Emilio Jiménez-Castellanos

Prevalence of alterations in the characteristics of smile symmetry in an adult population from southern Europe

STATEMENT OF PROBLEM Deviation from the facial midline and inclination of the dental midline or occlusal plane has been described as extremely influential in the laypersons perceptions of the overall esthetics of the smile. PURPOSE The purpose of this study was to determine the prevalence of deviation from the facial midline and inclination of the dental midline or occlusal plane in a selected sample. MATERIAL AND METHODS White participants from a European population (N=158; 93 women, 65 men) who met specific inclusion criteria were selected for the present study. Standardized 1:1 scale frontal photographs were made, and 3 variables of all participants were measured: midline deviation, midline inclination, and inclination of the occlusal plane. Software was used to measure midline deviation and inclination, taking the bipupillary line and the facial midline as references. Tests for normality of the sample were explored and descriptive statistics (means ±SD) were calculated. The chi-square test was used to evaluate differences in midline deviation, midline inclination, and occlusion plane (α=.05) RESULTS: Frequencies of midline deviation (>2 mm), midline inclination (>3.5 degrees), and occlusal plane inclination (>2 degrees) were 31.64% (mean 2.7±1.23 mm), 10.75% (mean 7.9 degrees ±3.57), and 25.9% (mean 9.07 degrees ±3.16), respectively. No statistically significant differences (P>.05) were found between sex and any of the esthetic smile values. CONCLUSIONS The incidence of alterations with at least 1 altered parameter that affected smile esthetics was 51.9% in a population from southern Europe.

Laypersons' perception of facial and dental asymmetries.

The purpose of this article was to determine the individual visual perception thresholds of certain facial and dental discrepancies for a symmetric face model (SFM). A facial photograph of a female subjects smile was digitally manipulated into an artificially symmetric picture. Modifications were made on the SFM for shifts in the dental midline, nose, and chin (group 1) and cants of dental midline and incisal plane (group 2), resulting in a total of 24 different images divided into two groups. One-hundred randomly selected laypersons divided into two groups were used to evaluate each image according to their own personal beauty and esthetic criteria using a visual analog scale. The visual perception thresholds found for the SFM were 2 mm for a dental midline shift, 4 mm for nose deviation, 5 degrees for dental midline cant, and 3 degrees for frontal incisal plane cant. Chin deviations of 6 mm or less were not noticed. Dental midline shift, nose deviation, dental midline cant, and incisal plane cant relative to an SFM have an impact on the perception of facial attractiveness. Chin deviations did not have a statistically significant impact.

Biometric analysis of the clinical crown and the width/length ratio in the maxillary anterior region

STATEMENT OF PROBLEM Restorative dentistry often involves correcting tooth size discrepancies. Therefore, dental biometrics should play an important role in the planning of an esthetic restoration. PURPOSE The purpose of this study was to analyze the clinical crown width, length, and width/length ratio of maxillary central incisors, lateral incisors, and canines in an adult population. The study also aimed to determine whether a correlation exists between natural tooth dimensions and the optimal tooth dimension guidelines suggested for planning esthetic restorations. MATERIAL AND METHODS Stone casts were poured from irreversible hydrocolloid impressions of 412 healthy adult participants. These casts were used to measure the maximum mesiodistal width and maximum crown-root length of the maxillary central incisors, lateral incisors, and canines with a digital precision caliper (0.01 mm). The width/length ratio was calculated for each tooth, and 40 casts were selected to test the reliability of the measuring method. RESULTS The mean age of the participants in the sample was 33.94 years; 60.7% were women and 39.3% were men. The mean width value was 8.71 mm for central incisors, 6.75 mm for lateral incisors, and 7.81 mm for canines. The mean length was 10.23 mm for central incisors, 8.59 mm for lateral incisors, and 9.93 mm for canines. The average width/length ratio was 85% for central incisors and 79% for lateral incisors and canines. CONCLUSION The data obtained from the population studied are similar to those from previous research studies with similar methodology. However, great discrepancies in the absolute values were found when compared with other studies of ideal tooth dimension guidelines on the personal preferences and the esthetic perception of dentists. The perception of what is considered natural seems to differ from what is considered esthetically perfect.

Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: A randomized, crossover, double-blind clinical trial

Statement of problem. The masticatory efficacy between dentate and edentulous individuals with and without the use of dental adhesives has been little studied. A comparative study of the addition of various agents of synthetic adhesion (vinyl methyl ether versus polyvinyl acetate) to these adhesives is needed. Purpose. The purpose of this randomized, crossover, double‐blind clinical trial was to compare the masticatory efficacy of wearers of complete dentures with and without dental adhesives of 2 different compositions and that of dentate controls. Material and methods. Seventeen participants with edentulism (edentulous control and 2 experimental groups) received new maxillary and mandibular complete dentures. After an adjustment period, they participated in masticatory tests with and without the use of 2 denture adhesives (Fittydent; Fittydent International GmbH and Corega; GlaxoSmithKline). The participants with edentulism were compared with 17 dentate controls. Masticatory efficacy was evaluated while the participants were masticating a substitute for irreversible hydrocolloid (20 g) and performing a single test of mastication (with 20 masticatory strokes) at 0, 7, and 14 days. Masticatory efficiency was measured immediately after each test with the sieving method and was calculated according to the weight of the particles of the substitute in each of the sieve filters. Data were analyzed using 1‐way ANOVA for simple pairs, and a multiple comparison was made using the Wilcoxon test with Bonferroni correction (&agr;=.05). Results. Significant differences were found between the 2 adhesives (P<.05) in the masticatory efficacy for filters 2 and 3, and nonsignificant differences occurred for filter 1. Compared with the edentulous control group, significant differences between the use or nonuse of adhesives were found in the edentulous group for the 3 filters (P<.05). Compared with the dentate control group, significant differences were found in masticatory efficiency between the dentate control group and the other groups for all comparisons (P<.05). Conclusions. Masticatory efficacy was higher with the use of Corega denture adhesive. The masticatory efficacy was significantly higher in dentate participants compared with participants with edentulism who had complete dentures, with or without denture adhesives. A significant increase of masticatory efficacy was observed among edentulous participants with denture adhesives in relation to those not using denture adhesives.

Layperson’s preference regarding orientation of the transverse occlusal plane and commissure line from the frontal perspective

STATEMENT OF PROBLEM Facial asymmetries in features such as lip commissure and interpupillary plane canting have been described as common conditions affecting smile esthetics. When presented with these asymmetries, the clinician must choose the reference line with which to orient the transverse occlusal plane of the planned dental restorations. PURPOSE The purpose of the online survey described in this study was to determine lay preferences regarding the transverse occlusal plane orientation in faces that display a cant of the commissure line viewed from the frontal perspective. MATERIAL AND METHODS From a digitally created symmetrical facial model with the transverse occlusal plane and commissure line parallel to the interpupillary line (horizontal) and a model constructed in a previous study (control), a new facial model was created with 3 degrees of cant of the commissure line. Three digital tooth mountings were designed with different transverse occlusal plane orientations: parallel to the interpupillary line (A), parallel to the commissure line (B), and the mean angulation plane formed between the interpupillary and commissure line (C), resulting in a total of 4 images. All images, including the control, were organized into 6 pairs and evaluated by 247 selected laypersons through an online Web site survey. Each participant was asked to choose the more attractive face from each of the 6 pairs of images. RESULTS The control image was preferred by 72.9% to 74.5% of the participants compared with the other 3 images, all of which represented a commissure line cant. Among the 3 pairs which represent a commissure line cant, 59.1% to 61.1% preferred a transverse plane of occlusion cant (B and C) compared with a plane of occlusion parallel to the interpupillary, line and 61.1% preferred a plane of occlusion parallel to the commissure line (B) compared with the mean angulation plane (C). CONCLUSIONS Laypeople prefer faces with a commissure line and transverse occlusal plane parallel to the horizontal plane or horizon. When faces present a commissure line cant, laypeople prefer a transverse occlusal plane with a similar and coincident cant.

Maxillomandibular osteomyelitis associated with osteopetrosis.

Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.

Layperson's perception of axial midline angulation in asymmetric faces

OBJECTIVE Asymmetric facial features such as a deviated nose and chin are common and known to affect smile esthetics. When presented with these asymmetries, the clinician must consider the impact they will have on the smile design parameters-especially the placement and angulation of the dental midline, which is a common starting point for a case involving smile design. The purpose of this article is to determine if the nose and chin deviations affect the perception of dental midline angulation. MATERIALS AND METHODS An asymmetric facial model (AFM) was created from a digital symmetric facial model, used in a previous study by digitally deviating the nose and chin to the same side. Eight different pictures of this AFM were created, each with different degrees of maxillary midline angulation (both in and against the direction of the deviated nose and chin). Using a visual Likert scaled delivered via Websurvey in the private practice setting, one hundred and ninety-six randomly selected laypersons were asked to evaluate each image according to their own notions of beauty. RESULTS A minor axial dental midline angulation of 3.5° can be perceived independently of the direction of the cant. All pictures where the midline was canted pointing in the opposite direction of nose and chin deviations presented lower rating mean values. CONCLUSIONS Off-center noses and chins can influence the perceived attractiveness of a smile with a canted dental midline. The degree and direction of a canted midline can influence the harmony between the smile and overall face, with canting in the same direction of the asymmetric features being rated as more attractive. CLINICAL SIGNIFICANCE The dental midline should be as vertically straight as possible. If a midline cant is present, however, it is more favorable to have a dental midline angulation which points in the same direction as nose and chin deviations, rather than in the opposite direction.

Fibromyalgia syndrome and temporomandibular disorders with muscular pain. A review

Abstract Objectives: Temporomandibular disorders (TMD) refer to a group of clinical picture affecting the masticatory muscles and temporomandibular joint that are characterized by muscular or joint pain, dysfunction (limited or altered functions) and joint noises, as well as other associated symptoms, such as tension headaches, otalgia, dizziness, tinnitus, and others. Fibromyalgia (FM) is a syndrome of unknown etiology involving generalized chronic pain accompanied, in a high percentage of cases, by other symptoms such as asthenia, anxiety, depression, sleep disturbances, and other less frequent symptoms, such as temporomandibular disorders (TMD). Data: Data were compiled by two experienced examiners following a specific form. Sources: An electronic search was carried out in the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and SCOPUS electronic databases (up to April 2016, unrestricted by date or language). Study selection: Comparative clinical studies with patients with both clinical pictures involving the study of pathogenic processes. Conclusions: Fibromyalgia and temporomandibular disorders with muscle pain both have profiles that affect the muscular system and therefore share many epidemiological, clinical, and physiopathological symptoms. Because of this, we are led to think that there is, if not a common etiology, at least a common pathogenesis. This article revises the physiopathological processes of both clinical pictures in an attempt to determine their similarities and likenesses. This would undoubtedly help in providing a better therapeutic approach.

Width/Length Ratio in Maxillary Anterior Teeth. Comparative Study of Esthetic Preferences among Professionals and Laypersons

PURPOSE Many studies have examined the esthetic preferences of professionals in the maxillary anterior region; however, only a few have taken into account the ratios that are more frequent within the population or other ratios suggested in the literature as ideal. Previous studies also failed to compare them with the esthetic preferences of the lay population with regards to the smile. The purpose of this study is to highlight the differences when perceiving the esthetics of smiles between general dentists and laypersons, and linking them with the width/length of the maxillary anterior teeth. MATERIALS AND METHODS Photographs of the full face of a female subject were modified with Photoshop CS regarding the length/width relationships of the 6 maxillary anterior teeth. The three modifications made were: (a) 80% length/width, (b) 85%, length/width, and (c) 85% length/width in central incisors, 80% length/width in lateral incisors and canines. Three sequences of photograph pairs were created with different ratios and presented in PowerPoint to a sample of 100 general dentists and 100 laypersons. RESULTS The ratio considered as the most esthetic by the majority of the judges was 85% for central incisors and 80% for lateral incisors and canines, with a statistically significant difference (p < 0.01). There was no statistically significant difference in the esthetic preferences of the studied populations either due to gender or professional experience of the dentists (p > 0.01). CONCLUSIONS According to the results obtained in this study, professionals and laypersons considered a width/length ratio of 85% for maxillary central incisors and 80% for lateral incisors and canines as the most esthetic for maxillary anterior teeth. These results do not support findings from other studies previously published with similar ratios in central incisors, lateral incisors, and canines. CLINICAL IMPLICATION Today clinicians practice in a treatment environment where not only function and utility but also esthetics is demanded in almost every procedure. Restoring/maintaining function is considered essential in any restorative dentistry treatment, but the esthetic aspects of any treatment should never be forgotten. This study was motivated by the increasing importance of obtaining a better appreciation of the perception of smile beauty, and of the role of maxillary teeth width/length ratio on the perception of dental esthetics.