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INTRODUCTION To assess the esthetic subjective effect of malocclusions in the anterior segment on children in the mixed dentition. METHODS A cross-sectional study was carried out with a population-based sample of 787 children aged 8-10 years in the late mixed dentition (n = 787). Orthodontic Aesthetic Subjective Impact Score determined the esthetic subjective effect. For assessing the malocclusions in the anterior segment (anterior crowding, anterior spacing, diastema, anterior open bite, and anterior maxillary overjet), the following Dental Aesthetic Index criteria were used. Sex, family income, and education level were used as control variables. The variables were analyzed using a simple logistic regression model, estimating crude odds ratios. The variables with P

Objective To evaluate the influence of a midline diastema on dentofacial esthetic perceptions of orthodontists, restorative dental specialists or prosthodontists, and laypersons in a frontal facial evaluation performed by means of video. Materials and Methods Two individuals aged between 20 and 25 years, one of each gender, with presence of a midline diastema were selected. An acrylic resin mockup was made of the maxillary anterior region, simulating ideal conditions of smile esthetics. Four standardized frontal view videos of the complete face were filmed of each individual in the following situations: with the ideal smile (unchanged mockup) and with the presence of midline diastemas of 0.5, 1.0, and 1.5 mm created by the mockup. In all videos, the patient said a certain sentence and, at the end, simulated a posed smile. Dentofacial esthetic perceptions of all four videos of each individual were evaluated by 51 orthodontists, 51 restorative dental specialists or prosthodontists, and 51 laypersons by means of visual analog scales. Data were evaluated using analysis of variance and Tukey post hoc test, with the level of significance set at 5%. Results The most attractive videos for all groups of examiners were those without diastema and with a diastema of 0.5 mm, for both the woman and the man. For a diastema of 1 mm or 1.5 mm, the dentofacial characteristics were considered unesthetic. Conclusions Diastemas equal to or greater than 1 mm negatively influence dentofacial esthetics in a frontal facial evaluation performed by means of video.

Background Pseudohypoparathyroidism (PHP) is a rare and inherited disease caused by mutations in the GNAS-gene or upstream of the GNAS complex locus. It is characterized by end-organ resistance to PTH, resulting in hypocalcemia and hyperphosphatemia. We aimed to investigate the dental anomalies according to tooth types and the orthodontic characteristics of patients with PHP. Methods Using a cross-sectional design, 29 patients (23 females) with PHP, living in Denmark, were included, and their clinical intraoral photos and radiographs were examined. Results Pulp calcification was found in 76% of the patients. Blunting of root apex was present in 55% and shortening of root in 48% of the examined patients. Blunting and shortening of roots were seen more often in premolars than in other tooth types (pboth Conclusion In the present study population, the teeth were frequently affected by pulp calcification and/or deviation of the root morphology. Blunting and shortening of root(s) were more often seen in premolars than in other tooth types. Class III malocclusion was relatively prevalent. It is important to pay attention to dental anomalies and occlusion in order to provide adequate care for patients with PHP.

No previous studies have investigated eye-movement patterns to show children’s information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators’ perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children’s ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children’s ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6–4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Maxillary midline diastema is a common aesthetic concern of dental patients. Various treatment modalities have been employed to close diastemas. This case report describes an unusual orthodontic treatment approach for a 25-year-old African American female patient with a large maxillary midline diastema of 5mm, bialveolar dental protrusion and unilateral Class III malocclusion. The treatment included one mandibular incisor extraction, followed by retraction of the incisors. At the end of the 16-month active treatment period, favourable aesthetic and occlusal outcomes were attained. Closure of midline diastema, good overjet and overbite with Class I molar relationships were achieved. CLINICAL SIGNIFICANCE: Fixed orthodontic treatment with single mandibular incisor extraction can be an effective treatment choice for a large maxillary midline diastema. With careful selection of the case and treatment planning, successful results can be obtained.

Equine dental disease remains a widespread affliction in domestic horses, with the potential to cause significant welfare problems. This retrospective study aimed to increase understanding of this aspect of equine health by examining dental records of 932 horses, taken from a 1-year period of first-opinion practice in south-western England and southern Wales. Three grossly-identifiable dental diseases were analysed: equine periodontal disease, diastemata and peripheral caries. The prevalence of active periodontal disease, diastemata and peripheral caries were 13.9%, 8.7% and 8.2%, respectively. Periodontal disease was more common in the mandibular than maxillary arcades (P

Maxillary frenectomy in children is a common procedure, but concerns about scar tissue affecting diastema closure prevent many clinicians from treating prior to orthodontics.To determine if maxillary frenectomy is safe and if diastema size is affected by early treatment.Paediatric patients with hypertrophic maxillary frena were treated under local anaesthesia with diode laser and COIn total, 109 patients were included: 95 patients with primary dentition (39% male; mean age 1.9 years±1.5 years) and 14 with mixed dentition (43% male; mean age 8.1±1.3 years) with a mean follow-up of 18.0±13.2 months. No adverse outcomes were noted other than minor pain and swelling. In the primary dentition, a decrease in diastema width was observed in 94.7% with a mean closure of -1.4±1.0mm (range +0.7 to -5.1mm). In the mixed dentition, a decrease in diastema width was observed in 92.9% with a mean closure of -1.8±0.8mm (range 0 to -3.5mm). 74.5% of patients in the primary dentition and 75% of patients in the mixed dentition with preoperative diastema2mm improved to2mm width postoperatively.Frenectomy is associated with cosmetic and oral hygiene benefits and when performed properly, does not impede diastema closure and may aid closure. Technique and case selection are critical to successful outcomes. IRB ethics approval was obtained from Solutions IRB protocol #2018/12/8, and this investigation was self-funded.

Summary Objectives To compare posterior crossbite correction frequency and dentoalveolar changes of the expander with differential opening (EDO) and the fan-type expander (FE). Trial design Two-arm parallel randomized controlled trial. Methods Forty-eight patients from 7 to 11 years of age were allocated into two groups. Twenty-four patients were treated with the EDO and 24 patients were treated with the FE. Block randomization was performed. The study was single blind. Digital dental models were acquired before treatment and 6 months after rapid maxillary expansion. The primary outcomes were crossbite correction rate and maxillary arch width changes. Secondary outcomes were interincisal diastema, arch perimeter, length, size and shape, and mandibular dental arch changes. Results The final sample comprised 24 patients (13 female and 11 male; mean initial age of 7.62 years) in the EDO group and 24 patients (14 female and 10 male; mean initial age of 7.83 years) in the FE group. The crossbites were corrected in 100 per cent of subjects from EDO group and in 75 per cent of patients in FE group. EDO showed greater increases in maxillary intermolar region (P < 0.001), while the FE demonstrated greater increases in the intercanine distance (P = 0.008). Increase in mandibular inter-first permanent molar distance was slightly greater in the EDO group (mean difference of 0.8 mm). Changes in arch length and perimeter were similar in both groups. Both expanders changed the maxillary arch shape. The post-treatment arch shape was larger in the anterior region for FE and in the posterior region in the EDO group. Harms Discomfort during activation was reported by 54 per cent of the participants. A temporary change in the nasal bridge was reported by one patient from FE group. Conclusions Maxillary arch width and shape changes were distinct between the EDO and the FE. Greater transversal increases of the anterior and posterior regions were observed for the FE and the EDO, respectively. A slightly greater mandibular spontaneous expansion was observed for the EDO only at the molar region. Trial registration NCT03705871.

Fraser syndrome (FS) is a rare autosomal recessive multiple congenital malformation syndrome characterized by cryptophthalmos, cutaneous syndactyly, renal agenesis, ambiguous genitalia, and laryngotracheal anomalies. It is caused by biallelic mutations of FRAS1, FREM2, and GRIP1 genes, encoding components of a protein complex that mediates embryonic epithelial-mesenchymal interactions. Anecdotal reports have described abnormal orodental findings in FS, but no study has as yet addressed the orodental findings of FS systematically. We reviewed dental radiographs of 10 unrelated patients with FS of different genetic etiologies. Dental anomalies were present in all patients with FS and included hypodontia, dental crowding, medial diastema, and retained teeth. A very consistent pattern of shortened dental roots of most permanent teeth as well as altered length/width ratio with shortened dental crowns of upper incisors was also identified. These findings suggest that the FRAS1-FREM complex mediates critical mesenchymal-epithelial interactions during dental crown and root development. The orodental findings of FS reported herein represent a previously underestimated manifestation of the disorder with significant impact on orodental health for affected individuals. Integration of dentists and orthodontists into the multidisciplinary team for management of FS is therefore recommended.

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17-21-year-old Estonians.Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17-21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants' opinions regarding their teeth were determined with a questionnaire.Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5 mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5 mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants' main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants' desire for orthodontic treatment.

Background: The aims of the study were as follows: (1) to examine the width of the dental arches of patients with maxillary midline diastema and compare it with control group; (2) to investigate the impact of the width of upper dental arch on the width of diastema. Materials and methods: Diagnostic orthodontic plaster models of 102 patients with permanent dentition were studied. Patients were divided into two groups: study group with diastema and control group without diastema. Patients with severe malocclusion, craniofacial diseases, hypodontia and microdontia and pa­tients with periodontal disease were excluded. The transpalatal width of palate, premolar and molar arch widths in Pont’s points of upper and lower jaw were measured using digital calliper. The results were statistically analysed. Results: Analysis showed a significant correlation between presence of diastema and premolar and molar width of the dental arches for both upper and lower jaw. Studied widths were larger in patients with diastema compared to the group without diastema. Analysis of the transpalatal width showed statistically significant differences between the study group and the control group. Analysis of widths of diastema and transpalatal widths showed that there was not statistically sig­nificant correlation. Conclusions: Patients with diastema had increased in size in both the premolar and molar width of the dental arches. Increase the width affect to both upper and lower dental arch. Patients with diastema also were characterised by often occurrence of normal or increased of the transpalatal width but the width of the diastema did not correlate with the width of the palate. (Folia Morphol 2018; 77, 2: 340–344)

Background Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities. Objectives The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders. Materials and methods The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified. Results The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects. Conclusion This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

SUMMARY The expectation of an esthetically harmonious smile increases the level of difficulty when treating patients. Laminate veneers stand out as a treatment option for cosmetic rehabilitation in clinical practice, as they are a more conservative procedure and mimic dental structures. These laminate veneers are generally made with different techniques; the most common requires an impression of the prepared tooth, an impression antagonist, fabrication models, and extensive laboratory time. The computer-aided design/computer-aided manufacturing (CAD/CAM) system optimizes the fabrication of prosthetic structures, reducing chairside time and promoting good esthetic results. Thus, the purpose of this case report is to present the esthetic result of multiple CAD/CAM manufactured laminate veneers using a new self-etching glass ceramic primer with a lithium disilicate ceramic, using the modified correlation and biogeneric modes.

Tooth agenesis (TA) is the developmental absence of one or more permanent teeth. We report on 10 members of a Pakistani family afflicted with TA with variable associated features inherited in autosomal dominant fashion with full penetrance. The malformation is bilateral in the majority of cases, and hallmark feature is the absence of lateral and central incisors and canines whereas first and second premolars are involved less often. Affected individuals also have pronounced variable features associated with TA such as diastema between central incisors, overgrown labial frenum, peg-shaped lower incisors, delayed exfoliation, over-erupted upper incisors and malocclusion but have no other signs of ectodermal dysplasia. Through linkage analysis coupled with exome sequencing, we identified novel nonsense variant EDAR c.1302G>A, p.(Trp434*). The variant is deduced to create a premature termination codon that leads to the deletion of the 15 C-terminal residues. Heterozygous EDAR variants most commonly cause hypohydrotic ectodermal dysplasia, but recently one nonsense and 10 missense variants have been reported in nonsyndromic TA, some with few mild features of hypohydrotic ectodermal dysplasia. The phenotype in the family we present, the largest with EDAR-related TA reported to date, is highly variable and without any signs of ectodermal dysplasia.

Orthodontic intrusion can be utilized to assist clinicians in meeting various esthetic, functional, and biomechanical problems. In this full-mouth reconstruction case, such therapy was used to initiate a multiphase treatment approach for an adult patient who presented with numerous concerns about her function and appearance, including a significant diastema, active wear on her lower anterior teeth, and chipped crowns. A variety of procedures conducted over a period of 6 years that comprised implant placement, gingival recontouring, orthodontic repositioning, and crown lengthening, along with the use of a Kois deprogrammer to equilibrate the final restorations, were utilized to achieve a successful outcome.

The aim of this study was to determine the differences in arch length, inter-canine distance, inter-premolar distance, intermolar distance and arch shape between dental discrepancies (crowding and spacing) in a sample of dental casts from the Afro-Colombian population of San Basilio de Palenque. An analytical, cross-sectional study was conducted on a convenience sample of 63 subjects aged 11 to 57years, of Afro-Colombian origin, with full dentition from first molar to first molar, without extensive caries or restorations, and excluding casts with defects due to loss. The differences between arch (upper and lower) variables were analyzed according to dental discrepancies. Plaster models digitalized with a TR1OS3 Mono scanner with exactitude (6.9 ± 0.9 pm) and precision (4.5 ± 0.9 pm) were analyzed with Orthonalyzer software. Statistical analyses were done on SPSS software (Version 20 for Windows) and Real Statistics. Spacing discrepancy of68.25% was found for upper arch and 66.66% for lower arch; crowding discrepancy of 19.04% for upper arch and 20.63% for lower arch, and an adequate ratio of 12.69% for both arches. No statistically significant difference (p0.05) was found between arch parameters except for inter-premolar distance on the lower arch. The most frequent arch shape in the population was oval for both upper arch, with 76.19%, and lower arch, with 71.42%. Tooth size was larger in males than females but the difference was not statistically significant.El objetivo de este estudio fue determinar las diferencias en longitud de arco, distancia intercanina, interpremolar, intermolar y la forma de arco entre discrepancias dentales (apiñamiento y espaciamiento), en una muestra de modelos dentales de la población afrocolombiana de San Basilio de Palenque. Se realizó un estudio analítico transversal, en una muestra por conveniencia de 63 sujetos con un rango de edad entre 11 y 57 años, de origen afrocolombiano, quienes tuvieron dentición completa de primer molar a primer molar, sin caries extensas, ni restauraciones; se excluyeron los modelos con defectos por el vaciado. Se analizaron las diferencias entre las variables de los maxilares (superior e inferior) con las discrepancias dentales. Se utilizaron modelos de yeso que fueron digitalizados con el escánerTR1OS3 Mono con una exactitud de (6.9 ± 0.9 pm) y una precisión de (4.5 ± 0.9 pm)y analizados con el software Orthonalyzer. Los análisis estadísticos se llevaron a cabo utilizando el software SPSS (Versión 20 para Windows) y Real Statistics. Se encontró una discrepancia de espaciamiento de un 68,25% para el arco superior y 66,66% en el arco inferior; y una discrepancia de apiñamiento en el arco superior de 19,04% e inferior de 20,63% y una relación adecuada de 12,69% para los dos arcos. No se encontraron diferencias estadísticamente significativas (p0.05) en los parámetros de arco a excepción de la distancia interpremolar del arco inferior. La forma de arco más frecuente en la población fue ovalada tanto en el arco superior con un 76,19% como en el arco inferior con un 71,42%. En cuanto al tamaño dental, se presentó mayor tamaño en los hombres que en las mujeres, pero este no fue estadísticamente significativo.

This study aimed to evaluate the influence of labial and dentogingival characteristics on facial and smile attractiveness.Four different close-up photographs each of six women models with different labial and dentogin-gival characteristics were obtained. One of the models was considered standard. Photographs were arranged in an album were evaluated by 100 laypersons, and 30 dentists who ranked each close-up of the models from according to the degree of attractiveness from first to sixth place, with first being the model considered most attractive and justified the reasons for choosing.The standard model received the best scores for both lips (7.75) and face (5.18). Medium-sized lips were preferred (p0.05), and the smile positively or negatively interfered with esthetic perception depending on the dentogingival alteration present. Diastema was the alteration that had the greatest negative influence.Not all dentogingival alterations interfere with esthetic evaluation. The lips are not decisive in facial attractiveness. Attraction is assessed significantly differently by laypeople than by dentists. The smile directly influences the analysis of facial beauty.Dentogingival alterations may be imperceptible, especially when evaluating the facial joint, so its correction will not always be necessary.

Objective The aim of this study is to assess if low-level laser therapy (LLLT) alleviates pain after the placement of orthodontic alignment archwire and if there could be a specific indication for the usage of LLLT according to the amount of dental crowding. Materials and Methods Ninety subjects were included and randomly assigned to the tested group (orthodontic treatment and LLLT), placebo group (orthodontic treatment and simulated LLLT), and control group (orthodontic treatment only). Inclusion criteria are age between 13 and 30 years, completely erupted mandibular teeth, and lower crowding of ≥3 mm. Exclusion criteria are spaces or diastema in the lower arch, ectopic teeth, treatment plan including extractions or the use of auxiliary devices, and previous orthodontic treatment. Patients reported the pain experienced by using a numeric rating scale, ranging from 0 to 10, at specific time intervals, that is, 2 hours, 6 hours, 24 hours, and from day 2 to 7. Kruskal–Wallis H Test was used to assess differences in the maximum pain and pain experienced at each time interval among the three groups and in the maximum pain reported among subjects with different degree of crowding. Results The final sample consisted of 84 patients, 41 male and 43 female patients, with a mean age of 16.5 ± 2.8 years. The pain experienced at each time interval and the maximum pain score were significantly lower in the tested group, whereas no differences were found between control and placebo groups. Moreover, no differences were found in the pain experienced among subjects with mild, moderate, and severe incisor crowding in all groups. Conclusions LLLT is effective in alleviating the intensity and duration of pain experienced by patients after the engagement of alignment archwire. However, there is no specific indication for the usage of LLLT according to the amount of crowding.

Purpose The objective of this case series was to determine the oral, dental and craniofacial features of patients with EvC syndrome. Material and methods Eight patients with EvC syndrome were enrolled. A complete family history, pedigree analysis, detailed medical history were collected. Findings of clinical examination, including craniofacial and orodental manifestations, and radiological investigations were thoroughly studied. Results All eight patients had characteristic face, hypertrophic frenulum, conical and peg-shaped teeth, hypodontia of deciduous and/or permanent teeth and also skeletal dysplasia, small chest, short stature and hypoplastic nails. Additionally dysmorphic filtrum, serrated appearance of gingiva, diastema, enamel hypoplasia, microdontia, taurodontism, single rooted permanent molar, delayed eruption and high caries rate were observed with varying degrees. Cephalometric evaluation revealed skeletal Class III growth pattern in four subjects and Class II growth pattern in one subject. Conclusion Evaluation of craniofacial and orodental anomalies of EvC syndrome is required for accurate differential diagnosis from other congenital syndromes.

Made available in DSpace on 2018-11-26T15:30:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-08-01 The purpose of this study was to compare the efficacy and the patients' subjective symptomatology between surgically assisted rapid maxillary expansion (SARME) with midpalatal split and SARME without midpalatal split. The sample consisted of 24 consecutive adult patients requiring treatment with SARME, who were divided into two groups. Group 1 patients (n = 14) underwent SARME with midpalatal split, and group 2 patients (n = 10) underwent SARME without midpalatal separation. The efficacy of the technique was assessed in relation to the presence of a diastema between the upper incisors and radiographic evidence of separation of the maxillary bones in the midpalatal suture. The patients' symptomatology was evaluated using pain scores. The results demonstrated a greater efficacy for group 1 (P = 0.00). The discomfort of surgery assessed immediately postoperative and at 14 days postoperative was similar in the two groups. Both surgical techniques were tolerated by the patients; the midpalatal separation did not influence patient discomfort due to surgery. The two groups showed a statistically significant difference regarding discomfort during appliance activation and pain during the postoperative phase, with group 2 showing greater discomfort. Pontificia Univ Catolica, Sao Paulo, Brazil Univ Ceuma, Div Orthodont, Sao Luis, Maranhao, Brazil State Univ Sao Paulo, Sao Paulo, Brazil Univ Sao Paulo, Bauru Dent Sch, Div Stomatol & Oral Surg, Sao Paulo, Brazil State Univ Sao Paulo, Sao Paulo, Brazil

To assess the differences in occlusal features in three cohorts at 9, 12 and 15 years of age, and compare orthodontic treatment need measured by the Dental Aesthetic Index (DAI) and Index of Orthodontic Treatment Need (IOTN).Cross-sectional study.School of Dentistry, University of Valencia.A total of 1086 children: 321 aged 9, 397 aged 12 and 368 aged 15.Children were examined to measure their orthodontic treatment need according to IOTN and DAI. The main outcome measure was orthodontic treatment need according to the DAI and IOTN indices.Overbite and inter-incisal diastema were the occlusal features that presented significant differences between the three groups, diminishing with age. Treatment need according to the IOTN was 15.4% at 9 years, 20.9% at 12 years and 12.8% at 15 years. Treatment need according to DAI was 44.8% at 9 years, 21.7% at 12 years and 14.1% at 15 years. The diagnostic agreement between the two indices on the treatment need by age group was very low at 9 years (Kappa 0.18) and moderate at 12 and 15 years (Kappa 0.451 and 0.405, respectively).Orthodontic treatment need is greater in the mixed dentition and falls slightly as the child grows. The greatest variation in results between 9 and 15 years were found in relation to the DAI, which is consequently not recommended for use in the mixed dentition.

We report on 19 individuals with a recurrent de novo c.607C>T mutation in PACS1. This specific mutation gives rise to a recognizable intellectual disability syndrome. There is a distinctive facial appearance (19/19), characterized by full and arched eyebrows, hypertelorism with downslanting palpebral fissures, long eye lashes, ptosis, low set and simple ears, bulbous nasal tip, wide mouth with downturned corners and a thin upper lip with an unusual "wavy" profile, flat philtrum, and diastema of the teeth. Intellectual disability, ranging from mild to moderate, was present in all. Hypotonia is common in infancy (8/19). Seizures are frequent (12/19) and respond well to anticonvulsive medication. Structural malformations are common, including heart (10/19), brain (12/16), eye (10/19), kidney (3/19), and cryptorchidism (6/12 males). Feeding dysfunction is presenting in infancy with failure to thrive (5/19), gastroesophageal reflux (6/19), and gastrostomy tube placement (4/19). There is persistence of oral motor dysfunction. We provide suggestions for clinical work-up and management and hope that the present study will facilitate clinical recognition of further cases. Canadian Institutes of Health Research (301221) HICF-1009-003 WT098051 2.259 JCR (2016) Q3, 96/167 Genetics & Heredity UEM

SummaryReasons for performing studyThere are limited reports on the efficacy of functional orthodontic correction of overjet or overbite in foals.ObjectivesTo report the outcome of using orthodontic tension bands in combination with an inclined plane biteplate in the treatment of overjet, with or without concurrent overbite, rates of correction of these 2 malocclusions and associated complications. And to examine factors associated with outcomes.Study designRetrospective case series.MethodsClinical records for 73 foals treated at a single clinic, by the same surgeon were analysed. Overall change and rates of change in overjet and overbite were calculated. Associations between potential explanatory variables including age, severity of initial malocclusion and surgeon experience were examined using linear regression.ResultsRecords for 73 foals (43 colts, 30 fillies) were evaluated. The median number of implant placements per animal was 2 (range 1–4). Of 61 cases with complete records, reduction in overjet and overbite dimensions were achieved in 95% and 90% of foals, respectively, with mean reductions in malocclusions of 9.9 and 8.4 mm, respectively. Complete reduction in overjet was achieved in 25% (15/61) and reduction of malocclusion dimensions to ≤5 mm (i.e. functionally corrected) was achieved in 51% (31/61). Increasing animal age was significantly associated with decreased total reduction in overjet and decreased rate of reduction in overbite. Increased original severity of overbite was significantly associated with increased rate of its correction. Short‐term complications included intraoperative haemorrhage, transient facial nerve neuropraxia and irritation of the mare's udder by the brace. Longer‐term complications included cheek teeth diastema formation and incisor discoloration and maleruption.ConclusionsUsing this technique, correction or improvement of these malocclusions is rapid, with minimal complications. Often more than one implant is required. Animal age at the start of treatment is associated with rate and amount of correction achievable, so initiating treatment at an early age is recommended.

Introduction. Full impaction of canines, in both jaws, is a rare phenomenon. It is usually coupled with the persistence of deciduous canines, or any other irregularity in the dental arch. Case report. Panoramic radiograph of a 24-year-old female patient showed bilateral canine impaction in both jaws. Due to vestibular, apical and medial position of canines in the upper jaw, the surgical approach implied the apically positioned flap technique. The position of impacted mandibular canines was vertical with more coronal position relative to the upper canines, thus requiring a closed eruption technique. Conclusion. Inadequate position of impacted canines in the bone fully justifies the use of orthodontic-surgical treatment.

People with a disability also sometimes lose a (front) tooth. Their closest relatives in particular are concerned that the person they love appears to be 'ordinary, natural and well-cared for' and often consider a diastema to be unacceptable. At the same time, they do not want to expose these patients to a painful, taxing treatment for purely aesthetic reasons. Fibre re-enforced adhesive bridges offer a very good alternative in such cases.Ook mensen met een beperking verliezen wel eens (front)elementen. Vooral hun naaste familieleden willen dat hun dierbaren er “gewoon, normaal en verzorgd” uitzien en vinden een diasteem vaak niet acceptabel. Aan de andere kant willen zij deze patiënten niet aan pijnlijke, belastende behandelingen blootstellen alleen voor de esthetiek. Vooral de glasvezelversterkte etsbrug biedt hier een zeer goede uitkomst.

This aim of this study is to evaluate and to compare the clinical performances of two nanohybrid composite resin systems used for diastema closure and tooth reshaping at 4 years.Twenty-three patients with midline or multidiastema problem were enrolled in this study. Nanohybrid resin composite systems to be used on each patient were randomly selected. Thirty seven teeth of 10 patients were restored with Filtek-Z550 (3M/ESPE) in combination with Adper™ Single Bond 2 (3M/ESPE) etch and rinse adhesive in Group 1 whereas 39 teeth of 13 patients were restored with Charisma-Diamond (Heraeus Kulzer) in combination with Gluma2 Bond (Heraeus Kulzer) etch and rinse adhesive in Group 2, by two operators. Esthetic, functional, and biological properties of the restorations were evaluated at baseline, 1, 2, 3, and 4 years using foreign direct investment criteria by two independent examiners.The data were evaluated using Fisher's Chi-Square (P = 0.05).Fifty-eight restorations (19 patients) with a mean service time of 43.4 months were evaluated (recall rate 82.6%). One Filtek-Z550 and two Charisma-Diamond restorations were repaired due to partial fracture (Score 4). Survival rates of Group 1 and Group 2 were 96.3% and 93.5%, respectively (Kaplan-Meier) (P0.05). Qualitative deteriorations were observed within each group according to baseline regarding surface luster, surface/marginal staining, marginal adaptation, patient's view, and periodontal response (P0.05). However, there were no significant differences between two restorative materials for any of the criteria assessed (P0.05).Both nanohybrid composite resin systems revealed esthetically, functionally, and biologically acceptable clinical performance when used for diastema closure and tooth reshaping at 4 years.

One of the challenges posed by diastema closure treatment in the presence of tooth size discrepancy is to achieve adequate distribution of the spaces between the teeth. The use of the Digital Smile Design can assist the clinician in visualizing and measuring dentogingival discrepancies with maximum predictability. The present clinical case describes an approach to space distribution with assistance of the digital tool, allowing adequate restorative procedures. The protocol used was shown to be efficient, achieving the esthetics desired by the patient both during and after multidisciplinary treatment, as well as having adequate stability.

Minimally invasive indirect veneers (MIIV) are ultrathin porcelain veneers that can be cemented onto labial surfaces after no or minimal tooth preparation. The benefits of no or minimal veneer preparation are conservation of tooth structure, absence of postoperative sensitivity, bonding to enamel, minimal flexural stresses, no need for provisionals and improved patient acceptance. However, no or minimal preparation veneers should be considered only after thorough functional and aesthetic evaluation. The article presented here illustrates a case of diastema closure using MIIV, to highlight the importance of treatment planning for achieving good results.

The aim of this 2-arm parallel trial was to compare the dentoskeletal effects of the expander with differential opening (EDO) and the Hyrax expander in the mixed dentition.Patients aged 7-11 years with maxillary dental arch constriction and Class I or Class II sagittal relationships were randomly allocated into 2 study groups. The experimental group comprised 22 patients (10 males, 12 females) with a mean age of 8.46 years treated with the EDO. The comparison group was composed of 24 patients (6 males, 18 females), mean age of 8.92 years treated with the conventional Hyrax expander. One complete turn per day for 6 days was performed for the posterior screw of the EDO and for the Hyrax expander. The anterior screw of the EDO was activated 1 complete turn per day for 10 days. The primary outcomes were the anterior opening of the midpalatal suture, changes on the interincisal diastema width, maxillary dental arch widths, arch perimeter, arch length, palatal depth, inclination of maxillary posterior teeth and on dental arch shape, and the amount of differential expansion in the anterior region compared with the posterior region of the maxillary dental arch. Computer-generated randomization was used. Allocation was concealed with sequentially, numbered, sealed, and opaque envelopes. Blinding was applicable for outcome assessment only. Occlusal radiographs of the maxilla were obtained at the end of the active expansion phase (T2). Intraoral photographs were obtained immediately pre-expansion (T1) and at T2. Digital dental models were obtained at T1 and 6 months after the active expansion period (T3). Intergroup comparisons of T1-T2 changes were performed using multiple linear regression analysis (P 0.05). The independent variables were both treatment and the starting forms. Bonferroni correction for multiple tests was applied.The experimental group showed a significantly greater opening of the anterior region of the midpalatal suture, a greater increase of the interincisal diastema width, and greater increases of the intercanine distance and inter-first deciduous molar distance than the Hyrax expander. The experimental group showed a significant differential expansion between the anterior and posterior regions, whereas the Hyrax group produced a similar expansion in the canine and molar regions. Serious harm was not observed.The EDO was capable of promoting greater orthopedic and dental changes in the anterior region of the maxilla than the conventional Hyrax expander. Similarity between the 2 expanders was observed for changes in the posterior region width, arch perimeter, arch length, palatal depth, and posterior teeth inclination.

SUMMARY Yttria-stabilized polycrystalline zirconia ceramics have greatly advanced over the past few years. High-translucent zirconia is a newly introduced ceramic that affords high strength and esthetics and that has significantly increased the clinical indications of monolithic zirconia restorations. Thus, the purpose of this case report was to evaluate the performance of ultrathin monolithic zirconia veneers adhesively luted to enamel surfaces after minimally invasive preparations; in addition, we aimed at presenting a clinical protocol for zirconia surface treatment in order to promote bonding effectiveness to resin cement. This type of restoration presented very acceptable esthetic results and decreased the risk of fracturing the veneer during try-in and clinical use. The results were still satisfactory after one-year follow-up. However, randomized, prospective, controlled clinical trials are required to determine the long-term clinical durability of this treatment.

The treatment of diastemas should be conservative to preserve tooth structure, and porcelain veneers provide an esthetic solution with minimal tooth preparation. However, asymmetric diastemas can be difficult to treat and may require redistribution of spaces. Additionally, extensive proximal restorations may negatively impact periodontal health. Minor tooth movement with elastic separators can be used to redistribute the interdental spaces and provide space for the interdental papilla. The aim of this paper was to present a clinical treatment involving the movement of peg-shaped maxillary lateral incisors with elastic separators to rearrange the spaces of asymmetric diastemas, thereby managing the horizontal distance during rehabilitation of the smile with minimally invasive ceramic veneers.

Objectives Restorative rehabilitation of missing single teeth in the posterior dentition is achieved primarily by dental implants or fixed dental prostheses. Here we introduce an uncommon, minimally invasive treatment option in order to close single tooth gaps. Methods The purpose of this study was to evaluate the clinical quality and survival of 45 direct composite buildups in the posterior dentition. A detailed clinical examination was performed, and restorations were rated qualitatively using the modified USPHS/FDI criteria. Results The mean extension of the direct composite buildups was 2.96 (1.12) mm per tooth. Interdental closures from both adjacent teeth had a significantly higher extension of the direct composite buildups than one-sided interdental closures (p = 0.03). Patients with a history of prior tooth loss showed a significantly greater extension of direct composite buildups than patients without prior tooth loss (p = 0.006). During the follow-up period, no restoration showed unfavorable events. The overall survival rate for the direct composite buildups was 100% after median follow-up of 78.96 months. The clinical quality rating indicated that most of the restorations (>94%) displayed excellent or good quality. No periodontal destruction, signs of gingival inflammation or increased plaque accumulation was observed. Conclusions The posterior direct composite buildups evaluated in this study showed promising clinical survival data and excellent quality parameters after a median observation time of 6.5 years. Clinical Significance If a minimally or non-invasive treatment approach is indicated, posterior direct composite buildups provide a successful treatment alternative for the closure of single-tooth gaps to implant-supported or fixed dental prostheses.

This article reports orthodontic treatment of a case of hypodontia of five premolars in an 11-year-old female patient with a positive tooth size-arch length discrepancy in both dental arches. The patient had a straight profile with balanced facial growth. Setup manufacture revealed the possibility of achieving ideal occlusion by mesializing permanent molars up to 15 mm, in addition to keeping a primary molar in the dental arch. With the aid of absolute anchorage, the proposed mechanics was performed and the occlusion predicted in the setup was achieved, while profile and facial growth pattern were maintained. The use of miniscrews for extensive orthodontic movements was successful. Furthermore, one primary molar was extensively mesialized. The indication of gingivoplasty to correct gingival smile proved effective. This is considered a useful technique for orthodontists. Este artigo apresenta o tratamento ortodôntico de um caso com hipodontia de cinco pré-molares, em uma paciente, de 11 anos de idade, com discrepância positiva de modelo em ambas as arcadas. A paciente apresentava perfil reto, com crescimento facial equilibrado. Por meio da confecção de set-up, verificou-se a possibilidade de se estabelecer uma oclusão ideal por meio da mesialização, de até 15mm, dos molares permanentes e manutenção de um molar decíduo no arco. Com o auxílio de ancoragem absoluta, foi realizada a mecânica proposta, alcançando-se a oclusão prevista em set-up, além da manutenção do perfil e do padrão de crescimento facial. A utilização de mini-implantes para grandes movimentos ortodônticos foi favorável, incluindo a extensa mesialização de um molar decíduo. A indicação da gengivoplastia para correção do sorriso gengival se mostrou acertada, sendo essa uma técnica de grande auxílio à Ortodontia.

To evaluate the medium-term clinical performance of direct composite build-ups for diastema closures and teeth recontouring using a nano and a nanohybrid composite in combination with three- or two-step etch-and-rinse adhesives following treatment with fixed orthodontic appliances. A total of 30 patients (mean age, 19.5 years) received 147 direct composite additions for teeth recontouring and diastema closures. A nano and a nanohybrid composite (Filtek Supreme XT and CeramX Duo) were bonded to tooth structure by using a three-step (Scotchbond Multipurpose) or a two-step (XP Bond) etch and rinse adhesive. Ten out of 147 composite build-ups (composite addition) constituted tooth recontouring cases, and the remaining 137 constituted diastema closure cases. The restorations were evaluated by two experienced, calibrated examiners according to modified Ryge criteria at the following time intervals: baseline, 1, 2, 3, and 4 years. The 4-year survival rates were 92.8 % for Filtek Supreme XT/Scotchbond Multi-Purpose Plus and 93 % for CeramX Duo/XP Bond. Only ten restorations failed (5 Filtek Supreme XT and 5 CeramX Duo). Statistical analysis revealed no significant differences between the two composite–adhesive combinations with respect to color match, marginal discoloration, wear/loss of anatomical form, caries formation, marginal adaptation, and surface texture on comparing the five time periods (baseline, 1, 2, 3, and 4 years) The 4-year survival rates in the present study were favorable. The restorations exhibited excellent scores with regard to color match, marginal adaptation, surface texture, marginal discoloration, wear/loss of anatomical form, and caries formation, after 4 years of clinical evaluation. Clinical relevance An alternative clinical approach for correcting discrepancies in tooth size and form, such as performing direct composite restorations following fixed orthodontic treatment, may be an excellent and minimally invasive treatment.

OBJECTIVE: To estimate the prevalence of the desire for orthodontic treatment and investigate associated factors among adolescents in southern Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out with 704 adolescents aged 12 and 13 years at municipal public schools in the city of Balneário Camboriú (southern Brazil). The adolescents answered a previously tested questionnaire addressing satisfaction with their dental appearance, speech function, chewing function, and the desire for orthodontic treatment. The parents/guardians answered a questionnaire addressing satisfaction with their child's dental appearance and socioeconomic variables. A trained and calibrated orthodontist collected clinical data on malocclusion using the Dental Aesthetic Index (DAI). Statistical analysis was performed using multivariate Poisson regression with robust variance. RESULTS: The prevalence of the desire for orthodontic treatment was 69.6% (490/704). In the adjusted analysis, the outcome was significantly more prevalent among girls (P < .001), those with difficulty chewing (P = .026), those dissatisfied with their dental appearance (P < .001), and those with greater malocclusion severity (P < .001). The following orthodontic characteristics were associated with the desire for orthodontic treatment in the multivariate model: diastema in anterior segment (P < .001), anterior maxillary irregularity (P < .001), maxillary overjet ≥6 mm (P < .001), and mandibular overjet (P = .047). CONCLUSIONS: The desire for orthodontic treatment among 12- and 13-year-old adolescents is influenced by gender, dissatisfaction with one's dental appearance, difficulty chewing, malocclusion severity, and orthodontic characteristics. These findings should be considered together with normative indications regarding the need for orthodontic treatment in adolescents.

Posterior crossbite might cause serious long-term functional problems if not early treated. Nevertheless, in older patients, treatment might include palatal expansion in order to correct such malocclusion. In view of the above, this article aims at reporting late correction of bilateral posterior crossbite associated with Angle Class III malocclusion, right subdivision, with consequent midline shift (good skeletal pattern). The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), with DI equal to or greater than 10, as a requirement for the title of certified by the BBO.

This clinical case reports the treatment of an Angle Class II malocclusion in a young woman with a balanced face affected by agenesis of second and third mandibular molars and subsequent extrusion of second maxillary molars. The atypical and peculiar occlusal anomaly led to individualized treatment proposed in order to normalize dental malpositions, with subsequent rehabilitation of edentulous areas by means of a multidisciplinary approach. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) in partial fulfillment of the requirements for obtaining the title of certified by the BBO.

The aims of the present study were to compare aspects related to malocclusion between individuals with Down syndrome (DS) and a control group, establish malocclusion severity, and identify determinant factors. A total of 120 individuals (60 with DS and 60 with no physical or mental impairment), were included in the study. Data were collected through interviews, analyses of the medical charts, and oral examinations. The criteria of the Dental Aesthetic Index were used for the diagnosis of malocclusion. Chi-square test (p ≤ 0.05) and multivariate logistic regression were used for comparisons between the two groups and to determine the association between the dependent (malocclusion severity) and independent variables. Statistically significant differences were found between the two groups for the following variables: missing teeth, diastema, overjet, mandibular protrusion, anterior open bite, posterior crossbite, facial type, lip incompetence, and Angle classification. DS, a history of premature birth, and long face pattern were found to be associated with malocclusion severity. Individuals with DS exhibited more occlusal problems than those in the control group.

Ceramic veneers of minimum thickness provide satisfactory esthetic outcomes while preserving the dental structure. Dental ceramics can both improve the esthetic appearance and reestablish the strength and function of teeth. In worn anterior teeth, functional surfaces, for example, anterior and lateral guidance, can be restored effectively. The characteristics of dental ceramics, such as color stability and mechanical and optical properties, make this material a good choice for indirect restorations, especially when optimum function and esthetics are required. This clinical report presents an occlusal, periodontal, and restorative solution with minimum thickness glass ceramic veneers for worn anterior teeth with multiple diastemas.

Due to improvements in esthetic dentistry, the number of patients seeking to obtain a more harmonious smile has increased. A 40-year-old woman was referred for treatment because she was dissatisfied with the effect that diastemas and a conoid tooth had on her smile. Her maxillary anterior teeth were relatively short, resulting in a compromised esthetic relationship between height and width. Orthodontic treatment for better distribution of her teeth was recommended to the patient, but she refused, wanting faster and less expensive treatment. After diagnostic and waxed-up study casts were obtained, composite resin esthetic mock-ups were made to confirm that sufficient space was left for formation of the interdental papilla. After the patient approved the mock-ups, her anterior teeth were submitted to bleaching, definitive restoration, and additional occlusal adjustments. At the 1-year follow-up, the patient exhibited a harmonious, esthetic smile without black spaces or periodontal inflammation.

Although much research has been undertaken on the rate of tooth movement, with different hypotheses having been put forward, the concepts of the threshold, light, heavy and optimal forces are not still clear. It has been stressed that an ideal orthodontic spring should have the ability to release a constant force throughout the entire range of its activation, but using traditional techniques applied initial force will decrease, depending on its deactivation due to the tooth movement and the physical properties of the force delivery system. The purpose of this study was to test the clinical use of a new and original spring, the drum spring (DS) retractor (developed in 1992), which applies a constant and continuous force without the need for reactivation, and to compare the effect of a constant and continuous force versus a continuous but diminishing force produced by a traditional pull coil (PC) retractor system on the rate of upper canine retraction. The clinical sample consisted of 15 patients with upper first premolar extractions. For each patient, the upper right canine was retracted by using a DS retractor applying a constant and continuous force of 50 g; the upper left canine was fitted with a conventional PC applying an initial force of 50 g, diminishing proportionally with the distal movement of the canine. In addition, each group was divided according to the age of each patient: eight patients (three males, five females) between 11.8 and 14.4 years of age (mean 13 +/- 1.2 years) represented the adolescent group, and seven patients (three males, four females) between 18.8 and 21.6 years of age (mean 18.2 +/- 1.9 years) representing the adult group. The experimental period started 1 week after the extraction of the first premolars. During this period no archwire was used, to avoid friction and force level changes, and the both springs were attached to a 6 mm hook fixed on the canine bracket to reduce tipping. The PC retractor was reactivated every 3 weeks whereas the DS retractor was left untouched over the entire experimental period. The study was continued until one of the two canines was completely retracted. The DS retractor was successful for space closure without any reactivation, and the continuous and constant force provided a more rapid canine movement than the continuous but diminishing force. Canine retraction occurred faster in adolescents than in adults. An entire field of clinical and research applications may be influenced by this new type of spring.

Objective: To study occlusal features and their relation to caries experience in Hong Kong Chinese preschool children. Methods: Seven kindergarten classes in Hong Kong were selected using a stratified random sampling method, and the 4- and 5-year-old Chinese kindergarten children were invited to join the survey. Two calibrated dentists performed the clinical examinations in the kindergartens. Occlusion features, including incisal overjet; canine and molar relationship; median diastema; and primate space as well as malocclusion features, including crossbite; anterior open bite; and scissor bite, were recorded. Caries experience was recorded with the dmft index. Results: A total of 538 children were invited to participate in the study, and finally 495 children were examined (92%). Approximately half (52%) had a normal incisor relationship. Most children had a class I canine relationship (left-79%; right-75%). Approximately two-thirds had a flush terminal plane (left-64%; right-65%). Most children (76%) had a maxillary primate space, and 47% had a mandibular primate space. The prevalence of median diastema, anterior crossbite, and unilateral posterior crossbite was 30%, 12% and 1%, respectively. No bilateral posterior crossbite or scissor bite was found. Approximately half (49%) had caries experience. The mean dmft score was 2.1. Gender and age were not associated with either the studied occlusal features or the mean dmft score (p > 0.05). Conclusion: Approximately half of the Hong Kong preschool children studied had a normal occlusion, and two-thirds of them had a flush terminal plane. About three-quarters of them had a maxillary primate space, and half of them had a mandibular primate space. Their occlusal traits were not associated with caries experience and prevalence.

A maxillary midline diastema (MMD) is a common complaint of dental patients. An MMD can be closed with treatment from different disciplines, including operative dentistry and orthodontics. A comprehensive smile analysis is also a necessity before beginning treatment. This article highlights the closure of a 3-mm MMD by using a combination of orthodontics and direct composite resin restorations.

Background: A mesiodens, is the most frequent supernumerary tooth present in the maxillary central incisor region. This study is conducted to know the radiographic characteristics and management of mesiodens in children visiting hospital.Methods: A cross-sectional retrospective data collection was done from hospital dental records of children who visited the institution from December 2015-December 2016. Radiographic characteristic of mesiodens including the number, shape, position, direction of crown and complication caused by mesiodens were recorded. Data were analyzed using IBM SPSS v.20.0.Results: Out of 1871 dental records, it was found that 40 children had 53 mesiodens, with male female ratio of 3:1 and most of them were discovered at 8 years. Majority of mesiodens, 54.7% were erupted, conical, palatally placed with 77.3% vertically directed crown.Complications associated with it were crowding followed by diastema and delayed eruption. Among 40 children, one had three mesiodens, eleven had two mesiodens and rest had one each. Radiographically fully formed tooth was seen in 29 mesiodens. Immature apex was seen in 38 central incisors associated with mesiodens. Management undertaken was simple/surgical extraction and only few cases were kept for periodic observation. Conclusions: Periodic radiographs act as an important tool for clinicians in detecting and managing mesiodens.

To assess the esthetic effectiveness of four illusion techniques applied to a composite resin veneer for diastema closure between maxillary central incisors.An acrylic model with six natural maxillary anterior teeth was fabricated with a 2-mm diastema between the central incisors. Resin veneers were constructed on the left central incisor and the following cases were derived: V0: no veneer; V1: veneer without optical illusion features; V2: veneer with centralized interproximal ridges; V3: veneer with curved incisal edges; V4: veneer with gray pigment mesially/distally; V5: veneer with gray pigment on the developmental lobes. Digital printed photos of the models (13.2 x 17.8 cm, and 6.1 x 8 cm), with low, medium, and high smile lines and without a smile line (processed by Adobe Photoshop CS6) were shown to three groups of people (faculty members, senior undergraduate students, and patients; n = 25/group) for them to assess the overall size and width of the two central incisors. The results were analyzed by Pearson's and chi-square goodness of fit tests.There was no significant influence in the estimation of the two central incisors as being the same size, according to the technique used (P = 0.869) and group of evaluators (P = 0.209). The estimated probability of assessing the tested incisor as wider was indicatively lower in V2 compared to V1 (adjusted odds ratio = 0.59; P = 0.088). The height of the smile line affected the evaluation of the veneers only in the large-sized photos.No interference is the best esthetic decision concerning a 2-mm diastema closure when restoring only one central incisor with a laminate veneer. The next best option is to deliver a veneer with centralized interproximal ridges.

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.

Case report: young adult woman with esthetic complaints regarding her smile and frontal teeth aspect. At first glance, the problem seemed to be only the shape of the lateral upper incisors and a small diastema between the central incisors. The diagnosis shared between the orthodontist and the prosthetist led us to consider some other important aspects, such as the deep bite, the teeth inclination and the lips support. All these findings led us to consider that the right way to improve the esthetics of the patient’s smile was to plan an orthodontic treatment. This would serve not only for the distribution of the spaces, but mostly it would improve all other problems, before the restoration of the upper lateral teeth with two ceramic veneers. Results: the treatment plan achieved the right distribution of spaces for upper lateral incisors, significant correction of the incisors inclination with important reduction of overbite and better lip support, upper laterals restorations with ceramic feldspathic veneers, obtaining a good integration with natural teeth satisfying patient complaint. Conclusion: in cases which involve interdisciplinary approach, the fundamental step comes from the beginning, when only an initial diagnosis shared among the team of specialists can define the patient problems from different points of view. In this way, we can better understand the competency fields and plan the right treatment and time sequence. Resumo Relato de caso: paciente adulta jovem, sexo feminino, buscou tratamento devido à queixa com a estética do sorriso e o aspecto dos dentes anteriores. À primeira vista, o problema parecia ser apenas o formato dos incisivos laterais superiores e um pequeno diastema entre os incisivos centrais. O diagnóstico conjunto do ortodontista e do protesista fez com que considerássemos outros aspectos importantes, tais como mordida profunda, inclinação dentária e suporte labial. A partir de todas essas constatações, consideramos que a maneira mais adequada de melhorar a estética do sorriso seria planejar o tratamento ortodôntico. Assim, o tratamento serviria não apenas para melhor distribuição dos espaços, mas também melhoraria todos os outros problemas antes da restauração dos dentes laterais superiores ser realizada com duas facetas de cerâmica. Resultados: o tratamento planejado levou à correta distribuição dos espaços nos incisivos laterais superiores, com correção significativa da inclinação dos incisivos, importante redução da sobremordida e um melhor suporte labial, com restauração dos laterais superiores usando facetas de cerâmica feldspática, obtendo-se uma integração ideal com os dentes naturais, resolvendo as reclamações da paciente. Conclusão: em casos envolvendo abordagem multidisciplinar, as etapas iniciais são fundamentais, e apenas um diagnóstico inicial discutido entre a equipe de especialistas pode determinar os problemas do paciente sob diferentes perspectivas. Dessa forma, podemos compreender melhor os campos de competência e planejar a sequência e o tempo de tratamento mais adequados.

Anterior spaces may interfere with smile attractiveness and compromise dentofacial harmony. They are among the most frequent reasons why patients seek orthodontic treatment. However, midline diastema is commonly cited as a malocclusion with high relapse incidence by orthodontists. Objectives: This study aimed to evaluate the stability of maxillary interincisor diastemas closure and the association of their relapse and interincisor width, overjet, overbite and root parallelism. Material and Methods: Sample comprised 30 patients with at least a pretreatment midline diastema of 0.5 mm or greater after eruption of the maxillary permanent canines. Dental casts and panoramic radiographs were taken at pretreatment, posttreatment and postretention. Results: Before treatment, midline diastema width was 1.52 mm (SD=0.88) and right and left lateral diastema widths were 0.55 mm (SD=0.56) and 0.57 mm (SD=0.53), respectively. According to repeated measures analysis of variance, only midline diastema demonstrated significant relapse. In the overall sample the average relapse of midline diastema was 0.49 mm (SD=0.66), whilst the unstable patients showed a mean space reopening of 0.78 mm (SD=0.66). Diastema closure in the area between central and lateral incisors showed great stability. Multivariate correlation tests showed that only initial diastema width (β=0.60) and relapse of overjet (β=0.39) presented association with relapse of midline diastema. Conclusions: Midline diastema relapse was statistically significant and occurred in 60% of the sample, while lateral diastemas closure remained stable after treatment. Only initial diastema width and overjet relapse showed association with relapse of midline diastema. There was no association between relapse of interincisor diastema and root parallelism.

Statement of problem Managing excess anterior spacing is a common problem in dental practice. During orthodontic or restorative treatment planning, clinicians must decide how to distribute this space. However, few reports are available in the dental literature about the attractiveness and esthetic impact of anterior spaces other than midline diastemas. Purpose The purpose of this study was to compare the esthetic perception of 4 different anterior diastemas, including simian diastemas (symmetrical diastemas between lateral incisor and canine), diastemas suggested by Frush and Fisher (asymmetrical diastemas between lateral incisor and canine and between central and lateral incisor), and by Lombardi (slight midline diastema and 2 larger diastemas between central and lateral incisors), and a midline diastema. Material and methods A picture of a young woman's smiling face was modified by using photoediting software to create the 4 previously mentioned diastemas. The resulting pictures were presented to laypersons questioned in French public places. The participants were asked to rank the pictures from most to least attractive, then to rate them with a mark from 1 to 10. Results One hundred and five participants completed the questionnaire. The median ranks and scores attributed to the pictures from most to least attractive were as follows: simian diastemas, 1 and 8; Frush and Fisher diastemas, 2 and 7; Lombardi diastemas, 3 and 5; and midline diastemas, 4 and 4, respectively. The hierarchy (simian diastemas>Frush and Fisher diastemas>Lombardi diastemas>midline diastemas) could be established statistically for the scores ( P =.03, P P P =.11, P =.03, and P =.06, respectively). Conclusions The results showed an esthetic hierarchy of anterior diastemas. The negative perception of anterior diastemas seems to mainly be related to the presence and width of a midline diastema. These results can guide clinical decisions for patients with excess anterior spacing.