Dental Press Jounal of Orthodontics
Dental Press International

v. 17, no. 5

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 17, no. 5

September / October



Esthetics and human perception

David Normando

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Esthetics, from Greek aisthesis, means perception, sensation. It is a philosophical reflection on beauty. In health sciences, the construction of meanings and values about body esthetics is increasingly present, influencing the identity construction of the individual and the perception that this one has about himself and what he understands as health.

In orthodontics, the patient?s seek for perfection is growing steadily in recent years. This increase has led orthodontists to search for new knowledge in other areas of dentistry and also in other health areas. This growing interest is strongly driven by consumption boosted by images generated by the great appeal of the media, where models with ?perfect? and ?white? smiles are presented to the public. It is clear, and concerning, that this appeal seems to induce the orthodontists to think as ?layman?, making us forget that we are, in first place, healthcare professionals.

The senses socially used to understand the care with what is considered healthy have been suffering strong influence of esthetic parameters that are apparently outside the field of health sciences. It is unquestionable that the esthetic rehabilitation of the patient is one of the primary objectives of orthodontic treatment; however, it cannot be the only focus. Just like it is impossible to understand the concept of health, and the care it imposes on contemporary urban society, without taking into account fashion, seduction, the spectacle and consumption. However, the appeal of esthetics-based ?marketing?, in its essence, has led many to think that way and make decisions based solely on the anxiety and pressure of this market, without considering the expectations of the patient.

The fragmentation of our professional view, due to the appeal of the media and the market together, often encourages us to induce the patient to treat problems that he had never realized he had, regarding both the esthetics of the smile and face. Explaining all treatment possibilities, including plausible esthetic improvements, is one of our obligations, but this approach must be made using common sense and without impositions, because understanding that  patients think in a diverse, individual and subjective way must be the premise of a cordial, honest and ethical relationship. Otherwise, the feeling is as if we were only dictators of an esthetic need, instead of spectators and connoisseurs of the needs of our patients.

The variability of esthetic perception is related to the educational, cultural and socioeconomic background, besides the emotional formatting of each individual. It is not easy to understand it. In orthodontics, it is not enough just to understand what affects the smile, it is necessary to diagnose what is outside the normal range, so we can establish a treatment plan. Just as in the functional problems we follow protocols which lead us to diagnose anomalies, the esthetic problems also require parameters so we can find the defects.1 In this context, the scientific research on the criteria used by orthodontists and patients to define a smile or a face as esthetically pleasing could build a solid stairway to understanding the differences between professional?s perception and patient?s perception. This issue of Dental Press Journal of Orthodontics, composed by articles that evaluate esthetics concepts in orthodontics, pretend to be one of these steps. Let?s take it... 

Orthodontics Highlights

Orthodontics Highlights

Matheus Melo Pithon

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Parameters used for referring Patients for orthognathic surgery

During the course of decades, orthodontics was based on linear and angular static measurements to define the orthodontic treatment plan. Nowadays, a great deal of attention has been paid to facial analysis. In line with this trend, an interesting article1 was published, in which the proposal was to verify whether it was necessary or not to refer Class II, division 1 patients for orthognathic surgery, based on observation of the face in lateral view. The conclusions drawn from this study were that the displacement of the soft tissues of the pogonium and point B in the posterior direction and the diminished facial profile angle were decisive factors for orthodontists to indicate these patients for orthognathic surgery. These results suggested that in the presence of cases with limitations it is always important to take a profile photograph of the patient and show it to the patient, so that he/she can evaluate his/her face and together with the orthodontist, define whether or not it would be convenient to undergo surgical treatment.

Orthodontic Insight

Esthetics in Orthodontics: Interest points, reference points and discrepancy points

Carlos Alexandre Câmara

Esthetics. Beauty. Orthodontics.

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It is fundamental for orthodontists and all professionals related with facial, oral and dental esthetics to know how the individuals observe dentofacial structures. Thus, it will be the purpose of this Orthodontic Insight to present and describe the Interest, Reference and Discrepancy. Points With the knowledge and perception of these points it will be easier for orthodontists to create a convergent canal of communication with their patients.


Paulo José d?Albuquerque Medeiros

Marco Antonio de Oliveira Almeida

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Prof. Paulo José d?Albuquerque Medeiros was born to Paulo Pinho de Medeiros and Conceição Rosário d?Albuquerque Medeiros in the city of Rio de Janeiro, Brazil on March 7, 1957. He has been married for 31 years to Patricia Leo Medeiros and they have two children: Alessandra Leão Medeiros Parente, 30, a law judge, and Leo Bruno Medeiros, 28, economist. He is fond of music and the movies, and is a fine singer. He has developed a refined taste for good wines, his favorite being Chateau Palmer. He is currently reading a pocket book titled ?1001 wines to drink before you die?. His most daunting challenge in life: ?Keeping up the motivation to teach, which is my true calling?. 

Marco Antonio Almeida

Original Article

Study of face pleasantness using facial analysis in standardized frontal photographs

Imara Castro Morosini, Ana Paula Lazzari Marques Peron, Keila Rodrigues Correia, Ricardo César Moresca

Facial analysis. Attractiveness. Facial esthetics

Objective: The purpose of this research was to check if the numeric facial analysis can determine facial attractiveness.

Method: The sample consisted of frontal and lateral standard facial photographs, in natural head position, of 85 Brazilian Caucasian women, without facial plastic surgery report. The sample mean age was 23 years and 9 months. A group of 5 orthodontists, 5 layman and 5 plastic artists classified the photographs according to their own attractiveness graduation in: pleasant, acceptable and not pleasant. The numeric facial analysis was then performed using a computerized method. Linear, proportional and angular measurements were compared among groups. 

Results: According subjective analysis the sample was consisted of 18.8% of pleasant, 70.6% of acceptable and 10.6% of not pleasant. In most measurements there were no differences among groups. Just in three of them significant statistical difference was observed and in two of them the comparison value was within decision limit. All the differences found were related to the lower third of the face and to facial pattern. 

Conclusion: On the present research, the numeric facial analysis, by itself, was not capable of detecting facial attractiveness, considering that beauty judgment seems to be very personal. 

Facial pattern of patients with post-foramen incisor cleft

Leopoldino Capelozza Filho, Rodrigo Silva Caldas, Rita de Cássia Moura Carvalho Lauris, Arlete de Oliveira Cavassan

Cleft palate. Orthodontics. Growth.

Objective: The assessment and establishment of the facial growth pattern for patients with a cleft palate. 

Material: This cross-sectional retrospective study was based on front and profile photos of a sample of 71 patients at the HRAC-USP, 22 males and 49 females, Brazilians, young adults, with a mean age of 17 years 8 months, without previous orthodontic treatment and no associated syndromes. The method was the subjective facial diagnosis based on technical concepts, that is, the qualitative morphologic analysis of the face through clinical examination. Individuals were classified as Pattern I, II, III, Long Face or Short Face. 

Results: The distribution found with the frontal morphologic analysis was: Pattern I (69%), II (6%), III (7%), Long (18%) and Short (0%). As for the profile morphologic analysis, the distribution was: Pattern I (35%), II (38%), III (10%), Long (17%) and Short (0%).The distribution observed in the frontal analysis was very positive, since individuals Pattern I prevailed. For the profile evaluation, the anterior-posterior dysplasias were essentially shown, significantly increasing their participation. Long Face Pattern maintained a balance in both ratings and Short Face Pattern was not found in the sample used, probably related to the low prevalence in the general population. 

Conclusion: The prevalence of different Facial Patterns for patients with cleft palate was similar to that found in individuals without cleft.

Conservative treatment of a Class I malocclusion with 12 mm overjet, overbite and severe mandibular crowding

Marcos Alan Vieira Bittencourt, Arthur Costa Rodrigues Farias , Marcelo de Castellucci e Barbosa

Malocclusion. Angle Class I Malocclusion. Comprehensive Orthodontics.

Introduction: A female patient aged 12 years and 2 months had molars and canines in Class II relationship, severe overjet (12 mm), deep overbite (100%), excessive retroclination and extrusion of the lower incisors, upper incisor proclination, with mild midline diastema. Both dental arches appeared constricted and a lower arch discrepancy of less than -6.5 mm. Facially, she had a significant upper incisors display at rest, interposition and eversion of the lower lip, acute nasolabial angle and convex profile. 

Objective: To report a clinical case consisting of Angle Class I malocclusion with deep overbite and overjet in addition to severe crowding treated with a conservative approach.

Methods: Treatment consisted of slight retraction of the upper incisors and intrusion and protrusion of the lower incisors until all crowding was eliminated.

Results: Adequate overbite and overjet were achieved while maintaining the Angle Class I canine and molar relationships and coincident midlines. The facial features were improved, with the emergence of a slightly convex profile and lip competence, achieved through a slight retraction of the upper lip and protrusion of the lower lip, while improving the nasolabial and mentolabial sulcus.

Conclusions: This conservative approach with no extractions proved effective and resulted in a significant improvement of the occlusal relationship as well as in the patient?s dental and facial aesthetics.

Orthodontic treatment in adults: Restoring smile esthetics

Leopoldino Capelozza Filho, Maria Fernanda Barros Aranha, Terumi Okada Ozawa, Arlete de Oliveira Cavassan

Orthodontics. Smile esthetics.

Introduction: The search for orthodontic treatment by adult patients is increasing. This demand may be explained by many reasons, but the most important was the change in the concept of normality, allowing the selection of simpler and more conservative and consistent therapeutic objectives. This conceptual evolution, combined with the technological advances allowed an improvement in orthodontic management, making it more effective, fast and comfortable. The promotion of awareness of the society on the advantages of this treatment and the increase in esthetic demands, with an increasingly longer and active social, affective and professional life, creates a context in which the need for Orthodontics is absolutely established for the adult individuals. 

Objective: The objective of this article is to report the nuances in diagnosis and orthodontic treatment of an adult patient, in a different perspective. Within this approach, the objective is to recover the shape, i.e. to establish occlusal conditions that would probably be present if the patient had been assisted at the proper time, namely during growth and tooth irruption. 

Impact of brackets on smile esthetics: Laypersons and orthodontists perception

Seandra Cordeiro de Oliveira, Rachel D’Aurea Furquim, Adilson Luiz Ramos

Esthetics. Dental. Visual perception. Orthodontic brackets.

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Objective: This study evaluated the influence of orthodontic appliances on smile esthetics assessed by lay adolescents, lay adults and orthodontists. 

Methods: A facial photograph of a smiling young woman was used under the following conditions: With metal orthodontic brackets ligated by different elastic ligature colors (green, red and gray), with ceramic bracket brackets (transparent elastic ligature) and without brackets, totaling five 15 x 20 cm pictures. For the photograph assessment, 16 lay adolescents, 16 lay adults and 16 orthodontists were randomly selected. The photographs were randomly arranged in an album, followed by a visual analog scale (VAS) for the scores registration. Scores in both evaluations of each group of evaluators (adolescents, adults and orthodontists) were submitted to error analysis by WILCOXON test and multiple comparison among groups performed by Kruskal ? Wallis at 5% significance. 

Results: Orthodontists, adults and adolescents agreed in their opinions, although the orthodontists gave lower scores in their assessments. It could be observed that ceramic brackets were more acceptable concerning the smile esthetics, whereas the metal brackets received the lowest scores. 

Conclusion: Orthodontists, adults and even adolescents seem to prefer esthetic solutions during orthodontic treatment. 

Photometric analysis applied in determining facial type

Luciana Flaquer Martins, Julio Wilson Vigorito

Diagnostic techniques and procedures. Orthodontics. Anthropometry.

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Introduction: In orthodontics, determining the facial type is a key element in the prescription of a correct diagnosis. In the early days of our specialty, observation and measurement of craniofacial structures were done directly on the face, in photographs or plaster casts. With the development of radiographic methods, cephalometric analysis replaced the direct facial analysis. Seeking to validate the analysis of facial soft tissues, this work compares two different methods used to determining the facial types, the anthropometric and the cephalometric methods. 

Methods: The sample consisted of sixty-four Brazilian individuals, adults, Caucasian, of both genders, who agreed to participate in this research. All individuals had lateral cephalograms and facial frontal photographs. The facial types were determined by the Vert Index (cephalometric) and the Facial Index (photographs). 

Results: The agreement analysis (Kappa), made for both types of analysis, found an agreement of 76.5%. 

Conclusions: We concluded that the Facial Index can be used as an adjunct to orthodontic diagnosis, or as an alternative method for pre-selection of a sample, avoiding that research subjects have to undergo unnecessary tests.

In vivo color changes of esthetic orthodontic ligatures

Andréia Viana Martins da Silva, Giselle Vasconcelos de Mattos, Carlos Mario Kato, David Normando

Elastomeric ligatures. Pigmentation. Visual perception.

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Objective: To assess the color changes that occur in four commercial brands of esthetic orthodontic elastomeric ligatures after exposure to the oral environment. 

Methods: The four elastomeric ligatures manufacturers mostly mentioned by orthodontists were investigated: Morelli, Uniden, American Orthodontics (AO) and TP. The sample comprised 25 patients. The elastomeric ligatures were randomly distributed and arranged in the four dental quadrants of each patient, r for 30 days. After this period, two units of each brand were photographed in a standardized manner. Subsequently, color changes were visually evaluated and assigned a score (0, 1, 2 or 3) by a panel of four examiners. The mean scores assigned by the examiners were statistically analyzed by ANOVA and Tukey?s test (p < 0.05). 

Results: The mean pigmentation scores assigned to Morelli (1.80 ± 0.78) and Uniden (1.92 ± 0.66) elastomeric ligatures after 30 days in the oral environment were not statistically different. However, these brands were significantly more pigmented after 30 days in the oral environment (p < 0.01) compared to American Orthodontics (0.97 ± 0.6) and TP (0.83 ± 0.79). 

Conclusions: Although all four brands exhibited an undesirable pigmentation after 30 days in the oral environment, color change for American Orthodontics and TP Orthodontics ligatures was significantly lower than Morelli and Uniden products.

The ability of orthodontists and laypeople in the perception of gradual reduction of dentogingival exposure while smiling

Elaine Cristina da Silva Barros, Marielly Damiana Oliveira de Carvalho, Karina Corrêa Flexa Ribeiro Mello, Patrícia Botelho, David Normando

Esthetic Dentistry. Gingiva. Orthodontics. Smile.

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Objective: To assess differences in how orthodontists and laypersons perceive a reduction in dentogingival display on smiling.

Methods: Sixty examiners from both genders (30 laypersons and 30 orthodontists) evaluated photographs of spontaneous smiles of two subjects , one male and one female. Based on the original images, smile height was modified by means of an image manipulation software program. The examiners assigned scores ranging from 0 to 10, according to the level of pleasantness. Method reproducibility was examined using the Wilcoxon test, while the Friedman and Wilcoxon tests (p < 0.05) were employed to observe intra- and interexaminer differences, respectively. 

Results: No differences were found between the groups of examiners - in terms of esthetics - in response to changes in smile height of both genders . However,men smile had lower acceptability than the women smile. A mild reduction in dentogingival display on smiling (2 mm) was not perceived by either laypersons or orthodontists (p > 0.05). 

Conclusions: women smiles achieved higher scores than men smiles however, samples involving a larger number of subjects in each group are required to ensure whether or not this finding is linked to the subjects gender.

Analysis of width/height ratio and gingival zenith in patients with bilateral agenesis of maxillary lateral incisor

Núbia Inocencya Pavesi Pini, Luciana Manzotti De Marchi, Bruno Frazão Gribel, Adilson Luiz Ramos, Laurindo Zanco Furquim , Renata Corrêa Pascotto

Dental agenesis. Width/length ratio. Gingival zenith.

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Objective: The purpose of this study was to evaluate the width/length ratio and the gingival zenith (GZ), by means of dental casts and digital caliper, in patients with missing maxillary lateral incisors after treatment. 

Methods: The sample was composed of 52 subjects divided into 3 groups: BRG (n = 18), patients with bilateral agenesis treated with tooth re-contouring; BIG (n = 10) patients with agenesis treated with implants and CG (n = 24), control group. The data were analyzed using Shapiro-Wilk, Spearman correlation, Wilcoxon, Kruskal-Wallis, t test and ANOVA tests (p < 0.05). 

Results: For the width/length ratio of the lateral incisors, BIG presented the lowest mean values (0.72 right and left), when compared with other groups. However, comparison between groups presented statistically significant differences for the right lateral incisor (BIG x CG) and for the canine (BRG x CG). GZ data evaluation showed the greatest difference for BRG (0.5 right and 0.48 left). BIG (0.95 right and 0.98 left) and CG (0.98 right and 0.8 left) presented more similar values, nevertheless, without statistical difference (p > 0.05). GZ data for the right and left sides of the smile were not considered statistically different. 

Conclusion: Although no statistical difference was found in the comparison between the groups, analysis of the descriptive values showed that group BIG showed the greatest difference in values with regard to width/length ratio. Regarding gingival zenith, BRG showed the greatest difference. 

Assessment of changes in smile after rapid maxillary expansion

Ana Paula Morales Cobra de Carvalho, Fernanda C. Goldenberg, Fernanda Angelieri , Danilo Furquim Siqueira, Silvana Bommarito, Marco Antonio Scanavini , Lylian Kazumi Kanashiro

Orthodontics. Smile. Interceptive orthodontics.

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Introduction: This study evaluated changes in the smile characteristics of patients with maxillary constriction submitted to rapid maxillary expansion (RME).?

Methods: The sample consisted of 81 extraoral photographs of maximum smile of 27 patients with mean age of 10 years, before expansion and 3 and 6 months after fixation of the expanding screw. The photographs were analyzed on the software Cef X 2001, with achievement of the following measurements: Transverse smile area, buccal corridors, exposure of maxillary incisors, gingival exposure of maxillary incisors, smile height, upper and lower lip thickness, smile symmetry and smile arch. Statistical analysis was performed by analysis of variance (ANOVA), at a significance level of 5%.?

Results: RME promoted statistically significant increase in the transverse smile dimension and exposure of maxillary central and lateral incisors; maintenance of right and left side smile symmetry and of the lack of parallelism between the curvature of the maxillary incisal edges and lower lip border.?

Conclusions: RME was beneficial for the smile esthetics with the increase of the transverse smile dimension and exposure of maxillary central and lateral incisors.

Esthetic perception and economic value of orthodontic appliances by lay Brazilian adults

Daniela Feu, Fernanda Catharino, Candice Belchior Duplat, Jonas Capelli Junior

Orthodontic appliances. Esthetics. Corrective orthodontic treatment. Cost-benefit analysis.

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Objective: To evaluate the esthetic perception of different appliances by Brazilian lay adults and its influence in the attributed value of orthodontic treatment, considering evaluators? socioeconomic status, age and gender. 

Methods: Eight different combinations of orthodontic appliances and clear tray aligners were placed in a consenting adult with pleasing smile. Standardized frontal photographs were captured and incorporated into a research album. A sample of adults (n = 252, median = 26 years old) were asked to rate each image for (1) its attractiveness on a visual analog scale and (2) the willingness to pay (WTP) for a cosmetic appliance when compared to a standard metalic appliance and a clear tray aligner. Comparisons between the appliances? attractiveness were performed using the Friedman?s test and Dann?s post-hoc test. Correlation between appliances? attributed value, socioeconomic status, age, gender, and esthetic perception was assessed using Spearman?s correlation analysis.

Results: Attractiveness ratings of orthodontic appliances varied significantly in the following hierarchy: Clear aligners>sapphire brackets>self-ligating/conventional stainless steel brackets>and golden metal appliances. The correlation between WTP and esthetic perception was week. However, for individuals with better socioeconomic status and aged between 17-26 years old significantly, a significantly higher WTP was found. 

Conclusion: Clear aligners and sapphire brackets with esthetic archwire were considered better esthetic options in this sample. Nevertheless, patients were not willing to pay more money for appliances they deemed more esthetic, however, they were significantly influenced by their socioeconomic level and age.

Influence of different width/height ratio of maxillary anterior teeth in the attractiveness of gingival smiles

Ana Carolina Guimarães Borges, Máyra Reis Seixas , Andre Wilson Machado

Smile. Dental esthetic. Gingiva.

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Objective: To evaluate, among laypersons and orthodontists, the influence of the width/height proportions of upper anterior teeth on the smile attractiveness, in photographs of close up smile from three adult Caucasian women, with 4 mm of gingival exposure. 

Methods: The photographs of close up smiles were digitally manipulated and six images were created from each smile with teeth?s width/height proportions in 65%, 70%, 75%, 80%, 85% and 90%. Then, all these images were manipulated again and a black mask covering all teeth from the lower arch was created. The figures were then assessed by 60 evaluators, 30 orthodontists and 30 laypersons, who assigned, in a visual analog scale, the level of attractiveness of each image. 

Results: The obtained results, in general, showed that the proportions of 75%, 80% and 85% received the highest scores while the proportion of 65% received the lowest scores, for both groups of examiners (p < 0.05). When orthodontists and laypersons were compared, it was not found, in most situations, a significant statistical difference between their assessments (p > 0.05). Yet, the comparison between scores assigned to smiles with and without inferior teeth showed that, for all situations, there was no statistically significant difference between them (p > 0.05). 

Conclusion: For patients with gingival smile, the width/height proportions of upper anterior teeth considered more esthetic were the ones of 75%,80% and 85% for laypersons and orthodontists, and the presence or absence of inferior teeth did not affect the attractiveness level of the assessed smiles.

Influence of in vitro pigmenting of esthetic orthodontic ligatures on smile attractiveness

Camila Ferraz, Marcelo de Castellucci e Barbosa, Márcio Costa Sobral

Elastomers. Esthetics. Pigmentation. Photograph. Smile.

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Objective: To evaluate the perception of dental students and orthodontists on the degree of influence that pigmented esthetic elastic ligatures have on smile attractiveness, by judging clinical photographs. 

Methods: Sixteen clinical facial photographs of the smile and 16 close up images of the smile of a single patient wearing monocrystalline porcelain orthodontic brackets, Teflon coated NiTi wire brackets and esthetic elastic ligatures of five different commercial brands were distributed into eight groups, G1 to G8 (Morelli?, Ortho Tecnology?, TP Orthodontics?, Unitek/3M?clear, Unitek/3M? obscure, American Orthodontics? clear, American Orthodontics? pearl and American Orthodontics? metallic pearl). Twenty ligatures were used in each group, totaling 160 ligatures. Half of them were used in their natural state, and the other half after in vitro pigmentation. All the photographs were judged by 40 evaluators, 20 orthodontists and 20 dental students.

Results: For orthodontists, American? pearl (G7) ligatures were those that least influenced the degree of attractiveness of the smile in the two types of photographs used. For the dental students, in the facial photographs of the smile, ligatures with the best performance were Morelli? (G1), American? clear (G6) and American? pearl (G7) and in the close up photographs of the smile, American? pearl, metallic pearl and clear (G7, G8 and G6).

Conclusions: For both orthodontists and dental students, pigmentation of the elastic ligatures had a negative influence on the degree of attractiveness of smiles in the two types of clinical photographs evaluated.

Assessment of facial profile changes in patients treated with maxillary premolar extractions

Renata Rodrigues de Almeida-Pedrin , Luciane Brigueli Marrone Guimarães, Renato Rodrigues de Almeida, Marcio Rodrigues de Almeida , Fernando Pedrin Carvalho Ferreira

Tooth extraction. Angle Class II malocclusion. Corrective orthodontics. Perception.

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Objective: Evaluate the facial profile changes of orthodontic treatment with extraction of two upper first premolars, from the perspective of orthodontists, dentists and lay people. 

Methods: Facial profiles of radiographs taken before and after treatment of 70 patients with Class II, division 1 malocclusion were traced. The silhouettes of the 70 patients were randomly assembled in an album with, being two profiles on each sheet of the same patient. Then, 30 orthodontists, 30 dentists and 30 lay people chose the more esthetic facial profile (A or B), and the amount of change they perceived between the two profiles before and after treatment, according to a visual analog scale (VAS). 

Results: The results revealed that 83 examiners preferred the post-treatment profiles, and only three dentists and four lay people chose the profiles pre-treatment more frequently. Thus, the orthodontists often chose the profiles after treatment, followed by dentists, with no statistically significant differences found between dentists and lay people. There were significant differences within groups in the preference of pre- and post-treatment profile. Furthermore, the three groups of evaluators indicated that pre and post-treatment profiles did not differ substantially. 

Conclusions: The treatment of Class II, division 1 malocclusion with extraction of two first premolars has a positive effect on facial profile esthetics.

Width of buccal and posterior corridors: Differences between cases treated with asymmetric and symmetric extractions

Nuria Cabral Castello Branco, Guilherme Janson , Marcos Roberto de Freitas, Juliana Fernandes de Morais

Orthodontics. Tooth extraction. Premolar.

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Objective: To verify if there is difference in the buccal and posterior corridor width in cases treated with extraction of one and four premolars.

Methods: Through posed smile photographs of 23 Class II patients, subdivision, treated with extraction of one premolar and 25 Class I and Class II patients, subdivision, treated with extraction of four premolars, the percentage of buccal and posterior corridor width was calculated. The two protocols of extractions were compared regarding the buccal and posterior corridor width by independent t tests.

Results: There was no statistically significant difference on the buccal and posterior corridor widths between patients treated with symmetric and asymmetric extraction. 

Conclusion: The buccal and posterior corridor did not differ between the evaluated protocols of extractions.

Influence of buccal corridor dimension on smile esthetics

Diana Cunha Nascimento, Êmeli Rodrigues dos Santos, Andre Wilson Machado, Marcos Alan Vieira Bittencourt

Orthodontics. Tooth extraction. Premolar.

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Objective: To verify if there is difference in the buccal and posterior corridor width in cases treated with extraction of one and four premolars.

Methods: Through posed smile photographs of 23 Class II patients, subdivision, treated with extraction of one premolar and 25 Class I and Class II patients, subdivision, treated with extraction of four premolars, the percentage of buccal and posterior corridor width was calculated. The two protocols of extractions were compared regarding the buccal and posterior corridor width by independent t tests.

Results: There was no statistically significant difference on the buccal and posterior corridor widths between patients treated with symmetric and asymmetric extraction. 

Conclusion: The buccal and posterior corridor did not differ between the evaluated protocols of extractions.

Capture, analysis and measurement of images of speech and smile dynamics

Vera Lúcia Cosendey, Stephanie Drummond, Jonas Capelli Junior

Aging. Video recording. Facial expression.

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Introduction: Dynamic analysis of smile and speech makes it easier to identify the features that define facial esthetics while allowing researchers to study different variables and observe the effects of aging.

Objective: The aim of this study is to present a method for capturing, analyzing and measuring video images to support the study of speech and smile dynamics.

Methods: Natural head positioning was standardized with the aid of a head holder (cephalostat). Image acquisition is performed with a video camera attached to a tripod, positioned at a fixed distance of 0.90 m. The subjects are trained to say out loud: "Tia Ema torcia pelo antigo time da Tchecoslováquia" and then to smile. The resulting images are fragmented and yielded four pictures that best represent a resting position, the least exposure of maxillary incisors, the greatest exposure of upper and lower incisors, and a posed smile. A freeware computer program called VIDEOMED was used to carry out measurements. 

Conclusion: The method presented in this study is an effective resource to record images captured during rest, speech and smile, thereby enabling a better understanding of changes in perioral soft tissues. 

Evaluation of immediate soft tissue changes after rapid maxillary expansion

Ki Beom Kim, Daniel Adams, Eustaquio A. Araújo, Rolf G. Behrents

Palatal expansion technique. Cone beam computed tomography. Corrective orthodontics.

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Objective: To evaluate immediate soft tissue changes following rapid maxillary expansion (RME) in growing patients, using cone beam computed tomography (CBCT).

Methods: Twenty-three consecutive patients (10 male, 13 female) treated by RME were selected. Patients were scanned using CBCT prior to placement of the rapid maxillary expander (T0), then immediately following full activation of the appliance (T1). Defined landmarks were then located on the pre- and post-treatment orientated images. Change in landmark position from pre- to post-treatment was then measured. In addition to landmarks, 10 direct measures were made to determine distance change without regard to direction to measure soft tissue change of the lips.

Results: Significant transverse expansion was measured on most soft tissue landmark locations. All the measures made showed significant change in the lip position with a lengthening of the vertical dimension of the upper lip, and a generalized decrease of anterior-posterior thickness of both the upper and lower lips. 

Conclusions: Significant changes in the soft tissue do occur with RME treatment. There is a transverse widening of the midface, and a thinning of the lips.

Treatment of Class II malocclusion with bialveolar protrusion by means of unusual extractions and anchorage mini-implant

Jong-Moon Chae

Mini-implant. Tooth extraction. Tooth movement.

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Introduction: Patients with dental Class II bialveolar protrusion are generally treated by extracting the four first premolars or two first and two second premolars, and retracting the anterior teeth. This case report describes the treatment of an adult patient with bialveolar protrusion, a Class II canine and molar relationship, and lip protrusion. 

Methods: In this patient, the maxillary right second molar (1.7) had to be extracted due to extensive caries. To create sufficient space to retract the anterior teeth, the maxillary right posterior teeth were distalized with a maxillary posterior mini-implant (1.2~1.3 mm in diameter, 10 mm long), which was placed into the maxillary tuberosity area and allowed an en masse retraction of the maxillary anterior teeth.  

Results: Overall, mini-implant can provide anchorage to produce a good facial profile even without additional premolar extraction in cases of dental Class II bialveolar protrusion with the hopeless second molar. 

Conclusion: The total treatment period was 42 months and the results were acceptable for 34 months after debonding.

BBO Case Report

Class III malocclusion with severe anteroposterior discrepancy*

Susana Maria Deon Rizzatto

Class III malocclusion. Corrective orthodontics. Orthognathic surgery.

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This study aims at reporting the clinical case of a patient with Class III skeletal malocclusion with severe maxillary deficiency, producing a reduced midface associated with severe mandibular prognathism. The pre-surgical orthodontic preparation was composed mainly by dentoalveolar expansion and repositioning of the incisors in the lower arch. Then, a combined maxillary and mandibular orthognathic surgery was performed. The treatment objectives were achieved, with significant improvement in facial esthetics and occlusion, followed by post-treatment stability. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requirements for obtaining the title of Diplomate by BBO.

Special Article

Gingival esthetics: An orthodontic and periodontal approach

Máyra Reis Seixas , Roberto Amarante Costa-Pinto , Telma Martins de Araújo

Orthodontics. Smile. Esthetics. Periodontics.

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Introduction: Currently, people?s esthetic requirements and expectations have increased substantially. Therefore, dentists have been seeking ways to provide excellent treatment results which, consequently, increasingly require a well organized transdisciplinary approach. The link between orthodontics and periodontics became evident from the moment professionals began to understand the biology of tooth movement. As regards smile esthetics, however, such cooperation is now essential. 

Objective: To show clinically how and when orthodontists and periodontists should work jointly to enhance smile esthetics based on the display and harmony of the gingival contour. 

Dental Press Journal of Orthodontics - v. 17, no. 5 Download full issue pdf