The purpose of this study was to assess the short-term psychosocial impact of dental aesthetic improvement in adult subjects. Sixty-nine adult patients (61 females and 8 males, aged 21-59 years) requesting aesthetic dental improvement were prospectively and randomly recruited for the study in a private orthodontic office. A general interview included patient motivation and expectations from treatment. After clinical examination, discussion of the mode of treatment and the expected outcome, the patients were requested to complete the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) with several additions. The duration of their treatment was 6-14 months, and the main goals were tooth alignment, crowding alleviation, or space closure. After removal of the appliances, they completed an identical PIDAQ. Each patient served as his/her own control. Assessment of the impact of aesthetic improvement was based on the responses to the same questions relating to the patients' perceived dental aesthetics before and after treatment, their self-esteem, and changes in their social behaviour resulting from the treatment. The data were analysed using Cohen's and Pearson's correlation analyses and chi-square and Student's t-tests. A statistically significant improvement (P < 0.001) was found for all four factors: dental self-confidence (DSC), social impact (SI), psychological impact (PI), and aesthetic concern (AC). The reliability of the questionnaire, using Cronbach's alpha, was between 0.709 and 0.947. The degree of significance was not related to age, marital status, education, or gender. Dental aesthetics generated a significant improvement in adult patients' quality of life for the period examined (up to 6 months post-treatment).

The objectives of this study were to quantitate lip symmetry/asymmetry from clinical photographs; to demonstrate that asymmetry due to functional side shifts (functional asymmetry) leading to unilateral crossbites including the canines, results from measurable thinning of the upper lip and thickening of the lower lip on the side of the crossbite when viewed in the intercuspal contact position; and to show that orthodontic treatment aimed at eliminating the functional shift and crossbite would achieve lip symmetry, both visually and quantitatively. The study consisted of 26 patients, who were divided into two groups: a study group of 13 patients (eight females, five males, aged 8-17 years) with a functional asymmetry, and a control group of 13 age- and gender-matched subjects with other forms of malocclusion without functional asymmetry. All patients in the study group exhibited unilateral crossbites including the canines in intercuspal contact position. Digitized images of frontal facial photographs were analysed for upper and lower lip symmetry pre- and post-orthodontic treatment. The upper and lower lips were subdivided into four quadrants and the surface area and length of each quadrant were measured and expressed as a percentage of the total surface area/length of the relevant lip. The degree of asymmetry was obtained by calculating the difference in percentage area or length between the two quadrants of each lip. In the study group, the lower lip quadrant on the shift side was enlarged while the contralateral side was reduced (mean area ratio 59.9 to 40.1 per cent, mean length ratio 53.0 to 47.0 per cent). The upper lip demonstrated differences that were smaller and inverse. The controls showed a small difference between the right and left sides (less than 1 per cent). After treatment, both groups displayed visual and quantitative lower and upper lip symmetry, i.e. an area or length of approximately 50 per cent of each quadrant. In absolute values, the control patients had up to 3 per cent asymmetry in area regardless of treatment. The patients in the study group exhibited mean absolute asymmetry of 9.2 per cent in the upper lip and 19.8 per cent in the lower lip. Asymmetry values in the study group were reduced to approximately 3 per cent post-treatment. The absolute values of asymmetry in length of all patients were up to 2 per cent in the control group regardless of treatment. The subjects in the study group exhibited mean absolute asymmetry of 6.3 per cent in the upper lip and 8.6 per cent in the lower lip. Asymmetry values in the study group were reduced post-treatment to approximately 2 per cent. Although asymmetry in the study group could be quantitated using both parameters (lip surface area and lip length), the surface area parameter proved to be a more sensitive tool for measuring lip asymmetry.

The objective of this study was to investigate whether skeletal mandibular asymmetry associated with unilateral and anterior crossbite will lead to lip asymmetry. The subjects were 26 females, 13 controls and 13 true skeletal asymmetric age-matched patients (24-50 years). The study group was diagnosed as asymmetric according to visual and panoramic radiographic examination and exhibited a unilateral anterior crossbite, an asymmetric mandible, and a deviation of the chin. The control group was visually symmetric and exhibited all forms of tooth malalignment without the presence of a crossbite. Digitized images of the frontal facial photographs of all the subjects, taken in an intercuspal contact position, were analysed for upper and lower lip symmetry pre- and post-orthodontic treatment. The upper and lower lips were subdivided into two quadrants each and the surface area of each quadrant was measured and expressed as a percentage of the total surface area of the relevant lip. The degree of lip asymmetry was obtained by calculating the difference in percentage area between the two quadrants of each lip. In the study group, the lower lip quadrant on the crossbite side was increased pre-treatment (56.85 +/- 1.75 per cent), while the contralateral side was reduced (43.15 +/- 1.75 per cent, P < 0.005), resulting in 13.7 per cent asymmetry. After treatment, the respective lip areas were 52.12 +/- 0.64 and 47.88 +/- 0.64 (P < 0.01) and asymmetry was significantly reduced (4.25 +/- 1.29 per cent). In the control group, the differences between the lower lip quadrant areas (range 48.5-51.5 per cent) were small (less than 3 per cent asymmetry) and did not change post-treatment. The findings demonstrate that in this study group, lower lip symmetry was mainly controlled by the support provided through the dental interarch relationships and less by skeletal factors.

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