetry affects smile aesthetics. However, cleft patients and dentists were tolerant of minor asymmetries. This suggests that small degrees of lip asymmetry do not affect relative smile aesthetics as much as large degrees of lip asymmetry (2.5 mm or more).

Effect of occlusal plane on smile attractiveness.

OBJECTIVE: To determine the influence of the occlusal plane angle on smile attractiveness as perceived by a group of adult orthodontic patients and dentists. MATERIALS AND METHODS: The first stage utilized a laboratory approach to record changes in vertical tooth position at different occlusal plane angles using a maxillary model mounted on an articulator. In the second stage, photographic manipulation was undertaken, using data from stage 1, to produce a computerized prediction of the appearance of the smile at differing occlusal plane angles (0, 5, 10, 15, and 20 degrees). Finally, the five developed photographs were assessed by participants. RESULTS: Alterations in the occlusal plane angle did affect relative smile attractiveness for both patients (n  =  66) and dentists (n  =  66). For patients, the 10 degree smile was rated better than the 0 and 20 degree smiles (P < .01); for dentists, the 15 degree smile was rated better than the 0 and 20 degree smiles (P < .01). The 5, 10, and 15 degree smiles were indistinguishable for patients, and the 10 and 15 degree smiles were indistinguishable for dentists. CONCLUSION: Changing the occlusal plane angle does affect relative smile attractiveness. However, patients were more tolerant of these changes than dentists. This suggests that large changes in the occlusal plane angle would affect relative smile attractiveness, and small changes are unlikely to affect smile attractiveness.