[Esthetic dentistry. The 10th Scientific Meeting of the European Academy of Esthetic Dentistry (EAED) of 10 to 16 March 1996 in St. Moritz].
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Dental Implantation↗
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[Pink esthetics. Surgical periodontology as prerequisite for esthetic tooth reconstruction].
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Adult↗
[Esthetics in implantology. "Esthetic Perfection in Oral Implantology"--the course of 17 to 18 October 1997 in Zurich].
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Dental Implantation↗
Evaluation of the esthetic results of a 40-patient group treated surgically for dentoskeletal class III malocclusion.
A dentoskeletal Class III malocclusion results in unesthetic alterations of the soft tissues, which may cause psychologic and interpersonal problems. Surgical treatment, if based on cephalometric evaluations alone, can result in inadequate correction of facial esthetics. The aim of this paper is to discuss the esthetic needs observed in surgical planning of a group of 40 Class III patients and to compare the presurgical esthetic parameters with those recorded in the sixth month of follow-up. To obtain the proper esthetic result and to restore proper stomatognathic functionality, surgical treatment planning required the integration and correction of skeletal cephalometric planning. In 24 of the 40 patients, the skeletal and esthetic planning were in agreement with each other. In the remaining 16 patients, the correction of skeletal planning with the esthetic planning was necessary to obtain the correct esthetic and functional restoration. In all patients, esthetic, radiographic, and functional analysis at the sixth month of follow-up revealed the restoration of correct facial esthetics in the vertical, transverse, and sagittal planes; no temporomandibular joint problems; and a high degree of personal satisfaction regarding the esthetic and functional result obtained, including improvements in social life and in masticatory function. Cephalometric indications should always be compared with esthetic clinical indications and, possibly, the skeletal planning must be corrected by the esthetic needs, so that esthetic and functional success can be reached at the same time.
Adult↗
Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate.
OBJECTIVE: The purpose of this study was to assess the ability of shape parameters of nasal morphology to predict esthetics in individuals with complete unilateral cleft lip and palate (CUCLP). METHODS: This retrospective study involved 28 patients with repaired CUCLP. Nostril morphology was analyzed using nose casts and a video-imaging technique. Calculated shape parameters included area, perimeter, centroid, angle of the principal axis, major and minor moments of area, anisometry, bulkiness, lateral offset, and three-dimensional internostril angles. Esthetics was assessed using a panel of six orthodontists who rated nasal esthetics from frontal, lateral, basal, and three-quarters view slides and from nose casts. Correlations between esthetics and the shape parameters were completed using the entire group as well as using two statistically determined subsets: those with the best and those with the worst esthetics. RESULTS: Nasal esthetics was related to only the perimeter and bulkiness parameter ratios. Symmetry of the perimeters between the right and left nostrils positively correlated with better esthetics using the entire sample group while symmetry of bulkiness between the right and left nostrils positively correlated with better esthetics using both the entire sample group and the best and worst subsets. CONCLUSIONS: Only perimeter and bulkiness showed positive correlations with nasal esthetics. The group of parameters used to assess nostril morphology had neither significant correlation with-nor predictive power for-esthetics. Thus, an assessment of the entire nasal surface topography in three dimensions needs to be completed and assessed with respect to predictability of nasal esthetics.
Adolescent↗
[Medical esthetics in the works of Polish doctors on the turn of the XIXth century].
The paper determines the objects of medical esthetics and the use of what is esthetic in doctor's practice and in medicine. The thesis of the paper is the assumption that medicine emerges out of esthetic distance. It is created by culture forms due to which biologicality of human body is restrained and subordinated. Medical esthetics examines these forms as well as their esthetic expressions in the art of therapy. The above assumption is documented by presenting the esthetic ideas of Polish doctors on the turn of the XIXth century. These ideas are represented first of all by: Zygmunt Kramsztyk, Henryk Nusbaum, Edmund Biernacki, Wladyslaw Bieganski, Heliodor Swiecicki and Wladyslaw Szumowski. The esthetic concepts and statement of the Polish doctors determine the limits of the objects of medical esthetics in which the doctor becomes the esthetic subject - creator of esthetic beauty, where as the medical art becomes esthetic form of medical practice.
Esthetics↗
Evaluation of profile esthetic change with mandibular advancement surgery.
Our purpose was to investigate the impact of mandibular advancement surgery on profile esthetics and to attempt to define guidelines that could be of value to the clinician in predicting profile esthetic change. The sample consisted of 34 patients who had been treated with a combination of orthodontics and mandibular advancement surgery without genioplasty. Initial (pretreatment) and final (posttreatment) cephalometric radiographs of each patient were used to produce silhouette images and to quantify skeletal changes that occurred with surgery. The images were displayed randomly to lay persons and orthodontic residents who were asked to score the esthetics of each profile. On average, after mandibular advancement surgery, B point moved forward 5.0 mm (SD = 2.6 mm) and downward 4.7 mm (SD = 3.1 mm), and the ANB angle decreased 3.0 degrees (SD = 1.6 degrees ) Graphical analysis and results of paired t tests revealed that for patients with an initial ANB angle >/= 6 degrees, a consistent improvement in profile esthetics was seen following surgery (P </=.001). This represented, on average, about a 45% improvement in esthetics. For patients with an initial ANB angle < 6 degrees, an improvement in profile esthetics after surgery was seen about half the time but poorer esthetics were equally likely. These results underscore the importance of using the ANB angle as a skeletal guideline when deciding whether to treat patients with mandibular advancement surgery. If improved profile esthetics are a desired outcome, an initial ANB angle of at least 6 degrees is recommended.
Adult↗
Perception of facial esthetics: a comparison of similar class II cases treated with attempted growth modification or later orthognathic surgery.
In recent years, there has been considerable interest in the esthetic outcomes of various types of Class II treatment. In this study, it was the authors' intent to determine the esthetic outcomes for 60 Class II division 1 patients: 28 patients treated during the active growth phase with an activator and fixed appliances and 32 patients treated at the completion of growth with fixed appliances and by orthognathic surgery. Using a visual analogue scale, a mixed panel of 14 judges scored the pre- and posttreatment attractiveness of these patients from frontal and lateral facial photographs. Statistical analysis by two-sample t-tests indicated that, on average, esthetic scores improved with treatment, regardless of the treatment modality. There was, however, considerable individual variation in the degree of improvement, even to the point that there was a decline in esthetics for some patients. Despite somewhat different modes of treatment, it was found that neither the average pre- and posttreatment esthetic scores nor the change in esthetic score with treatment was significantly different for the two groups. Although clinical planning decisions should still be made on an individual basis, the findings of this study suggest that the perceived esthetic outcome in many Class II division 1 patients may well be just as favorable, regardless of whether they are managed early during the growth phase or later, at the completion of growth by orthognathic surgery.
Activator Appliances↗
The influence of various fluoride exposures on the prevalence of esthetic problems resulting from dental fluorosis.
OBJECTIVES: This study sought to determine the prevalence of esthetic problems due to dental fluorosis, and determine the relationship of different fluoride exposure histories to the occurrence of these problems. METHODS: In 1993-94 2,715 children in grades 2 and 3 and 3,297 adolescents in grades 8 and 9 were examined by four dentists. Questionnaires detailing exposures to various fluoride technologies were collected from 3,022 of these study participants. Esthetic ratings of the participants' maxillary anterior teeth were made by the examiners, the participants themselves, and their parents using questionnaires designed for this purpose. RESULTS: Data indicate that 46 percent of the participants had dental fluorosis. Only 40 percent had fluorosis on anterior maxillary teeth. The prevalence of esthetic problems ranged from about 1 percent to 4 percent, depending on how an esthetic problem was defined. Esthetic problems as defined by the participant were more prevalent for the "over 11" age group. Logistic regression results demonstrated significant associations between several of the classifications of esthetic problems and the use of fluoride supplements and dentifrices, and exposure to fluoridated water during the third year of life. CONCLUSIONS: Results suggest that the prevalence of esthetic problems is low in the communities surveyed, and that exposure to any number of fluoride technologies in the third year of life can increase a child's risk for this problem.
Adolescent↗
Simulated shape design. Helping patients decide their esthetic ideal.
BACKGROUND: Esthetic care is changing dentistry from a need-based to a want-based practice. Patients are asking for esthetic treatment, and clinicians are retooling their practices to satisfy this need. One important part of providing esthetic dentistry is ensuring that the patient is as well-informed as possible about treatment outcomes. DESCRIPTION OF TECHNIQUE: This article describes a tool dentists can use to show patients potential tooth sizes, shapes and arrangements before carrying out treatment. Simulated shape design, or SSD, is a reversible method of demonstrating potential esthetic outcomes that involves creating trial restoration shapes and placing them over a patient's teeth. SSD is a simple technique that any dentist can perform. In essence, the technician makes new tooth shapes in wax, the dentist places these in the patient's mouth and the patient evaluates them. The dentist then makes modifications in the SSD, which he or she reports to the technician. CLINICAL IMPLICATIONS: With the decisions of shape, arrangement and size made at chairside, the whole flow of esthetic treatment can be handled smoothly. Preparations can be cut more accurately to better support the restorative material; decisions can be made to open or not open the contacts; and shapes can be agreed on in the earliest stage of evaluation, then duplicated faithfully in the provisional and final restorations. There are no surprises for the patient, the dentist or the technician. Both the esthetic (smile design) and functional elements (anterior guidance) of the restoration can be checked with SSD. SSD could become the standard in determining whether or not to proceed with esthetic treatment.
Cuspid↗
Achieving gingival esthetics.
INTRODUCTION: Dentists traditionally have thought of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. This no longer is true. The goal of this article is to show how esthetic crown-lengthening procedures, papillary regeneration and root coverage may enhance the overall esthetic results of periodontal treatment. METHODS AND RESULTS: Esthetic crown lengthening aims not only to provide biological width for the healthy restoration of teeth, but also to permit esthetic gingival and prosthetic contours. Papillary regeneration aims to fill the dark spaces that may occur interproximally with the progression of periodontitis or as a result of tooth alignment. Finally, root coverage procedures now can provide predictable results with the application of connective-tissue periodontal grafts and plastic surgery techniques. This article presents a case report for each type of procedure, each of which resulted in improved esthetics and cosmetic appearance. CLINICAL IMPLICATIONS: Periodontal treatment now is part of the solution for certain esthetic problems. While technically demanding, these procedures, in the hands of an appropriately trained and experienced clinician, can improve the overall results of patient treatment.
Connective Tissue↗
Clinical performance of esthetic posterior crowns in primary molars: a pilot study.
PURPOSE: The aim of this pilot study was to assess the clinical performance of esthetic crowns and to compare these to conventional stainless steel crowns (SSC). METHODS: Twenty two crowns (11 conventional and 11 esthetic) were placed in mandibular primary molars obeying the following criteria: the tooth was not mobile; no fistulae were present; the tooth had at least one caries free or properly restored antagonist and had to be in contact with one adjacent tooth mesially, in the case of the primary second molars or distally in the case of the primary first molars. Crown preparation was done in a conventional manner, but reduction was more extensive for the thicker esthetic crowns, to allow for proper occlusion. The crowns were evaluated clinically and radiographically after 6 months and the following parameters were assessed: gingival health, marginal extension, crown adequacy, proper position or occlusion, proximal contact, chipping of the facing (for esthetic crowns) and cement removal. RESULTS: At the 6 month evaluation all esthetic crowns were intact, without chipping of the facing, and no excess of cement was observed in both groups. No difference was found for marginal extension, occlusion, proximal contact, crown adequacy, and bone resorption, but a significant difference was found for periodontal health between esthetic crowns and conventional SSC (P < 0.001 McNemar test). CONCLUSIONS: The esthetic crowns assessed had several inconveniences, as they resulted in poor gingival health, are very expensive, and, although not measured, are bulky and without a natural appearance.
Cementation↗
Evaluation of esthetic parameters of resin-modified glass-ionomer materials and a polyacid-modified resin composite in Class V cervical lesions.
OBJECTIVE: The purpose of this study was to compare the esthetics of 3 resin-modified glass-ionomer materials and 1 polyacid-modified resin composite to the esthetics of a conventional glass-ionomer control material. METHOD AND MATERIALS: One hundred eighty-seven Class V cervical restorations were observed clinically over 18 months. The esthetic index system that was used evaluated color match, translucency or opacity, and surface roughness. RESULTS: The tested materials behaved very dissimilarly and inconsistently. In general, the esthetic results of the resin-modified glass-ionomer materials and the polyacid-modified resin composite were far from optimal. The esthetic appearance of restorations seriously deteriorated during clinical service, mainly because of discoloration of margins, changes in translucency and opacity, and rapidly appearing roughness or dullness on the surface. Both the resin-modified glass-ionomer materials and the polyacid-modified resin composite evaluated in this study performed better esthetically than did the conventional glass-ionomer material. CONCLUSION: Indications for these combination materials are limited to areas where esthetics is not a primary concern but where their ease of application may guarantee a more durable functional result.
Acrylic Resins↗
Long-term clinical performance of esthetic primary molar crowns.
PURPOSE: The aim of the study was to report the long-term clinical performance of esthetic primary molar crowns and compare them to that of stainless steel crowns (SSC). METHODS: Twenty crowns (10 conventional and 10 esthetic) placed in 10 children who had participated in a previously reported study, were assessed again after 4 years. The crowns were evaluated clinically and radiographically according to the following parameters: gingival health, marginal extension, crown adequacy, proper occlusion, proximal contact, chipping of the facing (for esthetic crowns only), and cement removal. RESULTS: At the 4 year evaluation, all the esthetic crowns showed chipping of the facing. No difference was found for marginal extension, occlusion, crown adequacy and periodontal health between SSCs and the esthetic crowns. CONCLUSIONS: After 4 years, all the esthetic crowns presented chipping of the facing and, consequently, a very poor esthetic appearance.
Child↗
The 5-year clinical performance of direct composite additions to correct tooth form and position. I. Esthetic qualities.
The aim of the study was to evaluate the esthetic performance of direct composite additions in correcting tooth form and position at 5 years. Composite additions were directly placed using the acid-etch technique and enamel bonding on 87 intact maxillary anterior teeth in 23 young patients (12-19 years old). The restorations were made by one operator using an ultrafine midway-filled densified restorative composite. Color slides were made at baseline and 5 years. At the 5-year recall, esthetic performance was assessed clinically by two evaluators at chair-side in subterms of color match, translucency/opacity, surface roughness, and anatomical form. Five additional examiners scored esthetics on the 5-year slides. Of the restorations, 89% were still esthetically satisfactory after 5 years of clinical service. The remaining restorations needed replacement, mainly because of severe loss of anatomical form, to a lesser degree because of severe color mismatch. Central incisors and small unilateral restorations generally showed the best results concerning color match (68% and 74%, respectively) and surface smoothness (84% and 100%, respectively). The slide scores on color match and translucency/opacity were generally similar or somewhat better than the direct clinical scores; however, the difference were not statistically significant (P > 0.05). As far as surface roughness is concerned, the results were significantly better (P < 0.05) when recorded indirectly than by direct clinical evaluation. In conclusion, direct composite additions are a valuable and effective procedure for esthetic and conservative treatment of malformed and misaligned anterior teeth. Loss of anatomical form due to wear points to a shortcoming of the composite material used, with which a durable esthetic result cannot always be guaranteed in the long term.
Adolescent↗
Smile esthetics after orthodontic treatment with and without extraction of four first premolars.
Standardized frontal photographs were taken of the face during smiling for 60 retention patients; 20 from each of three different private orthodontic practices. Thirty patients had been treated with extraction of four first premolars, and 30 with full edgewise appliances but no extractions. Smile esthetics were judged by a panel of 10 laypersons. There were no significant differences in the mean esthetic score of extraction and nonextraction patients. The only variable that strongly predicted the esthetics of extraction patients was the office in which they were treated, indicating that there may be a significant difference among practitioners in the esthetic outcome of four premolar extraction treatment. Variables related to the "buccal corridor" or other measures of the relationship between the width of the dentition and the width of the mouth during a smile showed no relationship to extraction esthetics. The results indicate that there is no predictable relationship between the extraction of premolars and the esthetics of the smile.
Adolescent↗
Esthetically objectionable fluorosis attributable to water fluoridation.
OBJECTIVE: We compared estimates of fluorosis prevalence and risk attributable to fluoridation using an index applied to the entire dentition and to the maxillary anterior teeth. We also estimated the prevalence of perceived esthetic problems attributable to current fluoridation policy (Attributable Burden). METHODS: Fluorosis prevalence estimates were obtained from the National Survey of Oral Health in US School Children (1986-87) for the 1839 survey children aged 12 -14 years who were scored for fluorosis, had never received fluoride drops or tablets, and had lived in only one home. For each child we calculated Dean's fluorosis index, and an anterior fluorosis index (value of the highest scored maxillary anterior tooth). We used each index to calculate risk of fluorosis attributable to fluoridation by subtracting at each level of severity the prevalence of fluorosis among those living in low fluoride areas (F <or= 0.3 ppm) from the prevalence among those living in optimally fluoridated areas (0.7 ppm F <or=1.2 ppm). Findings from five published studies were used to calculate risk of perceived esthetic problem attributable to fluorosis, by severity, i.e. the difference in the mean percentage of respondents who were satisfied with the appearance of their teeth with and without fluorosis. Finally, Attributable Burden was estimated by summing the products of risk of perceived esthetic problems attributable to fluorosis and risk of fluorosis attributable to fluoridation for each level of fluorosis severity. RESULTS: Prevalence of fluorosis, very mild or greater, was 26% with Dean's Index, which was significantly higher than the 18% figure calculated with the anterior index. Using the anterior index, fluoridation was a risk factor for very mild (attributable risk = 15%) and mild fluorosis (attributable risk = 3%). Risk of fluorosis (very mild or greater) attributable to fluoridation was significantly higher when calculated from prevalence estimates using Dean's Index than estimates calculated with the anterior index (24% versus 18%). The mean values of risk of perceived esthetic problems attributable to very mild and mild fluorosis were 9% and 33%, respectively. CONCLUSION: We found that approximately 2% of US schoolchildren may experience perceived esthetic problems which could be attributed to the currently recommended levels of fluoride in drinking water. The findings further suggest that both estimates of fluorosis prevalence and risk of fluorosis attributable to fluoridation will be higher when calculated with an index applied to the entire dentition. Data were unavailable for fluoridated toothpaste and diluted formula consumption, thus the risk of fluorosis attributable to fluoridation may be overestimated if consumption was higher in fluoridated areas. The risk of perceived esthetic problems attributable to fluoridation must be weighed against its lifetime benefits and the associated costs of alternative solutions such as educating parents about appropriate toothpaste use and lowering the fluoride content of children's toothpaste.
Adolescent↗
Influence of stainless steel inserts on the resistance to sliding of esthetic brackets with second-order angulation in the dry and wet states.
Stainless steel (SS) inserts have been added to plastic, ceramic, and composite brackets to improve their frictional characteristics while preserving their esthetic appeal. When coupled with SS archwires, the resistances to sliding of esthetic brackets with and without SS inserts were compared with control brackets of SS. The resistances to sliding were measured in both the dry and wet (saliva) states at 32 second-order angles between -12 and + 12 degrees. When clearances existed between the walls of the brackets and the archwires, the resistances to sliding for the esthetic brackets without inserts were between 38 cN in the dry state and 73 cN in the wet state; those of the esthetic brackets with inserts ranged from 42 cN in the dry state to 65 cN in both states. The resistances to sliding of the SS brackets equaled 38 and 52 cN in the dry and wet states, respectively. When clearances no longer existed, the resistances to sliding for the esthetic brackets with and without inserts generally increased with angulation at a rate equal to or greater than that of the SS brackets--except for the polycarbonate (PC) brackets in the dry state. Because PC brackets without inserts elastically deformed, they had lower resistances to sliding when deformation occurred. For the polycrystalline alumina brackets without inserts, the resistances to sliding increased rapidly and nonlinearly as angulation increased above 4.8 degrees. Upon examination, the presence of scratches on the archwires and SS debris on the brackets was observed. The addition of these particular SS inserts did not considerably improve the resistance to sliding over those esthetic brackets without inserts.
Aluminum Oxide↗