Smile esthetic: comparison of perception amongst orthodontists, dental students, orthodontic patients and surgical orthodontic patients

Most patients require orthodontic treatment to improve the esthetics of their smile. Orthodontists must consider how some parameters of mini-esthetics can influence the patient's esthetic perception. Methods: A photograph of the smile of a young female was taken and some modifications were made to the buccal corridor, gingival exposure, smile arc and midline position to assess the influence of these variables on smile attractiveness. Two hundred examiners were selected from four groups: orthodontists (O), dental students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP). Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. Significant level was set at P ≤ 0.05. Results: Only orthodontists considered buccal corridors of 4mm and midline deviation of 1mm as non-esthetic; all other examiners considered gingival exposures ≥3 mm and midline angulation as non-esthetic. All examiners assigned higher satisfaction values to the photo with the concordant smile arc and defined as non-esthetic the covered smile and the reverse smile arc. Patients perceived as non-esthetic only midline deviations of 4mm. The surgical orthodontic patients assigned lower values to the photos and showed greater attention to evaluating the esthetics of the smile than the orthodontic patients. Conclusion: Smile arc, gingival exposure and midline angulation influence smile esthetics; the role of buccal corridors and midline deviation is dependent on the type of examiner

Predictive Analysis of Maxillary Canine Impaction through Sella Turcica Bridging, Ponticulus Posticus Calcification, and Lateral Incisor Anomalies: A Retrospective Observational Study.

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.

Comparision of profile macro-estethic perception among orthodontists, dentistry students, orthodontic patients and surgical orthodontic patients.

BACKGROUND: The patient's needs should guide the orthodontist in choosing the most appropriate therapy. The purpose of the present survey was to compare the esthetic perception of the facial profile by orthodontists (O), dentistry students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP) and to evaluate the influence of gender, age and level of study. MATERIAL AND METHODS: A facial profile photograph of a young female was taken and twelve modified images were made, altering the position of the jaws in protrusion and in retrusion. Two hundred caucasian examiners, divided into four groups (O, DS, OP, SOP), were selected. Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. An ordinary least square OLS model was applied. Significant levels were set at P ≤ 0.05. RESULTS: All examiners considered a straight profile or a slight retrusion of the maxilla as the most attractive profile. Slight discrepancies (up to 2 mm) in jaw protrusion were barely perceived by patients. Mandibular retrusion (2 and 4 mm) was one of the least appreciated condition by all examiners. Surgical-orthodontic patients assigned lower ratings compared to orthodontic patients. Female subjects assigned lower ratings than males. Patients with secondary school education assigned higher statistically significant values compared to other levels of study. The lowest values were attributed by the sample of age > = 17 years. CONCLUSIONS: The choice of the most appropriate therapy is based not only on a correct diagnosis, but on the evaluation of esthetic and psychological aspects. Key words:Estethic, profile, orthodontic, surgical orthodontic patients.

Uprighting Impacted Mandibular Second Molar Using a Skeletal Anchorage: A Case Report.

The aim of this case report is to present an innovative combined orthodontic-surgical technique to disimpact mandibular second molar (MM2) using an orthodontic miniscrew and an elastic chain. The impact on the Oral health-related quality of life (OHRQoL) was also evaluated. Using the present techinique, it is possible to expose the impacted tooth, insert a self-drilling miniscrew in the retromolar area, and remove the bud of third mandibular molar. At the same time the orthodontic force is applied with the use of an elastomeric chain that connects the head of miniscrew and vestibular and oral buttons bonded on MM2. A close traction is performed for the whole treatment time without the reactivation of the elastic force. The use of skeletal anchorage allowed the disimpaction of impacted MM2 in a short treatment time (about three months) avoiding the typical biomechanical side effects of traditional orthodontic appliance and increasing the effectiveness of the treatment. Further studies are necessary to evaluate the real advantages and disadvantages of this combined orthodontic-surgical approach.

Computer-guided palatal canine disimpaction: a technical note.

AIM: To present a minimally invasive approach to solve the impaction of palatal canines using computer-guided orthodontic miniscrews. MATERIALS AND METHODS: Miniscrew-supported appliances for palatal canine disimpaction are performed with CAD/CAM technology. With adequate software, it is possible to match the STL files of the dental arch with the DICOM images of the maxilla, previously transformed into STL files. The ideal points for miniscrew insertion can be identified on the STL 3D model file on the basis of the width and thickness of the palatal vault. A software application allows for the design of the surgical guide, which is printed using a 3D printer. The virtual position of the planned miniscrews is transferred onto a printed dental cast on which the orthodontic device is realized. On the day of surgery, both the surgical guide and the orthodontic appliance are ready for use. RESULTS: Miniscrew insertion and palatal canine disimpaction can be achieved in one surgical procedure. CONCLUSION: The use of computer-guided skeletal anchorage allows for both the reduction of the biomechanical side effects typical of conventional treatment and the risk of damaging adjacent anatomical structures, increasing the effectiveness of treatment. Controlled clinical trials are necessary to evaluate more fully any advantages of this minimally invasive technique.

Relationship between upper lateral incisors anomalies and palatal displaced canine: a case-control retrospective study.

BACKGROUND: An observational case-control study was designed to retrospectively assess the association among sex, skeletal and dental variables and the and the palatal maxillary canine impaction. METHODS: The STROBE guidelines were followed. The records of 2195 subjects were analyzed. The data records of subjects with palatally displaced canine (PDC) were compared with the data of randomly selected subjects without PDC. Descriptive statistics, logistic regression model and χ2 test were used. RESULTS: One hundred and one subjects presented at least one PDC; 106 subjects without PDC were randomly selected. From the logistic model, it was found that only gender and persistence of the deciduous canine were significantly associated with PDC. The Chi-square test showed a correlation between the presence of upper lateral incisor anomalies and PDC, otherwise, considering the unilateral impaction, there was no statistically significant difference in the relationship between canine impaction and the presence of the lateral incisor anomalies, on the same or opposite side of the impaction. CONCLUSIONS: The female sex and the persistence of maxillary deciduous canines are associated with PDC. The anomalies of the lateral incisor do not seem to play a mechanistic role, but could rather represent a genetic variable of the canine eruption disorder.