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Wrangstål L, Pigg M, Almutairi N, Fransson H. A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model. Int Endod J 2024; 57:119-132. [PMID: 38082460 DOI: 10.1111/iej.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/28/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
AIM To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields. METHODOLOGY The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant. RESULTS Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001). CONCLUSIONS According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.
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Affiliation(s)
- Linnéa Wrangstål
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Department of Cariology, Malmö University, Malmö, Sweden
| | - Maria Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Nawaf Almutairi
- Conservative Dental Science Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia
| | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Dawadi A, Humagain M, Lamichhane S, Sapkota B. Clinical and psychological impact of lip repositioning surgery in the management of excessive gingival display. Saudi Dent J 2024; 36:84-90. [PMID: 38375390 PMCID: PMC10874780 DOI: 10.1016/j.sdentj.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 02/21/2024] Open
Abstract
Background Excessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD. Methodology This experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively. Results Among the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively. Conclusion A significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.
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Affiliation(s)
- Asmita Dawadi
- Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Manoj Humagain
- Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Simant Lamichhane
- Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Birat Sapkota
- Department of Health care administration, Canadore College, North York, Ontario, Canada
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Tatakis DN, Silva CO. Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility. J Dent 2023; 138:104711. [PMID: 37730094 DOI: 10.1016/j.jdent.2023.104711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES Excessive gingival display (EGD), also known as gummy smile, has various causes, including altered passive eruption (APE) and hypermobile upper lip (HUL). This state-of-the art narrative review explores current concepts regarding soft tissue EGD etiologies and the contemporary modalities available for APE or HUL treatment. DATA, SOURCES, STUDY SELECTION Literature search was conducted for a narrative review on the etiology, diagnosis, and treatment of EGD caused by APE and HUL. Searching for articles was carried out in PubMed and Google Scholar. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature (e.g., systematic reviews) on the etiology, diagnosis, and treatment of EGD caused by APE and HUL were retrieved and reviewed. Particular focus was placed on novel treatment modalities introduced in the last five years. CONCLUSIONS Recent research evidence indicates that APE and HUL are the two major soft tissue-based EGD etiologies. Aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) are the established surgical treatment modalities for APE and HUL, respectively. The last few years have seen the introduction of new techniques for APE and HUL management, an expansion of the available ACL and LRS technique variations, and additional evidence further supporting the effectiveness of these two procedures. Several of the recently introduced approaches offer unique, innovative, and potentially impactful concepts. However, for many of these newly described treatments the available evidence is limited to case reports and the exact indications remain to be adequately defined. CLINICAL SIGNIFICANCE Altered passive eruption and hypermobile upper lip are the common soft tissue causes of gummy smile and can be successfully managed through aesthetic crown lengthening and lip repositioning surgery, respectively. A wide range of newly introduced approaches promises to further facilitate gummy smile treatment and improve outcomes.
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Affiliation(s)
- Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cléverson O Silva
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
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Clear Aligners and Smart Eye Tracking Technology as a New Communication Strategy between Ethical and Legal Issues. Life (Basel) 2023; 13:life13020297. [PMID: 36836654 PMCID: PMC9967915 DOI: 10.3390/life13020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Smart eye-tracking technology (SEET) that determines visual attention using smartphones can be used to determine the aesthetic perception of different types of clear aligners. Its value as a communication and comprehension tool, in addition to the ethical and legal concerns which it entails, can be assessed. One hundred subjects (50 F, 50 M; age range 15-70) were equally distributed in non-orthodontic (A) and orthodontic (B) groups. A smartphone-based SEET app assessed their knowledge of and opinions on aligners. Subjects evaluated images of smiles not wearing aligners, with/without attachments and with straight/scalloped gingival margins, as a guided calibration step which formed the image control group. Subsequently, the subjects rated the same smiles, this time wearing aligners (experimental images group). Questionnaire data and average values for each group of patients, and images relating to fixation times and overall star scores, were analyzed using these tests: chi-square, t-test, Mann-Whitney U, Spearman's rho, and Wilcoxon (p < 0.05). One-way ANOVA and related post-hoc tests were also applied. Orthodontic patients were found to be better informed than non-orthodontic patients. Aesthetic perception could be swayed by several factors. Attachments scored lower in aesthetic evaluation. Lips distracted attention from attachments and improved evaluations. Attachment-free aligners were better rated overall. A more thorough understanding as to the opinions, expectations and aesthetic perception of aligners can improve communication with patients. Mobile SEET is remarkably promising, although it does require a careful medicolegal risk-benefit assessments for responsible and professional use.
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A Lip Repositioning Technique Using Polyester Threads for Gummy Smile Treatment. Int J Dent 2022; 2022:3972150. [PMID: 36284524 PMCID: PMC9588359 DOI: 10.1155/2022/3972150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
A new technique is proposed in this study to correct the gummy smile (GS) with myotomy, combining lip repositioning with the insertion of polyester threads at the surgical site to act as a physical barrier and control relapse. 11 patients were clinically assessed (30.2 ± 7.43 years old, 90.9% females and 9.10% males). All patients presented gingival display (GD) greater than 4 mm. Hypermobile upper lip (HUL), vertical maxillary excess (VME) + HUL, altered passive eruption (APE) + HUL, and VME + APE were the etiologies identified. Three polyester threads were inserted in each patient one month after the surgery. The GS was measured before, 6 months, and 12 months after the surgery. The results showed a reduction in the mean GD of the patients, 4.42 mm after 6 months (p value = 0.000) and 4.13 mm after 12 months (p value = 0.000). The largest relapse was 0.29 mm and was not statistically significant (p value = 0.07). The Friedman test with pairwise comparisons was used to determine the existence of statistically significant differences in GD between the periods analyzed. The results showed that the proposed technique was successful in treating GS, presenting significant reductions in the GD 12 months after surgery and controlling the relapse.
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Bohluli B, Keyhan SO, Saadoun AP, Dimitris T, McLaren E, Mintrone FL, Demetriades N, Kim SG, Ghasemi S, Kasir M. Smile Management: A Discussion with the Masters. Dent Clin North Am 2022; 66:489-501. [PMID: 35738741 DOI: 10.1016/j.cden.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Smile design is an ongoing challenge in both dentistry and facial cosmetics surgery. Herein, some very common smile design scenarios are shared with six world known masters. Each case will be reviewed by 2 cosmetic dentists, 2 periodontists, and 2 oral and maxillofacial surgeons. At the end, contributors will describe current advances and future prospects of this evolving field.
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Affiliation(s)
- Behnam Bohluli
- Oral and Maxillofacial Surgery, University of Toronto, 124 Edward Street, Toronto ON, M5G 1G6, Canada.
| | - Seied Omid Keyhan
- College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea; Department of Oral & Maxillofacial Surgery, University of Florida, College of Medicine, Jaksonville, FL, USA
| | - André P Saadoun
- Diplomate, American Academy of Periodontology; Diplomate of the International Congress of Oral Implantologists; Private Practice limited to Esthetic Periodontics and Implant Surgery, Paris, France
| | - Tatakis Dimitris
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | | | - Francesco Luigi Mintrone
- Department of Dentistry and Oral Maxillo Facial Surgery, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - Neophytos Demetriades
- Oral and Maxillofacial Surgery, European University of Cyprus School of Medicine, Facial Plastic and Reconstructive Surgery, European University of Cyprus School of Medicine, Nicosia, Cyprus
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457, Republic of Korea
| | - Shohreh Ghasemi
- Department of Oral and Maxillofacial surgery, The Dental College of Georgia at Augusta University, Augusta, GA, USA
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Abstract
A common etiology of excessive gingival display is hypermobile upper lip, which can be managed by non-surgical and surgical approaches. Among the surgical options, lip repositioning surgery is a relatively simple procedure with minimal complications. Since the original description of the technique almost 50 years ago, several minor and major modifications have been introduced. The available evidence indicates that, when applied to properly diagnosed cases, the technique is effective in reducing gingival display and results in improved smile esthetics and high patient satisfaction. This article reviews the various techniques and modifications and summarizes the reported outcomes of the procedure.
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Affiliation(s)
- Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Postle Hall, 305 West 12th Avenue, Columbus, OH 43210-1267, USA.
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Longo BC, Rocha TTC, Santin GC, Tatakis DN, Silva CO. Gingival pigmentation: Concurrent assessment of distribution, intensity, and extent in a black population. J ESTHET RESTOR DENT 2021; 34:897-906. [PMID: 34825763 DOI: 10.1111/jerd.12846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate prevalence, distribution, intensity and extent of physiologic gingival melanin pigmentation (GMP) in black individuals. MATERIALS AND METHODS For this cross-sectional study, GMP was evaluated on digital images by three calibrated examiners, according to de Krom (distribution), DOPI (intensity) and Melanin Index (extent) classifications. Descriptive statistics, Wilcoxon, Mann-Whitney, Kruskal-Wallis, Two-way ANOVA, chi square, and K-means cluster analysis were used. RESULTS Seventy participants were recruited. The most prevalent GMP categories were: de Krom category 2 (34.3%), DOPI heavy intensity (57.2%), and Melanin index Degree IV (50%). Significant inter-group differences were found for age (p < 0.05) but not gender (p > 0.05). Significant correspondence/overlap was observed between classifications (p > 0.05). Three GMP clusters were identified: Cluster 1 (27%; n = 19) had mild asymmetric and interspersed pigmentation; Cluster 2 (46%; n = 32) had heavy pigmentation in one long continuous ribbon, with pink marginal gingiva; and Cluster 3 (27%; n = 19) had heavy pigmentation in one long continuous ribbon, symmetric, and uniform. CONCLUSIONS There may be overlap among GMP classification systems. In black individuals, the predominant GMP presentation is one of a broad zone of heavily pigmented attached gingiva, in a continuous strip from central incisors to canines, symmetrical across the midline, and with pink free marginal gingiva. CLINICAL RELEVANCE This is the first study to analyze distribution, intensity, and extent of gingival melanin pigmentation in the same population and to integrate the various classification systems through cluster analysis. The novel findings provide a foundation for patient assessment and counseling and for future studies.
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Affiliation(s)
- Bruna C Longo
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
| | - Talita T C Rocha
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
| | - Gabriela C Santin
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Cléverson O Silva
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
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