Cosmetic/Esthetic - A Quarterly Newsletter on Dental SpecialtiesJADA

Photo morphing study considers appearance

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Characteristics like tooth shape, size, width to height ratio and position that make the upper front teeth esthetically pleasing are usually considered individually.

Scientists in Germany filtered out individual characteristics to highlight group characteristics. Their findings are published in the November/December 2014 issue of the Journal of Esthetic and Restorative Dentistry.

Researchers photographed the upper front teeth of 320 men and women aged 18 to 30. Each participant answered a questionnaire that included the query: “Are you content with the appearance of your teeth?” Based on the answers, researchers categorized photos into three groups: “discontent,” “average” or “content.”

After removing pictures with excluding defects, they divided the images equally by gender, resulting in a total of 16 in the “discontent” group, 64 in the “average” group and 32 in the “content” group. Researchers used morphing—an image processing technique in which one image is merged with another—to make six new images: one composite image for each gender (male or female) and category (“discontent,” “average” or “content”).

A group of 128 evaluators, (68 dentists and 60 laymen) ranked the six composite images for attractiveness within one minute on a visual analogue scale. Each of the evaluators, 85 females and 43 males, were also asked to identify a gender for each of the composite images.

Results showed that the laymen’s assessments of attractiveness weren’t significantly different from those of dentists and dental students so scientists pooled assessments of attractiveness from the two groups.

Composite images from the categories of subjects who rated themselves as “average” or “content” were rated significantly higher by the evaluators than the images from the “discontent” category. The composite image categorized as “female average” received the highest ratings compared to all other categories. No significant difference in attractiveness was found between the male and female composite images in the “discontent” group.

Gender assessments by dentists and laymen didn’t show any statistically significant differences so the two groups’ evaluations were again pooled. Evaluators were unable to judge the correct gender, yet they assigned higher attractiveness as female.

“The fact that composite images judged as attractive were correlated to the female gender by most participants deserves special attention,” authors said. “Since those composite images rated negatively were mainly assigned to the male gender, this result seems to support the conventional wisdom about males having an esthetically less pleasing dental appearance.”

Other than the subjective gender relation, participants were unable to correlate gender of the photographed participants and composite images.

Noticing that individual tooth characteristics are averaged out in the composite images, authors said that one key group characteristic of the composite images seems to be the width to height ratio of the upper front teeth. In this study, evaluators categorized composite images as “average” or “content”  when they were close to values deemed esthetically pleasing in previous research.

Among conclusions, scientists said their findings reflect “a European culture bias favoring the female gender as being attractive.”


High-fluoride toothpaste and white spot lesions

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Daily use of high-fluoride toothpaste can significantly reduce the prevalence and incidence of white spot lesions (WSL) adjacent to fixed orthodontic appliances in adolescents, according to scientists publishing in the December 2014 issue of the European Journal of Orthodontics. Furthermore, high-fluoride toothpaste should be considered as one of several alternative fluoride supplements for patients with a temporarily increased caries risk.

Study conclusions, derived from a randomized controlled trial conducted by scientists in Denmark and Sweden, follow previous research showing some evidence that topical fluoride or fluoride-containing bonding materials could reduce the occurrence and severity of WSLs adjacent to bands and brackets. Prior research suggested better caries-protective effect of a high-concentrated dental cream and gel in orthodontic patients and another study showed that high-sodium fluoride toothpaste had greater anti-caries potential than a standard formula in patients with orthodontic bands.

In this study, researchers aimed to evaluate the effectiveness of daily tooth brushing with high-fluoride toothpaste on WSL development in adolescents during treatment with fixed maxillary and mandibular orthodontic appliances.

They studied 482 healthy adolescents from 2008 to 2012, 11-16 years of age, who had been referred for orthodontic treatment to five specialist clinics in Sweden. Participants were randomly assigned to use either toothpaste containing 5,000 ppm fluoride or regular toothpaste with 1,450 ppm fluoride. To be eligible, adolescents had to be scheduled for full treatment with fixed orthodontic appliances for an expected period of at least one year.

Results showed that the use of high-fluoride toothpaste resulted in fewer WSL with a risk reduction of 32 percent over those patients who had used toothpaste with regular fluoride concentration. The WSL incidence was 18.1 percent in the high-fluoride group compared with 26.6 percent in the reference group. While the formation of WSLs in adolescents with braces was not removed, the reduction in this large population study was certainly clinically significant, the authors said.

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Design technique uses patient input

The template calls for the image at 180 by 180 but adjustments can be made

Treating unsatisfactory appearance and function in the esthetic zone can follow a standardized protocol that is easy to perform and involves the patient in the decision-making process, according to an article published in the Spring 2015 issue of the International Journal of Esthetic Dentistry. 

Although graphic pre-visualization has long been used to increase effective communication between the dentist and the dental laboratory technician, researchers in Italy described the need for more powerful evaluation instruments to communicate with patients. They also note that a patient’s functional problems can prevent the creation of a graphically produced proposed treatment.

To solve the problem, researchers devised a diagnostic protocol to identify unattractive aspects, show the patient possibilities for improvement and give the dental team an opportunity to check functionality of the prosthetic design while changes could still be made. Instruments and steps necessary for the technique are explained in detail in the article.

“With regard to other techniques of smile analysis, we believe that presenting the patient with nothing but images of the possible esthetic changes might raise expectations that may not be met in the realization stage,” researchers said. “This is due to the fact that this technique only elaborates on images, whereas the technique we propose, operating both on chalk models and in the oral cavity, confronts the functional and morphological issues.”

Researchers illustrated the effectiveness of their process by comparing it with a purely graphic technique in a group of ten patients who had requested prosthetic improvement of the esthetic aspect of their anterior maxillary teeth. They evaluated the degree of the patients’ involvement in the two techniques and the degree of reliability of the intraoral prosthetic design ultimately presented to the patients.

Results showed that 30 percent of patients would have accepted prosthetic therapies after having examined the simulations of proposed alterations on the computer monitor with simple graphic processing. Of those who refused the therapeutic proposal, 75 percent reported not having enough information to accept it. The remaining 25 percent reported that they did not consider the changes to be correct.

All patients accepted the prosthetic proposals after the protocol suggested by the researchers was followed and they all reported that they had enough information to accept the treatment. Thirty percent of the patients requested further alterations to the prototype before giving their consent to proceed with the prosthetic therapy—changes that pleased both the patient and the dental team, according to researchers.

In discussion, they noted that all subjects who accepted the simulation performed with graphic pre-visualization alone were in the 60- to 70-year-old age group. “Despite the limits imposed by the small number of subjects taking part in this study, this may suggest that they are less demanding with regard to esthetics than younger subjects.”

The 30 percent of subjects who requested alterations after accepting the therapeutic proposal were in the 30- to 50-year-old age group.     


Evaluating esthetics shows cultural differences

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Dentists need to rely on patient feedback to avoid esthetic treatment failures, according to findings published in the November/December 2014 issue of The International Journal of Prosthodontics. That’s because patients and professionals evaluating esthetic appearance seem to disagree.

A team of scientists in Germany who aimed to compare esthetic perceptions of complex oral rehabilitations between patients and dentists observed significant differences between them. They also found significant differences in rehabilitation evaluations among dentists from four different countries: Germany, Switzerland, China and the United Kingdom.

Although patients and dentists of all four countries found a significant esthetic improvement after treatment, “the professionals and patients’ ratings hardly matched,” researchers said. Illustrating the complexity of patients’ perceptions, the authors referred to previous research reporting that although girls were more critical of their own tooth color than boys were about theirs, parents and dentists were more critical of tooth color in boys than in girls.

With regard to cultural differences in the current study, dentists from various countries very often disagreed when evaluating the patients’ esthetics. Results included that European dentists may have a slightly different perception of dental esthetics than do Chinese. Yet, even the European judgment was not consistent.

Myths About Denture Patients

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In today’s economy, dentists are learning new techniques and procedures as a way to increase production in their offices and to reduce open time in their schedules. Others are increasing marketing spending to help drive new patients to their practices. Given this scenario, dentists today should consider removable prosthodontics as a viable source of both new patients and income to their practices. There are many common misconceptions about denture patients. Dentists would be wise to unlearn myths regarding how denture patients feel and think about their existing dentures. Cornerstone Research and Marketing conducted an independent survey of denture wearers from December 2013 to June 2014. The results of this survey should help dentists realize the potential in removable prosthodontics, the areas of focus to meet their patients’ needs, communication points and products available to improve results in the prosthodontic services they provide. See the survey findings at

Whitening: Start the conversation

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To help patients visualize whiter smiles, dental teams can rely on educational brochures from the ADA. “Tooth Whitening for a Better Smile” makes whitening approachable by explaining considerations and techniques, from whitening toothpastes to home-use whiteners to in-office whitening.

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Tooth Whitening for a Better Smile” is sold in packs of 50 brochures. Brochure interior can be viewed here. To order, call 1-800-947-4746 or go to Readers who use the code 15410E before March 27 can save 15 percent on all ADA Catalog products.

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