Imaging of Fibro-osseous Lesions and Other Bone Conditions of the Jaws.

This review directs the focus on the imaging features of various fibro-osseous lesions and other bone lesions that can be of similar presentation. Broad diagnosis of "fibrous osseous lesion" may culminate in improper treatment and management. Radiographic discriminating factors between these entities are highlighted and summarized to improve the diagnostic process when encountering these lesions.

Assess the Association Between Periodontitis and Maxillary Sinusitis: A Cross-Sectional Cone-Beam Computerized Tomography (CBCT) Study.

Background/purpose Periodontal pathologies which are considered odontogenic in origin can be a major cause of maxillary sinusitis, along with other dental and non-dental causes. The aim of this study is to define and assess the relationship between periodontitis and maxillary sinusitis. Material and methods A total of 415 CBCT datasets of periodontitis patients were cross-sectionally evaluated. Alveolar bone loss and maxillary sinus mucosal thickening were measured in coronal and sagittal sections, these two variables represent the severity of periodontitis and maxillary sinusitis, respectively. Results This study found that mucosal thickening was significantly higher in patients with increased alveolar bone loss severity (P=0.03). Mucosal thickening was significantly higher among males (83.5%) than among females (69.8%) (P=0.001). moderate or severe alveolar bone loss had a significantly higher risk of mucosal thickening with an odds ratio of 1.8 when compared to those with mild alveolar bone loss (95% CI: 1.04-3.2). Males had an increased risk of mucosal thickening compared to females with an odds ratio of 2.2 (95% C.I.: 1.4-3.6). Conclusion In conclusion, periodontal structure can affect maxillary sinus and its health. Therefore, after confirming a diagnosis of maxillary sinusitis, a detailed examination of periodontal health is needed. These results can be used to increase the awareness of dental students and practitioners in clinical and diagnostical judgement.

Reliability of tomographic 3D ultrasound in measuring internal carotid artery plaque volume.

BACKGROUND: Tomographic 3D ultrasound (t3DUS) is a promise imaging technique for quantifying carotid plaque through measuring the degree of stenosis and plaque volume. Carotid plaque volume (CPV) could add benefit in predicting the potential risk of stroke. PURPOSE: To assess the reproducibility and accuracy of t3DUS for measuring CPV within the internal carotid artery in patients undergoing carotid endarterectomy. MATERIAL AND METHODS: t3DUS was used to obtain CPV in vivo from 25 symptomatic patients prior to surgery. Ex vivo CPV from the carotid endarterectomy specimen was then measured using a validated saline displacement method as a reference standard. CPV for each patient was measured twice using both methods (total n = 50 per technique). Intraclass correlation coefficient (ICC) and Bland-Altman plot were used to establish bias and limit of agreement between CPV measurements. RESULTS: There was an excellent agreement between t3DUS and reference test with respect to measuring CPV with an ICC value of 0.98 (95% confidence interval = 0.97-0.99, P < 0.001). Bias in measurements was 0.02 ± 0.11 cm3 (95% limit of agreement = -0.19 to 0.25). Intra-observer agreement of t3DUS CPV measurements was excellent with an ICC value of 0.95 (95% confidence interval = 0.92-0.97, P < 0.001). Bias in measurements was 0.004 ± 0.07 cm3 (95% limit of agreement = -0.14 to 0.15). CONCLUSION: t3DUS is a reproducible imaging method and showed excellent agreement with the reference standard with respect to measuring CPV. These findings suggest that t3DUS has the potential to be a valuable non-invasive tool for assessing carotid plaque burden and predicting the risk of stroke.

Tomographic 3D ultrasound for grading stenosis of superficial femoral artery.

INTRODUCTION: Treatment decision of lower extremity peripheral arterial disease (PAD) is governed by the severity of stenosis. Tomographic 3D ultrasound (t3DUS) is a reliable imaging technique for measuring vessel stenosis. In this study we attempted to provide a precise measurement of superficial femoral artery (SFA) stenosis using t3DUS in patients with PAD. METHODS: t3DUS was used to measure maximum stenosis percentage in SFA from 50 patients with lower extremity PAD. The maximum stenosed segment in SFA was defined using Duplex 2DUS aliasing was noted. The peak systolic velocity (PSV) was measured at the maximum stenotic site and proximal to aliasing for calculating the velocity ratio. The association between blood flow velocity ratio and the degree of stenosis measured using Duplex 2DUS and t3DUS, respectively, was assessed using Spearman rank correlation. RESULTS: There was a strong positive correlation between velocity ratio and degree of stenosis in SFA measured using t3DUS (correlation value (r) = 0.99, p < 0.001). The correlation between Stenosis percentage and velocity ratio in SFA are as followed: <50:<2; 50-54:2-2.4; 55-59:2.5-2.9; 60-64:3-3.4; 65-69:3.5-3.9; 70-74:4-4.4; 75-79:4.5-4.9; >80:>5.t3DUS can be used to provide precise measurement of the severity of SFA stenosis in patients with lower extremities arterial disease. The established criteria for grading SFA stenosis in this study can be applied to the current practice alongside Duplex 2DUS as it showed a strong positive correlation with velocity ratio. Further studies investigating the sensitivity and specificity of t3DUS in the assessment of stenosis in lower limbs arteries are required.

Spontaneous cholecystocutaneous fistula secondary to xanthogranulomatous cholecystitis: a case report.

BACKGROUND: Xanthogranulomatous cholecystitis, a rare variant of cholecystitis, may infrequently be complicated by spontaneous cholecystocutaneous fistula. CASE PRESENTATION: We report the case of a 75-year-old Saudi Arabian man who presented with "a painful area of redness" (cellulitis) over his right upper abdomen. Abdominal computed tomography revealed multiple collections, which were drained surgically. A discharging sinus was identified, and a fistulogram revealed cholecystocutaneous fistula during his follow-up visit. The patient underwent laparoscopic management and recovered uneventfully. Final histopathological evaluation confirmed acute-on-chronic xanthogranulomatous cholecystitis . CONCLUSIONS: Although rare, surgeons should consider cholecystocutaneous fistula in the differential diagnosis of anterior abdominal wall abscesses, particularly in patients with concurrent or background symptoms of gallbladder disease. We report the first case of laparoscopic management for cholecystocutaneous fistula in Saudi Arabia.

Exploring Saudi Individuals' Perspectives and Needs to Design a Hypertension Management Mobile Technology Solution: Qualitative Study.

Hypertension is a chronic condition caused by a poor lifestyle that affects patients' lives. Adherence to self-management programs increases hypertension self-monitoring, and allows greater prevention and disease management. Patient compliance with hypertension self-management is low in general; therefore, mobile health applications (mHealth-Apps) are becoming a daily necessity and provide opportunities to improve the prevention and treatment of chronic diseases, including hypertension. This research aims to explore Saudi individuals' perspectives and needs regarding designing a hypertension management mobile app to be used by hypertension patients to better manage their illnesses. Semi-structured interviews were conducted with 21 Saudi participants to explore their perspectives and views about the needs and requirements in designing a hypertension mobile technology solution, as well as usability and culture in the Saudi context. The study used NVivo to analyze data and divided the themes into four main themes: the app's perceived health benefits, features and usability, suggestions for the app's content, and security and privacy. The results showed that there are many suggestions for improvements in mobile health apps that developers should take into consideration when designing apps. The mobile health apps should include physical activity tracking, related diet information, and reminders, which are promising, and could increase adherence to healthy lifestyles and consequently improve the self-management of hypertension patients. Mobile health apps provide opportunities to improve hypertension patients' self-management and self-monitoring. However, this study asserts that mobile health apps should not share users' data, and that adequate privacy disclosures should be implemented.

Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI-Based Retrospective Study.

Introduction: The temporomandibular joint is a complex synovial joint in the body. It is the area in which the mandible articulates with the cranium. The temporomandibular joint space is located between the articular eminence and the glenoid fossa of the temporal bone at the base of the skull and the condylar process of the mandible. This interarticular space is divided into superior joint space (1.2 ml) and inferior joint space (0.9 ml) by the articular disc. The purpose of this study is to detect and evaluate the variations in the temporomandibular joint space among patients having temporomandibular joint disorders. Materials and Methods: In this retrospective study, 60 magnetic resonance imaging scans were evaluated at King Faisal Specialist Hospital in Riyadh, Saudi Arabia, between the years 2006 and 2016. Measurements were done in sagittal view in three areas: anterior, central, and posterior areas. However, coronal view readings were recorded in two different areas: medial and lateral joint spaces. All measurements were recorded at the highest point of the condyle that is perpendicular to the opposing bone. The SPSS program was used for statistical analysis. Results: The central joint space values were higher than the anterior and posterior joint spaces in both coronal and sagittal views. We also found that joint spaces among male patients were higher than female patients (right side P=0.015 and left side P=0.006). It is worth mentioning that the number of temporomandibular joint disorder female patients was more than the number of male temporomandibular joint disorder patients (52 females versus 24 males). Additionally, patients who were older than 55 years old had wider joint spaces than patients who were younger than 25 years old. Conclusion: The central joint space value was the highest among the other joint spaces on both views of magnetic resonance imaging, and the values of joint spaces among males were larger than those of females on sagittal magnetic resonance imaging. Patients with elderly temporomandibular joint disorders showed larger joint spaces than young patients. This study spotlights the importance of magnetic resonance imaging evaluation in temporomandibular joint disorder patients for a better understanding of the clinical evolution of temporomandibular disorders.

Reliability and Accuracy of Tomographic 3-D Ultrasound for Grading Vessel Stenosis: A Phantom Study.

The aim of this phantom study was to assess the accuracy of 3-D tomographic ultrasound (t3DUS) for grading stenosis, using the manufacturer's measurements as the gold standard. The percentage of maximum stenosis was obtained using 2-D ultrasound (2DUS) and t3DUS imaging techniques on a peripheral vascular phantom, including channels with 50%, 75% and 90% stenosis. The inter-observer reproducibility of t3DUS for grading stenosis was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Mean and mean differences were used to evaluate the accuracy of 2DUS and t3DUS in measuring maximum stenosis in all channels. Inter-operator agreement was excellent, with an ICC value of 0.99 (95% confidence interval: 0.994-0.998, p < 0.001). Bias in measurements was -0.59 ± 2.01% (95% limits of agreement: 4.54, 3.36). The mean difference (MD) between maximum stenosis measurements and reference values for all channels was lower in t3DUS than in 2DUS (t3DUS MD: +1.01%, diameter reduction 2DUS MD: -6.10%; area reduction 2DUS MD: +8.20%). Tomographic 3DUS is a reproducible and accurate imaging method for grading stenosis. The current B-mode 2DUS stenosis grading criteria used in vascular assessment may be underestimating or overestimating the percentage stenosis. Further phantom and human studies investigating the reliability of t3DUS for grading stenosis and other metrics including plaque volume are required.

Study of Lateral Wall Thickness of the Maxillary Sinus in Left and Right Sides for Female and Male: A Cross Sectional Retrospective Study Using Cone Beam Computed Tomography.

BACKGROUND: Dental implants are considered the first option to replace missing teeth. Alveolar bone resorption gradually progresses following tooth extraction leading to loss of vertical bone dimension for implant placement. The lateral window approach is the most commonly used procedure to treat vertical bone loss. OBJECTIVE: The aim of the present study is to evaluate the Lateral Wall Thickness (LWT) of the maxillary sinus and determine the influence of gender and side on maxillary LWT. METHODS: This study involved a cross sectional retrospective study. Cone- beam computed tomography data were collected from 99 patients with a total of 198 maxillary sinuses that met the inclusion criteria. The patient age ranged between 18 to 35 years. On the selected sagittal section, the points of measurement are determined by a perpendicular line at 5 mm from the lowest point of the sinus floor. Measurements were taken at four different areas; first premolar (P1), second premolar (P2), first molar (M1), and second molar (M2). Descriptive statistics were used to calculate mean lateral wall thickness for each tooth, and student's t-test was used to test the effect of gender and side on maxillary LWT. RESULTS: The greatest mean LWT was observed around the left first maxillary molar (2.43±0.82), while the lowest mean LWT was observed around the right second maxillary premolar (1.62±0.61). There was no significant difference in the LWT around any tooth (M1 p=0.56, M2 p=0.92, P1 p=0.14, P2 p=0.19). CONCLUSION: There was no significant difference in both males and females of the lateral wall thickness in the left and right side of maxillary sinus.

Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications.

Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies.

Vertical relationships between the divergence angle of maxillary molar roots and the maxillary sinus floor: A cone-beam computed tomography (CBCT) study.

AIM: To assess the relations between the divergence angle of the maxillary molar roots and their proximity to the maxillary sinus floor using CBCT. METHOD: This study comprised CBCT scans of the maxilla, including at least the inferior one-third of the maxillary sinus and at least one molar present in any quadrant with complete eruption and root formation. Evaluation included the vertical relations between the maxillary molar root apices and the maxillary sinus floor (MSF), and the root divergence was measured from the root apices to the floor of the pulp chamber. The chi-square test was used for the associations between the study parameters. For the correlation between root divergence angles and MSF vertical relationship types, the Spearman test was used. A P-value < 0.05 was considered significant. RESULTS: A total of 100 scans were analyzed, including 316 permanent maxillary first and second molars. The MSF Type II vertical relationship was the most prevalent (39.6%), followed by Type I (31.3%). The highest divergence angle was found between the distobuccal and palatal roots (mean = 44.9 ± 10.5°). For the mesiobuccal-distobuccal angle groups, there were higher percentages of the MSF Type I and II relationships among the angle groups < 1° and 21-45°. For the mesiobuccal-palatal angle groups, a higher prevalence of the MSF Type II relationship was found in the <21° and >45° angle groups, and a higher prevalence of the Type I relationship was found in the 21-45° angle group. For the distobuccal-palatal angle groups, higher percentages of the MSF Type II relationship were found in the three angle groups. For all teeth, there was a significant positive correlation between the MSF vertical relationship and the mesiobuccal-palatal angle (r = 0.116; P = 0.039). CONCLUSION: There was a positive correlation between the divergence angle of the roots and their vertical relationship with the MSF. Clinicians should assess the divergence between the roots before performing extraction or endodontic treatments.

The mid-mesial canal prevalence in mandibular molars of a Saudi population: A cone-beam computed tomography study.

INTRODUCTION: The aim was to assess the prevalence of Mid Mesial Canal (MMC) in the first and second mandibular molars in a Saudi subpopulation sample and assess its relation to side, gender, and age using Cone beam computed tomography (CBCT). METHODS: The CBCT scans at King Saud University Dental Hospital between 2016 and 2019 were reviewed and filtered. The MMC of the mandibular molars were assessed according to Pomeranz et al. classification which was: (1) independent; (2) fin; (3) confluent with the mesiobuccal canal; and (4) confluent with the mesiolingual canal. Three calibrated observers examined the MMC on all planes at both sides. Age and gender factors were used to analyze that prevalence. A chi-squared test was used and (P ≤ 0.05) was considered to be statistically significant. RESULTS: 395 patients, and 1377 teeth met the inclusion criteria. The total number of mid-mesial canals was 12 (0.9%): nine at the mandibular first molar (1.3%) and three in the mandibular second molar (0.4%). The most common type of mid-mesial canal was confluent (n = 10), of which 6 fused with the mesiobuccal canal and 4 fused with the mesiolingual canal. Two canals were of the fin type, and there was no instance of independent mid-mesial canal. There was no significant difference between all variables: tooth type, tooth side, patient gender, and patient age group (p > 0.05). CONCLUSION: In this study, the most common MMC configuration was the confluent type followed by the fin type and no independent type were found. The patient side, gender and age did not influence the prevalence of the MMC.

Functional results and survivorship after medial unicompartmental knee arthroplasty: a single center experience from Saudi Arabia.

BACKGROUND: Isolated involvement of the medial compartment of the knee in degenerative disease is encountered in about 25% of patients with gonarthrosis. We aim to show that in a well-selected group of such patients, medial unicompartmental knee arthroplasty (UKA) is a good option. OBJECTIVES: Review the functional outcomes of patients undergoing UKA and determine the long-term survivorship of the implants and complications of the procedure. DESIGN: Analytical retrospective chart review. SETTING: Academic tertiary care medical center and tertiary care private hospital in the western region of Saudi Arabia. PATIENTS AND METHODS: We selected patients who underwent medial UKAs by the same surgeon between December 1988 and December 2009. The life table approach and the Kaplan-Meier statistical method were used to estimate the survival rate (5-30 years) with revision as the endpoint. Functional outcome scores were determined according to the Knee Society Clinical Rating System. MAIN OUTCOME MEASURES: Change in performance scores for pain, walking, and range of movement. Survivorship of the implants with removal of the implant as the endpoint; post-operative complications. SAMPLE SIZE: 218 implants on 142 patients. RESULTS: The survival rate of UKA was 94.7% at 10 years (95% CI 0.906-0.970), 80.9% at 20 years (95%CI 0.724-0.871), and 77.8% at 30 years (95%CI 0.669-0.855). The average grand total functional score increased from 61 (maximum 200) at 0 months to above 150 at ≥6 months. CONCLUSION: UKA is a good option for isolated medial compartment gonarthrosis with excellent functional outcome and good survivorship in selected patients. LIMITATION: Single center experience, retrospective. We lost 6.0% of patients during follow-up. Comparison with other treatment modalities is based on literature review and not on our own data. CONFLICT OF INTEREST: None.

Incidental findings of temporomandibular joint osteoarthritis and its variability based on age and sex.

PURPOSE: This study investigated the prevalence of temporomandibular joint osteoarthritis (TMJ-OA) using the Research Diagnostic Criteria for Temporomandibular Disorders image analysis criteria, assessed the severity of incidental osteoarthritic changes affecting the TMJ, and evaluated the correlations of sex and age with the prevalence and severity of TMJ-OA. MATERIALS AND METHODS: This retrospective study assessed 145 randomly selected cone-beam computed tomography scans (261 TMJs) from the authors' institutional maxillofacial radiology archive following the application of inclusion and exclusion criteria. The criteria described by Ahmad et al. were used to determine whether each TMJ was affected by OA, and the severity of the osteoarthritic changes was scored for each joint based on the method described by Alexiou et al. The chi-square, McNemar, Bhapkar chi-square, and Stuart-Maxwell chi-square tests were applied to evaluate the significance of the relationships between variables (age and sex). RESULTS: Sixteen TMJs (6.1%) had no OA, 74 (28.6%) were indeterminate for OA, and 171 (65.5%) had OA. Flattening and sclerosis were observed in 86.6% and 12.3% of cases, respectively, while resorption was observed in 7.3% of the joints. Only 21 (8.1%) of the examined TMJs had subchondral cysts. Erosion of the articular eminence was observed in 58 (22.1%) cases, while sclerosis and resorption were found in 68 (25.9%) and 16 (6.1%) TMJs, respectively. CONCLUSION: Female patients had a higher prevalence and severity of TMJ-OA than male patients. The prevalence and severity of TMJ-OA increased with age, with peaks in the fifth and seventh decades of life.

Assessment of potential reduction in multidetector computed tomography doses using FBP and SAFIRE for detection and measurement of the position of the inferior alveolar canal.

OBJECTIVE: The objective was to identify the lowest doses required to detect and measure the position of the inferior alveolar canal (IAC) on multidetector computed tomography (MDCT) images using filtered backprojection (FBP) and sinogram-affirmed iterative reconstructions (SAFIRE) 3 and SAFIRE 5. STUDY DESIGN: Four cadaveric mandibles were imaged using a reference protocol with standard dose and FBP and 3 ultra-low-dose protocols (LD1-LD3), using an MDCT scanner. All test examinations were reconstructed with FBP, SAFIRE 3, and SAFIRE 5. Subjective visibility of the IAC in the images and digital measurements of the height of the ridge above the IAC were recorded from test images and compared with those from the reference image using one-sample t tests, Bland-Altman plots, and linear regression. RESULTS: Subjective visibility comparable to the standard protocol was obtained with an 84.6% dose reduction using the LD2 protocol. No statistically significant difference was found between the height measurements from the reference protocol and any of the LD1 and LD2 protocols. The t tests indicated a significant difference between the measurements from the reference and all LD3 test protocols. SAFIRE did not have an advantage over FBP images. CONCLUSIONS: Significant dose reduction from the reference dose can allow adequate detection and measurements of the IAC.

Using hand-held dental x-ray devices: ensuring safety for patients and operators.

BACKGROUND: Since the introduction of hand-held x-ray units in dentistry, a few inexpensive devices have emerged that lack the necessary safety measures and failed to meet U.S. Food and Drug Administration (FDA) standards. They are advertised actively and sold online in the United States. METHODS: The authors present several safety issues associated with an imported hand-held x-ray device that has not been cleared by the FDA and compare the device with an FDA-cleared unit. RESULTS: The authors found that the non-FDA-cleared device posed major safety hazards, including high radiation doses to patients and operators, lack of operator shielding, lower-than-acceptable kilovolt (peak) value, inadequate collimation, lack of an audible signal of x-ray generation and absence of a so-called dead-man switch. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Dental professionals must be aware of unsafe x-ray equipment and use only those devices that have been cleared by the FDA to protect themselves and their patients.

Calcification of the stylohyoid ligament in panoramic radiography and cone beam computed tomography among patients referred for dental implant treatment planning.

BACKGROUND: Calcification of the stylohyoid ligament (SHL) is a common condition noted as an incidental finding in routine radiographic examination. Due to proximity with important neurovascular structures, elongation and calcification may sometimes lead to dysphagia and pain. The objective of this study was to evaluate the incidence of calcified SHL detected on cone beam computed tomography (CBCT) scans and panoramic radiographs (PR) in patients referred for dental implant therapy. METHODS: Retrospective analysis of 30 patients referred for dental implants to the Department of Oral and Maxillofacial Radiology at the University of Connecticut School of Dental Medicine was done. Patients were imaged using Hitachi CB MercuRay CBCT machine, and PRs were obtained using Planmeca panoramic machine. CBCT reconstructions and panoramic images were evaluated for the incidence and pattern of SHL calcification. RESULTS: Nineteen patients (63.3%) had calcified SHLs, 16 of whom were reported to have bilateral involvement. PR was unable to show complete calcification of the ligament in any of the cases, whereas CBCT showed evidence of complete calcification when present (14 cases). CONCLUSION: CBCT was more accurate in determining the pattern and extent of calcification of the SHL in patients undergoing implant treatment planning.

Turcot syndrome: a synchronous clinical presentation of glioblastoma multiforme and adenocarcinoma of the colon.

Turcot syndrome (TS) is a rare hereditary disorder clinically characterized by the occurrence of primary tumors of the colon and the central nervous system (CNS). Here we present the case of an 11-year-old boy with a synchronous clinical presentation of both glioblastoma multiforme (GBM) and colonic adenocarcinoma. A molecular genetic study revealed microsatellite instability in the DNA mismatch repair (MMR) gene. This patient ultimately survived for 13 months after clinical presentation. Based on this case study, the synchronous presentation of glioblastoma multiforme and adenocarcinoma of the colon might suggest a shorter survival rate for patients with Turcot syndrome. A literature review complements this paper.

Evaluation of different esthetic smile criteria.

PURPOSE: The aim of this study was to evaluate the existence of different esthetic smile criteria as determined on the smiles of celebrities, which were considered by lay people to be beautiful. MATERIALS AND METHODS: An Internet search for "best smile" and "female celebrities" in the years 2007 and 2008 identified 50 celebrities who were voted to have beautiful smiles. Another search was made for images of these celebrities that showed the entire face with an open smile. The images were analyzed using Digimizer image analysis software for different esthetic smile criteria. RESULTS: Eighty percent of the sample was classified as having an average upper lip position, 62% showed upward upper lip curvature, and 78% had a parallel smile line. Forty-two percent of the images showed the maxillary anterior teeth not touching the lower lip, while 34% were touching, and 24% slightly covered it. Sixty percent displayed up to the second premolar, and 32% displayed up to the first molar when smiling. Midline deviation was detected in 36% of the sample. Diastema and golden proportion were not seen in any of the subjects. CONCLUSION: Female celebrities voted to have the best smile by lay people showed most of the esthetic smile criteria with slight variations, except for the golden proportion. The opinions and perceptions of lay people about beauty should be studied and evaluated.