The effects of computer-aided anteroposterior maxillary incisor movement on ratings of facial attractiveness

The effects of maxillary incisor positions and chin prominences on the perception of lateral smiling profile attractiveness among orthodontists and laypersons

Objective

To evaluate the ideal anteroposterior position of incisors in lateral smiling profiles with different chin prominences and to relate these positions to nose and chin landmarks based on the perceptions of orthodontists and laypersons.

Methods

A lateral smiling profile image of a female subject was adjusted to create five levels of chin prominence (-6, -3, 0, +3, +6 mm). For each level, the anteroposterior positions of the maxillary incisors were adjusted across five positions (-4, -2, 0, +2, +4 mm). Thirty-six orthodontists and 36 laypersons rated the attractiveness of each profile using a visual analog scale. The maxillary incisor position (U1) was measured relative to the external nose and chin landmarks (E-lines). Differences in perceptions between orthodontists and laypersons were analyzed.

Results

For profiles with 6 and 3 mm chin retrusion, the most favored incisor positions were the 2 mm retrusion and unaltered positions, respectively. For the unaltered chin prominence, orthodontists preferred unaltered incisors, while laypersons favored 2 mm protrusion. Conversely, for 3 and 6 mm chin protrusion, both groups preferred 4 and 2 mm protrusion, respectively. The distance between U1 and the E-line is the most attractive images ranged from 8.5 to 11.5 mm. Based on the regression model, an optimal U1-E-line distance of 8.95 mm was recommended.

Conclusions

The preferred incisor position is influenced by chin prominence, with the incisor position shifting in the same direction as the chin. The U1 E-line can be a useful clinical tool for determining the proper incisor positioning. Esthetic perceptions were generally consistent between orthodontists and laypersons.

Extraction camouflage treatment of a skeletal Class III malocclusion with severe anterior crowding by miniscrews and driftodontics in the mandibular dentition

An 18-year-old Chinese woman presented with chief complaints of crowded teeth and mild mandibular prognathism. Clinical and imaging examinations revealed a concave profile, a protruded chin, increased lower anterior facial height mild, skeletal Class III and Angle's Class III malocclusion, with anterior crossbites, and crowded teeth. Extraction camouflaged therapy combined with miniscrews skeletal anchorage was employed to relieve crowding and retract the mandibular anterior teeth. The total active treatment time was 31 months. After treatment, functional occlusion and smile esthetics were significantly improved.

Placing the maxilla in the most aesthetic sagittal position: validation of several reference lines in relation to the forehead shape

The ideal sagittal position of the maxilla is highly subjective in orthognathic surgical treatment planning. There is no consensus on an analysis to predict the ideal sagittal position of the maxilla. The objective of this study was to determine the preferred maxillary position in relation to the forehead shape, in the Southern Chinese population. The maxilla position of eight patients was simulated based on Steiner's analysis (SA), glabella vertical (GV), Andrews' Element II (AE2), and the Barcelona reference (BR). The simulations were then used in an electronic survey, where respondents ranked the images for each patient from to 1-4 (most to least attractive). A total of 128 responses were collected from dental professionals and laypersons. The most preferred to the least preferred simulation was as follows (mean rank scores for the male and female patients in parenthesis): BR (males 2.06; females 1.98), GV (males 2.11; females 2.21), SA (males 2.59; females 2.40), and AE2 (males 3.24; females 3.41). There was no significant difference in the results according to the sex, age group, or profession of the respondents. The Barcelona reference and glabella vertical are useful in predicting the ideal maxillary position in patients with a flat forehead, and the Barcelona reference is the most preferred in patients with a rounded forehead.

Novel Parameter in Pre-Surgical Orthodontic Preparation: A Retrospective Study on the Role of the Upper Incisor Position and a Morphological Evaluation of the Anterior Nasal Spine

The position and inclination of the incisors play a crucial role in achieving optimal outcomes in orthodontic and orthognathic surgical treatment, given their impact on facial aesthetics. Background/objectives: Due to numerous distorting factors that affect the reliability of the ANB angle, the aim of the present work is to evaluate a more constant parameter over time, the anterior nasal spine (ANS), and explore whether aligning the incisal margin of the upper incisors with the anterior nasal spine could be a reliable indicator for achieving appropriate labial support in pre-surgical orthodontic preparation. Methods: From a pool of 500 cone beam computed tomography (CBCT) scans, 50 CBCT examinations displaying a Class 1 skeletal pattern (ANB = 2° ± 2°) with an intermediate (3.2-4 mm) or mixed (4-6 mm) sagittal maxillary position (MX), as determined by the 3D multiplanar total face approach (TFA), were selected and compared with CBCT examinations randomly chosen from the initial pool. Moreover, 12 landmarks were identified, and measurements were automatically obtained, using software, and recorded. Mean and standard deviation values were calculated for each sample. A comparison was made between the two samples, aligning the results with the morphological analysis of the anterior nasal spine and the sagittal position of the upper maxilla. Results: In Class 1 subjects, the distance between the incisal margin and the plane passed in relation to the anterior nasal spine should range between -1 mm and 1 mm, aligned with or slightly ahead of the anterior nasal spine or slightly ahead of this limit. Conclusions: The anterior nasal spine can serve as a reliable reference point for planning the position of the upper incisors, with excessive proclination or retroclination from this reference point deemed unacceptable.

Factors influencing the perception of profile beauty in Class III dental compensation: A comparative cross-sectional study according to three categories of assessors

INTRODUCTION

The main objective of this study was to evaluate the different factors influencing the perception of female profile facial beauty in Class III patients with protruded mandible that can be treated with orthodontic dental compensation: (1)severity of the protrusion, (2) the upper incisors inclination and (3) the presence of jawlines. The secondary objective was to determine if the rater's gender and profession played a role in the assessment of the preferred profile.

METHODS

A normal and smiling photographs of a female subject with normal facial and skeletal profile criteria were digitally manipulated to obtain 3 different mandibular sagittal positions: 0mm, +4mm and +8mm. Each position of the chin was evaluated with the presence or not of jawlines. In the smiling profiles, the same chin modifications were scored, and the maxillary incisor inclination was changed from 0 to +10 degrees with 5 degrees increments. A total of 320 raters (107 dentists, 103 orthodontists and 110 laypeople) scored the attractiveness of the different images using a Visual Analogue Scale. The limit of statistical significance was P<0.05. Generalized estimating equation (GEE) models were conducted to assess the predictors of variations in ratings within each set of photos, as well as the interactions of predictors where adjusted odds ratios (aOR) and their 95% confidence intervals were calculated and reported.

RESULTS

In the profiles without a smile, image +4mm chin (Class III treated by compensation) and image +8-mm mandible (Class III not treated) were selected as the most and least attractive images, respectively, by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). No significant difference was found between genders in this study.

CONCLUSIONS

Class III treated by compensation (+4mm) are more attractive than non-treated Class III (+8mm) by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). Orthodontists older than 50 years old are aware of the difficulty to treat a skeletal Class III and tend to accept it due to their long career experience. No significant difference was found between genders in this study.

Barcelona line. A multicentre validation study of a facial projection reference in orthognathic surgery

The purpose of this study was to validate an already published facial anteroposterior reference: upper incisor (UI) to soft tissue plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla. A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in natural head orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcare professionals and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey. Seventy-four raters (50 laypeople, 12 orthodontists, and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0-4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤-4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (-4-0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r = 0.68, p < 0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k = 0.49, 95% CI: 0.39 to 0.59). The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualised, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.

Anteroposterior relationship of the maxillary central incisors to the forehead in adult Chinese females

Objectives:

The objectives of the study were to evaluate the anteroposterior (AP) relationship of the maxillary central incisors to the forehead in adult Chinese females.

Material and Methods:

The study sample consisted of 100 lateral smiling photographic images of adult Chinese females who were seeking orthodontic treatment (mean age = 24.0 + 6.5 years old). The study sample was compared to a control sample consisting of 100 images of adult Chinese females with harmonious facial profiles downloaded from the internet. The images were resized and rotated to the upright head position in an image editing software. Reference lines were constructed to evaluate forehead inclinations and AP positions of the maxillary central incisors.

Results:

In the control sample, 80% of the maxillary central incisors were positioned between the facial axis point of the forehead (FFA) and the glabella. About 13% were positioned posterior to the FFA point and 7% anterior to the glabella. In the study sample, 31% of the maxillary central incisors were positioned between the FFA point and glabella, 52% posterior to the FFA point, and 18% anterior to the glabella. There was a strong correlation between the position of the maxillary central incisors and forehead inclination in the control sample (r2 = 0.827). The difference in AP maxillary central incisor position relative to the forehead between the two groups was found to be statistically significant (P = 0.000).

Conclusion:

The forehead may be an important landmark when evaluating the AP position of maxillary incisors in adult Chinese female patients.

Psychometric and Perceptometric Comparisons of the Perspectives of Orthodontists, Oral and Maxillofacial Surgeons, and Laypeople of Different Ages and Sexes towards Beauty of Female Jaw Angles (Intergonial Widths and Gonial Heights) on Frontal and Three-Quarter Views

Objectives

The jaw angle plays an important role in facial beauty. Therefore, this study is aimed at comparatively determining the range of most attractive female intergonial widths and gonial heights on Perceptometric frontal-view and three-quarter-view images, from the perspective of orthodontists, oral maxillofacial (OMF) surgeons, and laypeople of different ages and sexes.

Methods

This prospective multivariate Perceptometric study was performed on 4191 esthetic scores given by 127 individuals to 33 Perceptometric face images. Frontal view and three-quarter-view photographs of a normal young woman were modified by image editing software to create two Perceptometric sets, one for the 24 gradual changes of intergonial width on the frontal view, and the other for the 9 vertical changes of the jaw angle on the three-quarter view. An online questionnaire was designed including 24 frontal and 9 oblique view photographs. The questionnaires' internal consistencies were almost perfect. Enrolled were 127 raters, including 33 orthodontists, 32 OMF surgeons, and 62 laypeople. The esthetics of different images were compared across different professions, across different ages, and between the sexes using 2-way MANCOVA, ANCOVA, and Bonferroni; the zones of esthetic jaw angles and also the sensitivity of judges to Perceptometric anatomical changes were assessed using 2-way RM-ANCOVA and Bonferroni (α = 0.05, α = 0.0056, α = 0.0021, and β = 0.05).

Results

Orthodontists and surgeons gave the highest attractiveness scores to intergonial: interzygomatic ratio of 72.53%, while the best ratio was 74.45% for the laypeople. The range of beautiful intergonial is as follows: interzygomatic ratio was 72.53% to 86.03%. OMF surgeons and orthodontists gave the highest score to a gonial height of 4.5 mm above the mouth corner, while the laypeople gave the highest score to the gonial height of 4.5 mm below the mouth corner. The range of beautiful gonial height was from 4.5 mm above the mouth corner to 9 mm below the mouth corner. The education of observers may affect their perception of beauty; orthodontists tended differ from laypeople, overall and also specifically in the case of the highly attractive frontal images concerning the intergonial width changes. However, no such differences were detected between surgeons with orthodontists or laypeople. Although age did not affect the overall esthetic scores, it did affect the sensitivity of the judges to the anatomic changes. So did expertise, i.e., the expertise of judges affected their sensitivity to anatomical changes; orthodontists showed steeper slopes of esthetic preference alterations to anatomical changes, while laypeople had the gentlest slope of preference changes. Judges' sex did not affect either their overall esthetic preferences or their sensitivity to anatomic changes.

Conclusion

Narrower female jaw angles and jaw angles that are vertically close to the level of the mouth corner may be unanimously more desirable. Thus, treatments aiming at widening the jaw angle of a woman or lowering it should be discouraged, at least in Persians. Orthodontists, but not surgeons, are more sensitive than laypeople to anatomic changes of the jaw angle. The judges' age can affect this perceptive sensitivity, but their sex cannot.

Customized maxillary incisor position relative to dentoskeletal and soft tissue patterns in Chinese women: A retrospective study

Objective

To provide reliable prediction models based on dentoskeletal and soft tissue variables for customizing maxillary incisor positions and to optimize digitalized orthodontic treatment planning.

Methods

This study included 244 Chinese women (age, 18–40 years old) with esthetic profiles after orthodontic treatment with fixed appliances (133 in group I 1° ≤ The angle between the nasion [N]-A point [A] plane and the N-B point [B] plane [ANB] ≤ 4°; 111 in group II 4° < ANB ≤ 7°). Dental, skeletal, and soft tissue measurements were performed on lateral cephalograms of the participants. Correlation and multiple linear regression analyses were used to determine the influence of dentoskeletal and soft tissue variables on maxillary incisor position.

Results

The ideal anteroposterior position of the maxillary incisor varied between sagittal skeletal patterns. The position of the maxillary incisor correlated with the sagittal discrepancy between the maxilla and the mandible (ANB), protrusion of the midface, nasal tip projection, development of the chin, and inclination of both the maxillary and mandibular incisors. Distance from the maxillary central incisor to nasion-pogonion plane predicted using multiple linear regression analysis was accurate and could be a practical measurement in orthodontic treatment planning.

Conclusions

Instead of using an average value or norm, orthodontists should customize a patient’s ideal maxillary incisor position using dentoskeletal and soft tissue evaluations.

Sagittal Relationship between the Maxillary Central Incisors and the Forehead in Digital Twins of Korean Adult Females

OBJECTIVE

Digital twins of adult Korean females were created as a tool to evaluate and compare the sagittal relationship between the maxillary central incisors and the forehead before and after orthodontic treatment.

METHODS

Digital twins were reconstructed for a total of 50 adult female patients using facial scans and cone-beam computed tomography (CBCT) images. The anteroposterior position of the maxillary central incisor and the forehead inclination were measured.

RESULTS

The control group presented a mean of 6.7 mm for the sagittal position and 17.5° for forehead inclination. The study group showed a mean of 9.3 mm for the sagittal position and 13.6° for forehead inclination. Most Korean females seeking orthodontic treatment had their maxillary central incisor anterior to the glabella. In contrast, fewer Korean females who completed their orthodontic treatments had their maxillary central incisor anterior to the glabella. Furthermore, patients who had completed the orthodontic treatment were more likely to have the maxillary central incisor between the forehead facial axis and glabella.

CONCLUSION

The use of digital twins for three-dimensional (3D) analysis of the profile implies a high clinical significance. In addition, as the facial profile of Koreans is different from that of Caucasians, careful consideration should be made when setting treatment goals for the anteroposterior position of the maxillary central incisors.

Effects of deviations in the nose and chin prominence on facial attractiveness

OBJECTIVE

To assess the effects of deviations in the nose and chin prominence on facial attractiveness.

METHODS

In this study, a reference digital photograph was taken from the facial profile view of an adult female model. Some changes were made in the nose and chin prominence in Photoshop software using the Crumley's analysis. Changes made in the nose prominence yielded a prominent nose (2:11 ratio), a normal nose (3:53 ratio) and a small nose (4:61 ratio). Changes made in the chin prominence were protrusion by +2 and 0 mm and retrusion by -2, -4 and -6 mm (distance from the pogonion to the vertical reference line). In total, 18 orthodontists, 18 oral and maxillofacial surgeons, 18 art students and 18 laypeople evaluated the photographs (n = 15) and expressed their opinion regarding the facial profile attractiveness using a visual analogue scale (0-100). Data were analysed using SPSS version 18.

RESULTS

A significant difference was noted in the ratings of photographs (Greenhouse-Geisser, P < 0.001). Orthodontists gave a significantly higher score than laypeople to photographs with a small nose and deviations of the chin prominence (P = 0.015). Art students gave a significantly higher score than laypeople to photographs with a prominent chin and deviations in the nose prominence (P = 0.012).

CONCLUSIONS

Facial profile with a normal (3:53 ratio) or small (4:61 ratio) nose and chin protrusion/retrusion by 2 mm (pogonion-vertical line) is considered attractive.

Aesthetic evaluation of the labiolingual position of maxillary lateral incisors by orthodontists and laypersons

BACKGROUND

The maxillary anterior teeth play a crucial role in smile aesthetics. Previous studies regarding the importance of maxillary lateral incisors for smile aesthetics concentrated on their size, incisor edge level, and inclination, etc. However, the aesthetic effect of lateral incisor movement in the spatial position has not been studied yet. Therefore, the purpose of this study was to explore the influence of the labiolingual position of maxillary lateral incisors on the aesthetic perception of smiles by orthodontists and laypersons, as well as analyze differences in this perception between male and female raters.

METHODS

A three-dimensional (3D) dental model was generated from the photograph of a man's smile using iOrtho7.0 software (Time Angel, Wuxi, China). Based on this model, seven images were generated with different labiolingual positions of the maxillary lateral incisors in 0.5 mm increments (+ indicating labial translation, and-indicating lingual translation). The images were evaluated by 86 orthodontists and 161 laypersons using a visual analog scale, with lower scores indicating less attractiveness. Data were analyzed using Student's t test and one-way analysis of variance with post hoc test.

RESULTS

There was no significant difference in smile ratings by males and females. Orthodontists assigned lower scores to all images than laypersons. The smile at + 1.5 mm was considered the least attractive by orthodontists, while smiles at + 1.5 mm and - 1.5 mm were regarded as the least attractive by laypersons. The smile at 0 mm was evaluated as the most attractive by all raters. Laypersons gave different scores to smiles at 0 or - 0.5 mm, but orthodontists did not.

CONCLUSIONS

The labiolingual position of maxillary lateral incisors does affect the perception of smile aesthetics. Orthodontists may rate smile aesthetics more critically than laypersons. Therefore, communication and discussion between orthodontists and patients is needed to achieve better therapeutic and aesthetic outcomes.

Quality in orthodontics: The role of customized appliances

Orthodontics as well as dentistry are undergoing a technological revolution with advances in medical imaging, 3D printing and customization of appliances and devices. Digital orthodontics can be defined as the process of manufacturing customized appliances based on a target setup which incorporates tooth positioning in six-degrees-of-freedom. Three-dimensional medical imaging provides better diagnostic tools and allows for fabrication of orthodontic appliances based on the coordinates system of the occlusal plane within the facial anatomy. This article describes the state-of-the-art in goal-driven orthodontic treatment, warns against the commercialization of our profession, and highlights the advantages of lingual orthodontics in terms of protection of the enamel.

Effect of maxillary median diastema on the esthetics of a smile

INTRODUCTION

With the increasing demand for facial esthetics, patients' expectations regarding dental treatment have increased. The treatment of maxillary median diastemas (MMDs) stands out as one of the most noticeable esthetic alterations performed on patients. The objectives of the present article were to evaluate the effects of MMD and its restorations on the esthetics of a smile and to determine the differences in esthetic perceptions among 3 different groups of patients: orthodontists, prosthodontists, and laypeople.

METHODS

Printed photographic images were randomly arranged in an album that contained the original photograph of the smile, 8 photographs with digitally created diastemas (0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 4.0 mm, and 5.0 mm), and 8 with simulated restorations of these spaces. Each evaluator assigned scores to the images using a 100-mm visual analogue scale.

RESULTS

Orthodontists, prosthodontists, and laypeople presented similar perceptions regarding the levels of attractiveness of the original smiles and those of smiles involving restorations of diastemas with widths of 0.5 mm and 1.0 mm. The ratings assigned to the smiles with diastemas differed significantly from those of the corresponding restored smile with the same magnitude of diastema.

CONCLUSIONS

The prosthetic space closure of diastemas is better than leaving the space untreated. Restorations of MMD up to 1 mm perform similar to orthodontic closure. Larger MMDs are ideally treated with orthodontics because the restorative treatment is more invasive, leading to incremental damage to the dental tissues.

Correlations between objective measurements and subjective evaluations of facial profile after orthodontic treatment

Objective

To investigate the correlations between objective measurements and subjective evaluations of post-treatment facial attractiveness.

Methods

Ten orthodontists rated the subjective visual analog scale (VAS) scores of the facial profiles of 95 patients who had undergone orthodontic treatment. Post-treatment cephalograms and photographs were used. Eleven soft tissue measurements and eight maxillary incisor measurements were constructed and analyzed. Correlations between objective measurements and subjective VAS scores were evaluated using Pearson correlation and quadratic regression analysis.

Results

The VAS scores of different facial proportions were all correlated with the total VAS score. Among soft tissue measurements, the distances from the upper and lower lips to the E line, H angle, forehead inclination, distance from lower lip to the H line, and pogonion-menton angle were negatively correlated with the VAS scores. The Z angle, with a parabolic distribution, was also correlated with the VAS scores. Among maxillary incisor measurements, the distance from the maxillary incisors to the forehead’s anterior limit line and the angulation of the maxillary incisors to the APo line were negatively correlated with the VAS scores.

Conclusions

Several soft tissue and maxillary incisor position measurements were correlated with facial profile evaluation and therefore might be used to evaluate facial attractiveness.

Selected Orthodontic Principles for Management of Cranio-Maxillofacial Deformities

An understanding of fundamental orthodontic principles involving diagnosis, treatment planning, and clinical strategies is essential for achieving successful outcomes in the treatment of craniofacial patients, particularly cleft lip/palate. This article focuses on: customizing a mandibular dental arch form using the WALA ridge; accurately diagnosing the maxillary skeletal transverse dimension (cusp to cusp/fossa to fossa); coordinating the upper dental arch with the lower; using a smiling profile and glabella vertical to assess anteroposterior jaw position; and leveling the mandibular curve of Spee while considering the lower one-third of the face. These concepts influence treatment outcomes to the extent they are used.

Effects of laterality on esthetic preferences of orthodontists, maxillofacial surgeons, and laypeople regarding the lip position and facial convexity: a psychometric clinical trial

INTRODUCTION

There are few, controversial, and limited studies on factors associated with the perception of profile beauty. Moreover, no study has ever assessed the role of laterality in esthetic judgment. Hence, this clinical trial was conducted.

METHODS

Photographs of 6 patients (3 women) with normal lip position (Ricketts norm = 0 mm) and facial convexity (Legan-Burstone norm = 12°) were digitally manipulated to create two series of 9 gradient images each, with convexity changes of 2° and anteroposterior lip modifications of 1 mm. Half of profiles were flipped horizontally. Laypeople (n = 35), orthodontists (n = 19), and maxillofacial surgeons (n = 10) selected the esthetically acceptable images (6912 esthetic evaluations [2 parameters × 6 sets × 9 images × 64 judges]). Effects of photogrammetric stimuli and other factors on judges' zone of esthetical acceptability (ZA) and its midrange were assessed statistically (α = 0.05).

RESULTS

Orthodontists and surgeons had respectively the broadest and narrowest ZAs (p < 0.05, ANOVA). Mean midranges of surgeons, orthodontists, and laypeople were respectively 0.27 ± 1.35, 0.56 ± 1.46, and 0.41 ± 1.77 mm for males' lower lips (p = 0.710, ANOVA); 0.27 ± 1.10, - 0.44 ± 0.91, and 0.03 ± 1.56 mm for females' lower lips (p = 0.034); 10.40 ± 3.17°, 11.09 ± 2.86°, and 11.57 ± 3.84° for men's profile convexity (p = 0.246); 10.27 ± 3.20°, 11.05 ± 1.87°, and 11.13 ± 3.26° for women's profile convexity (p = 0.346). Judges' gender did not affect their esthetic perception (p > 0.1). When patients' left side of face was visible, judges' esthetic preference parameters shifted towards a less convex profile and a narrower ZA (p < 0.05).

CONCLUSION

Slightly protruded lips (for men) and slightly less convex profiles (for men/women) might be favored by all groups. Women's esthetic lip positions might differ among groups. Judges' gender might not be a determinant. Subjects' face side can influence judges' esthetic perception of facial convexity.

Facial Versus Skeletal Landmarks for Anterior-Posterior Diagnosis in Orthognathic Surgery and Orthodontics: Are They the Same?

PURPOSE

The purpose of this investigation was to evaluate diagnostic agreement in anterior-posterior (AP) categorization of the maxilla and mandible between a skeletal-landmark analysis and a facial-landmark analysis for treatment planning of orthognathic surgery and orthodontics.

MATERIALS AND METHODS

This retrospective, consecutive case series of adult patients who presented to the Mayo Clinic orthodontic department compared maxillary and mandibular AP diagnoses. Steiner's analysis of the sella-nasion-A point angle and sella-nasion-B point angle was used for a skeletal-landmark diagnosis. Element II of Andrews' 6 elements of orofacial harmony was used for a facial-landmark diagnosis. Both diagnoses were categorized as either deficient, optimal, or excessive for each jaw. Categorization of the skeletal landmark was determined by normative data, whereas the facial landmark provides a customized categorization unique to each individual.

RESULTS

Weighted κ statistics were completed to test agreement between the categories determined by the skeletal and facial landmarks. The maxilla showed poor agreement, and the mandible showed slight agreement.

CONCLUSIONS

No agreement was found for AP categorization of the maxilla and mandible between skeletal-landmark and facial-landmark analyses. Most mandibles were diagnosed as retrognathic by the facial landmark, whereas most were diagnosed as optimal by the skeletal landmark. When the 2 landmarks disagreed, the facial landmark defined the optimal position farther anterior. The landmark chosen for diagnosis will impact the optimal jaw position and can affect orthognathic and orthodontic outcomes.

Evaluation of aesthetic anteroposterior position of maxillary incisors in patients with extraction treatment using facial reference lines

Objective

To examine whether facial reference lines could be used to evaluate the anteroposterior position of the maxillary incisors in patients that had undergone extraction treatment.

Methods

The study enrolled Angle Class I patients who had favourable facial profiles after extraction treatment. Superimposition of post-treatment lateral photographs and cephalograms were constructed and anatomical landmarks on the forehead were identified. Reference lines of the forehead’s anterior limit line (FALL) and the vertical line through the soft-tissue glabella (G line) were constructed. The distance between the maxillary incisors and the FALL and G line were measured. Regression analyses were performed between the maxillary incisor position and forehead inclination.

Results

Forty-one patients (31 females and 10 males) were included in the study. The mean ± SD distances of the facial-axis point of the maxillary incisors (FA)–FALL and FA–G line were 1.8 ± 1.9 mm and –2.4 ± 1.8 mm, respectively. The distance of the maxillary incisors to FALL and the relative position of the maxillary incisors were both significantly correlated with forehead inclination.

Conclusions

The mean position of the maxillary incisors in patients with extraction was approximately in the middle of the G line and the FALL. Correct maxillary incisor position was correlated with forehead inclination.

Optimal antero-posterior position of the maxillary central incisors and its relationship to the forehead in adult African American females

OBJECTIVES

To determine an optimal anteroposterior (AP) position of the maxillary central incisors and their relationship to the forehead in adult African American (AA) females.

MATERIALS AND METHODS

Smile profile photographs of 150 AA females were acquired and divided into an optimal control group (N = 48) and a study group (N = 102) based on the position of the maxillary central incisors, as judged by a panel of orthodontists and orthodontic residents. The AP position of the maxillary central incisors and the forehead inclination (FI) were measured relative to Glabella vertical (GV). A two-sample t-test was used to compare the incisor AP position and the FI between the two groups. Linear regression was used to quantify the relationship between the incisor AP position and the FI.

RESULTS

In all groups, the maxillary incisors were anterior to GV. However, a significant difference was found in the incisor AP position between the groups (8.58 ± 3.96 mm for the control group and 11.2 ± 4.48 mm for the study group; P = .001). Furthermore, the control group demonstrated a positive association between the optimal AP position of the maxillary central incisors and FI ( P < .0001).

CONCLUSIONS

GV is a reliable landmark with which to access the AP maxillary incisor position in AA females. The optimal AP position of the maxillary central incisors is significantly associated with FI; the greater the FI, the more anterior the optimal maxillary incisor position. A prediction equation to determine the optimal position of the maxillary incisors relative to GV for AA females is proposed.

[The smile: a challenge in the treatment of class III]

INTRODUCTION

The smile poses a challenge in the treatment of class III. Untreated, the class III patient presents excessive maxillary torque and a predominant display of the mandibular incisors, a sign that becomes more visible with age. Functional orthopedics restores the aesthetic appearance of the smile by maxillary protraction (sometimes temporarily because 20% of cases will still need surgery). Depending on the initial severity of the case (-4.5 mm AoBo would be the threshold value), the options are compensation or surgical correction. In both cases, the profile is improved but without normalising the cephalometric values. In recent years, the number of published cases treated by compensations (often using skeletal anchorage) has multiplied with broader indications, particularly for Asian patients in whom Le Fort I surgery gives questionable aesthetic results. Attention must be focused on the occlusal plane rotation which alters the smile by displaying the mandibular incisors. Nevertheless, surgery can handle the most severe cases with a greater degree of improvement.

AIM

The aim of this article is to determine the cephalometric cut-off values for an acceptable smile in Class III patients.

MATERIALS AND METHODS

We performed a search on Pubmed using the following keywords: Class III, anterior cross bite, smile, camouflage, orthognathic surgery; then secondarily, using references supplied by the articles found. We then analysed the data.

RESULTS

The ortho-surgical protocol associated with extractions of maxillary first premolars appears to be the way to obtain the best results in terms of the smile (versus surgery without extractions and versus orthodontic compensations) because it is, in fact, the only way to restore the normal position and torque of the maxillary incisors, thus increasing their display during smiling.

Evaluation of black spaces between maxillary central incisors by dentistry students and laypeople

This study aimed to compare the perception of smile esthetics and alterations among dentistry degree students and laypeople to identify differences in the esthetic perception of black spaces between the maxillary central incisors among Turkish laypeople and students in different study years. Photographs altered to include black spaces of various sizes at the midline were evaluated by 208 dentistry students in years 1-5 and 45 Turkish laypeople. Perceptional differences in different photographs were statistically significant. The students in years 2-5 were more aware of differences between photographs than year 1 students and laypeople. The proportion of participants who decided the most attractive photograph as A was highest among 3rd year students, followed by 5th year students. However, the proportion of students agreeing on the least attractive image was highest among 4th year students, followed by 3rd year students. Photographs A and H were selected as the most and least attractive, respectively, by all participants. The esthetic perception of 1st and 2nd year dentistry students was very different from that of laypeople. To increase esthetic perception among dentistry students, specific lessons with clinical photography should be included in dental education.

Comparison of the effect of labiolingual inclination and anteroposterior position of maxillary incisors on esthetic profile in three different facial patterns

Objective:

To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position.

Materials and Methods:

A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe.

Results:

Significant differences (P < 0.001) were detected when ratings of each photograph in each of the individual facial type was compared. In dolichofacial and mesofacial pattern, the position of the maxillary incisor must be limited to 2 mm from the goal anterior limit line. In brachyfacial pattern, any movement of facial axis point of maxillary incisors away from GALL is worsens the facial esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles.

Conclusion:

The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types.

How orthodontic records can influence torque choice decisions?

INTRODUCTION

The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions.

METHODS

Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement.

RESULTS

The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively.

CONCLUSIONS

This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Psychometric properties of the Albanian version of the Orofacial Esthetic Scale: OES-ALB

Abstract

The aim was to adapt the Orofacial Esthetic Scale (OES) and to test psychometric properties of the Albanian language version in the cultural environment of the Republic of Kosovo.

Methods

The OES questionnaire was translated from the original English version according to the accepted techniques. The reliability (internal consistency), and validity (construct, convergent and discriminative) were tested in 169 subjects, test-retest in 61 dental students (DS), and responsiveness in 51 prosthodontic patients with treatment needs (PPTN).

Results

The corrected item correlation coefficients of OES-ALB ranged from 0.686 to 0.909. The inter-item correlation coefficient ranged between 0.572 and 0.919. The Cronbach’s alpha was 0.961 and IIC 0.758. Test- retest was confirmed by good ICCs and by no significant differences of the OES scores through the period of 14 days without any orofacial changes (p > 0.05). Construct validity was proved by the presence of one-factor composition that assumed 79.079 % of the variance. Convergent validity showed significant correlation between one general question about satisfaction with orofacial esthetics and the OES summary score, as well as between the sum of the 3 OHIP-ALB49 questions related to orofacial aesthetics and the OES summary score. Discriminative validity was confirmed with statistically significant differences between DS, prosthodontic patients without treatment need and PPTN (p < 0.01). Responsiveness was confirmed by a significant increase of OES scores after PPTN patients received new fixed partial or removable dentures (P < 0.001).

Conclusion

The results proved excellent psychometric properties of the OES-ALB questionnaire in the Republic of Kosovo.

Effects of transverse relationships between maxillary arch, mouth, and face on smile esthetics

OBJECTIVE

To identify the ideal ratios between the widths of the maxillary arch, mouth, and face, respectively, and to determine the range of acceptable esthetic variations based on these ideal ratios.

MATERIALS AND METHODS

A photograph of a young female with a harmonious smile was selected and digitally altered to produce two sets of images. The first image showed an altered intercanine width, while the second one showed an altered oral fissure breadth. These alterations were independently rated by judges, including 23 orthodontists and 30 undergraduates. The Mann-Whitney U-test was used to compare the scores given by male and female judges and those given by professional and nonprofessional judges.

RESULTS

The following ideal transverse ratios were determined: intercanine width/oral fissure breadth, 0.638; oral fissure breadth/interparopia width: the distance between left and right paropia, 0.617; and intercanine width/face width at the level of the labial commissures, 0.300. A range of -10% to +10% was proposed as the thresholds of esthetic smile evaluations. It was shown that gender of the raters had no effect on the rating of photographs, nor were there any statistically significant differences between the professional and nonprofessional judges' ratings.

CONCLUSIONS

Balanced transverse relationships in the facial region are important for smile esthetics, and there is a wide range of esthetically acceptable variations in the transverse relationships between the maxillary arch, mouth, and face.

Changes in anteroposterior position and inclination of the maxillary incisors after surgical-orthodontic treatment of skeletal class III malocclusions

PURPOSE

The purpose of this study was to evaluate and compare the anteroposterior (AP) position and inclination of the maxillary incisors in subjects with class I normal occlusion and a harmonious profile with patients with skeletal class III malocclusions, and to investigate the changes in maxillary incisor inclination and AP position after surgical-orthodontic treatment in class III patients.

MATERIAL AND METHODS

Sixty-five subjects (35 female and 30 male; mean age: 21.8 ± 3.89 years) with normal profiles and class I skeletal and dental patterns were selected as a control sample. Sixty-seven patients (38 female and 29 male; mean age: 21.3 ± 3.31 years) with skeletal and dental class III malocclusions who sought surgical-orthodontic treatment were used as the study sample. Subjects were asked to smile and profile photographs were taken with the head in a natural position and the maxillary central incisors and the forehead in full view; cephalograms were taken and superimposed on the profile pictures according to the outline of the forehead and nose. Forehead inclination, maxillary incisor facial inclination and the AP position of the maxillary central incisor relative to the forehead (FAFFA) were measured on the integrated images and statistical analyses were performed.

RESULTS

In both groups, there were no significant male/female differences in either the maxillary central incisor inclination or AP position. Female subjects had a significantly steeper forehead inclination compared with males (P < 0.001) in both groups. After combined surgical-orthodontic treatment, the significant labial inclination (P < 0.001) and posterior positioning (P < 0.001) of the maxillary central incisors had been corrected to close to normal range (P > 0.05). In the control group, 84.6% had the facial axial point (FA) of their maxillary central incisors positioned between lines through the forehead facial axis (FFA) point and the glabella. In the study group, however, 79.1% had the maxillary central incisors positioned posterior to the line through the FFA point and the difference with the control group was statistically significant (P < 0.001). The position of the maxillary central incisors was strongly correlated with forehead inclination in the control sample (r(2) = 0.456; P < 0.01), but only a poor correlation was detected in the class III group (r(2) = 0.177; P > 0.05).

CONCLUSIONS

With the integrated radiograph-photograph method, the lateral cephalogram was reoriented, which makes it possible to accurately measure the variables on profile photographs. The AP position and inclination of the maxillary central incisors relative to the forehead plays an important role in the esthetics of the profile during smiling and could be an important variable to be considered during diagnosis and treatment planning.

Nonsurgical correction of a Class III malocclusion in an adult by miniscrew-assisted mandibular dentition distalization

This article reports the successful use of miniscrews in the mandible to treat a 20-year-old Mongolian woman with a chief complaint of anterior crossbite. The patient had a skeletal Class III malocclusion with a mildly protrusive mandible, an anterior crossbite, and a deviated midline. In light of the advantages for reconstruction of the occlusal plane and distal en-masse movement of the mandibular arch, we used a multiloop edgewise archwire in the initial stage. However, the maxillary incisors were in excessive labioversion accompanied by little retraction of the mandibular incisors; these results were obviously not satisfying after 4 months of multiloop edgewise archwire treatment. Two miniscrews were subsequently implanted vertically in the external oblique ridge areas of the bilateral mandibular ramus as skeletal anchorage for en-masse distalization of the mandibular dentition. During treatment, the mandibular anterior teeth were retracted about 4.0 mm without negative lingual inclinations. The movement of the mandibular first molar was almost bodily translation. The maxillary incisors maintained good inclinations by rotating their brackets 180° along with the outstanding performance of the beta-titanium wire. The patient received a harmonious facial balance, an attractive smile, and ideal occlusal relationships. The outcome was stable after 1 year of retention. Our results suggest that the application of miniscrews in the posterior area of the mandible is an effective approach for Class III camouflage treatment. This technique requires minimal compliance and is particularly useful for correcting Class III patients with mild mandibular protrusion and minor crowding.

Esthetic perception of black spaces between maxillary central incisors by different age groups

INTRODUCTION

The aim of this research was to evaluate esthetic perceptions of the smile, especially regarding black spaces between the maxillary central incisors, by laypersons in 3 age groups.

METHODS

Photographs were digitally manipulated to simulate black spaces in the region of the maxillary central incisor crenations. The images were printed on photographic paper and attached to a questionnaire that was given to 150 laypersons in 3 age groups: 15 to 19, 35 to 44, and 65 to74 years. They were asked to use a visual analog scale method to rate the smiles from a score of 0, corresponding to "not very attractive," to 10, "very attractive." Differences between the examiners were verified by the Mann-Whitney test. All statistics were performed with a degree of confidence of 95%.

RESULTS

The results showed that older persons had more difficulty perceiving black spaces. In the younger groups, the subjects were better able to perceive the black spaces, and the larger the black space, the less attractive they rated the photograph (P < 0.01).

CONCLUSIONS

Younger people are more likely than older people to perceive black spaces in maxillary incisor crenations. The larger the black spaces, the less attractive they rate the smile.

Assessment of facial profile changes in patients treated with maxillary premolar extractions

OBJECTIVE: Evaluate the facial profile changes of orthodontic treatment with extraction of two upper first premolars, from the perspective of orthodontists, dentists and lay people. METHODS: Facial profiles of radiographs taken before and after treatment of 70 patients with Class II, division 1 malocclusion were traced. The silhouettes of the 70 patients were randomly assembled in an album with, being two profiles on each sheet of the same patient. Then, 30 orthodontists, 30 dentists and 30 lay people chose the more esthetic facial profile (A or B), and the amount of change they perceived between the two profiles before and after treatment, according to a visual analog scale (VAS). RESULTS: The results revealed that 83 examiners preferred the post-treatment profiles, and only three dentists and four lay people chose the profiles pre-treatment more frequently. Thus, the orthodontists often chose the profiles after treatment, followed by dentists, with no statistically significant differences found between dentists and lay people. There were significant differences within groups in the preference of pre- and post-treatment profile. Furthermore, the three groups of evaluators indicated that pre and post-treatment profiles did not differ substantially. CONCLUSIONS: The treatment of Class II, division 1 malocclusion with extraction of two first premolars has a positive effect on facial profile esthetics.

Patients' self-perception of dentofacial attractiveness before and after exposure to facial photographs

OBJECTIVE

To determine whether exposure to pretreatment photographs of themselves influenced patients' self-perception of dentofacial attractiveness and willingness to undergo treatment.

MATERIALS AND METHODS

A total of 100 subjects of white ancestry aged 18 years or older (Study Group) and 100 sex- and age-matched controls (Control Group) were selected. Photographs of the frontal view of the face and the profile view of the face, both at rest and while smiling, were taken of each participant. Only Study Group subjects were given a printed copy of their own images to be examined at home between the initial observation (T0) and a set date an average of 30 days later (T1). Each of the 200 subjects in the study completed a questionnaire at T0 and T1 exploring happiness regarding their smiles and their facial profiles, as well as willingness to undergo treatment.

RESULTS

At T1 in the Study Group, 50% of subjects responded with a lower opinion of their facial profiles than at T0; 11% and 45% were willing to undergo more comprehensive procedures to change the appearance of their smiles and profiles, respectively. No statistically significant change was seen in questionnaire answers between T0 and T1 for the Control Group.

CONCLUSION

Laypeople generally are not aware of their facial profiles. Pretreatment photograph exposure can increase profile self-awareness, an important factor in reducing the discrepancy between orthodontists' and patients' visual emphasis on dentofacial esthetics.

Effect of maxillary incisor labiolingual inclination and anteroposterior position on smiling profile esthetics

OBJECTIVE

To test the null hypothesis that there is no effect of maxillary incisor labiolingual inclination and anteroposterior (AP) position on smiling profile esthetics in young adult females.

MATERIALS AND METHODS

A facial smiling profile photograph of a Chinese woman with a normal profile, a Class I occlusion, and a Class I skeletal pattern was digitized. The digital image was modified to obtain four series comprising 29 smiling profiles. The sample of individuals rating these pictures comprised 21 orthodontic professionals and 66 undergraduates. Post hoc tests were done with the Student Newman Keuls method to analyze the data.

RESULTS

Significant differences (P < .001) were detected when each photograph's ratings were compared. The smiling profile with the highest score was the one with 5° lingual inclination, while the ones with 15° labial inclination or 4-mm retrusion had lower scores than the others. Maxillary incisor protrusion and lingual inclination were preferable compared with retruded or flared incisors. There was no significant discrepancy between the professional and nonprofessional groups in terms of their assessments.

CONCLUSIONS

The hypothesis is rejected. Both maxillary incisor labiolingual inclination and AP position play an essential role in the esthetics of the smiling profile. However, when formulating treatment plans, dentists should never underestimate the labiolingual inclination's influence on the smiling profile.

Assessing soft-tissue characteristics of facial asymmetry with photographs

INTRODUCTION

Precise diagnosis and treatment of facial asymmetry are important in orthodontics. The aims of this study were to determine the soft-tissue characteristics of patients perceived to have severe asymmetry requiring treatment and the soft-tissue factors affecting the subjective assessment of facial asymmetry.

METHODS

In the first part of this study, 5 observers examined 1000 photographs of patients receiving orthodontic treatment and selected 100 for further assessment. These photographs showed 50 patients who were considered to have little or moderate asymmetry and 50 who were considered to have severe asymmetry. A pilot study was performed to select the reference photographs representing the most symmetric (score of 0) and the most asymmetric (score of 100). A panel of 9 orthodontists then rated the facial asymmetry of the 100 patients on a 100-mm visual analog scale. The scale was divided into 3 equal regions. Region 1 included patients with the least facial asymmetry; according to the orthodontists, these patients did not require treatment. Region 2 included patients with moderate facial asymmetry who did not require treatment. Region 3 included patients with the most facial asymmetry who did require treatment.

RESULTS

One-way analysis of variance showed that lip canting, chin deviation, body inclination difference, and gonial angle difference had significant differences between the groups. Chin deviation and gonial angle difference were significant factors affecting the assessment of facial asymmetry, according to stepwise linear regression analysis.

CONCLUSIONS

These results will help in the diagnosis and treatment planning for patients with asymmetry.

AP relationship of the maxillary central incisors to the forehead in adult white females

OBJECTIVE

To evaluate and compare the anteroposterior relationship of the maxillary central incisors to the forehead in adult white females with harmonious profiles and in adult white female orthodontic patients.

MATERIALS AND METHODS

Ninety-four photographic images of adult white females with good facial harmony (control sample) were compared with 94 photographs of adult white females seeking orthodontic treatment (study sample). All images were of the face in profile with the maxillary central incisors and the forehead in full view. The images were scanned, resized, and rotated to the upright head position. Reference lines were constructed to assess the anteroposterior positions of the maxillary central incisors as well as forehead inclinations.

RESULTS

In the control sample, 93% had maxillary central incisors positioned between the FFA point and glabella, 4% posterior to the FFA point, and 3% anterior to glabella. The positions of the maxillary central incisors were strongly correlated with forehead inclination (r2 = .642). In the study sample, 21% had maxillary central incisors positioned between the FFA point and glabella, 64% posterior to the FFA point, and 15% anterior to glabella. The positions of the maxillary central incisors were poorly correlated with forehead inclination (r2 = .094). The difference between the means for anteroposterior maxillary incisor position was statistically significant (P = .0001).

CONCLUSION

The forehead is an important landmark for anteroposterior maxillary incisor positioning for adult white female patients seeking improved facial harmony.

Comparison of soft-tissue profiles after treatment with headgear or Herbst appliance

INTRODUCTION

Herbst and headgear appliances are considered effective for correcting Class II malocclusions in growing patients, although their skeletal and dental effects differ. In the literature, there is no comparison between profile esthetic outcomes with the Herbst and headgear. The purpose of this study was to provide that comparison.

METHODS

Lateral cephalometric radiographs of 48 matched pairs of growing Class II Division 1 patients treated with either the Herbst appliance or headgear (both combined with fixed appliances) were used to generate pretreatment and posttreatment standardized silhouettes. The silhouettes were randomly arranged and judged by lay people and orthodontic residents using a 7-point Likert scale. Statistical analyses including nonparametric procedures and intraclass correlation were used to compare initial, final, and change profile esthetic scores for the 2 groups of subjects and agreement between evaluators.

RESULTS

Both groups of subjects had significant profile improvements with treatment (P <.05), and there were no statistically significant differences between the groups in average final profile scores. Overall, there was strong agreement between the evaluations of laypersons and orthodontic residents.

CONCLUSIONS

Class II Division 1 growing patients treated with either Herbst appliance or headgear (both combined with fixed appliances) will benefit from significantly improved profiles that are equally attractive.