Changes in the arch width and buccal corridor after fixed orthodontic treatment with Damon self-ligating system: premolar extraction vs. non-extraction

INTRODUCTION

Extraction vs. non-extraction is a crucial decision in orthodontic therapy.

OBJECTIVE

The aim of the present study was to investigate the changes in the dental arch width and buccal corridor after orthodontic treatment using extraction and non-extraction therapy with Damon self-ligating system.

MATERIAL AND METHODS

This retrospective study consisted of 35 patients (20 female and 15 male patients with median age of 12.5 years), treated by extracting 4 or 2 premolars, and 37 patients (16 female and 21 male patients with the median age of 12.8 years), treated without premolar extraction. Both groups were treated with Damon self-ligating system. Plaster models before (T0) and after (T1) treatment were measured, and the arch width values were determined at the level of the first molars, second premolars, canines and palatal rugae. Buccal corridor width was measured using the extraoral images at T0 and T1. Paired t-test was used for the analysis of the normally distributed data, and Wilcoxon Mann-Whitney U test was used for the data with non-normal distribution. Values of p<0.05 were set as statistically significant.

RESULTS

The upper intercanine width increased significantly in both groups (p<0.01). In the non-extraction group, the arch width increased significantly in the maxillary second premolar and first molar region (p<0.01) as well as in the region of the canines (p=0.04), second premolars (p=0.01) and first molars (p<0.01) of the mandible. The buccal corridor decreased significantly in the non-extraction group (p<0.01).

CONCLUSION

Premolar extraction in combination with Damon self-ligating system did not lead to reduction of the dental arch width in the maxilla, nor did it increase the size of the buccal corridors.

Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Smile attractiveness in patients treated with or without 4 premolar extractions: A 36-year follow-up

INTRODUCTION

This study aimed to assess the smile attractiveness in patients treated with or without 4 premolar extractions at a 36-year follow-up.

METHODS

The sample comprised 52 patients with Class I and II malocclusion divided into 2 groups. Group 1 consisted of 15 patients treated without extractions (10 females and 5 males), with a mean pretreatment, posttreatment, and long-term posttreatment (T3) age of 13.2, 15.1, and 49.8 years, respectively. The mean treatment time was 1.9 years, and the mean long-term follow-up period was 34.7 years. Group 2 consisted of 37 patients (25 females and 12 males) treated with 4 premolar extractions, with a mean pretreatment, posttreatment, and long-term posttreatment age of 13.3, 15.7, and 53.6 years, respectively. The mean treatment time was 2.3 years, and the mean long-term follow-up period was 37.9 years. The mean retention time was 2 years for both groups. Frontal smiling photographs were obtained at long-term follow-up. Smile attractiveness was evaluated in an online questionnaire in which the evaluator could rate the smiling photographs with a 10-point scale. The randomly selected evaluator sample consisted of 62 laypeople, 33 dentists, and 89 orthodontists. Independent t tests, 1-way analysis of variance, and Tukey tests were used for intergroup comparisons at P <0.05.

RESULTS

The smile attractiveness on the long term was similar in the groups treated with 4 premolar extractions (4.70 ± 1.35) or without extractions (4.51 ± 1.46). Women and orthodontists were more critical in assessing smile attractiveness than men, dentists, and laypeople.

CONCLUSIONS

After long-term posttreatment, the smile attractiveness was similar in patients treated with 4 premolar extractions or without extractions.

New Trend in Treating Class II Division 2 Subdivision: A Case Report

Class II correction in non-growing patients will always pose a challenge in treatment, especially in a subdivision condition where one quadrant will exhibit class II molar and canine, and the other side will exhibit class I. In such a scenario, a contemporary extraction protocol will face a challenge in symmetric space closure. This case report describes the management of class II subdivision malocclusion by the latest approach, i.e., extraction of a single premolar. At the end of the treatment, midlines were corrected and good functional class I canine relations on both sides were established.

Evaluation of the attractiveness of lips with different volumes after filling with hyaluronic acid

To compare the attractiveness of lips with different volumes after filling in the view of laypersons, dentists, and specialists. The sample comprised close-up frontal and lateral photographs of the lips of 16 women who underwent lip filling procedure with hyaluronic acid and was divided into 2 groups. Group 1: eight women with thinner lips at pretreatment. Group 2: eight female patients with thicker lips at pretreatment. Photographs from before and 10 days after lip filling were used to assess attractiveness randomly displayed in a Google Forms questionnaire and then sent via a messaging app to the evaluators. The evaluators' groups were general dentists, dentists with degrees in facial aesthetics, and laypersons. The attractiveness was evaluated with scores from 0 to 10 (0: least attractive and 10 the greatest). T-tests were used for the statistical comparisons. The group with thinner lips showed significantly improved attractiveness after filling. The group with thicker lips showed a worsening attractiveness after filling. The group with thicker lips had significantly higher attractiveness scores than those with thinner lips. There was no significant difference in the preference between men and women. The group of laypersons was more rigorous, giving significantly lower lip attractiveness scores. Thinner lips showed a significant improvement in attractiveness after filling. Thicker lips showed a worsening of the attractiveness score after filling. Before and after filling, thicker lips had significantly higher attractiveness scores than thinner lips.Clinical relevance: The amount of fillers applied to each patient must be individually evaluated.

Effect of smile esthetics on the quality of life in a Han Chinese population

OBJECTIVE

This study aimed to explore the influence of smile esthetics on the quality of life in a Han Chinese population.

METHODS

A total of 110 Han Chinese volunteers (52 males and 58 females, mean age 26.7 years) were recruited, and frontal images of their smiles were collected. A photoediting program was used to evaluate the following components of smile esthetics: the buccal corridor ratios, the angle between the interpupillary and commissural lines, the number of visible teeth, and width-to-length ratios of the maxillary central incisors. Oral health-related quality of life (OHRQoL) in these volunteers was evaluated using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed by using Pearson's correlations and multiple linear regression (α = 0.05).

RESULTS

Compared to males, females scored higher on psychological impact (p = 0.017). Moreover, the number of visible teeth had a significant effect on social impact, psychological impact and esthetic concern (all p < 0.05). However, the buccal corridor ratios, the angle between the interpupillary and commissural lines, and the width-to-length ratios of the maxillary central incisor did not correlate with the OHRQoL (all p > 0.05).

CONCLUSIONS

The number of visible teeth significantly influenced the quality of life in a Han Chinese population. Smile esthetics had a significantly greater psychological impact on females than males.

CLINICAL SIGNIFICANCE

This study highlights the effects of smile esthetics on the quality of life in a Han Chinese population. Female patients may raise more esthetic concerns in clinical practice.

The effect of orthodontic treatment on smile attractiveness: a systematic review

BACKGROUND

Smile attractiveness is a primary factor for patients to seek orthodontic treatment, however, there is yet no systematic evaluation of this topic in the literature.

OBJECTIVES

To assess the current evidence on the effect of orthodontic treatment on smile attractiveness.

SEARCH METHODS

Seven electronic databases (MEDLINE, Cochrane Library, Virtual Health Library, SCOPUS, Web of Science, Google Scholar and Embase) were searched on 14 September 2022.

SELECTION CRITERIA

Studies evaluating smile attractiveness before and after orthodontic treatment or only after completion of orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were planned a priori.

METHODS

After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, an evaluation of the overall evidence was performed. The included studies were evaluated based on the characteristics of their study and control groups and based on their main research question. Also, all outcome measures were standardized into a common assessment scale (0-100), in order to obtain more easily interpretable results.

RESULTS

Ten studies were included in this review, nine of which were assessed as being at serious risk of bias and one at moderate risk of bias. The large heterogeneity between the included studies did not allow for a meta-analysis. Orthodontic treatment has a moderately positive effect on smile attractiveness. When compared to no treatment, orthodontic treatment with premolar extractions improves smile attractiveness by 22%. Also, surgical correction of Class III cases increases smile attractiveness by 7.5% more than camouflage treatment. No other significant differences were shown between different types of treatment.

CONCLUSION

Based on the available data, orthodontic treatment seems to moderately improve the attractiveness of the smile. There is significant bias in the current literature assessing the effect of orthodontics on smile attractiveness; therefore, the results cannot be accepted with certainty.

Age and Gender Are Associated with the Component of Psychosocial Impact of Dental Aesthetics Questionnaire in Young People: A Cross-Sectional Study

(1) The aim of the study was to investigate the association between age, gender, and the component of psychosocial impact of dental aesthetics (PIDAQ) in Malaysian young people. (2) Cross-sectional data on the PIDAQ (comprised of dental self-confidence, social impact, psychological impact, and aesthetic concern variables) of Malaysian youth (n = 1425) recruited through multi-stage sampling were analyzed for mediation and moderated mediation analyses using the PROCESS macro on SPSS software. (3) Participants (mean age 16.0 ± 2.8) represented 54.8% of girls and 45.2% of boys. In the mediation model, psychological impact and aesthetic concern completely mediated the effects of social impact on dental self-confidence. In the moderated mediation model, social impact directly influenced dental self-confidence amongst participants at one standard deviation below the sample mean age and among boys. However, psychological impact completely mediated the influence of social impact on dental self-confidence amongst participants at the sample mean age and at one standard deviation above the sample mean ages, and among girls. Neither age nor gender moderated the effect of aesthetic concern on dental self-confidence. (4) Age and gender moderated the influence of social impact and psychological impact on dental self-confidence.

Smile attractiveness in class III patients after orthodontic camouflage or orthognathic surgery

OBJECTIVE

The study's objective was to compare the smile attractiveness in patients with class III malocclusion treated with orthodontic camouflage or orthognathic surgery.

MATERIAL AND METHODS

The sample consisted of 30 patients with class III malocclusion treated without extractions divided into two groups, according to the treatment performed: G1, orthodontic camouflage, consisting of 15 patients (9 female; 6 male) with mean initial age of 21.26 years (SD = 7.39) and mean final age of 24.52 years (SD = 7.10). The mean treatment time was 3.26 years (SD = 1.50). G2, ortho-surgical, consisting of 15 patients (8 females; 7 males), with mean initial age of 23.12 years (SD=7.37), mean final age of 25.82 years (SD = 7.14) and mean treatment time of 2.71 years (SD = 0.90). The smile attractiveness was evaluated in black and white photographs of posed smiles taken before and after treatment, with a numerical rating scale from 1 to 10, with 1 being the least attractive and 10 the greatest smile attractiveness. The smiles were evaluated in a questionnaire by 111 participants, 67 orthodontists (mean age 41.31 years, SD = 9.44) and 44 laypeople (mean age 41.41 years, SD = 14.38). Intergroup comparison was performed with independent t test.

RESULTS

There was a significant improvement in the smile attractiveness with both camouflage and ortho-surgical treatments. The smile attractiveness was similar between the camouflage and surgical groups at the beginning. There was a significantly greater improvement in smile attractiveness with treatment in the surgical group than in the camouflage group, and at the end of treatment, the surgical group showed greater smile attractiveness than the camouflage group. Orthodontists considered the smiles more attractive both at the beginning and the end of treatment when compared to the assessment made by laypeople.

CONCLUSION

The ortho-surgical treatment promoted a greater improvement in the smile attractiveness, and at the final stage, a greater smile attractiveness than the orthodontic camouflage.

CLINICAL RELEVANCE

Smile attractiveness is an important characteristic of the final result of orthodontic treatment. Knowing which treatment protocol will provide a better improvement and outcome regarding smile esthetics is essential.

Evaluation of Smile Characteristics in Three Different Sagittal Malocclusions Before and After Nonextraction Orthodontic Treatment

Introduction:

To investigate the smile esthetics variables in three malocclusion classifications of angle to find out if the final smile esthetics was correlated with the initial types of malocclusion.

Materials and Methods:

This cross-sectional study was performed on 90 adult patients (18–28 years old) with three classes of malocclusion (n = 30 for each class), who were just treated by an orthodontist based on standard edgewise (0.018 inch). A standardized smile mesh analysis was used to evaluate seven smile characteristics.

Results:

Orthodontic treatment improved all the smile characteristics in the three groups. All groups showed an increase in smile width, smile index, and vertical indices; while, the transverse indices decreased. Significant increase was observed in four smile measurements in patients with Class II malocclusion. Comparing the smile characteristic changes among the three groups revealed that the changes induced by orthodontic treatment were significantly higher in patients with Class II malocclusion.

Conclusion:

The smile esthetics in all the three types of malocclusion benefited from the orthodontic treatment; however, the changes were more significant in Class II malocclusions. None of the three malocclusion types showed significant difference between the pre- and post-treatment smile characteristics.

Comparison of smile esthetics among celebrities, dentists, and dental students in a Han Chinese population

STATEMENT OF PROBLEM

Various components of smile esthetics have been evaluated. However, whether these components affect smile esthetics in Han Chinese celebrities, dentists, and dental students is unknown.

PURPOSE

The purpose of this study was to evaluate the smile esthetics of celebrities, dentists, and dental students in a Han Chinese population.

MATERIAL AND METHODS

Frontal images of smiles were obtained from the Internet for the celebrity group, while images of dentists and dental students were collected for the dentist and dental student groups. The buccal and posterior corridor ratios, the alignment discrepancy between the commissural and interpupillary lines, the number of teeth revealed, the width ratio relative to the golden proportion, and the width-to-length ratios of maxillary anterior teeth were calculated by using a photo-editing software program. Statistical analysis was performed by using 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Eligible images were obtained for 81 celebrities, 83 dentists, and 78 dental students. The celebrities were found to have the highest buccal and posterior corridor ratios and reveal the least teeth in the smile among the 3 groups (all P<.001). The alignment discrepancy for celebrities was significantly less than that for dental students (P=.025). Moreover, the absolute difference of width ratios from the golden proportion was significantly different from 0 for all groups (all P<.001).

CONCLUSIONS

Significant differences were found in the smiles of Han Chinese celebrities, dentists, and dental students in regard to the buccal and posterior corridor ratios, the alignment discrepancy between the commissural and interpupillary lines, and the number of teeth revealed. Chinese celebrities tended to have a smile that displays to the second premolar, with a medium buccal corridor width.

Long-term profile attractiveness in Class II Division 1 malocclusion patients treated with and without extractions

INTRODUCTION

This study evaluated the influence of Class II treatment protocols in profile attractiveness.

METHODS

Sixty-eight patients with initial full Class II Division 1 malocclusion, orthodontically treated an average of 15 years before, and matched by sex, age, time after treatment, orthodontic outcomes, and overjet, were compared. Three groups were formed, according to the treatment protocol: NE, nonextraction (n = 20; mean age 29.94 years, 15.62 years after treatment); 2E, 2-premolar extractions (n = 27; mean age 30.56 years, 15.09 years after treatment); and 4E, 4-premolar extractions (n = 21; mean age 32.29 years, 17.20 years after treatment). Cephalometric measurements and profile silhouettes were obtained from posttreatment and long-term posttreatment lateral cephalograms. With a 10-point numeric scale, 77 orthodontists and 77 laypeople rated profile attractiveness of each silhouette on a website.

RESULTS

The raters' posttreatment and long-term posttreatment scores, respectively, were: NE 4.76 and 4.32; 2E 5.35 and 5.08; and 4E 4.53 and 4.33.

CONCLUSIONS

The posttreatment profile attractiveness was significantly higher in the 2E than in the 4E group, and in the NE group it was similar to the others. The long-term profile attractiveness in the 2E group was significantly greater compared with the NE and 4E groups.

Dentoskeletal and soft tissue changes in class II subdivision treatment with asymmetric extraction protocols

Background

This study cephalometrically compared the dentoskeletal and soft tissue changes consequent to one and three-premolar extraction protocols of class II subdivision malocclusion treatment.

Methods

A sample of 126 lateral cephalometric radiographs from 63 patients was selected and divided into two groups. Group 1 consisted of 31 type 1 class II subdivision malocclusion patients treated with asymmetric extractions of two maxillary premolars and one mandibular premolar on the class I side, with an initial mean age of 13.58 years. Group 2 consisted of 32 type 2 class II subdivision malocclusion patients treated with asymmetric extraction of one maxillary first premolar on the class II side, with an initial mean age of 13.98 years. t test was used for intergroup comparison at the pre- and posttreatment stages and to compare the treatment changes.

Results

Group 1 had greater maxillomandibular sagittal discrepancy reduction and greater maxillary first molar extrusion. Group 2 had mandibular incisor labial inclination and protrusion, and group 1 had mandibular incisor lingual inclination and retraction. Maxillary molar asymmetry increased in group 2, while mandibular molar asymmetry increased in group 1.

Conclusions

The treatment changes produced by these two class II subdivision protocols are different to adequately satisfy the different needs for types 1 and 2 class II subdivision malocclusions.

Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a cross-sectional study

BACKGROUND

The normative orthodontic treatment need, established by dental professionals during the dental appointment, becomes ineffective when it does not evaluate all the factors that influence the decision-making process, including individuals' perception and satisfaction with their dental appearance. Therefore, the purpose of this study was to investigate the perception of children and their mothers as regards orthodontic treatment need and satisfaction with dental aesthetics and test if these variables are associated with the objective orthodontic treatment needs, assessed by the Dental Aesthetic Index (DAI).

METHODS

A cross-sectional study was conducted on 308 children aged 12 years, and their mothers were randomly selected by cluster sampling (primary schools). The variables "orthodontic treatment need," "satisfaction with chewing," and "dental appearance" were assessed by means of a questionnaire. The questions were answered individually at school or home, in cases of children or mothers, respectively. DAI was assessed to make an objective clinical assessment. The variables were dichotomized and statistically analyzed by the chi-square and Fisher's exact tests, contingency coefficient C, and logistic regression.

RESULTS

The results of the clinical evaluation (DAI) were statistically associated with the perception of orthodontic treatment need and satisfaction with dental appearance in children (p ≤ 0.01). However, no association was observed with regard to satisfaction with chewing and DAI (p = 0.10). The children's perception of orthodontic treatment need and satisfaction with the appearance of their teeth was statistically associated (p ≤ 0.01) with their mothers' perception. Maxillary overjet, maxillary and mandibular misalignment, and dental crowding were associated with the orthodontic treatment need by children and their mothers, with p value -0.05 and 5 % level of significance. Maxillary overjet was a significant predictor for the perception of orthodontic treatment need in children (OR 1.86, 95 % CI 0.98-3.55) and mothers (OR 3.02, 95 % CI 1.54-5.92).

CONCLUSIONS

Children and parents realize the need for orthodontic treatment according to the different types of malocclusion, as noted in the association between orthodontic treatment need and dental appearance perceived by children and their mothers, which was also observed-with low correlation-with regard to DAI.

Comparison of two scales for evaluation of smile and dental attractiveness

OBJECTIVE:

To compare the visual analogue scale (VAS) and the simplified Q-sort method used to investigate the highest level of agreement among dentists, orthodontists and laypeople when assessing smile and dental attractiveness.

MATERIAL AND METHODS:

An album containing 258 photos of 86 individuals with their lips at rest, a slight and broad smile, was assessed by 25 dentists (general clinicians and various specialties), 23 orthodontists and 27 laypeople with regard to smile and dental attractiveness. To this end, both VAS and simplified Q-sort method were used. Agreements were calculated by intraclass correlation coefficient (ICC).

RESULTS:

For the single measurement between the VAS method and the simplified Q-sort method, all simplified Q-sort rates were higher in all groups. The simplified Q-sort method results ranged between 0.42 and 0.49 while those of the VAS method varied between 0.37 and 0.42. The simplified Q-sort method also presented higher mean measurement values (0.95 and 0.96) in comparison to VAS (0.94 and 0.95).

CONCLUSIONS:

Both scales may be considered reliable for evaluating smile and dental attractiveness; however, the simplified Q-Sort method presented slightly higher values than the VAS method.

Efficiency of Class II subdivision malocclusion treatment with 3 and 4 premolar extractions

INTRODUCTION

In this study, we compared the efficiency of Class II subdivision malocclusion treatment with symmetric and asymmetric extractions.

METHODS

A sample of 71 patients with complete Class II subdivision malocclusion was selected: group 1 consisted of 40 patients treated with 4 premolar extractions with an initial mean age of 13.37 years, and group 2 had 31 patients treated with 3 premolar extractions (2 maxillary premolars and 1 mandibular premolar on the Class I side) with an initial mean age of 14.44 years. To compare the efficiency of each treatment protocol, the initial and final occlusal results were evaluated on dental casts with the Peer Assessment Rating occlusal index, and time spent in treatment was calculated from the clinical charts. The amounts of initial and final midline deviation and improvement of midline deviation correction were also evaluated. Efficiency was calculated as the rate between occlusal improvement by the treatment time. The groups were compared with t and Mann-Whitney tests.

RESULTS

The results showed that group 2 had a significantly smaller final amount of midline deviation and a greater correction of midline deviation.

CONCLUSIONS

Treatment efficiency of type 1 Class II subdivision malocclusions with 3 or 4 premolar extractions is similar. However, treatment with 3 premolar extractions provides a better occlusal success rate.

Unilateral Maxillary First Molar Extraction in Class II Subdivision: An Unconventional Treatment Alternative

The asymmetrical intra-arch relationship in Class II subdivision malocclusion poses challenges in the treatment planning and mechanotherapy of such cases. This case report demonstrates a treatment technique engaging unilateral extraction of a maxillary first molar and Begg fixed appliances. The outcome stability and the enhancing effect on the eruption of the third molar in the extraction segment were confirmed by a 4-year follow-up examination.

Influence of premolar extractions on long-term adult facial aesthetics and apparent age

OBJECTIVES

This study aimed to assess whether non-extraction, two-premolars and four-premolars extraction Class II treatment protocols are different regarding long-term facial aesthetics, age appearance, and soft-tissue measures.

METHODS

Frontal and lateral photographs of 63 full Class II division 1 patients, treated at least 8 years before, were evaluated by 83 laypeople and 76 orthodontists, who assigned to each one's attractiveness scores from 1 to 10, and opined about their apparent ages. Patients were divided in three groups: XP0 (non-extraction, n = 20; 30.77 years, 15.63 years post-treatment), XP2 (two-premolars extractions, n = 25; 30.99 years, 15.68 years post-treatment), and XP4 (four-premolar extractions, n = 18; 32.80 years, 18.01 years post-treatment), that were matched by gender, post-treatment occlusal and soft-tissue outcomes, age, and post-treatment time. Soft-tissue measures were obtained with Dolphin Imaging 11.5 software.

RESULTS

Two-way analysis of variance revealed that attractiveness and apparent age were not affected by treatment protocols, but laypeople were slightly more critical then orthodontists. Analysis of variance showed more vertical facial pattern in XP4 group. Pearson correlation test revealed no influence of soft-tissue measures on sample's attractiveness.

CONCLUSIONS

Treatment of full Class II division 1 malocclusion with and without extractions did not influence facial attractiveness, age appearance, and overall soft-tissue measures in the long-term.

Long-term evaluation of Class II subdivision treatment with unilateral maxillary first molar extraction

OBJECTIVE

To evaluate the long-term effects of asymmetrical maxillary first molar (M1) extraction in Class II subdivision treatment.

MATERIALS AND METHODS

Records of 20 Class II subdivision whites (7 boys, 13 girls; mean age, 13.0 years; SD, 1.7 years) consecutively treated with the Begg technique and M1 extraction, and 15 untreated asymmetrical Class II adolescents (4 boys, 11 girls; mean age, 12.2 years; SD, 1.3 years) were examined in this study. Cephalometric analysis and PAR assessment were carried out before treatment (T1), after treatment (T2), and on average 2.5 years posttreatment (T3) for the treatment group, and at similar time points and average follow-up of 1.8 years for the controls.

RESULTS

The adjusted analysis indicated that the maxillary incisors were 2.3 mm more retracted in relation to A-Pog between T1 and T3 (β  =  2.31; 95% CI; 0.76, 3.87), whereas the mandibular incisors were 1.3 mm more protracted (β  =  1.34; 95% CI; 0.09, 2.59), and 5.9° more proclined to the mandibular plane (β  =  5.92; 95% CI; 1.43, 10.41) compared with controls. The lower lip appeared 1.4 mm more protrusive relative to the subnasale-soft tissue-Pog line throughout the observation period in the treated adolescents (β  =  1.43; 95% CI; 0.18, 2.67). There was a significant PAR score reduction over the entire follow-up period in the molar extraction group (β  =  -6.73; 95% CI; -10.7, -2.7). At T2, 65% of the subjects had maxillary midlines perfectly aligned with the face.

CONCLUSIONS

Unilateral M1 extraction in asymmetrical Class II cases may lead to favorable occlusal outcomes in the long term without harming the midline esthetics and soft tissue profile.

The unique contribution of elements of smile aesthetics to psychosocial well-being

Pleasant smile aesthetics is an important contributory factor to psychosocial well-being. The aim of this study was to determine the psychosocial influence of smile aesthetics. The study was cross-sectional on a convenient sample that included patients, pupils, students and faculty staff. A total of 155 subjects (36% male) aged 12-39 (mean age 21, interquartile range 19-23) were included. Occlusal characteristics were recorded by the Index of Complexity, Outcome and Need, and smiling frontal view photographs were obtained. Fourteen variables were measured using photogrammetric analysis: smile width, visibility of buccal corridors, maximum teeth exposure, total gingival display, lip thickness, degree of occlusal cant and deviation from golden proportion of the teeth in maxillary intercanine sector. Psychometric instruments included the Psychosocial Impact of Dental Aesthetics Questionnaire and the Rosenberg Self-Esteem Scale. Statistical analysis comprised multiple linear regressions. Malocclusion severity is the most important predictor of psychosocial influence of smile aesthetics and self-esteem, the unique contribution of which accounts for a total of 4-27% of variability. Female gender is associated with higher psychological influence of dental aesthetics while male gender and older age with self-esteem. Malocclusions have higher psychosocial impact than parameters of mini- and micro-aesthetics of smile related to visibility of buccal corridors, amount of teeth exposure, gingival display, lip thickness, presence of occlusal cant and deviation from golden proportion of the teeth. It appears that people are not as focused on details of their smile as they are on distinctive malposition of teeth.