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The process of removing a frenulum is one of the specialties of cosmetic dentistry. Inside the mouth there are two tissues known as the frenulum. This tissue includes both the teeth and the gums. It is usually divided into the frenulum of the tongue, which is the space between the level of the mouth and the tongue. Its function is to prevent the tongue from moving freely, which is why doctors recommend removing it. While the other section is known as lip frenulum, which is when the lip is too high, which forms an obstacle in front of the front teeth and pushes them away from each other. Also, this problem requires frenulectomy surgery. In this case report, we present a case of surgery performed to remove the upper labial frenulum in a patient in his forties. The previous patient visited the clinics of the International University for Science and Technology complaining of a massive diastema in his upper jaw. Therefore, we performed surgical resection of the superior labial frenum. We administered local anesthesia to the patient in order to perform the surgical procedure. We monitored the patient's condition for two and a half weeks in order to ensure his recovery and the success of the surgery.

Objectives: To evaluate the trueness of dental arches digitised by two intraoral scanning (IOS) technologies from patients presenting crowding, diastema, and bilateral posterior edentulous space with tilted molar., Methods: Conventional impressions and dental stone models were generated from three patients presenting the aforementioned dental arch conditions. These models were digitised on a desktop scanner, and the resulting mesh was used as reference. Subsequently, the patients were scanned using confocal based (CF; iTero Element 2) and blue laser-multiscan (BLM; Virtuo Vivo) imaging IOS technology, totalling thirty scans. The meshes from the scans were exported in Standard Tessellation Language format and analysed using Geomagic Control X software. Root mean square (RMS) indicated deviation magnitude. Differences in IOS technologies were evaluated with paired t-tests, and dental arch conditions compared using ANOVA and post-hoc Tukey tests (α=0.05)., Results: Digital dental arch from blue laser-multiscan technology showed lower trueness compared to confocal based technology for crowding (p = 0.0084) and edentulous spaces (p = 0.0025) conditions. When the types of oral condition were compared, discrepancies were significantly different for both IOS technologies, featuring the arch with diastema showing the lowest trueness, followed by edentulous spaces and crowding., Conclusion: Dental arches presenting crowding and edentulous spaces digitised by blue laser-multiscan technology exhibited greater discrepancies compared to confocal based imaging technology. Furthermore, trueness varied among the dental arch conditions., Clinical Significance: The IOS technology and patient's dental arch condition can influence the trueness of dental arch digitisation. Being aware of these effects allows clinicians to take them into account during scanning procedures, digital planning and manufacturing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: This study aimed to compare the characteristics of pleasant and unpleasant smiles from the perception of laypeople., Methods: Two-hundred posed smile photographs were obtained from adult participants with no anomaly, restoration, or severe crowding and spacing in anterior teeth. Photographs were shown to 26 judges to give each photograph a score for attractiveness. Upper and lower quartiles for the most and least rated smiles were determined, and variables including gingival display, smile arc, midline deviation, buccal corridor, smile width, tooth rotation or malposition, diastema, upper and lower vermilion show, and tooth form were measured. Independent-sample t test and Pearson chi-square analysis were used to determine the differences between the pleasant and unpleasant groups for quantitative and qualitative variables, respectively. The linear regression model revealed variables with the most significant impact on the mean score., Results: All quantitative and qualitative variables except tooth form significantly differed between pleasant and unpleasant smile groups (P <0.05). The consonant smile arc was associated with an increase of 12.59% in mean scores compared with the inconsonant smile arc. Each tooth reported with malposition was correlated with a decrease of 9.37% in the scores. In the same way, each 1-mm increase in midline diastema and occlusal cant coincided with a drop of 8.73% and 3.59% in scores, respectively., Conclusions: The results of this study suggested that smile arc, tooth malposition, midline diastema, and occlusal plane canting had the most impact on smile esthetics and should be given priority by orthodontists in the treatment plan of choice., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: In patients affected by dimensional discrepancy between size of anterior maxillary and mandibular teeth, orthodontic therapy could be necessary to solve occlusal problems. However, anterior restorations are indicated to finalize the aesthetic aspect of the therapy. The aim of the present retrospective clinical study was to evaluate the long-term outcomes of direct additive composite restorations performed to correct anterior teeth discrepancies persisting after orthodontic treatment., Methods: Patients with dimensional teeth discrepancy, subjected to a combined orthodontic-restorative treatment, between January 2009 and January 2019, were recalled for the present retrospective evaluation and divided in two groups according to the restoration performed: G1) diastema closure; G2) tooth shape modification. All patients, after ortho therapy, were subjected to a standardized restorative rehabilitation of the anterior area. All restorations were performed by a single experienced operator employing the same materials. During recall visits, two calibrated examiners evaluated the restorations and recorded USPHS data. Kaplan-Meier estimator and Cox-regression analysis were performed. Statistical significance was set for p < 0.05., Results: 53 patient were included, with a total of 169 restoration (G1:110;G2:59). The mean study time period was 5 year (ranging from 6 month to 10 years). The overall survival rate of additive restoration was 2,59% (G1:2,07%; G2:0,47 p < 0.05). Chipping of the material was the most frequent adverse event (G1:13,64%; G2:1,69), followed by composite wear (G1:9,09%; G2:5,17)., Conclusions: Based on the obtained results, good clinical performances were shown at a 5-year interval. A low number of failures were collected and most of them were classified as reparable. Only few cases needed complete reintervention., Clinical Significance: Showing that a direct approach in restoring anterior teeth for diastema closure or shape modification is a valid alternative in terms of durability and aesthetics to more invasive procedure such as indirect restorations., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Orodental disorders are common in equidae and can lead to serious clinical complications. This study determines the prevalence rate (PR) of orodental disorders in working donkeys in Egypt and their potential risk factors. During 4 years, 3,791 donkeys were examined in six Egyptian governorates. Full case history and thorough clinical and oral examinations were performed. Radiography and oroendoscopy were undertaken whenever possible. All data were statistically analyzed using Poisson generalized linear models to compare PR among governorates, sex, years, body condition score, and age groups and to determine the potential risk factors. Of 3,791 examined donkeys, 954 donkeys (25.17%) had orodental disorders. The PRs of acquired disorders were 9.81% sharp enamel points, 5.86% buccal ulcers, 4.88% hook, 4.70% overgrown teeth, 4.19% periodontal disease, 3.11% ramp, 2.60% dental caries, 2.37% dental calculus, 2.30% diastema, 2.06% step mouth, 2.00% soft tissue injuries other than buccal ulcers, 1.77% worn tooth, 1.37% loose tooth, 1.29% exaggerated transverse ridge, 1.24% fractured teeth, 0.82% missing teeth, 0.69% wave mouth, 0.50% molar table angle change, and 0.45% wolf tooth overgrowth. The PRs of the congenital disorders were 1.90% displaced teeth, 1.37% deviated teeth, 0.58% retained teeth, 0.16% overbite, 0.16% underbite, 0.11% supernumerary teeth, and 0.11% premolar cap. The risk factors significantly associated (P < .05) with the orodental disorders were age and sex of the animal, geographic location, and year of examination. This study provides a database for future studies on orodental disorders and for designing effective preventive and therapeutic strategies for these disorders in donkeys., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Our objective was to determine whether dental esthetics have any influence on finding a new job., Methods: Ten patients with orthodontic treatment needs for various types of malocclusions were selected. Smiling facial photographs of all patients were obtained and digitally altered (orthodontic correction of teeth). After the images were obtained, 2 different questionnaires were prepared (survey groups A and B) with the photographs without alteration (showing malocclusion) and altered (with orthodontic correction). Subjects appeared in one questionnaire (survey group) with an ideal smile and also in the other (survey group) with a nonideal smile. The images were evaluated by 100 persons responsible for hiring staff for commercial companies. In each survey group, 4 questions were asked regarding the individuals' likelihood of being hired, honesty, intelligence, and efficiency at work. Analysis of variance for repeated measures was used to determine the differences in the evaluations of patients with ideal and nonideal dental esthetics for the 4 characteristics evaluated. The level of significance adopted was 5%., Results: The photographs of persons with ideal dental esthetics were, on average, evaluated as superior with respect to intelligence and likelihood of being hired than were the photographs of the same subjects with nonideal dental esthetics. For the characteristics of honesty and efficiency, no significant differences were observed in the evaluations between those with ideal and nonideal smiles (P <0.05)., Conclusions: Persons with ideal smiles are considered more intelligent and have a greater chance of finding a job when compared with persons with nonideal smiles., (Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Adhesive resin composite technology enables dentists to add composite material to tooth surfaces to close gaps and reshape tooth form without cavity preparation. This option creates new possibilities for minimally invasive dentistry as the tooth shape, position and colour can be altered without loss of tooth substance. However, evidence-based data on direct composite buildups are rare., Methods: The purpose of this study was to evaluate the outcome and to document the occurrence of unfavourable events and clinical findings of 176 direct composite buildups that had been performed in the Department of Conservative Dentistry, University Hospital Heidelberg, Germany, between 2002 and 2008. Outcome was categorised as failure (F), survival (SR) or success (S). Restorations still in place and without prior failure at follow-up were qualitatively rated using modified USPHS/FDI criteria., Results: During the follow-up period, 30 restorations were found to have had unfavourable events or clinical findings. All restorations were repaired, and they remained in situ (SR). No complete loss (F) was recorded. The overall survival rate was 84.6% after 60 months (95%, confidence interval [CI]: 78.5 and 90.6). Clinical quality was rated excellent or good for most (>90%) of the restorations examined., Conclusions: The direct composite buildups observed in this study were found to have promising clinical outcome and good quality parameters after 5 years. If a noninvasive or minimally invasive treatment approach is indicated, direct composite buildups provide an acceptable treatment alternative for the aesthetic correction and reshaping of anterior teeth., Clinical Significance: The application of direct composite buildups in clinical cases in which a non- or minimally invasive treatment approach is indicated provides an excellent treatment alternative for gold-standard treatment options like laboratory-made crowns and porcelain veneers. Restorations in the present investigation showed a functional survival rate of 100%, an overall survival rate of 84.6% after 5 years., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: The purpose of this study was to investigate a simple method for correcting upper dental midline shift, by physiologic movement of the incisors during the retention period of rapid maxillary expansion., Methods: Thirty-two patients with upper midline shifts due to constricted maxillae and anterior crowding were selected. All had undergone radiological and clinical examinations to be sure that the midline shift was not functional and was caused only by crowding. The patients were randomly divided into 2 groups. In both groups, acrylic cap splint type expansion appliances were used. In group 1, the acrylic cap covered all the dentition except the incisors and the canine on the shifted side. After expansion, the incisors on the shifted side were allowed to move toward the midline, and the incisors of the other side were held by the acrylic cap. In group 2, the acrylic cap covered only the posterior teeth, from the first premolars on both sides. After expansion, the incisors on the shifted side were allowed to move toward the midline diastema, whereas those on the other side were held in place by ligation of the brackets, which had been placed immediately after expansion., Results: In both groups, the midline shift was corrected by the movement of the shifted incisors toward the midline diastema, without orthodontic force., Conclusions: Residual or unwanted forces produced during rapid maxillary expansion can be used to correct an upper dental midline shift.

Introduction: Previous studies evaluated the perception of laypersons to symmetric alteration of anterior dental esthetics. However, no studies have evaluated the perception of asymmetric esthetic alterations. This investigation will determine whether asymmetric and symmetric anterior dental discrepancies are detectable by dental professionals and laypersons., Methods: Seven images of women's smiles were intentionally altered with a software-imaging program. The alterations involved crown length, crown width, midline diastema, papilla height, and gingiva-to-lip relationship of the maxillary anterior teeth. These altered images were rated by groups of general dentists, orthodontists, and laypersons using a visual analog scale. Statistical analysis of the responses resulted in the establishment of threshold levels of attractiveness for each group., Results: Orthodontists were more critical than dentists and laypeople when evaluating asymmetric crown length discrepancies. All 3 groups could identify a unilateral crown width discrepancy of 2.0 mm. A small midline diastema was not rated as unattractive by any group. Unilateral reduction of papillary height was generally rated less attractive than bilateral alteration. Orthodontists and laypeople rated a 3-mm distance from gingiva to lip as unattractive., Conclusions: Asymmetric alterations make teeth more unattractive to not only dental professionals but also the lay public.

The objective of this study was to determine the prevalence of malocclusion among predominantly Yoruba adolescents in Ibadan, Nigeria, and to compare the results with those of other authors. The sample for this epidemiological survey comprised 636 secondary school students, (334 [52.5%] boys and 302 [47.5%] girls), aged 12-17 years (mean age, 14.72 +/- 1.16 SD). The subjects were randomly selected, and none had received previous orthodontic treatment. Occlusal anteroposterior relationships were assessed based on the Angle classification. Other variables examined were overjet, overbite, crowding, and midline diastema. The results showed that about 24% of the subjects had normal occlusions, 50% had Class I malocclusions, 14% had Class II malocclusions, and 12% had Class III malocclusions. Over 66% had normal overbites, and 14% and 9% had increased and reduced values, respectively. Overjet relationship was normal in 66%, increased in 16%, and decreased in 8%. Crowding was observed in 20% of the subjects and midline diastema in 37%. No statistically significant differences were observed for any occlusal variables (P > .05). Class I malocclusion is the most prevalent occlusal pattern among these Nigerian students. Different patterns of Class II and Class III might be present for the dominant ethnic groups in the country. Therefore, a survey of the occlusal pattern in southeastern Nigerians (Ibo ethnic group) would appear to be worthwhile.

The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most (P <.0005). This suggests that, from the children's point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania.

Rapid palatal expansion has been a clinically accepted technique used by orthodontists for over 100 years. Its primary goal is to maximize orthopedic and minimize orthodontic movements of teeth. Historically, this was best accomplished by including 4 teeth in the appliance. However, including more teeth makes construction and insertion more difficult. The appliance also is less comfortable for patients and hinders oral hygiene. The 4-point hyrax expander can be modified by removing the 2 anterior wires, creating a 2-point expander between the first molars only. The purpose of this study was to determine the difference, if any, between midpalatal suture separation and dental expansion produced between 2-point and 4-point palatal expanders. Thirty subjects between the ages of 6 and 16 years were randomly assigned to either the 2-point (n = 15) or the 4-point group (n = 15). The groups were compared on dental and radiographic landmarks. The groups showed no statistical differences in total molar cusp width, molar gingival width, canine cusp width, canine gingival width, or diastema width. There were slight differences in arch perimeter and midpalatal suture separation. The results of this study showed that the 2-point appliance produced similar effects on the midpalatal suture and the dentition as did the 4-point appliance. It might therefore be considered instead of the 4-point appliance to successfully produce adequate skeletal and dental expansion.

Aims: To estimate the prevalence and the severity of malocclusion and treatment need for 329 handicapped individuals., Subjects and Setting: 329 handicapped individuals aged 11-30 years, attending eight different nonresidential special schools of South Canara, India., Method: Examination and recording using the Dental Aesthetic Index (DAI)., Results: 53% had a dental appearance which required no orthodontic treatment, 24% had a definite malocclusion, where treatment was 'elective' and treatment for a further 12% was considered to be 'highly desirable'. The remaining subjects (11%) had a handicapping malocclusion where treatment was considered mandatory., Conclusions: The prevalence of definite and severe malocclusions was higher in the mentally subnormal individuals when compared to other handicapping conditions. Orthodontic services for the handicapped have generally been neglected.

The purpose of the study was to estimate familial correlations and heritability to evaluate familial aggregation patterns of maxillary midline diastemas. The sample consisted of 30 extended families: 15 black, 14 white, and 1 mixed race. A single ascertainment scheme was adopted to collect the sample. Family data were collected with a 7-question survey. In all, the sample of 430 subjects consisted of 220 females, 210 males, 99 nuclear families, 534 sibling pairs, 422 avuncular pairs, 318 grandparent pairs, and 27 cousin pairs. Families were stratified by race to avoid any bias. The mixed-race family was excluded from the analysis. Data were analyzed using the program REGC in the Statistical Analysis for Genetic Epidemiology (S.A.G.E., Case Western Reserve University, Cleveland, Ohio) software. Heritability was found to be 0.32 +/- 0.14 in the white sample and 0.04 +/- 0.16 in the black sample. The preliminary results suggest a possible genetic basis for maxillary midline diastema and a greater role of environmental factors in the black sample than in the white sample.

The purposes of this study were to determine the prevalence of posttreatment open gingival embrasures in adult orthodontic patients and to examine the association of pretreatment maxillary incisor malalignment, posttreatment alveolar bone height, interproximal contact position, root angulation, crown shape, and embrasure area with open gingival embrasures. Posttreatment intraoral photographs of 337 adult orthodontic patients were evaluated to determine the prevalence of open gingival embrasures. A subsample of 119 patients was identified for measurement and divided into 2 groups: normal gingival embrasures and open gingival embrasures. Digital images of the pretreatment maxillary models and posttreatment maxillary central incisor periapical radiographs were made to measure the pretreatment and posttreatment variables. The prevalence of posttreatment open gingival embrasures in adult orthodontic patients was 38%. Pretreatment maxillary central incisor rotation and overlap were not statistically associated with posttreatment open gingival embrasures. A posttreatment alveolar bone-interproximal contact distance greater than 5.5 mm was associated with open gingival embrasures. Short and more incisally positioned posttreatment interproximal contacts were associated with open gingival embrasures. Open gingival embrasures were found to have more divergent root angulations and more divergent or triangular-shaped crown forms than normal gingival embrasures. Embrasure areas larger than 5.09 mm(2) were also correlated with open gingival embrasures. Increased alveolar bone-interproximal contact distance and increased root angulation demonstrated the greatest increase in the odds of an association with an open gingival embrasure. This investigation indicates that open gingival embrasures are common in adults who have undergone orthodontic treatment and that posttreatment variables are significant factors in open gingival embrasures.

Debates about the "ideal" timing of orthodontic treatment have focused on issues of biologic development and readiness. In this article we examine psychologic issues that should be considered in the decision to initiate orthodontics in the younger child or to wait until adolescence or later. Psychologic development during the preadolescent and adolescent stages may influence the child's motive for, understanding of, and adherence to treatment regimens. Results of a study of some personality characteristics, motives, and aesthetic values of young phase I patients are presented. Questionnaires were completed by 75 children (mean age 10.85 years, 52.1% female, 84% white) and their parents. Children's perceived reasons for treatment were consistent with their parents' reports (chi 2 = 76.08, p < .001); most were referred for crowded teeth (56%) and overbite (17.3%). Although body image and self-concept scores were within the normal range, both children and their parents expected the most improvement in self-image and oral function, with greater expectations by parents on self-image (p < .0001), oral function (p < .0001), and social life (p < .03) than children themselves. Although white and minority children were similar in their self-ratings and expectations from orthodontics, the former were more critical in their aesthetic judgments. They rated faces with crowded teeth (p < .02), overbite (p < .02), and diastema (p < .01) more negatively than did ethnic minorities. These results suggest that younger children are good candidates for Phase I orthodontics, have high self-esteem and body-image, and expect orthodontics to improve their lives. White children who have been referred for Phase I orthodontics appear to have a narrower range of aesthetic acceptability than minority children.

The purpose of this case report is to present a description of the diagnosis and treatment to ABO standards of a patient with a mutilated Angle's Class II, Division 1 malocclusion, complicated by anterior dental crowding, and a dolichofacial skeletal pattern. Treatment involved extraction of the maxillary first premolars, lingual arches to enhance anchorage, and J-hook headgear to retract the maxillary anterior segments.

Loss of periodontal bone support was examined in 24 patients orthodontically treated for pathologic tooth migration in one jaw. Prior to orthodontic realignment of the front teeth, the patients had received periodontal treatment. Active appliance therapy was not given until inflammation was eliminated and the patients demonstrated a high level of oral hygiene. A 0.020-inch spiral wire was bonded to each adjacent realigned tooth for retention. The levels of marginal bone of the front teeth in the treated and untreated jaws were measured in percentage of "maximum bone height" on periapical radiographs made before and after treatment. Relapse was evaluated from study models. Mean averaged loss of periodontal bone from the period before to after orthodontic treatment was 4.94% (SD 4.03, P less than 0.001) and 2.69% (SD 3.66, P less than 0.001) of the treated and untreated front teeth, respectively. The mean difference in averaged loss between treated and untreated front teeth was 2.24% (SD 3.28, P less than 0.01). The majority of the sites showed little or no loss. Maximum loss (35%) was observed in one site only. No association was found between initial bone loss and bone loss during orthodontic treatment. Spaces from 0.1 to 1.8 mm opened up adjacent to the retainer in seven patients. Relapse within the retained segment was associated with failures of the retainer. Of the 19 patients who had been in retention for more than 4 months (mean 16.0, SD 12.1), ten failures were recorded in nine patients. The failure mode was loosening of one or two teeth between wire and composite.