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This article demonstrates a method for smile enhancement involving the familiar "gummy" smile as well as irregular incisor gingival emergence levels. In this case study, financial considerations limited a comprehensive restorative treatment plan, restricting changes to several anterior teeth. Despite the restrictions, a solution was found.
The composition of an esthetic smile can be an elusive goal. The purpose of this paper is to present and clarify the principles of perception and the common errors in dental esthetics. A review of the literature is distilled into basic building blocks for composing the esthetic smile. Utilization of the principles presented here will allow the practitioner+ to improve the appearance of fixed and removable restorations.
With the continued increase in patient expectations for appearance-related restorations, the final result may be deficient in aesthetic qualities, such as color, contour, and shape. This is generally due to a breakdown in communication among the patient, dentist, and laboratory technician with regard to basic smile design principles prior to fabrication of the restoration. With the introduction of advanced porcelain systems (IPS Empress System, Ivoclar Williams, Amherst, NY), the clinician and technician can produce restorations that mimic the optical characteristics and color vitality of natural teeth. This article presents methods to improve communication, effectively evaluate smile design principles, and fabricate aesthetic all-ceramic restorations.
The diagnosis and treatment of the "gummy smile" (altered passive eruption, excessive gingival display) help the periodontist to provide the most beautiful smiles possible for patients. This article describes diagnosis, surgical planning, and case reports that show the benefits of treatment of this common clinical problem for the patient and restorative dentist who can now provide ideal cosmetic results for their patients.
Smile design is a new discipline that has come to the forefront with the recent popularity of cosmetic dentistry techniques. This article explores some of the principles used in smile design that can enhance the esthetics of any anterior restorative procedure.
Current concepts of total facial rejuvenation involve a comprehensive integrated approach to achieve a balanced youthful appearance. Recently introduced endoscopic-assisted techniques allow us to rejuvenate the face through small, remote incisions. Previously, we have considered only young patients with good skin turgor as candidates for minimally invasive procedures, but the advent of the resurfacing laser has allowed us to expand our indications for single stage minimal access rejuvenation. Full facial immediate laser resurfacing at the time of standard rhytidectomy has been avoided due to risk of flap necrosis. Subperiosteal minimally invasive endoscopic assisted techniques do not substantially interfere with facial blood supply. We can now perform endoscopic-assisted full facelifts combined with immediate laser resurfacing to reposition the tissues in a more youthful position and then tighten the skin envelope. Extended endoscopic-assisted subperiosteal forehead lift is performed through three to five scalp incisions; subperiosteal midface lift is performed through a crow's foot or intraoral incision. Cervicoplasty, if needed, is performed through a small submental incision. Full face laser resurfacing is done using a Coherent Ultrapulse laser. To date we have performed eleven subperiosteal minimally invasive laser endoscopic (SMILE) rhytidectomies. There has been no evidence of flap necrosis with this technique. Postoperative recovery has been no different from patients treated only by full face resurfacing, except perhaps for the slight increase in early facial edema. We believe the SMILE facelift is a viable alternative to standard techniques. The limitations of this procedure still need to be elucidated.
The asymmetrical status of facial beauty has rarely been investigated. We studied positive facial characteristics, attractiveness and smiling, through the use of left-left and right-right composites of unfamiliar faces of women and men with natural expressions. Results showed that women's right-right composites were judged significantly more attractive than left-left composites while there was no left-right difference in men's composites (Experiment 1). On the other hand, left-left composites were judged to have more pronounced smiling expressions than right-right composites in both women's and men's faces (Experiment 2). The results confirm previous findings for leftward facial expressiveness and show for the first time asymmetry in facial attractiveness and a difference in its manifestation in women's and men's faces. The findings have biological implications for the relationship between the appearance of the sides of the face and hemispheric specialization. The organization of beauty in the human face may have been shaped by evolutionary pressures on facial asymmetries, especially as they pertain to mate selection.
UNLABELLED: A multidisciplinary team associating members from the hospital, national education and local council sectors prepared, and led, a carie-free smile educational campaign in Toulouse. OBJECTIVES: The aim was two-fold: to teach children how to manage their routine oral hygiene while giving a positive image to health care-hence the carie-free smile theme chosen by the team; secondly, to promote an awareness campaign targeting professionals in the education sector (public health sector, independent paediatricians and odontologists) who together constitute the transmitters of our initiative. MATERIAL AND METHODS: The action involved 12,000 children in the 5-8-year age group from 76 public and private schools, 36 kindergarten and primary school leisure centres, six holiday centres together with infant patients from the children's hospital, all of whom were volunteers in the scheme. The team produced back-up material in the form of posters, booklets and stickers; there was also a website dealing with oral hygiene themes, caries and their treatment. Those taking part included practising dentists and students of dentistry. Before the presentation, posters were sent to teachers and other educational partners so as to prepare the children; this included an interactive phase in the presence of the teacher, and a brushing session. Each child was given a booklet, a sticker and a toothbrush. RESULTS: By means of a poll organised among the partners the impact of the campaign could be assessed: firstly, on teachers and children by evaluating their motivation in the setting up of the toothbrushing session in 17 classes following the midday meal, thus appraising their appreciation of the visual material, and secondly, to the dentistry students: the future dentists had noted disparities in oral hygiene practices according to residential area, and thus could appreciate the importance of early provision in the school curriculum, as well as the value of accomplishing this health education task in the daily exercise of their profession.
Based on the structural characters of PPAR modulators, a virtual combinatorial library containing 1226,625 compounds was constructed using SMILES strings. Selected ADME filters were employed to compel compounds having poor drug-like properties from this library. This library was converted to sdf and mol2 files by CONCORD 4.0, and was then docked to PPARgamma by DOCK 4.0 to identify new chemical entities that may be potential drug leads against type 2 diabetes and other metabolic diseases. The method to construct virtual combinatorial library using SMILES strings was further visualized by Visual Basic.net that can facilitate the needs of generating other type virtual combinatorial libraries.
The SMILES (simplified molecular input line entry system) nomenclature was used to elucidate the molecular structure in constructing the quantitative structure-property/activity relationships (QSPR/QSAR) for predicting quail toxicity after oral exposure. The presence of chemical elements in different electronic states (e.g., C, c, O, o, Cl, Br, etc.) and of different covalent bonds (i.e., -,=, and #) was used as local invariants. Combinations of different presence/absence codes for local features of the SMILES were used as global invariants. The statistical characteristics of this model are n=97, r(2)=0.755, s=0.445, F=293 (training set); n=18, r(2)=0.731, s=0.587, F=43 (test set).
Most approaches to structure-activity-relationship (SAR) prediction proceed in two steps. In the first step, a typically large set of fingerprints, or fragments of interest, is constructed (either by hand or by some recent data mining techniques). In the second step, machine learning techniques are applied to obtain a predictive model. The result is often not only a highly accurate but also hard to interpret model. In this paper, we demonstrate the capabilities of a novel SAR algorithm, SMIREP, which tightly integrates the fragment and model generation steps and which yields simple models in the form of a small set of IF-THEN rules. These rules contain SMILES fragments, which are easy to understand to the computational chemist. SMIREP combines ideas from the well-known IREP rule learner with a novel fragmentation algorithm for SMILES strings. SMIREP has been evaluated on three problems: the prediction of binding activities for the estrogen receptor (Environmental Protection Agency's (EPA's) Distributed Structure-Searchable Toxicity (DSSTox) National Center for Toxicological Research estrogen receptor (NCTRER) Database), the prediction of mutagenicity using the carcinogenic potency database (CPDB), and the prediction of biodegradability on a subset of the Environmental Fate Database (EFDB). In these applications, SMIREP has the advantage of producing easily interpretable rules while having predictive accuracies that are comparable to those of alternative state-of-the-art techniques.
MATERIALS: A consecutive group of 73 patients (77 calcaneal fractures) treated with open reduction and internal fixation through a smile-shaped lateral approach to the hindfoot were reviewed retrospectively. Inclusion criteria were a closed displaced intra-articular fracture of the calcaneus, no compartment syndrome, and adequate followup. Followup ranged from 4 months to 4 years. RESULTS: One patient had a deep wound infection that required removal of hardware and intravenous antibiotics. No deep dehiscence or flap necrosis occurred. Superficial dehiscence occurred in three patients (4%) and superficial necrosis was seen in nine patients (12%); all resolved with continued casting to protect the wound. Six patients (8%) complained of numbness or pain in the sural nerve distribution. No symptomatic neuromas were seen. Reflex sympathetic dystrophy occurred in three patients (4%); all resolved with sympathetic blocks. Only one patient required an additional procedure for treatment of a wound-related problem or infection. CONCLUSION: The "smile" incision provides good fracture exposure for reduction without added morbidity.
We present theory and simulations for a spectral narrowing scheme for laser diode arrays (LDAs) that employs optical feedback from a diffraction grating. We calculate the effect of the so-called smile of the LDA and show that it is possible to reduce the effect by using a cylindrical lens set at an angle to the beam. The scheme is implemented on a 19-element LDA with smile of 7.6 microm and yields frequency narrowing from a free-running width of 2 to 0.15 nm. The experimental results are in good agreement with the theory.
PURPOSE: To determine the response of infants and children to the Moving Dynamic Random Dot Stereosize (MDRS) test and to collect cross-sectional age-related data. METHODS: Sixty visually normal individuals were divided into four age groups: 0.5-<2, 2-<5, 5-<8, and 8-<20 years. Stereopsis was measured with the MDRS test on two occasions, plus the Frisby, Randot, or Stereo Smile tests, as was age appropriate. RESULTS: All children aged >2 years and 80% of the children between ages 6 months and 2 years were able to perform the MDRS test on at least one occasion. Sixty percent of the 6-month to 2-year-old children were able to perform the Stereo Smile test on both occasions. Performance on the MDRS test improved with age up to 9 years. Improvement on the Frisby and Randot tests was seen in children aged up to 7 years. Mean and 95% confidence interval ranges for each test are given. CONCLUSION: This study gives evidence that aspects of the visual system are not fully mature until age 7-9 years. The MDRS test is a visually demanding but cognitively simple test that shows potential for detecting visual anomalies in young children.
The authors present a multidisciplinary approach to the gingival smile in which its three components are evaluated. These components are the dynamic component of the lip (repose versus smiling) and the two static elements of the gum and maxilla. Once an appropriate diagnosis has been made, the authors act on the gingiva for delayed passive eruption, on the maxilla for long face syndrome, and on the lip with lip-elongation techniques. When delayed passive eruption is associated with hyperfunction of the lip elevators, an intraoral approach with an incision at the level of the upper labial frenulum and dissection from the anterior nasal spine to the anterior maxillary fossae, in addition to gingival remodeling, is recommended to reduce gingival exposure.
The Mona Lisa, painted by Leonardo Da Vinci, 1503, pictures a smile that has been long the subject of conjecture. It is believed, however, that the Mona Lisa does not smile; she wears an expression common to people who have lost their front teeth. A closeup of the lip area shows a scar that is not unlike that left by the application of blunt force. The changes evident in the perioral area are such that occur when the anterior teeth are lost. The scar under the lower lip of the Mona Lisa is similar to that created, when, as a result of force, the incisal edges of the teeth have pierced the face with a penetrating wound.
The rationale, design, organization and outcome definitions of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) study are described in detail. The recruitment of a total of 1500 patients (750 per treatment group) has been planned for this multicenter, double-blind, randomized, placebo-controlled study to investigate the effects of oral treatment with zofenopril calcium (7.5-30 mg twice a day) on the combined short-term total mortality and occurrence of severe refractory congestive heart failure in patients with acute anterior myocardial infarction (AMI). Secondary end-points of the study include recurrent myocardial infarction, angina, progression of congestive heart failure as well as long-term mortality. Patients are initially treated in hospital within 24 hours from the onset of symptoms of AMI and their active follow-up continued for 6 weeks. In addition, the patients will be passively followed for a total of 12 months from the index AMI to assess their vital status and the occurrence of congestive heart failure. The study data will be analyzed on an intention to treat basis. An international independent Policy and Safety Monitoring Board is acting as the overall supervisory body and is responsible for the ethical conduction of the trial. A Scientific Committee is responsible for the scientific aspects of the trial and for the regular review of the progress of the study. We assume that the rationale and design of the SMILE trial will provide reliable information on the ability of ACE-inhibitors to reduce the occurrence of major cardiovascular events in patients with acute myocardial infarction.
Reconstruction of a natural, spontaneous, symmetrical smile remains the ultimate goal of reanimation of the mid-face after facial paralysis. Recently the one-stage mini-gracilis muscle transplantation, innervated by the contralateral facial nerve, has been introduced to solve this difficult problem. This paper illustrates by means of a historical review the numerous procedures which have led to the development of this intervention. Moreover, it addresses relevant differences between the classical two-stage procedure using a cross-facial nerve graft and the recently advocated one-stage procedure. The underlying neurophysiological mechanism and determination of the final functional outcome of the neurovascular muscle transfer to the face are discussed, and areas which deserve future research are mentioned.