Evaluation of the Relationship between Subjects? Perception and Professional Assessment of Esthetic Treatment Needs

General dentists' treatment plans in response to cosmetic complains; a field study using unannounced-standardized-patient

Background

This field study explored general dentists' treatment plans in response to the request for cosmetic services of an unannounced standardized patient (USP) in Mashhad, Iran.

Methods

The researcher, as a USP, visited 24 and 23 offices in a high-income and a low-income area, respectively. The primary complaint was that, according to her friend's comments, a dental student, her smile was "crooked and yellow" due to the congenitally missing tooth number 10 and peg-shaped tooth number 8. The dentists' treatment plans for teeth color and form and the cosmetic services expenses were recorded. The treatment plans of the two areas were compared.

Results

For dental form, most dentists' treatment plans were categorized as "No intervention" (privileged area: 37.5 %, less-privileged area: 56.53 %, and total: 46.80 %). The percentage of dentists in the privileged area who prescribed cosmetic services was twice that of the less-privileged area (33.33 % versus 17.39 %). The intervention for dental form varied from placing 1 unit of composite veneer to 10 units of ceramic laminates or orthodontics with a wide range of treatment costs ($42.09 to $1079.14). For tooth color, most dentists (privileged area: 62.50 %, less-privileged area: 30.43 %, and total: 46.80 %) were categorized as "Interventionists." For tooth color, the treatment plans varied from scaling and root planing, bleaching, and composite veneer with various costs ($7.19 to $197.84).

Conclusion

Cosmetic treatment plans and expenses varied significantly for a single USP, with many not aligning with the standard treatment plan. Some dentists offered treatments even without a chief complaint from the patient. Dentists in privileged areas were twice as likely to prescribe cosmetic treatments compared to those in less privileged areas. Therefore, cosmetic services necessitate monitoring, establishing clear diagnostic criteria, and implementing educational interventions.

The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants' demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants' ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were "cannot be treated" 99.3% and "non-surgical periodontal treatment" 67.1%. Meanwhile, the least reported was "modify the porcelain" 41.8%. The most reported cause of BT was "periodontal disease" 85.1%. However, the least reported were "parafunction" and "deep implants" 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = -0.034, P = 0.475) or treatment (r = -0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Evaluating smile aesthetic satisfaction and related smile characteristics in dental students

Aim

This study aimed to assess the association between self-rated smile satisfaction and the smile dimensions among dental students.

Method

An analytical cross-sectional study was conducted on 216 Vietnamese dental students. A standardized photograph was taken of each student with their frontal social smiles to assess aesthetic dimensions. A single-session self-administered questionnaire containing five questions about smile aesthetic satisfaction related to various aspects was administered to all students. Differences in smile characteristics and satisfaction scores between the two genders were evaluated. The impact of smile characteristics on satisfaction scores was assessed using multiple linear regression models.

Results

Most dental students had a high smile line, parallel smile arcs, an upward upper lip curvature, a non-touching labiodental relationship, a dental midline that coincided with the midline of the face, and eight teeth displayed during smile. Most participants were satisfied with their smiles, and the self-rated satisfaction score was 67 out of 100. Self-perceived overall smile satisfaction was associated with the "smile arc", the "upper lip curvature", the "number of teeth displayed during smile", and the "dental midline". Female students had a statistically significant correlation between self-perception and smile characteristics, such as upper lip curvature, dental midline shift, and smile line.

Conclusions

The smile arc, upper lip curvature, and dental midline shift affected self-perceived satisfaction among dental students. Female students showed an association between the smile parameters and self-perceived satisfaction.

Extra-oral assessment of conventional and CAD-CAM complete denture appearance by dental professionals and CRDP wearers: A randomized survey

INTRODUCTION

Complete removable dental prostheses' (CRDPs) appearance may vary between conventional and contemporary CAD-CAM manufacturing techniques.

OBJECTIVES

The aim of this randomized survey was to analyze appreciation of CRDPs, manufactured with different techniques, by dental professionals and elder CRDP wearers.

METHODS

Four participant groups, comprised of undergraduate students (n=10), postgraduate residents (n=10), dental technicians (n=10) and elder CRDP wearers (n=10), evaluated the appearance of maxillary CRDPs manufactured by six different techniques: three conventional methods 1. flask-pack-press (FP), 2. Injection-molded (IM), 3. intrinsically colored natural gingiva finish before injection-molded (NG) and three CAD-CAM methods 4. milled base with bonded prefabricated teeth (M), 5. fully milled including milled teeth (FM) and 6. rapid-prototyped including printed teeth (P). A randomized, blinded survey included 18 pairwise comparative assessments and 12 individual judgements of the CRDPs on general appearance as well as pink and white aspects. Statistical analyses included parametric- and nonparametric tests as well as linear regression models; the level of statistical significance was set at p<.05.

RESULTS

NG was preferred by the professional groups but not by the elder CRDP wearers (p<.05). P was scored lowest by all four participant groups (p<.05). CRDP wearers' ratings were less severe and within a narrower range. The ratings of the two CAD-CAM milled CRDPs (M and FM) were ranked closer to FP and IM); the order of preference was different depending on the participant groups.

CONCLUSIONS

The findings of this study revealed marked differences in the assessment of CRDP appearances between dental professionals and older CRDP wearers.

CLINICAL SIGNIFICANCE

A shared and informed approach to decision making concerning the CRDP appearance might foster denture acceptance and treatment success.

Normative and subjective need for dental prosthesis: accuracy and agreement in a population based-study

The aim of our study was to compare normative need for dental prosthesis (estimated by dentists) with subjective need (self-reported) by testing the accuracy and agreement and comparing direction and magnitude of associations with independent variables using both as outcomes. A representative sample of a birth cohort study (n = 900) was assessed at 31 years of age. Subjective need was obtained from questionnaire. Both normative and subjective need variables were dichotomized in (a) individuals with need for dental prosthesis and (b) without need for dental prosthesis. Accuracy was assessed by sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values. Agreement of normative and subjective need was assessed estimating kappa index. Sex, income, educational level, use of dental services and self-reported oral health were used to compare the associations with normative and subjective need. Prevalence of normative need was 48.9% and subjective need was 34.9%. Agreement (kappa: 0.43) and accuracy between normative and subjective need for dental prosthesis was low (SE: 56.5, 95%CI: 50.3-62.6; SP: 85.8, 95%CI: 81.1-89.7; PPV: 79.1, 95%CI: 72.6-84.7; NPV: 67.3, 95%CI: 62.1-72.2). When considering individuals with loss in anterior teeth, results showed a good agreement (kappa: 0.82) and accuracy between normative and subjective need (SE: 93.3, 95%CI: 68.1-99.8; SP: 88.9, 95%CI: 51.8-99.7; PPV: 93.3, 95%CI: 68.1-99.8; NPV: 88.9, 95%CI: 51.8-99.7). Direction and magnitude of associations with normative and subjective need were similar. Thus, normative need for dental prosthesis differs from subjective need in adults, except when anterior losses are present.

Perception of orofacial appearance among laypersons with diverse social and demographic status

BACKGROUND

The perception of dentofacial esthetics differs considerably between patients and dentists. Patient's expectations regarding his/her esthetics are important and should be assessed ahead of any planning of esthetic treatment. The aim of this study was to explore the differences in perception of orofacial appearance by laypersons with different social and demographic status.

MATERIALS AND METHODS

Self-administered questionnaires were distributed to 400 subjects. The questionnaire comprised three parts; the first part addressed the demographic variables. The second part queried about dental prosthesis, orthognathic or plastic surgery, and/or ongoing or previous orthodontic treatment. The third part included the Arabic version of the-8-item Orofacial Esthetic Scale (OES-Ar) whose responses were scored in the 5-point Likert scale. These scores were compared by different grouping factors (age, gender, marital status, and education) using non-parametric Mann-Whitney U and Kruskal Willis tests with 95% confidence interval (α > 0.05).

RESULTS

A total of 268 questionnaires were eligible for analysis, representing 67% response rate. The satisfaction with facial profile appearance was the highest (4.0±1.1) followed by facial appearance (3.9±1.1), while the color of teeth was the least satisfying item (3.1±1.3). No significant differences were found between age groups for the mean summary score as well as for each item independently. No significant difference was found between both sexes except for the last item "overall impression". Married subjects rated one item (alignment of teeth) better than their counterparts. Positive perception of orofacial appearance increased significantly with the increase of education level, the perception of the oral health status, and the perception of the general health status.

CONCLUSION

Good oral health and/or high education level are significant determinants of more positive perception of orofacial esthetic appearance. Patients with these characteristics might be more concerned about their orofacial appearance, and this should be taken into consideration before planning any esthetic restorative dental treatment.

Measuring Patient’s Orofacial Estheticsin in Prosthodontics: A Scoping Review of a Current Instrument

Objective:

Although prosthodontic treatment is aimed at improving oral function, esthetics has become the most common motivation for treatment. To ensure successful outcomes, valid and reliable instruments for comprehensively evaluating the esthetic aspects of prosthodontic treatment from both clinician perspective and patient self-assessment are needed. The literature on measurement tools used in prosthodontics to evaluate orofacial esthetic aspects was also studied.

Methods:

A scoping review was conducted to map existing instruments such as a questionnaire, index, or scale designed to evaluate orofacial esthetics by clinician and patient for prosthodontic treatment.

Results:

Of the 27 studies evaluated, the Orofacial Esthetic Scale (OES) was used mostly for evaluating a patient’s esthetic perception. The ‘Dental Esthetic Screening Index’ (DESI) was found as the most currently developed instrument with objective quantification for the clinical situation having good reliability and validity. The Prosthetic Esthetic Index (PEI) also has sufficient psychometric properties as an objective assessment tool for clinicians. But the PEI and the DESI are still rarely used in research and practice. Teeth color and position were determined to be the most important factors in recognizing esthetic impairment. Following tooth analysis (appearance, color, alignment, space, proportion, and wear), gingival appearance, smile analysis, facial analysis, and unaesthetic restoration or prosthesis were the most important esthetic factors identified.

Conclusion:

Esthetics is subjective and is influenced by many factors. Instruments for subjective and objective evaluation are needed to determine the esthetic perceptions of clinicians and patients. OES, PEI and DESI were found to be relevant instruments for this.

The dental esthetic screening index: A new tool for assessment of dento-facial esthetics in restorative dentistry

OBJECTIVES

There is a lack of comprehensive indexes, which can measure conditions or changes in dento-facial esthetics before and after treatment. Therefore, the 12-item Dental Esthetic Screening Index (DESI) was developed and validated.

MATERIALS AND METHODS

Reliability was tested by five dental professionals, who evaluated 30 standardized patient photographs baseline and after 14 days. Clinical validation was done on 52 patients before and after restorative treatment. For subjective assessment, patients completed a validated questionnaire before and after treatment. Statistical analysis included inter and intrarater reliability, Wilcoxon test and linear regression analysis.

RESULTS

The single item analysis identified two weak extraoral items (κ = 0.15; κ = -0.05), that were removed from the DESI. After this modification, both inter- (κ = 0.83-0.86) and intrarater reliability (ICC_1-5 = 0.75-0.86) were in excellent to good agreement. In the clinical validation, the DESI was significantly lower after restorative treatment (P < .0001). The patients' perception questionnaires showed significant improvement after restorative therapy (P < .0001). A correlation of the DESI and the results of patients' perception questionnaires could be assumed (P < .0001; R² = 0.32).

CONCLUSIONS

The DESI was found to be a reliable and valid instrument for the quantitative assessment of dento-facial esthetics. It correlated well with the subjective assessment of the patients.

CLINICAL SIGNIFICANCE

This comprehensive index would allow for objective quantification of clinical situations, for reliable baseline and outcome assessment in esthetic dentistry. As patients' esthetic feelings and sensations are subjective, this objective index is also proven to be congruent to patients' individual subjective assessment of dento-facial esthetics.

The Ideals of Facial Beauty Among Chinese Aesthetic Practitioners: Results from a Large National Survey

Abstract

As the demand for cosmetic procedures increases, the importance of patient-centred care in this field becomes more prominent. The aesthetic practitioners’ ideals of beauty, in addition to their knowledge and perception of patients’ ideals of beauty and expectations, are important during doctor–patient communication. These are important in strengthening practices of patient-centred communication and treatment. This study was conducted to investigate ideals of facial beauty among Chinese aesthetic practitioners. A questionnaire with simple sketches of facial features was given to aesthetic practitioners in Chinese cosmetology hospitals and clinics to assess aesthetic practitioners’ ideals of beauty and their preferences for facial shapes, facial profile, nose and lip shape, jaw angle, and chin shape. A total of 596 surveys were completed. This survey revealed that Chinese aesthetic practitioners preferred a heart/inverted triangular facial shape with a reduced lower face height, a straight and small nose, as well as lips that are full medially and taper off laterally with well-defined borders and Cupid’s bow. An obtuse jaw angle for women and a square well-defined jaw angle for men, and a round and pointy chin for both women and men were the most preferred. A majority (66.7%) of the respondents said they would have plastic surgery. However, if given the choice 82.9% indicated they would opt for non-surgical procedures. Finally, a clear majority (90.5%) believed that being beautiful would improve their daily life. The results were then compared to a similar previous study in which the same ideals of beauty were investigated among Chinese laypersons. This information will help the aesthetic professionals to understand their patient’s requests and expectations better and therefore aid in offering and providing treatments that are in line.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of esthetic smile perceptions among male and female Indonesian dental students relating to the buccal corridors of a smile

Background: A smile constitutes a form of measurement as to whether or not an orthodontic treatment has proved successful. A smile is said to be ideal if a balance exists between the shape of the face and teeth. One benchmark used to assess the quality of an ideal smile is that of buccal corridors. These are formed of the black space between the lateral edge of maxillary posterior teeth and the corner of the lip which appears during the action of smiling. Evaluating the contrasting perceptions of male and female smiles based on buccal corridor aspects is considered important to identifying the specific qualities an ideal smile. Purpose: The purpose of this study was to determine the difference between the perceptions of an ideal smile held by Indonesian dental students of both genders based on buccal corridors. Methods: A total of 36 dental students, equally divided between male and female students and ranging in age from 18-21 years old, were enrolled in this study. The smiles of all subjects were photographed from the front for later assessment by the subjects themselves. Assessment was undertaken twice, with a two-week interval between the first and second, by comparing subjects’ photographs with reference pictures of buccal corridors. Data gathered were analyzed by using kappa-statistic and U-Mann Whitney. Results: The results indicated that all the subjects showed a good level of coincidence in their analysis (κ=0.76). Statistical analysis showed that the score of 0.123 (p>0.05) was shown in U-Mann Whitney. Conclusion: Indonesian male and female dental students have the same perception of an aesthetic smile with regard to its buccal corridor.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 2: Blinded Subjective Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations among lay people, general dentists, and prosthodontists, when evaluating images of patients wearing a maxillary denture with a labial flange in comparison to an experimental flangeless denture.

MATERIALS AND METHODS

A random sample of 20 maxillary edentulous patients from the original sample of 31 patients described in part 1 of the study was selected for this study. A total of 60 judges comprising 15 general dentists, 15 prosthodontists, and 30 lay people were recruited for subjective analysis. The judges were blinded about the objectives of the study and were asked to rate the facial esthetics of each image using a 100 mm visual analog scale (VAS) instrument. Four digital images per subject (total of 80 images) were evaluated in a random order, twice by all 60 judges. A repeated measures general linear mixed modeling method using restricted maximum likelihood estimation was performed using mixed procedure in a statistical software package to study the differences in evaluations.

RESULTS

The overall VAS ratings of facial esthetics for images with flangeless dentures were slightly lower compared to images with labial flanges, and this difference was statistically significant (p < 0.05). This was true for both profile and frontal images; however, the magnitude of the difference was too small (no greater than 4 mm on a 100 mm scale) to be clinically significant. There were no statistically significant differences in facial esthetics ratings irrespective of the background or gender of the judges.

CONCLUSIONS

Flangeless dentures resulted in slightly lower ratings of facial esthetics compared to images with a labial flange, but the differences were clinically insignificant. This was true for all judges comprising general dentists, prosthodontists, and lay people and for both frontal and profile images.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 4: Patient-Centered Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations and the ability to distinguish facial changes due to changes in lip support, when evaluated by patients themselves. An additional objective was to study the differences between patients' self-evaluation versus evaluation of other patients.

MATERIALS AND METHODS

A total of 22 maxillary edentulous patients from the original sample of 31 patients described in Part 1 of the study, returned to participate in this part of the study. The 22 patients acted as judges for all images in this study, and were therefore un-blinded to the objectives and details of the study. Patients first completed evaluation of facial esthetics on a visual analog scale (VAS). Four digital images per patient (total of 88 images) were evaluated in a random order, twice by all 22 patients. The mean scores from all judgments were used as the outcomes to be analyzed. All patients then took a discriminatory sensory analysis test (triangle test) where they were required to correctly identify the image with a flangeless denture out of a set of 3 images. Both the VAS and triangle test ratings were conducted twice in a random order, and mean ratings were used for all analyses.

RESULTS

For VAS analysis, there were no statistically significant or clinically significant differences in facial esthetics ratings between flange and flangeless dentures (p < 0.05). This was true for both profile and frontal images, irrespective of self-evaluation versus evaluation of other patients, years of patient edentulism, and judge (patient) gender. For the triangle test, frontal images had a correct identification rate of 50.2% and profile images of 50.4%, and the difference was not significant. There were no significant differences in triangle test results with respect to self-evaluation versus evaluation of other patients and judge (patient) gender. For all patients, the likelihood of correctly identifying images with flangeless dentures was significantly greater than 1/3, which was the minimum chance for correct identification (p < 0.0001).

CONCLUSIONS

Flangeless dentures resulted in no differences in facial esthetics ratings for frontal and profile images, when evaluated by patients. When patients were forced to look for differences, flangeless dentures were detected in half of the image sets. These findings were similar for self-evaluation versus evaluation of other patients and for both patient genders.

Subjective Differences between Dentists and Patients about Relative Quality of Metal Ceramic Restorations placed in the Esthetic Zone

INTRODUCTION

Esthetic perceptions could differ between the dentist and his patients among various regions and cultures.

AIM

The aims of this study were to evaluate the subjective differences between the dentist and the patient in terms of esthetics of metal-ceramic crowns (MCcs). The study also aims to compare the mesiodistal (MD) and buccolingual (BL) dimensions of the cemented crown with its respective natural antimeric tooth.

MATERIALS AND METHODS

A total of 85 patients seeking treatment for a single crown (MC) were treated by the undergraduate students under supervision of respective academic staff. After cementation of the crowns, a 9-point questionnaire was given to patient and different dentists. A treatment cast for every single crown was poured. Then, the MD and BL dimensions of the crowns were compared against their respective antimeric tooth.

RESULTS

The dentists and the patients agreed in the range of 50.5 to 90.5%. Least subjective differences were found for the length and width of the cemented crowns. The highest differences were noted for symmetry between the cemented crown and its antimeric natural tooth. A total of 31 to 38% of the patients differed from the dentist's evaluation for shade of the crown, color of the crown at the margin, contour of the crown, and the relationship of the crowns with the surrounding gingiva. The highest MD and BL dimensions were in the cemented crown of canines, while the lowest MD and BL diameters were for the cemented crowns of the lateral incisor crowns.

CONCLUSION

Dentist and patient mostly agreed in terms of length (90%), width (81%) and relation of crown with free gingiva (74%). However, they differed mostly on the symmetry of the cemented crowns. The highest MD dimensions and BL diameter were in the cemented MCcs of canine, while the lowest were with lateral incisors.

CLINICAL SIGNIFICANCE

While fabricating a dental prosthesis, the dentist must know about patients' perception of esthetics; otherwise both clinical and laboratory efforts would not be enough to satisfy the esthetic needs of the patient even if the restoration is technically correct. Perceptions related to symmetry differ mostly between dentist and patient.

Satisfaction with Dental Appearance and Attitude toward improving Dental Esthetics among Patients attending a Dental Teaching Center

AIM

The aim of this study was to evaluate the factors influencing the satisfaction of dental appearance and attitude toward treatments to improve dental esthetics among patients attending a dental teaching center.

METHODS

A questionnaire was used to collect data of four background variables among 450 patients attended a dental teaching center in the city of Irbid in Jordan. The questionnaire enclosed self-reported questions about the appearance of anterior teeth, received esthetic treatment and desired treatment for improving esthetics. Descriptive, multiple logistic regression and Chi-square tests were used for data analysis (p ≤ 0.05).

RESULTS

The 450 participants consisted of (66.2%) male and (33.8%) female. Of these, 69.3% were satisfied with their dental appearance and 58.0% with the color of their teeth. Esthetic restorations were the most received treatment (39.8%) and whitening of teeth was the most desired treatment (55.3%). The patients' satisfaction with dental appearance was influenced by teeth color, crowding and receiving whitening (p < 0.05. r = 0.561, r(2) = 0.315). The most desired esthetic treatments influenced by the satisfaction with dental appearance were esthetic restorations and orthodontics (p < 0.05. r = 0.223, r(2) = 0.05). Significantly more female reported having esthetic restorations and orthodontics (p = 0.008, 0.000) and desired to have orthodontic, crowns or veneers and esthetic restorations (p = 0.000, 0.015, 0.028).

CONCLUSION

Satisfaction with dental appearance was affected by teeth color, feeling teeth are crowded, desire for esthetic restorations and orthodontic treatment. A high percentage of patients were not satisfied with the color of their teeth.

CLINICAL SIGNIFICANCE

Recognizing the factors that affect patients' satisfaction with their present dental appearance and attitude toward treatments to improve dental esthetic can guide clinicians to strategies to improve esthetics.

Patient's Perception on the Esthetic Outcome of Anterior Fixed Prosthetic Treatment

OVERVIEW

Patient's perception to the esthetic result of the treatment received can be different from a dentist opinion. Understanding patient's opinion, demand and expectation is part of successful treatment procedure.

OBJECTIVE

The purpose of this study was to investigate patient's opinion about the esthetic result of the fixed prosthetic treatment received in upper anterior teeth.

MATERIALS AND METHODS

About 90 volunteer subjects, 58 males and 32 females were given a self-evaluation questionnaire with 11 questions to respond as Yes or No. The questions regarded the esthetic result of a fixed prosthodontic treatment received for their upper anterior teeth. The same questioner was completed for each subject by three clinicians through clinical photographs for different views of subject's smile. Agreement between patients and clinicians was calculated for all subjects to evaluate patient's perception to their esthetic results.

RESULTS

An agreement of 47.8 to 72.2% was observed between patients and clinicians, and the average agreement was 53.64 to 60%. The highest agreement was related to satisfaction with the color of the crown and/or bridge margin while the least agreement was related to the satisfaction with the natural looking of the restoration.

CONCLUSION

There was variability in the agreement between the patients and the dentists with the satisfaction of the esthetic result of anterior restoration. Factor, such as gender, age and educational level may affect the results of the agreement.

Instructional Design for Assessment of Dental Esthetic Treatment Needs in a Indian Undergraduate School: A Randomised Controlled Trial

In the recent years esthetic dentistry has been the area of focus amongst the public. Esthetics is an important dimension in dental practice and the upcoming dentists need to be enabled to demonstrate their competencies for an efficient clinical outcome. The purpose of this study was to institute a cultural change within traditional didactic dental education towards student centred learning to cope up with the accelerating pace of medical technological change and achieving positive impact on patient care and patient satisfaction. Intervention that was considered for the project included David Merrill's first principles of instruction. A randomized controlled trial was conducted with all the students from four cohorts of final year dental undergraduate students, divided into an intervention group (n = 40) and a control group (n = 40). A professional assessment questionnaire is used to evaluate the relationship between the students and professional's assessment of esthetic treatment needs. The results of the study indicated that the ranking of the most and least noticeable dental features differed significantly (p = 0.0061) between the intervention and non intervention group and the indicates the intervention group to be in better agreement with professional assessment than the non intervention group of students with z value of 2.7435. The relative agreement between intervention group of undergraduate students and the professional assessment of esthetic treatment need shows the importance of intervention of Merrill's first principles of instruction in learning, emphasising the significance of PBL and therefore indicating a positive impact on successful esthetic treatment for patients.

Influence of Gender on the Patient's Assessment of Restorations on the Upper Anterior Teeth

OBJECTIVE

The aim of this study was to assess the level of patients' satisfaction with appearance of maxillary anterior teeth restorations and to determine if there is a significant difference in patients' assessment of restoration appearance with regard to gender.

MATERIALS AND METHODS

Two hundred subjects evaluated the colour, anatomical shape and surface texture of maxillary anterior teeth restorations (composite fillings, acrylic faceted metal crowns, porcelain-fused-to-metal crowns and all-ceramic crowns) in comparison with adjacent natural teeth. The data were expressed in patients' average assessment scores for colour, anatomical shape and surface texture as well as overall patients' average assessment scores for every type of restoration and overall patients' average assessment scores for colour, anatomical shape and surface texture of all the restorations in general. Patients also assessed the general impression of their maxillary anterior teeth restorations and rated it as satisfactory or unsatisfactory.

RESULTS

There was a statistically significant gender difference in patient assessment of colour and surface texture for composite fillings and the overall patient average assessment score for colour of all assessments (p <0.05). Women were more dissatisfied with the general impression of their restorations on the upper teeth than men (p >0.05). Only overall patients' average assessment score for composite restorations almost reached the level of significance (p = 0.069) on patients' general impression.

CONCLUSION

Colour of the restorations and the composite material are significant factors which affect dental appearance of maxillary anterior teeth in patients.

Development of a new chewing function questionnaire for assessment of a self-perceived chewing function

OBJECTIVE

To develop a new unidimensional questionnaire for patients' self-assessment of their chewing function (chewing function questionnaire: CFQ) and to test its psychometric properties.

METHODS

A focus group of 7 dentists and 15 prosthodontic patients generated a pool of 30 relevant items. A 5-point Likert scale (0-4) was used. A focus group reduced some redundant items, and 21 items remained for pilot testing after which additional four items were eliminated. Then, the 17-item questionnaire was tested on a larger sample (200 participants). Factor analysis was obtained to investigate the dimensionality of the questionnaire. Finally the 10 items remained, and the CFQ was unidimensional. To test the psychometric properties, the CFQ was administrated to 224 individuals: 100 patients were already removable denture wearers (RDWs), 24 patients needed a removable prosthodontic treatment, and 100 individuals had natural teeth (NT group). Discriminative validity was tested between the RDWs and the NT groups. Convergent validity and internal consistency were tested on 200 subjects. The internal consistency was assessed by calculating the Cronbach's alpha coefficient and the average interitem correlation. The test-retest reliability was tested on 60 subjects. Responsiveness was tested on 24 patients who received new removable prosthodontic treatment.

RESULTS

The initial factor analysis revealed that the items had been grouped in three different dimensions. By eliminating items with complexities greater than one, additional six questions were eliminated. One more item with the lowest correlation was further eliminated. The final questionnaire included 10 items. Discriminative validity showed significant differences between the NT group and the RDWs, as predicted (P < 0.001). Convergent validity was confirmed by the Spearman's rank correlation. A significant positive association (P < 0.001) was found between the CFQ and one general question about chewing difficulties, as well as between the CFQ and five items from the OHIP49 related to chewing. The test-retest reliability showed high intraclass correlation and no significant differences between the two administrations of the CFQ (P > 0.05). The internal consistency showed satisfactory Cronbach's alpha values (0.916 for all subjects, 0.742 for the NT group, and 0.852 for the RDWs). Responsiveness was confirmed by a significant difference between the baseline and the follow-up score (P < 0.001) and a high effect size (0.95).

CONCLUSIONS

The developed CFQ provides an assessment instrument of the hypothetical construct invoked to explain the chewing function. Psychometric properties are satisfactory demonstrating that the instrument is suitable for the assessment of a self-perceived chewing function.

Influences of age and maxillary anterior teeth status on patient's satisfaction with dental appearance and tooth colour

OBJECTIVES

To study the impact of age, gender, tooth colour and maxillary anterior teeth status on patient's satisfaction with their dental appearance.

MATERIAL AND METHODS

A total of 259 Caucasian subjects participated in the study (119 men, mean age 56 years; 140 women, mean age 61 years) divided into three age groups (young <35 age; middle aged 35-54 age; old ≥55 age). Their maxillary anterior teeth status was classified into three groups: (1) natural teeth (NTG) group; (2) composite filling group (CFG) and (3) porcelain-fused-to-metal fixed prosthodontic restoration group (FPDG). The participants judged appearance and tooth colour using a scale with three categories: completely dissatisfied, moderately dissatisfied and completely satisfied.

RESULTS

Almost half of the participants were completely satisfied with their dental appearance and tooth colour. Half of the 'young' and 'middle-aged' participants with natural maxillary anterior teeth were completely satisfied and half of the 'old' participants were moderately satisfied with their dental appearance and tooth colour. The majority of participants with composite restorations (45-51%) were moderately satisfied with their dental appearance, one-third of 'young' and 'middle-aged' participants were moderately satisfied or dissatisfied with their tooth colour and more than 70% of older participants were dissatisfied with their tooth colour (p > 0.05).

CONCLUSIONS

Satisfaction with the appearance of the maxillary anterior teeth differed both between individuals of different age and different dental status.

Influence of esthetic dental and facial measurements on the Caucasian patients' satisfaction

PURPOSE

The purpose of the present study was to investigate how some esthetic dental and facial measurements may correlate the variability of patients' ratings of their satisfaction with the maxillary anterior teeth appearance in different gender groups.

MATERIALS AND METHODS

The following measurements were made on 78 Caucasian subjects: width and length of each maxillary anterior tooth, their distal gingival zenith displacements, the upper lip height, intercommisural width, maximum maxillary central incisal, and gingival display at rest and smile. All the patients rated their satisfaction with the dental appearance on the visual-analogue scale (0 meaning absolute dissatisfaction, whereas 4 indicated complete satisfaction). All the parameters have been analyzed with respect to gender.

RESULTS

The majority of the esthetic dental and facial measurements were larger in men (p<0.05). The great majority of the participants were completely satisfied with their dental appearance (75% of men and 89% of women; p>0.05). In the men, the two factors of maximal maxillary incisal display at rest and intercommisural width at smile paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05). In women, the combination of central incisor width/length ratio, intercommisural width at rest, central incisor gingival zenith displacement, intercommisural width at smile, upper lip height, and maximum maxillary incisal display at rest paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05).

CONCLUSIONS

Within the population tested, the results suggest that the use of esthetic dental and facial measurements may serve as an esthetic guideline and should be considered in esthetic anterior oral rehabilitation.

CLINICAL SIGNIFICANCE

The information presented in this article may be useful in helping to create dental restorations with an acceptable esthetic appearance to the patient. Prior to the treatment the dentist should consider not only the size of maxillary anterior teeth but also their gingival architecture and the soft tissue surrounding the teeth.

Patients' and dentists' perception of dental appearance

The purpose of this study was to compare the patients' and dentists' perception of dental appearance. Based on internationally accepted guidelines about dental esthetics, a questionnaire was developed to measure "dental appearance" (QDA). Eleven items defined a QDA sum score (0 = "absolutely satisfied", 44 = "absolutely dissatisfied"). The QDA was completed by 16 patients (eight women, eight men, mean age 63 ± 9 years) before and after a complete oral rehabilitation. Forty-two dentists evaluated the esthetics before and after rehabilitation on a visual analog scale (VAS, 0 = "absolutely unesthetic", 100 = "absolutely esthetic"). The patients' quoting showed a significant esthetic improvement (QDA sum score) from 22 before treatment to 3.5 after treatment (P ≤ 0.001). Although most of the dentists judged an improvement in most of the patients dental appearances, no significant correlation could be found between patients' and dentists' judgment regarding dental appearance (r = -0.13-0.53, P > 0.05). When evaluating the influence of age, gender, and experience on rating dental appearance, no significant differences (P > 0.05) could be found.

Changes in patient evaluation of completed orthodontic esthetics after dental bleaching

As dental professionals, we tend to assess separately different treatment modalities; our patients, however, may only be aware of the total outcome, not discerning the contribution from each treatment. Orthodontists focus on dentoskeletal positioning, usually leaving other areas of esthetics such as tooth shade to other dental colleagues. Laypeople may not see the same differentiation. We suggested that patients would be more pleased with their orthodontic outcomes when cosmetic bleaching was done afterwards, not discriminating between the benefits derived from orthodontics alone and those derived from bleaching. Seventy-five orthodontic patients were selected for the study. Two experimental groups underwent different bleaching protocols, while the third control group received no bleaching. A visual analog scale questionnaire evaluating different aspects of their orthodontic outcome was given to each participant 2 days after treatment and again 1 month later. The first survey was filled out prior to the bleaching procedure, while the second survey was post bleaching. None of the participants were informed that the questionnaire was related to the bleaching. A calibrated photospectrometer was used to measure the dental shade prior to bleaching and again at 1-month follow-up. The two bleached groups had significant shade improvement and a significant overall increase in their orthodontic evaluation, while the patients in the control group displayed a decrease in their assessment of their orthodontic treatment. Altering smile esthetics through bleaching does not change any of the parameters that orthodontists strive to correct, yet it has a positive effect on the patients' perception of previous orthodontic treatment.

CLINICAL SIGNIFICANCE

Patients are more satisfied with previous orthodontic treatment when it is coupled with cosmetic bleaching. When providing multidisciplinary treatment, we dental professionals may tend to assess the outcome of each segment separately. To patients, however, there is an additive effect, and their opinion is based on the overall composition of the outcome.