Patients' and dentists' perception of dental appearance

Osseo-integration potential of zirconia versus titanium implants

The success of dental implants depends on osseo-integration because titanium (Ti) maintains good mechanical stability while zirconia (Zr) prevents bacterial adhesion. The early-stage adhesion of MG-63 osteo-blast-like cells to Ti surfaces reached 78% ± 2.5% during the initial period (p<0.05). However, Zr demonstrated superior long-term cell proliferation and mineralization throughout the analysis period (p<0.05). The alkaline phosphatase (ALP) levels at day 7 remained comparable between Ti (1.25 ± 0.09 U/mL) and Zr (1.18 ± 0.07 U/mL) while Zr showed better growth of mineralized surface at day 14. Nonetheless, additional testing using animal subjects are required to confirm Zr as a suitable substitute for Ti implants.

An Analysis and Validation Questionnaire-Based Survey in Hindi on the Psychosocial Effects of Pre-Treatment Aesthetic Dentistry from Delhi NCR

PURPOSE

One of the many tools used to assess several facets of oral health-related quality of life in individuals with dental aesthetic deficits is the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ). The PIDAQ, however, was created for orthodontic patients, who usually possess different aesthetic concerns than those receiving prosthodontic treatment.

AIM

Analyzing and confirming in Hindi the psychosocial effects of pretreatment dental aesthetics among patients in Delhi NCR is the study's main objective.

MATERIALS AND METHODS

The survey was conducted with 323 participants, ranging in age from 18 to 70 years, with a balanced gender distribution. The inquiries centred on the perceived psychosocial effects of aesthetic prosthodontic therapies being received by all individuals.

RESULT

The comparative evaluation of the mean and standard deviation for dental self confidence, social impact, psychological impact, and aesthetic concern parameters, respectively, are 14.6423, 7.0307, 5.3344; 3.6503; 68727, 2.02575, 3.26876, and 1.36115.

CONCLUSION

Dental aesthetics have a profound psychosocial influence on prosthodontic patients, influencing their self-esteem, social interactions, emotional well-being, and professional success. By addressing aesthetic concerns through prosthodontic interventions, patients can experience profound improvements in their overall quality of life.

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.

Development and psychometric properties of the Turkish version of the Orofacial Esthetic Scale

OBJECTIVE

This study aimed to develop the Turkish version of the Orofacial Esthetic Scale (OES-Tr) and to evaluate its psychometric properties.

MATERIALS AND METHODS

The OES-Tr questionnaire was obtained from the English version of OES by translation and back-translation. The current version's psychometric properties were evaluated in a cohort of 221 participants (81 dental students, 70 dentists with 1-10 years of clinical experience, and 70 dentists with 11-20 years of clinical experience). To assess the test-retest reliability, the OES was administered twice to all participants, with a time interval of 2-4 weeks. The reliability and validity of the questionnaire were assessed. Also, in validity studies, OES total scores were correlated with Oral Health Impact Profile-Turkish Version (OHIP-Tr) total scores.

RESULTS

The Cronbach's alpha value obtained from seven items was 0.866 in the examination performed on all individuals. Reliability results show that all questionnaire items are consistent within the test. Bartlett's test of sphericity was statistically significant (p < 0.05) and Kaiser-Meyer-Olkin test was 0.794. The results of the exploratory factor analysis indicated the creation of a single-factor structure. The examinations conducted on all participants revealed a statistically significant weak negative correlation between OES and OHIP scores (r = -0.144).

CONCLUSIONS

OES-Tr can be utilized as a reliable tool to evaluate an individual's perception of their orofacial appearance. With its excellent psychometric properties, it serves as a valuable instrument for assessing self-perceived orofacial esthetics.

CLINICAL SIGNIFICANCE

OES-Tr is a valuable instrument for assessing the appearance of the orofacial region, with good psychometric properties.

Gingival Zenith Correction by Laser Gingivectomy

A healthy gingival structure showcases a knife-edged gingival margin, firmly adherent to the tooth surface, accompanied by a cone-shaped or pointed interdental papilla, mirroring the lowest point in the gingival margin, termed the gingival zenith. Tooth transposition denotes an anomaly in tooth positioning, commonly involving the canine and the first maxillary premolar. It represents a form of ectopic eruption, wherein two adjacent teeth interchange positions within the same quadrant of the dental arch. Laser wavelengths are utilized for precise incision of gingival tissues to address restorative, cosmetic, and periodontal needs. Post-operatively, rapid healing and diminished discomfort are frequently observed, often eliminating the necessity for periodontal packing or sutures. Gingivectomy is the accepted modality for the establishment of esthetics in situations with abnormal gingival contour. This study highlights the use of contemporary technology namely a 940 nm diode laser for correction of gingival zenith to achieve optimal esthetics post orthodontic treatment.

Perceived esthetics and value of clear aligner therapy systems: A survey among dental school instructors and undergraduate students

OBJECTIVE

To investigate the attractiveness, acceptability, visibility and willingness-to-pay for clear aligner therapy (CAT) systems in first-year and final-year dental students and instructors.

METHODS

A questionnaire designed to collect information regarding esthetic preferences and intentions related to seven CAT systems was handed out to 120 undergraduate students and instructors at the Academic Centre for Dentistry Amsterdam (ACTA). Proportional odds models and population average generalized estimating equation models were used to examine potential association between participant characteristics, esthetic perceptions and CAT systems.

RESULTS

Overall, the examined CAT systems received favorable esthetic ratings. Expertise status was significantly associated with willingness-to-pay additionally for CAT, compared to fixed orthodontic appliances. There was no association between sex, previous orthodontic treatment history, satisfaction with own dental appearance and potential interest in treatment and aligner visibility and willingness-to-pay. CAT system was significantly associated with the perceived aligner visibility, acceptability and attractiveness by students and instructors.

CONCLUSIONS

CAT systems were considered to a great extent attractive and acceptable for future treatment by dental school instructors and students. Willingness-to-pay for CAT systems was significantly associated with expertise status, with instructors appearing more reluctant to pay for CAT.

Development and validation of the Italian version of the Orofacial Esthetic Scale (OES-I)

OBJECTIVE

To develop an Italian version of the Orofacial Esthetic Scale (OES-I), validated in a prosthodontic and non-prosthodontic patients' cohort, for clinicians and researchers to use in their practice.

MATERIALS AND METHODS

The OES-I was obtained with a process of translation and back translation from the English version of the questionnaire (OES-E). The psychometric properties of the obtained version were then observed in a group of 70 prosthodontic and 70 non-prosthodontic patients. Validity (discriminative and convergent) and reliability (internal and external) were measured. Also, CFA (confirmatory factor analysis) was run, and several models were obtained.

RESULTS

The OES-I scores were much higher for patients who were not scheduled for an esthetic prosthodontic treatment (p < 0.05); similarly, the same analysis conducted by a clinicians provided similar results (Pearson's coefficient = 0.93, p < 0.05). Reliability results show that the different items of the questionnaire are consistent within the test (Cronbach alpha = 0.93) and that the obtained results are stable within a reasonable time period (test-retest reliability = 0.98). The Final CFA model showed that OES score can properly characterize orofacial esthetic.

CONCLUSIONS

The OES-I is a reliable means both for clinicians and researchers to assess patients' self-perceived esthetic.

CLINICAL RELEVANCE

The OES-I can be used effectively for measuring the self-perceived esthetic appearance in all areas of dental practice and research.

Influence of Practitioner-Related Placement Variables on the Compressive Properties of Bulk-Fill Composite Resins-An In Vitro Clinical Simulation Study

Aims: To determine if restoration location and/or execution behavior force parameters have an influence on the mechanical properties of bulk-fill composite dental restorations. Methods: Pressure transducers were placed within each quadrant of dental mannequin jaws. Cylindrical molds were placed above the transducers and filled with two bulk-fill composite materials, Filtek and Tetric, by four experienced dentists. Each dentist prepared five specimens per quadrant and material. The total placement time, mean force, number of peak forces (above 25 N), and mean peak(s) force during placement were measured. Then, the stiffness and maximal compressive strength of the specimens were determined while loading the specimens up to failure using a universal loading machine. Results: Placement time was affected by jaw (p < 0.004) and side (p < 0.029), with the shortest time demonstrated for the left side of the mandible. Force exerted during restoration placement was not normally distributed without differences in location (jaw) or material. A higher application force was found on the right side (p < 0.01). The number of peak forces was affected by side (p < 0.03), with less peaks on the left side. No significant differences were found in compressive strength when correlated to restoration location, participant, or material (p = 0.431). The stiffness values of Filtek (3729 ± 228 N/mm) were found to be 15% higher than Tetric (3248 ± 227 N/mm) (p < 0.005). No correlations were found between the compressive strength or stiffness and the amount of force applied during placement. Conclusions: The individual restoration material placement parameters did influence practitioner performance; however, these differences did not affect the mechanical properties of the final restoration.

Development of a one-item version of the Orofacial Esthetic Scale

OBJECTIVES

Orofacial appearance is increasingly recognized as an important dental patient-reported outcome making instrument development and refinement efforts to measure the outcome better necessary. The aim of this study was to derive a one-item version of the Orofacial Esthetic Scale (OES).

MATERIALS AND METHODS

OES data were collected from a consecutive sample of a total of 2113 adult English- or Spanish-speaking dental patients from HealthPartners dental clinic in Minnesota. Participants with missing data were excluded and analysis were performed using data from 2012 participants. Orofacial appearance was assessed with the English and the Spanish language version of the OES. Linear regression analysis was performed, with the OES item 8 ("Overall, how do you feel about the appearance of your face, your mouth, and your teeth?") as the predictor variable and the OES summary score as the criterion variable, to calculate the adjusted coefficients of determination (R2).

RESULTS

The value of adjusted R2 was 0.83, indicating that the OES item 8 score explained about 83% of the variance of the OES summary score. The difference in R2 scores between the two language groups was negligible.

CONCLUSION

The OES item 8 can be used for the one-item OES (OES-1). It is a psychometrically sound instrument for measuring orofacial appearance.

CLINICAL RELEVANCE

Due to its easy application and sufficient psychometric properties, the OES-1 can be used effectively as an alternative to longer OES instruments in all areas of dental practice and research.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background:

Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment

Objectives:

The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations.

Participants, Materials, and Methods:

The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic.

Results:

The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P < .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02).

Conclusion:

The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

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.

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.

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.

Preserving esthetics, occlusion and occlusal vertical dimension in a patient with fixed prostheses seeking dental implant treatment

The preservation of esthetics and occlusal vertical dimension is critical in patients with existing full-arch tooth-retained fixed prostheses. This clinical report describes the provision of a maxillary immediate complete denture in a patient with a maxillary full-arch fixed dental prosthesis over nonviable teeth. The existing fixed dental prosthesis was used in the fabrication of the maxillary immediate complete denture to preserve esthetics. The technique involved recording and preservation of the occlusal vertical dimension and occlusion of the existing prosthesis. The technique is simple, quick, cost-effective and less challenging clinically and technically.

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.

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.

The shortened dental arch revisited: from evidence to recommendations by the use of the GRADE approach

Clinicians must frequently decide whether or not to treat patients with loss of posterior teeth, a condition called the shortened dental arch (SDA). Although many studies have been reported, there are no clear recommendations for the management of SDA cases. In this work, therefore, an innovative system, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, was used to grade the evidence and strength of recommendations for clinical intervention. An extensive literature search for longitudinal studies was conducted on 17 November 2010 in the PubMed and LILACS electronic databases using the term shortened dental arch. A 'snowballing' strategy, for example, manual searching of the reference lists of included papers, was also conducted. Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine 'Google' (Scholar) in English, French, German, Italian, Portuguese and Spanish. Finally, grey literature was searched in OpenSIGLE (System for Information on Grey Literature in Europe). Titles and abstracts of 133 articles were initially assessed. Nine studies were finally included. Although there was no difference between the effectiveness of restorative and non-restorative approaches for SDA, fixed partial dentures seem better than removable prostheses. The overall body of evidence was, however, graded as low quality. Two different clinical scenarios are used to illustrate recommendations in the management of SDA cases by the use of the GRADE system. The GRADE approach may improve transparency in a shared decision-making process, mainly under conditions in which the quality of evidence is low or unclear.