The effect of canine characteristics and symmetry on perceived smile attractiveness when canine teeth are substituted for lateral incisors

Esthetic Perception of Different Clinical Situations of Maxillary Lateral Incisor Agenesis According to Populations with Dental and Non-Dental Backgrounds: A Systematic Review and Meta-Analysis

Treatment of unilateral or bilateral maxillary lateral incisor agenesis is challenging, time-consuming, expensive, and requires careful treatment planning, predictability, and esthetics. This review aimed to identify differences in esthetic perception among orthodontists, general dentists, differentiated dentists, and laypersons, which may interfere with treatment options. EBSCO, PubMed, ScienceDirect, Cochrane Library databases, and Google Scholar were searched using keyword pairing and a Boolean expression, "(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists)." Reviews and case studies were excluded. A total of 13 studies were selected for qualitative analysis (adapted ROBINS-I) and 11 were selected for meta-analysis (p < 0.05) after being sub-grouped into "Opening vs. Closure" and "No remodeling vs. Dental remodeling vs. Dental and gingival remodeling" groups. A meta-analysis evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% CI; Z-value 1.96), revealing that the esthetic perception of maxillary lateral incisor agenesis treatment remains controversial even among professionals. Gingival remodeling was not valued compared to isolated dental remodeling. Studies lack rigorously comparable methodologies. Discussion with the patient is pertinent in doubtful situations, as the best treatment option remains unclear, and overtreatment should be avoided.

The value of adult orthodontics: Do the public's willingness-to-pay values reflect the profession's?

OBJECTIVE

To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies 'strength of preference' in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.

DESIGN

Cross-sectional survey.

SETTING

General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).

PARTICIPANTS

Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.

METHODS

Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.

RESULTS

A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.

CONCLUSION

The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.

Clinical performance of a modified Resin-Bonded fixed partial denture (Carolina bridge): A retrospective study

OBJECTIVES

This research aims to retrospectively evaluate the clinical performance of Carolina bridge (CB) placed at a dental school.

MATERIALS AND METHODS

Data were collected from the electronic patient record system. A follow-up letter was sent to the subjects' mailing address explaining the research purpose along with a questionnaire to assess their satisfaction with the treatment. A phone interview was performed to assess patient satisfaction, function, and choice of permanent restoration. Finally, a clinical exam was conducted for patients that agreed to come for a follow-up and still had their CBs.

RESULTS

Twenty-three patients with 26 resin-bonded CBs met the inclusion criteria. All patients who did the phone interview reported to be very satisfied with the treatment. Most chose to keep the CB as definitive treatment and not to move forward with implant therapy. According to the number of rebonding needed to maintain the CB, the types of survival were analyzed as 42.3% complete survival (no rebonding needed), 26.9% functional survival (rebonded once), 23.1% survival with multiple rebondings, 7.6% failure.

CONCLUSION

The performance of CBs revealed highly acceptable performance with high-patient satisfaction.

CLINICAL SIGNIFICANCE

Carolina ridge is an esthetic and conservative interim treatment option that can be utilized in favorable clinical situations.

Mini-Implant-Assisted En Masse Protraction of Maxillary Posterior Segment

Protraction of posterior teeth to close the spaces in patients with congenitally missing maxillary lateral incisors is challenging. Mini-implants are a reliable source of anchorage for this purpose. This case report demonstrates the application of a T-bar protraction appliance with a palatal mini-implant for en masse protraction of posterior teeth into the lateral incisor space in an adolescent patient. The patient's occlusion and esthetics were significantly improved, and ideal overjet and overbite were obtained after 30 months of treatment. Follow-up records six months after the completion of the treatment displayed stable results.

Management of a Class I malocclusion with traumatically avulsed maxillary central and lateral incisors

This case report describes orthodontic space closure for managing an avulsed maxillary central incisor and a lateral incisor in a growing girl with a Class I deep bite malocclusion with moderate lower and mild upper crowding. The treatment approach moved a central incisor across the midline and substituted a lateral incisor for a central incisor, in combination with canine substitution. Veneers on all maxillary anterior teeth attained acceptable esthetics. The right central incisor was moved to serve as the avulsed left central incisor. The right lateral incisor was moved to the position of the right central incisor and restored. The canines on both sides were substituted as lateral incisors; the posterior occlusion was left in Class II. Mesialization of central and lateral incisors with prosthetic rehabilitation is an acceptable treatment option.

Canine edge width and height affect dental esthetics in maxillary canine substitution treatment

Background

To investigate the effect of canine edge width and height on dental esthetics in maxillary canine substitution treatment.

Methods

A total of 127 canine substitution treatment cases were screened and evaluated by a panel of orthodontic experts and laypersons in the pilot study. The top five subjects with the esthetically most pleasant canine substitution were included in the study, resulting in 140 computerized images displaying only the upper dentition, with different canine edge widths (0%, 12.5%, 25%, 37.5%, 50%, 62.5%, and 75% of the central clinical width) and heights (− 0.5 mm, 0 mm, 0.5 mm, and 1.0 mm vertically relative to the central incisor edge) finally used for the esthetic evaluation by 101 observers (41 orthodontists and 60 laypersons). The ordered logistic regression analysis, the univariate analysis of variance, the chi-square, and Fisher’s exact tests were used for statistical analyses.

Results

The most esthetic canine shape for canine substitution was found to be a shape with the edge width of 62.5% of the central incisor width and the edge height of 0.5 mm gingival to the central incisor edge (P < 0.05). The canine edge width of 50–75% and height of 0.5–0 mm gingival to the central incisor edge were generally considered to be esthetic by all observers. Orthodontists and laypersons had the same ranking on the top two most esthetic canine shapes (edge width and height 62.5% and 0.5 mm gingival; 50% and 0 mm incisal) as well as the bottom two most unesthetic canine shape (0% and 0.5 mm gingival; 75% and 1 mm incisal). Male and female observers generally had similar esthetic grades and rankings on the canine shapes (P > 0.05).

Conclusions

The most esthetic canine shape for canine substitution is a shape with the canine edge width of 62.5% of the central incisor width and the edge height of 0.5 mm gingival to the central incisor edge. The different collocations of the canine edge width and height affect dental esthetics of the canine during canine substitution treatment.