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- The Smile Has Left Your Eyes
This finding is corroborated by recent publications confirming that during personal interactions greater attention is given to the mouth and the eyes. Additionally, because the mouth is one of the centers of attention of the face, the smile plays an essential role in facial esthetics. While conducting researches at the Postgraduate Program in Orthodontics of the Federal University of Bahia UFBA , we cast doubt on the following: Up to which point is smile really mandatory for us to assess global facial esthetics?
Thus, several studies 13 , 15 , 16 submitted manipulated images to orthodontists and laypeople who assessed them in terms of frontal view of the face and closed-up smile. Furthermore, they demonstrated that assessment of smile esthetics in frontal view including patient's nose, hair, eyes, facial contour, etc. These data reinforce the supremacy of the smile in the context of global facial esthetics. Once we realize the importance of the smile in a facial context, we are able to extrapolate even further.
It is determining not only in the perception of facial attractiveness, but also with the perception of one's psychological characteristics. The presence or absence of deleterious alterations in an individual's smile significantly influences how this individual is perceived and evaluated. You have certainly witnessed improvements in patient's self-esteem and quality of life after esthetic treatment is performed. Thus, the above explains why patients seek dental treatment with chief esthetic complaint. Whenever patient's smile undergo esthetic changes they become more attractive and young with positive changes in psychological terms.
On the other hand, the issue of whether orthodontic planning has dealt with smile esthetics in order of priority is subject to discussion. The study conducted by Schabel et al, 19 for example, revealed no strong relationship between well-finished orthodontic cases, from an occlusal standpoint, with smile esthetics.
Behind The Smile – A Story of Life After Loss
In other words, the authors suggest incorporating new criteria that includes smile esthetics in the overall evaluation of orthodontic cases. Smile evaluation is basically performed by clinical means such as photographs and filming. In fact, clinical examination is prevalent in a dental context; however, registering patient's data is also necessary.
To this end, photographs have always been gold standard. Nevertheless, the validity of photographs has been recently questioned in comparison to filming used for registering one's smile. That occurs because the smile is a dynamic and complex movement comprising interaction of several facial muscles that together produce different positions of dentolabial architecture. According to Rubin, 21 there are three smile levels or patterns Fig 1.
The commissure smile, 21 also known as Mona Lisa smile, is commonly found when people greet each other in social contexts or at unusual locations such as the elevator Fig 1A. In this smile, the commissures are pulled upward, showing or not the teeth. The second type of smile is known as cuspid 21 or social smile. It has been globally used in self-portraits divulged in social networks.
In this smile pattern, the upper lip is uniformly pulled upward showing anterosuperior teeth Fig 1B , spontaneously or not. It oftentimes help patients with negative smile alterations such as gingival smile to disguise them, thereby limiting a more reliable analysis. The third smile pattern is known as complex smile 21 characterized by movement of lower lip and wide movement of the upper lip.
It is also known as spontaneous smile usually involuntary which realistically depicts patients' smile design Fig 1C. According to Camara, 5 esthetic planning should be based on complex smile, since social smile may not correspond to reality as it may represent a voluntary movement previously learned. Thus, the difficulty in accurately registering patient's smile at the exact moment and with static photographs is clear. Furthermore, photographs are also hindered when the patient is encouraged to smile, since what is funny for some people is not funny for others.
Based on the aforementioned difficulties, it seems obvious to understand that registering patient's smile by filming may provide clinicians with more reliable and elucidating data. Importantly, the filming method also has some disadvantages such as: a The final quality of frames taken from the film is lower than the quality of photographic images; b filming requires more data storage space bytes ; c filming requires specific technical knowledge for taking and assessing it. A-D at speaking and E-H at smiling.
In short, clinical assessment by means of through clinical examination associated with communication between clinicians and patients provides reliable data. Similarly, photographic protocols provide coherent smile data, thereby favoring esthetic treatment planning. Lastly, filming proves to be a complete and interesting tool that provides clinicians with dynamic data on smile and levels of anterior teeth exposure Fig 2. As previously mentioned, articles researching isolated features of the smile are of major scientific importance; however, they pose difficulties to clinicians who seek step-by-step instructions to plan maximum smile esthetics.
Furthermore, it is useful for communication between clinicians and between patients and clinicians. The ten commandments suggested herein are as follows: 1 st Smile arc - Maxillary incisors in vertical position; 2 nd Maxillary central incisors ratio and symmetry; 3 rd Anterosuperior teeth ratio; 4 th Presence of anterosuperior space; 5 th Gingival design; 6 th Levels of gingival exposure; 7 th Buccal corridor; 8 th Midline and tooth angulation; 9 th Details - Tooth color and anatomical shape; 10 th Lip volume.
Special attention is given to disposition of anterosuperior teeth canine to canine or first premolar to first premolar or the area known as esthetic zone where central incisors are known as key elements and characterize the term " dominance of central incisors " Fig 3. In short, central incisors must be highlighted as true protagonists of smile.
Thus, commandments from 1 to 4 are directly related to "dominance of central incisors". Esthetic planning must begin in the noblest area of the smile: Maxillary central incisors. That is the first step to be planned in esthetic treatment. Figure 4A shows a smile with satisfactory tooth color and anatomical shape. Despite such qualities, the smile shown in Figure 4A is considered highly unesthetic, particularly due to inappropriate vertical incisors positioning considered as essential for smile esthetics.
An ideal smile arc has the maxillary incisal edges slightly contouring the lower lip Fig 5A. The ideal configuration of smile arc is described as follows: convex arc, curved arc, consonant arc, deep plate-shaped arc, etc. On the other hand, when the incisal contour of teeth in the esthetic zone does not follow the contour of the lower lip, the smile arc is classified differently. Additionally, it is also described as inverted, reverse or nonconsonant arc in which the incisal edges of teeth do not contour the lower lip and have an inverted curvature 23 Fig 5C.
A comparison between convex and inverted smile arcs raises the following question: Why are they complete opposites from an esthetic standpoint? First, in terms of beauty of the arched contour of incisal edges of teeth in the esthetic zone, considered as the most important factor of dental esthetics Fig 6. The more arched the incisal contour of anterosuperior teeth is, the younger the smile looks; whereas the more plane, the older it looks. Additionally, according to the literature, 24 the older someone is, the less maxillary incisor exposure and the more mandibular incisor exposure there will be both at smiling, at rest or while speaking.
In modern society, esthetics and joviality are strongly associated, i. A few esthetic features have been highlighted in TV stars, singers and models. Greater maxillary incisor exposure at rest is one of them and has been associated with beauty, joviality, sensuality and sexuality. It is possible to infer that the current standard of beauty comprises not only a beautiful smile, but also voluminous lips and greater maxillary incisor exposure at smiling, at rest or while speaking.
We conducted another research to test the vertical position of maxillary central incisors and found that slightly extruded central incisors were more attracted than slightly intruded ones. Results reveal that the vertical position of incisors is when the edge of central incisors is near the lower lip and far from the incisal edge of lateral incisors and canines, thereby ensuring dominance of central incisors.
With a view to aiding clinicians to achieve ideal design of incisal contour in the esthetic zone, the step between central and lateral incisors must range from 1. After discussing this concept, we are able to reassess Figure 4A , in which case the need for maxillary central incisor extrusion to fulfill the 1 st commandment is clear Fig 4B. Importantly, the need for individualizing orthodontic bracket bonding should be highlighted. Should height guidance provided by the brackets manufacturer had been used in this clinical case, suggesting that canines should be as high as central incisors, treatment would hardly achieve the ideal smile arc.
It would achieve a plane arc instead. Similarly, should bonding be based on brackets positioned on the center of clinical crowns, the ideal curved smile arc would not be achieved. Thus, orthodontic bonding should be individualized in the esthetic zone, following patient's lower lip contour and anatomical shape of teeth. Figure 4C shows bracket positioning following this principle and with the major aim of extruding central incisors. In this case, the height of brackets bonded to canines was 3.
Thus, after alignment and leveling, maxillary central incisors were ideally positioned in accordance with the aforementioned recommendations, thereby achieving a pleasant and young smile Fig 4D. Importantly, planning vertical changes of teeth in the esthetic zone requires that three important points be considered: The first regards occlusal maxillary plane and head inclination while assessing patient's smile. Clockwise maxillary plane and head inclination lead to greater incisor exposure. As a result, convex smile arcs are more easily found. The second point is with regards to mandibular function which must be absolute in dental planning.
In other words, esthetic goals must not disrupt occlusal balance. Incisor extrusion or intrusion may influence protrusion and laterality. Therefore, mandibular function must be carefully assessed in which case occlusal adjustments might render necessary. The third point to be considered is axial proclination of maxillary and mandibular incisors interincisal angle. This feature is a determining factor that allows or not incisors extrusion, thereby increasing smile visibility at rest and while speaking.
In the event of proclined incisors decreased interincisal angle , extrusion is hindered or hampered as in cases of Class I bimaxillary protrusion or Class I division I malocclusion. In these cases, incisors angulation must be corrected so as to optimize vertical positioning. To bring this commandment to a conclusion, we carefully reassess Figure 6 which shows that, with a view to ideally adjusting the incisal contour of teeth in the esthetic zone, gingival margin positioning also changes.
In most clinical cases, clinicians face the following: If central incisors incisal edge is below canines incisal edge, what is the final design of gingival margins? Such questioning is answered by the 5 th commandment. Once maxillary incisors vertical positioning is determined, maxillary central incisors ratio and symmetry are adjusted.
Should that be the case, this tooth will be used as reference template to change the other central incisor. Should both central incisors be altered, their height is used as reference for correction. In other words, esthetic central incisors usually have 9. Figure 10 shows a patient whose chief complaint was having a big tooth in the esthetic zone.
His right central incisor was 9. His left central incisor, however, was 8. Thus, treatment comprised 0. Subsequently, with a view to fulfilling the 2 nd commandment, left central incisor reconstruction was repeated so as to achieve maximum symmetry between central incisors. The demand for symmetry between central incisors is based on the clinical assumption that the nearer the midline, the greater the need for symmetry, and the further from the midline, the higher the number of slight asymmetries clinically acceptable.
On the other hand, slight asymmetries on the side of incisors may go unnoticed, 1 while in canines, even greater asymmetries may not be identified Fig Hence, in cases requiring orthodontic finishing, we suggest that multidisciplinary treatment be conducted to achieve maximum symmetry between maxillary central incisors. This feature is widely considered in Dentistry and it is based on the golden ratio initially proposed by Levin in Clinically, this feature is easily noticeable in view of conoid or extremely narrow lateral incisors.
There are reference rulers and guides used in the clinical practice. They demonstrate that in both smiles, lateral incisors are narrow and do not respect the most esthetically pleasant proportion between anterosuperior teeth. The case described in Figure 15 shows asymmetrical proportion between anterosuperior teeth.
The golden ratio grid makes it easier to clearly identify the discrepancy, revealing that the right lateral incisor had reduced mesiodistal dimension. Orthodontic treatment opened up a space in the lateral incisor area which would undergo further esthetic restoration so as to fulfill the 3 rd commandment which is the proportion between anterosuperior teeth.
Furthermore, reshaping was performed to improve symmetry between central incisors and adjust the step between central and lateral incisors, emphasizing the dominance of central incisors in one's smile. Esthetic perception of diastema in the esthetic zone is widely discussed in the literature. At the same time, it arouses considerable controversy. Nevertheless, one should question the following: Are diastemas in the esthetic zone esthetic or unesthetic? According to the literature, 14 small midline diastemas not greater than 2. This finding may somehow explain why some famous artists have diastemas and find such spaces attractive.
On the other hand, this finding 14 might also be questioned, since it is too optimistic in terms of the impact midline diastemas have over smile esthetics. Although esthetics is highly subjective, the 4 th commandment asserts that all midline diastemas must be closed either by orthodontic or multidisciplinary treatment.
One should also ask whether diastema in the lateral incisors area mesial, distal or both affects smile esthetics. With a view to answering this question, we conducted another research to assess the esthetic impact of diastemas over two female patients' smile. The only exception was for 0. Thus, if space is to remain after orthodontic treatment, the distal surface of lateral incisors should be the area of choice.
In the former, the remaining space was between central incisors; whereas in the latter, the remaining space was in the distal surface of the left lateral incisor. In both cases, with a view to fulfilling the 4 th commandment, all remaining spaces were closed. Gingival tissue architecture must also be taken into account in esthetic treatment. The terms "pink esthetics" and "red esthetics" have been used to describe ideal gingival contour at smiling. Some dental textbooks bring the following parameter of ideal esthetic gingiva: "Canine gingival margin must coincide with central incisors gingival margin, whereas lateral incisors gingival margin must be slightly below this line" Fig 18A.
Indeed, such parameter provides maximum smile esthetics. However, should clinicians follow the aforementioned parameter in cases in which canines and central incisors are equal in length, 2 they might position central incisors incisal edge at the same level or above canines. As a result, plane or inverted smile arcs might be produced, and so are unesthetic smiles. This clinical doubt arouses from the following: Which esthetic parameter is more important?
Incisal contour white esthetics or gingival design pink esthetics? We have recently published a research in which we establish a relationship between esthetic perception and incisal edge smile line as well as gingival margin smile line. It is clear that extrusion of central incisors must be conducted according to patient's lower lip contour and sex, respecting the recommendation of greater extrusion of incisors for female smiles. Furthermore, the degree of extrusion must not violate lateral guidance. Another esthetic parameter widely divulged is the positioning of gingival apexes defined as the most apical points of gingival contour.
Frontal analysis of teeth in the esthetic zone reveals that gingival apexes are located in the center of the crowns or slightly distally. On the other hand, based on the limits of acceptability of smile asymmetry Fig 11 , changes in gingival apexes hardly affect one's smile negatively. Importantly, even after determining the ideal design of gingival margins in the esthetic zone, the clinician might face gingival asymmetry between teeth. Asymmetry between incisal edges of central incisors are considered unesthetic. Can it be identified by laypeople?
According to the literature, gingival asymmetry not greater than 1.
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We conducted another research at the Federal University of Bahia UFBA to investigate the esthetic impact of gingival asymmetry between canines 16 and found the same limit of perception 1. These findings highlight once again that white esthetics is more important than pink esthetics Fig Even though a number of studies yields positive results regarding the esthetic impact of asymmetry, 11 , 14 the 5 th commandment asserts that after determining ideal gingival design, whether classic or modified, the clinician should focus on correcting potential asymmetries, provided that they are evident at smiling.
Gingival smile displays greater asymmetry and, for this reason, must be corrected. Nevertheless, little gingival display at smiling does not require correction Fig It is worth noting that should discrepancies be visible at smiling and near the midline, the need for correction if even greater. Cases of gingival discrepancy between central incisors Fig 20 are basically corrected by either one of the following three treatment methods: a gingivoplasty of the lowest incisor; b intrusion and incisal restoration of one central incisor; c extrusion of one central incisor with posterior incisal wear.
In this case, it is tooth 11, which requires gingivoplasty a or intrusion b. Subsequently, treatment planning requires that the cementoenamel junction be identified by means of clinical probing and periapical radiograph or tomography so as to determine whether gingivoplasty is feasible or not.
Interoperability Issues on BCPs. Initially, an extensive analysis will be performed to analyse the existing standards WP9 and technologies used in BCP controls worldwide, as well as the corresponding national and international legislations By this analysis a set of specifications will be defined that should be followed during the design and development of the mobile platform that will be able to support border control checks-cards and related action and services.
This WP will have a dedicated task that will address the integration of the mobile BCP system with the cloud-based interoperable system, whilst ensuring extendibility and adaptability to BCP standards and devices. FINT will work in close collaboration with the end-user partners of the consortium. This will be done all along the project performing as much as possible pre-tests of subsystems and field tests and integrity tests success will be the results of these fruitful collaborations.
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Finally a DEMO will be performed where several Border Crossing Points at the same time and location are being monitored in order to control the flow of people and to prevent and to detect illicit activity. WP7 is strongly connected with the previous ones as it requires the competences of all the partners that have set up the SMILE framework in order to install it in an operational way DEMO. In order to guaranteed the adherence of project activities and their future implementation to privacy protection needs, it identifies the legal frameworks regulating the management of biometric data gathered and the information from monitoring public spaces and their adaptive capacity to the introduction of new monitoring technologies in EU.
The WP also addresses ethic issues, by identifying the key concerns on the protection of privacy implied in the monitoring and management of data for research purposes. Furthermore, the WP adopts a dynamic and flexible perspective, investigating the degree at which legal frameworks convey and are able to keep adapting to current and emerging ethical issues linked to always more sophisticated border monitoring and control technologies.
WP 9 also aims at ensuring that project activities comply with EU regulations on data protection.
The Smile Has Left Your Eyes
WP focuses also on reaching pre-normative standards capable to facilitate the interoperability of secure technologies. Recommendations on policies and ethical aspects which are relevant for the development of SMILE will be also delivered. Further, by taking into account the regulatory and policy compliance perspectives, this work package will also enhance the application and adoption potential of the SMILE research outcomes. Given these objectives and the required activities to meet them, this WP will run throughout the whole duration of the project and have a high number of interactions e.
Finally This work package is committed to provide an essential contribution to rapid and consistent decision making for Border Security systems deployment and operations to support Member State administrations to gain full benefit of the advantages of a ubiquitous and standardized approach that will foster transnational collaboration and homogeneity across member states and different types of Border Security Technologies.
With respect to this ambition the vision of this WP is:. WP9 - Awareness raising and Exploitation Activities. This WP is designed to manage and facilitate the dissemination of project results from the scientific and public understanding point of view as well as investigate the possibilities of further research or actual implementation and exploitation of these results.
Main activities include the presentation and dissemination of results, support to synergies with related projects, preparation of International Scientific and Technological publications, participation to Scientific and technical meetings and Analysis and preparation of commercial exploitation. WP2 — User Requirements, Use Cases and BCP System Architecture The main aim of this WP is to set the end-user requirements that will drive the research and development of the context-aware biometrics as well as to define a set of enriched use cases that will be deployed in the pilot application scenarios foreseen in the project.
With respect to this ambition the vision of this WP is: to support Border Security Strategy of Europe to support national deployment strategies, activities and operations to support related decision making processes to be more efficient and faster via an easy to access single entry , consistent linked to all necessary data sources and processed to one information source , up-to-date maintained toolkit for Border Security applications decision making.