Andrej Pavlić

The unique contribution of elements of smile aesthetics to psychosocial well-being.

Pleasant smile aesthetics is an important contributory factor to psychosocial well-being. The aim of this study was to determine the psychosocial influence of smile aesthetics. The study was cross-sectional on a convenient sample that included patients, pupils, students and faculty staff. A total of 155 subjects (36% male) aged 12-39 (mean age 21, interquartile range 19-23) were included. Occlusal characteristics were recorded by the Index of Complexity, Outcome and Need, and smiling frontal view photographs were obtained. Fourteen variables were measured using photogrammetric analysis: smile width, visibility of buccal corridors, maximum teeth exposure, total gingival display, lip thickness, degree of occlusal cant and deviation from golden proportion of the teeth in maxillary intercanine sector. Psychometric instruments included the Psychosocial Impact of Dental Aesthetics Questionnaire and the Rosenberg Self-Esteem Scale. Statistical analysis comprised multiple linear regressions. Malocclusion severity is the most important predictor of psychosocial influence of smile aesthetics and self-esteem, the unique contribution of which accounts for a total of 4-27% of variability. Female gender is associated with higher psychological influence of dental aesthetics while male gender and older age with self-esteem. Malocclusions have higher psychosocial impact than parameters of mini- and micro-aesthetics of smile related to visibility of buccal corridors, amount of teeth exposure, gingival display, lip thickness, presence of occlusal cant and deviation from golden proportion of the teeth. It appears that people are not as focused on details of their smile as they are on distinctive malposition of teeth.

Secular trend of earlier onset and decelerated development of third molars: Evidence from Croatia

The purpose of this study was to evaluate the influence of the secular trend on development of third molars in 30 years period in Littoral region of Croatia. A total of 1103 panoramic radiographs of subjects aged from 6 to 18 years were analysed. First group comprised 531 panoramic radiographs (258 girls) taken from year period 1977 till 1979 and second group 572 radiographs (325 girls) taken from year period 2007 till 2009. Demirjians method was used to determine the developmental stage of third molars. A secular trend in 30 years period was observed as earlier onset of third molars development in boys (6 months on average maxillary and 11 months mandibular) and girls (6 months for maxillary and 4 months for mandibular). Now-a-days, an increase in mineralisation for one Demirjian stage occurs at a slower pace of 5.2 months in boys and 3.4 in girls in maxilla and 2.3 or 2 months in mandible for boys and girls, respectively. The study showed a secular trend present as earlier onset but decelerated development of third molars in both genders and both jaws.

Comparison of Activator-Headgear and Twin Block Treatment Approaches in Class II Division 1 Malocclusion

The purpose was to compare the treatment effects of functional appliances activator-headgear (AH) and Twin Block (TB) on skeletal, dental, and soft-tissue structures in class II division 1 malocclusion with normal growth changes in untreated subjects. The sample included 50 subjects (56% females) aged 8–13 years with class II division 1 malocclusion treated with either AH (n = 25) or TB (n = 25) appliances. Pre- and posttreatment lateral cephalograms were evaluated and compared to 50 untreated class II division 1 cases matched by age, gender, ANB angle, and skeletal maturity. A paired sample, independent samples tests and discriminant analysis were performed for intra- and intergroup analysis. Treatment with both appliances resulted in significant reduction of skeletal and soft-tissue facial convexity, the overjet, and the prominence of the upper lip in comparison to untreated individuals (p < 0.001). Retroclination of maxillary incisors and proclination of mandibular incisors were seen, the latter being significantly more evident in the TB group (p < 0.05). Increase of effective mandibular length was more pronounced in the TB group. In conclusion, both AH and TB appliances contributed successfully to the correction of class II division 1 malocclusion when compared to the untreated subjects with predominantly dentoalveolar changes.

Biological predictors of mandibular asymmetries in children with mixed dentition

Objectives: The objective was to investigate the severity of skeletal mandibular asymmetry in children with mixed dentition and other factors associated with asymmetry. Method: The study was cross sectional, with stratified sampling according to malocclusion type consisting of 205 subjects with mixed dentition (median 10, interquartile range 9–11 years). There were 59 subjects presenting Class II/1, 77 Class II/2, and 69 Class III. The mandibular asymmetry has been estimated from orthopantomograms using the Habets’ method and the dental maturation by Demirjian’s method. The sagittal skeletal relationship and facial growth pattern were assessed from lateral cephalograms. Results: Asymmetries in general, were not rare and were more present in the condylar height rather than in the height of the ramus. The highest severity of condylar asymmetry was in Class II/2 subjects (median of asymmetry index 7.3; 64% subjects exhibiting moderate and severe asymmetry), while the Class III subjects exhibited the highest severity of both ramus and total height asymmetry (2.1; 13% and 2.0; 15%, respectively). Multiple logistic regression unveiled male gender as the only predictor of moderate or significant overall asymmetry. Dental age, the difference between dental and chronological age, and facial growth pattern were not significant predictors of asymmetries. Discussion: Overall, asymmetries in mixed dentition cannot be considered rare; however, no strong relationships between asymmetry and observed biological factors were found.

Mediation and moderation effect of the big five personality traits on the relationship between self-perceived malocclusion and psychosocial impact of dental esthetics

OBJECTIVE To explore the mediation and moderation effects of personality traits on the relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics. MATERIALS AND METHODS The sample included 252 subjects (62% female) aged 12-39 years. Self-perceived malocclusion was estimated using the 10-point scale Aesthetic Component of the Index of Orthodontic Treatment Need. The Psychosocial Impact of Dental Aesthetics Questionnaire was used to assess the psychological impact and the Big Five Inventory for personality traits. Moderation and mediation effects were evaluated with Pearson correlations and stepwise regression analysis, respectively. RESULTS Self-perceived malocclusion ranged from 1 to 8 and was the most significant predictor of psychosocial impact of dental esthetics, whose unique contribution accounted for 11%-36.4% of variability, while age and sex accounted for 1.2%-2.5%. Personality traits had no mediating effect on this relationship. The moderating effect of agreeableness was present in the relationship between self-perceived degree of malocclusion and Social Impact (SI), Psychological Impact (PI), and Aesthetic Concern (AC) (ΔR2  =  0.035, 0.020, and 0.013, respectively; P < .001), while conscientiousness affected the relationship between perception of malocclusion and SI and PI (ΔR2  =  0.018 and 0.016, respectively; P < .05). In people with lower agreeableness and conscientiousness, increasing the severity of self-perceived malocclusion leads to less increase in SI and PI. In people with lower agreeableness, the increase influences AC in a similar manner. Extraversion, neuroticism, and openness do not have a moderating effect. CONCLUSIONS The relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics appears to be moderated and not mediated by personality traits. Adolescents and young adults with lower agreeableness and conscientiousness seem to be less affected by the increased severity of self-perceived malocclusion, as demonstrated in reporting some psychosocial impacts.

Oral antiseptics and nickel–titanium alloys: mechanical and chemical effects of interaction

The effect of oral antiseptics on the corrosion of nickel–titanium (NiTi) alloys with various coating was investigated. Uncoated, titanium nitride-coated and rhodium-coated NiTi archwires (0.020 × 0.020″) were tested in interaction with artificial saliva pH 4.8 and oral antiseptics based on hyaluronic acid (Gengigel), chlorhexidine (Curasept) and essential oils in alcohol base (Listerine). The dynamics of nickel and titanium ions release were recorded during 28 days. Springback ratio and modulus of resilience were assessed by three-point bending test. The results showed that corrosion of NiTi is related to type of antiseptic mouth rinse and coating formulations. Exposure to an artificial saliva and antiseptics tend to reduce flexibility and resilience of NiTi archwires. The influence of the media is more significant than the influence of the type of the alloys coating. The largest release of nickel ions is in the first 3 days. Antiseptics do not cause further deterioration of the elastic properties in uncoated NiTi compared to saliva. As a result of exposure of nitrified NiTi wires in Listerine, there is bigger release of nickel ions, decrease in elastic properties and lower force delivery in unload. Listerine tends to reduce elastic properties of rhodium-coated wires also. In conclusion, except for Listerine, changes of mechanical characteristics induced by antiseptics are small and would not have a clinically important impact. Generally, Curasept would be the most suitable option.

Development and validation of a new condition-specific instrument for evaluation of smile esthetics-related quality of life

OBJECTIVE Orofacial esthetics raises psychosocial issues. The purpose was to create and validate new short instrument for psychosocial impacts of altered smile esthetics. MATERIALS AND METHODS A team of an orthodontist, two prosthodontists, psychologist, and a dental student generated items that could draw up specific hypothetical psychosocial dimensions (69 items initially, 39 in final analysis). The sample consisted of 261 Caucasian subjects attending local high schools and university (26% male) aged 14 to 28 years that have self-administrated the designed questionnaire. Factorial analysis, Cronbachs alpha, Pearson correlation, paired samples t-test and analysis of variance were used for analyses of internal consistency, construct validity, responsiveness, and test-retest. RESULTS Three dimensions of psychosocial impacts of altered smile esthetics were identified: dental self-consciousness, dental self-confidence and social contacts that can be best fitted by 12 items, 4 items in each dimension. Internal consistency was good (α in range 0.85-0.89). Good stability in test-retest was confirmed. In responsiveness testing, tooth whitening induced increase in dental self-confidence (P = 0.002), but no significant changes in other dimensions. CONCLUSION The new instrument, Smile Esthetics-Related Quality of Life (SERQoL), is short and has proven to be a good indicator of psychosocial dimensions related to perception of smile esthetics. CLINICAL SIGNIFICANCE Smile Esthetics-Related Quality of Life questionnaire might have practical validity when applied in esthetic dental clinical procedures.

Changes in Quality of Life Induced by Tooth Whitening are Moderated by Perfectionism: A Randomized, Double-Blind, Placebo-Controlled Trial

PURPOSE To explore the influence of perfectionism on the short-term changes in satisfaction with smile esthetics and quality of life (QoL) induced by tooth whitening. MATERIALS AND METHODS A total of 60 subjects were analyzed: 30 in the active group, in which the subjects anterior teeth were whitened with a photoactivated gel, and 30 in the placebo group. The Smile Esthetics-Related Quality of Life and Multidimensional Perfectionism Scale questionnaires were administered to all participants. RESULTS The active group demonstrated an increase in dental self-confidence and a decrease in dissatisfaction with color (P < .05). The amount of color change did not correlate linearly with change in dissatisfaction or with QoL. In subjects with higher perfectionism, increasing the color change led to more decrease in dental self-consciousness. CONCLUSION Perfectionism moderates perception of smile esthetics.

Satisfaction with facial profile aesthetics: are norms overrated?

This study aimed to explore to what extent adults perceive deviations from the norm of a balanced profile with normal occlusion as reducing satisfaction with facial appearance and having a psychosocial impact. This cross-sectional study included 225 Caucasian subjects (64% women) aged 18-42 years. Their facial profiles were analyzed photogrammetrically and they were classified into three categories: within, below, or above the standard range for the Croatian population with a normal occlusion. Psychosocial issues were assessed by self-reported satisfaction with facial appearance and domains from the Orthognathic Quality of Life Questionnaire: social aspects of dentofacial aesthetics (SA), facial aesthetics concern (FA), and awareness of dentofacial aesthetics (AW). Men with a concave profile were less satisfied with their faces than those with a flat or convex profile (P<0.05). A reduced upper lip height in men resulted in a lower level of satisfaction and increased FA score, when compared to men with a normal or increased upper lip height (P<0.05). In women, a reduced middle third of the face increased AW (P=0.045). Deviations from a well-balanced facial profile, as well as the morphology of the nose and lip, do not increase psychosocial issues to a great extent. The range of acceptable facial characteristics is evidently much broader than the norms.

Perception of facial profiles: influence of female sex hormones and personality traits

OBJECTIVES The observational study investigated whether womens perception of the facial profile is related to changes in sex hormones during the menstrual cycle and under the influence of personality traits. SETTING AND SAMPLE POPULATION Participants were heterosexual Caucasian normally menstruating women not using oral contraceptives (N = 30, aged 20-44 years). MATERIAL AND METHODS The profile attractiveness was assessed by grading of thirteen mens and womens Caucasian profile distortions by a visual analogue scale (0 = least to 100 = most attractive) in the non-ovulating phase and ovulating phase of the menstrual cycle. Male profiles were graded twice-in social and emotional contexts. Personality traits were assessed by Big Five Inventory. RESULTS The most attractive male profiles in both phases and contexts were a straight profile or mild lip retrusion. According to cluster analysis, non-ovulating females distinguish skeletal from dentoalveolar alterations; however, maxillary retrognathism was considered to be closer to an attractive profile, which were resulting from dentoalveolar manipulations only. Ovulating females, when considering emotional relationship, exhibit lowest preference for males with convex profiles and extreme concave profile, while they consider males with slightly prominent chins due to maxillary retrognathism, mandibular prognathism or pronounced lip retrusion closer to the most attractive males. No clear patterns of influence of personality traits were detected. Moderate lip protrusion was the most attractive female profile in ovulating and straight profile in non-ovulating phase. CONCLUSION The favorable profiles, on average, are the same regardless of the female hormonal status and personality traits.