Perception of general dentists and laypersons towards altered smile aesthetics

Effects of facial forms and midline deviations and rolls on female facial beauty according to laypeople, orthodontists, and prosthodontists or restorative dentists

No study has examined the simultaneous effect of facial forms, midline deviations and midline angulations on facial beauty. Therefore, this comprehensive study aimed to evaluate these and many other hypotheses. This psychometric study was performed on 15,042 observations. A female frontal photograph was edited to 45 perceptometric images with controlled anatomical alteration: 3 facial forms (euryprosopic [brachyfacial], mesoprosopic [mesofacial], leptoprosopic [dolichofacial]), each having either 9 bidirectional midline deviations (0, 1, 2, 3, and 4 mm deviated to the left and right) or 7 bidirectional midline angular deviations (0°, 5°, 10°, and 15° deviated to the left and right). One of the photographs were repeated. These 46 images were esthetically judged by 327 participants (243 laypeople, 49 orthodontists, and 35 'prosthodontists or restorative dentists'). Hierarchical mixed-model multiple linear regressions and post hoc tests were adopted to evaluate the simultaneous impacts of the photomodel's facial forms, midline deviations to the right or left, and midline rolls to the right or left plus sex, age, experience, and dental specialty of the referees on their perception of facial beauty as well as the tolerable zones of midline alterations. These were also done separately for each specialty group, and also for each facial face. Ideal combinations of anatomic features were determined using repeated-measures ANOVAs. Differences between esthetic preferences of different groups in terms of each image were assessed using one-way ANOVAs and t-tests (α = 0.05, α = 0.008, α = 0.001). All 5 anatomical features significantly and independently influenced perception of facial beauty. The tolerance threshold for midline deviations was 1 mm deviations to the right and left sides. For midline rolls, the only tolerable form was the no-roll ('on') midline; the judges preferred right-oriented defects over left-sided ones. The most beautiful facial form was mesoprosopic, followed by leptoprosopic. Men perceived the female face slightly more attractive than did women. The viewers' specialty (or lack of it), their age, or their experience did not affect their esthetic preferences. Predictors of esthetic preferences were all 5 anatomical features plus views' sex, but not their dental specialty, age, or experience. Zones of acceptability and also the ideal range of anatomical features were determined.

Perception of dental appearance and aesthetic analysis among patients, laypersons and dentists

BACKGROUND

Current concepts of beauty are increasingly subjective, influenced by the viewpoints of others. The aim of the study was to evaluate divergences in the perception of dental appearance and smile esthetics among patients, laypersons and dental practitioners. The study goals were to evaluate the influence of age, sex, education and dental specialty on the participants' judgment and to identify the values of different esthetic criteria. Patients sample included 50 patients who responded to a dental appearance questionnaire (DAQ). Two frontal photographs were taken, one during a smile and one with retracted lips. Laypersons and dentists were asked to evaluate both photographs using a Linear Scale from (0-10), where 0 represent (absolutely unaesthetic) and 10 represent (absolutely aesthetic). One-way analysis of variance (ANOVA) and t-test analysis were measured for each group. Most patients in the sample expressed satisfaction with most aspects of their smiles and dental appearance. Among laypersons (including 488 participants), 47 pictures "with lips" out of 50 had higher mean aesthetic scores compared to pictures "without lips". Among the dentist sample, 90 dentists' perception towards the esthetic smile and dental appearance for photos "with lips" and "without lips" were the same for 23 out of 50 patients. Perception of smile aesthetics differed between patients, laypersons and dentists. Several factors can contribute to shape the perception of smile aesthetic.

AIM

To compare the perception of dental aesthetic among patients, laypersons, and professional dentists, to evaluate the impact of age, sex, educational background, and income on the judgments made by laypersons, to assess the variations in experience, specialty, age, and sex on professional dentists' judgment, and to evaluate the role of lips, skin shade and tooth shade in different participants' judgments.

METHODS

Patients sample included 50 patients who responded to DAQ. Two frontal photographs were taken: one during a smile and one with retracted lips. Laypersons and dentists were asked to evaluate both photographs using a Linear Scale from (0-10), where 0 represent (absolutely unaesthetic) and 10 represent (absolutely aesthetic). One-way ANOVA and t-test analysis were measured for each group.

RESULTS

Most patients in the sample expressed satisfaction with most aspects of their smiles and dental appearance. Among laypersons (including 488 participants), 47 pictures "with lips" out of 50 had higher mean aesthetic scores compared to pictures "without lips". Whereas among the dentist sample, 90 dentists' perception towards the esthetic smile and dental appearance for photos "with lips" and "without lips" were the same for 23 out of 50 patients. Perception of smile aesthetics differed between patients, laypersons and dentists.

CONCLUSION

Several factors can contribute to shape the perception of smile aesthetic.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial

BACKGROUND

Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation.

METHODS

Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction.

RESULTS

Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients.

CONCLUSIONS

Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Long-term vertical stability of horseshoe osteotomy for the correction of large vertical excess of the maxilla, a retrospective assessment in 15 patients

INTRODUCTION

Vertical stability after a Le Fort I (LF1) osteotomy with substantial upward movement can be compromised by the position and the volume of the inferior turbinate. A horseshoe (HS) osteotomy represents then an alternative as it preserves the hard palate and the intranasal volume. The aim of this study was to assess the vertical stability of the maxilla after HS osteotomy.

MATERIALS AND METHODS

Patients who underwent a HS osteotomy for the correction of long-face syndrome were retrospectively analyzed. The vertical stability was assessed on lateral cephalograms performed preoperatively (T0), immediately postoperatively (T1), and at the last follow-up (T2) by studying points C (the distal cusp of the first maxillary molar), point P (the prosthion, the lowest edge of the maxillary alveolus of the central incisor), and point I (the upper central incisor edge) in a coordinate system. Postoperative complications and aesthetics of the smile were also investigated.

RESULTS

Fifteen patients were included (7 females, 8 males, mean age 25.5 ± 9.8 yeras). The mean impaction ranged from 5 mm on point P to 6.1 mm on point C, with a maximal movement of 9.5 mm. A non-significant relapse of 0.8 ± 1.7, 0.6 ± 0.8, and 0.5 ± 1.8 mm was observed after a mean 20.7 months on point C, P, and I respectively. Smile parameters were significantly improved by the procedure, mainly regarding the correction of the gum smile.

CONCLUSION

HS osteotomy represents a good alternative to total LF1 osteotomy for substantial maxillary upward movement in long face syndrome deformities.

Effect of the ethnic, profession, gender, and social background on the perception of upper dental midline deviations in smile esthetics by Chinese and Black raters

BACKGROUND

The purpose of this study was to compare the perception of upper dental midline deviation on the attractiveness of a smile among raters from different ethnicities, professions, genders, and ages and measure to what extent the presence or absence of the associated smiling structures influence the raters' evaluations.

METHODS

A male subject (26 years of age) with adequate smile characteristics was selected by 3 experienced orthodontists, and 561 raters from 2 different ethnic groups (281 Chinese raters and 280 Black raters) rated the subject's smile after the subject's upper dental midline was digitally altered from 0 to 5 mm using a 5-point Likert scale on 12 smile photographs divided into two groups: group 1, in the presence of smile related structures, two-thirds of the nose, lips, and chin (NLC), and group 2, in the absence of smile related structures, the lips only (L).

RESULTS

There were statistically significant differences (p < 0.05) between the two ethnicities, in 2 mm and 4 mm in-group NLC and 5 mm in-group L, as well as the raters' profession to each midline shift of both groups (NLC) and (L) for both ethnicities except for 0 mm. Regarding the role of associated smile structures, the smile photos were observed in the presence of smile-associated structures, and in its absence (NLC × L), statistically significant differences (p < 0.05) were found when the deviation was 5 mm among the Chinese raters; in 1 mm, and 4 mm among the Black raters. Among different genders, statistical differences were only reported (p < 0.05) for Chinese raters for 5 mm in NLC, while statistical differences were observed for 2 mm and 3 mm in NLC for Black raters. For age categories, differences were observed (p < 0.05) for 4 mm, 5 mm in NLC and 4 mm, and 5 mm in L for Chinese raters, while 5 mm in NLC and 1 mm in L for Black raters.

CONCLUSION

Perception of the upper dental midline deviations was influenced by the factors of ethnicity, profession, presence or absence of smile-associated structures, as well as the gender and age of the raters.

Maxillary Midline Diastemas in West African Smiles

The maxillary midline diastema (MMD) has experienced a renaissance in popular culture over the last 10 years. Current literature states that MMDs should be eliminated where possible or be reduced to 1 mm or less in width. This literature review explores the evidence for this in a West African population. A systematic search of the literature (Medline and Google Scholar) followed by a hand search was carried out to identify all papers evaluating perceptions of MMDs. In all, 209 papers were identified in the literature search, 8 of which met the inclusion criteria. The review revealed that midline diastemas are desirable in this specific population with a width of 2 to 4 mm deemed as attractive. As many as 95% of participants found the MMD beautiful, and as many as 95% would consider having one created artificially. The literature does not support the position that MMDs larger than 1 mm should always be treated to be perceived as attractive in this population. MMDs are accepted as attractive and should be considered a key feature in smile design for this population.

Influence of Lip Appearances and Tooth Shade on Smile Attractiveness Perception

This study determined the effect of lip thickness, lipstick color, and tooth shade on the smile attractiveness perceptions of dentists, laypersons, dental students, and other faculty students. A set of 27 smile photographs was prepared with different lip thicknesses (Tk, thick; M, medium; and Tn, thin), lipstick shade (R, red; P, pink; and O, orange), and tooth shades (0M1, 0M3, and A1). A total of 212 Thai participants in four rater groups (dentists, laypersons, dental students, and other faculty students) rated smile attractiveness using a visual analog scale (VAS). Statistical analyses were performed using the Kruskal-Wallis test and pairwise analysis at a 0.05% level of significance. Tk or M lip thickness was associated with more smile attractiveness than Th lip thickness. The R lipstick is more attractive than the P and O lipsticks. The 0M1 tooth shade appeared to be the most attractive for laypersons and other faculty students, whereas tooth shades (0M1, 0M3, or A1) did not influence the smile attractiveness perception of dentists and dental students. The smile attractiveness perception was influenced by the lip appearance and tooth shade for each rater group, which are essential for an attractive smile design.

Digitally Guided Workflow for the Esthetic and Prosthetic Oral Rehabilitation of a Patient with Excessive Gingival Display: A Case Report

This report describes the esthetic and prosthetic oral rehabilitation of a patient with excessive gingival display using a digital guided workflow. As per this digital workflow, the patient’s photographs, three-dimensional radiographic images, and a diagnostic digital intraoral scan were obtained. Preoperative digital case planning and designing were followed by the fabrication of surgical guides, printed casts, and matrices to accurately execute surgical esthetic crown lengthening and reproduce the digital design in the subsequent prosthetic rehabilitation.

Esthetic and functional rehabilitation of peg-shaped maxillary lateral incisors: Practical recommendations

Peg-shaped maxillary lateral incisors cause many functional and esthetic major consequences in affected patients. Their esthetic and functional rehabilitations are often multidisciplinary, involving different clinical procedures like periodontal, orthodontic, or prosthodontic procedures. No exhaustive protocol has been established to improve their comprehensive management by general dentists or specialists. The aim of this article is to elaborate a simplified clinical protocol of complete management of peg-shaped maxillary lateral incisors by a multidisciplinary team (general practitioners, orthodontists, and prosthodontists). A clinical case of two peg-shaped maxillary lateral incisors completely rehabilitated with multidisciplinary approaches including orthodontic treatment and restoration by veneers and direct composite resin, according to the established protocol. Extraoral, intraoral, and smile clinical analysis are crucial to ensure optimal rehabilitation. Treatment results previsualization via wax-up and/or mock-up play a key role in the communication between practitioner and patient to help the latter make decision. These options also facilitate the achievement of a multidisciplinary approach by accurately estimating the number of dental movements and the type of restorations that are most suitable to the presenting clinical situation.

The perceptions of preclinical and clinical dental students to altered smile aesthetics

Introduction

This prospective cohort study was designed to identify which components of a smile make it more or less aesthetically acceptable to dental students.

Aim

To investigate whether students at different stages of their undergraduate dental education held similar views on smile aesthetics. Additionally, to see whether students from the same ethnicity were more likely to have similar perceptions of smile aesthetics than students from different backgrounds.

Methodology

Dental students in either Year 1 (preclinical) or Year 5 (clinical) of their studies at the University of Bristol were asked to complete a questionnaire. Students were asked to rank 12 photographic images in order from most aesthetically pleasing (1) to least pleasing (12). The 12 images included one ‘ideal’ smile and 11 digitally altered images of the same “ideal” smile.

Results

A total of 123 questionnaires were completed. Clinical students were more likely to rank the ‘ideal smile’ as more aesthetically pleasing and identify it as the “best” smile from the set of images. Preclinical students considered retroclined incisors to be significantly less pleasing than clinical year students, whilst clinical year students found a midline diastema significantly less pleasing than preclinical students.

Conclusions

Dental students at different stages of their undergraduate dental education have different perceptions of smile aesthetics. There was no evidence that the perception of dental attractiveness was affected by students’ ethnicities or location of upbringing.