HOW DO WE MEASURE OROFACIAL ESTHETICS? › media › 13811 › permilla-larsso… · Dimensional...
Transcript of HOW DO WE MEASURE OROFACIAL ESTHETICS? › media › 13811 › permilla-larsso… · Dimensional...
|SYMPOSIUM 2014 , TANDLEGEFORENINGEN|
Pernilla Larsson Gran
Odont Dr, PhD,
Specialist in Prostodontics,
Senior consultant
Centre of Oral Rehabilitation
Östergötland and Malmö University
SWEDEN
HOW DO WE MEASURE OROFACIAL ESTHETICS?
HOW DO WE MEASURE OROFACIAL ESTHETICS?
WE SMILE – EVERYWHERE
|EKMAN & FREISEN (1971 ) CONSTANTS ACROSS CULTURES IN FACE AN D EMOTIONS|
”Duchenne smile”
“…the zygomatic major can be
willed into action, but that only the
“sweet emotions of the soul” force
the orbicularis oculi to contract. “Its
inertia, in smiling,”
WE SMILE – TOGETHER
Abel and Kruger (2010)
Smile Intensity in Photographs Predicts Longevity
WE SMILE – AND SURVIVE
|DENTAL IMPLANTS FOR L IFE |
E M E L I E - W I T H O U T A S M I L E
C E M E N T A N D R O O T D Y S P L A S I A
|DENTAL IMPLANTS FOR L IFE |
E M E L I E - W I T H O U T O C C L U S I O N
|DENTAL IMPLANTS FOR L IFE |
O R A L H A B I L I TAT I O N
|DENTAL IMPLANTS FOR L IFE |
E M E L I E S M I L E S
|DENTAL IMPLANTS FOR L IFE |
|HOMUNCULUS |
Penfield & Rasmussen: The Cerebral Cortex of Man:
A Clinical study of Localization of Function. Macmillan 1950.
”A state in which we neither suffer pain nor are hindered in
the functions of daily life.” Galen 200 eKr
Biostatic/analytic perspective:
”identical with the abscence of disease” The goal is survival and reproduction. Boorse
Holistic perspective:
”A is completely healthy if, and only if, A has the ability, given standard
circumstances, to reach all his or her vital goals.”Nordenfeldt
HEALTH
QUALITY OF LIFE- QoL
How good is
your life for
you?
Dr David Locker
”Quality of life seems to be influenced by the extent to which we feel
capable of participating in activities that meet our needs and
expectations.
These activities, in turn, are influenced by our environment, economic
status, responsibilities, biological constitution and, of course, time.”
MacEntee 2007
Q U A L I T Y O F L I F E
Allison, Locker, and Feine
“Quality of life: a dynamic construct”
Social Science & Medicine 1997.
By Jonathan Miller
|AUNT MÄRTA 99 ÅR|
W H AT I S O R A L H E A LT H R E L AT E D Q U A L I T Y O F L I F E ?
Märta 99 yrs
SOCIAL IMPACT
ESTHETICS
ORAL FUNCTION
IMPAIRED QUALITY OF LIFE
|AUNT MÄRTA 99 YEARS|
D E N TA L I M P L A N T S F O R Q U A L I T Y O F L I F E
|AUNT MÄRTA 100 ÅR|
M Ä RTA S M I L E S
|SCIENT IF IC DOCUMENTAT ION |
D I M E N S I O N S O F O R A L H E A LT H R E L AT E D Q U A L I T Y O F L I F E
John et al J Dent Res 2004
”Esthetics is one dimension of oral health related quality of life”
OHIP
N= 2050; age 16-79 yrs
Dimensional structure explored by factor analysis
Psychosocial impact
Orofacial pain
Oral functions
Appearance
E S T H E T I C S
”a set of principles concerned with the nature and appreciation of beauty” the Oxford English Dictionary
Nature of beauty:
Objective and subjective perspective
Eco: Aesthetics has historically been
connected to thoughts what is good
and right.
D E N TA L A N D O R O FA C I A L E S T H E T I C S
Esthetic Dentistry
“an appearance showing harmony between natural and
reconstructed parts of the dentition” Belser 2004
Dental Aesthetics
”the science of copying or harmonizing our work with nature and
rendering our art inconspicuous” Pilkington 1936
D E N TA L A N D O R O FA C I A L E S T H E T I C S
Aesthetically successful restorations were positively
correlated with patient´s self-esteem and QoL. Davis et al 1998
An attractive smile is important from a psychosocial viewpoint.
Dentofacial aesthetics is important for personal success. van der Geld et al 2007
Aesthetic perception differ between clinical experts and
patients. Öwall et al 2005, Kokich et al 2006
H E A LT H Y T E E T H – F O C U S S H I F T T O WA R D S E S T H E T I C S
Web
Development
Theobald et al
2006
Samordnitsky et al
2008
|ESTHET ICS |
White teeth more important than
prevention…
Larsson P et al 2010
• 4 out of 5 dissatisfied with tooth color
• Only 10 % satisfied with facial
appearance
”Munhälsa i Sverige”
1500 subjects
H E A LT H Y T E E T H – F O C U S S H I F T T O WA R D S E S T H E T I C S
Survey Swedish dental nurse association
2013
|ESTHET ICS |
A G A P B E T W E E N PAT I E N T S A N D P R O F F E S S I O N
Larsson P et al. (2010)
Deep interviews with
patients Focusgroup with dental
proffessionals
A G A P B E T W E E N PAT I E N T S A N D P R O F F E S S I O N
V I O C H PAT I E N T E R N A S E R O L I K A P Å E S T E T I K
”Både små och stora tänder i en rad är störande” ”Bleker alla på TV sina tänder? Vita är fräscht.” ”Det är inte okej i Sverige med gluggar ju” ”Min haka är för liten” ”Stora, utstående, gulbruna tänder är värst”
”Mjukvävnaden runt en krona
är avgörande för estetiken”
”Ocklusionsplanet vill man ska
vara rakt och snyggt”
”Mittlinjen och smileline är
viktigt för intrycket”
”Snyggt när man karaktäriserar
proslinet med rotfärg och
transpa”
Larsson P et al. Development of Orofacial Esthetic Scale
(2010)
C O M M U N I C AT E
LISTEN, UNDERSTAND, MEET AND GUIDE
Proffessional
Realistic
Natural
My daughters test Kelleher 2012
|PSYCHOMETRICS |
I S O H R Q O L A N D E S T H E T I C S M E A S U R A B L E ?
?
|PSYCHOMETRICS |
I S E S T H E T I C S M E A S U R A B L E ?
The theory and technique of psychological
measurement – such as of knowledge, abilities,
attitudes, and behaviors – primarily by
questionnnaires and tests.
Streiner and Norman
PSYCHOMETRICS
|PSYCHOMETRICS |
IS ESTHETICS MEASURABLE?
• Screening of psychosocial aspects, population surveys,
outcome-measures in clinical trials, cost-benefitanalyser
• Psychometric properties
• Problems with ad-hoc scales
• Often both esthetics and psychosocial impact in the same
scale. What is what?
Q O L , F U N C T I O N , E S T H E T I C S
Why do we give our patients oral rehabilitation?
Three different concepts capturing
patients´ experience
Three PROM´s
Can be used separately or in combination
|DENTAL IMPLANTS FOR L IFE |
R E B E C K A - W I T H O U T A S M I L E
|DENTAL IMPLANTS FOR L IFE |
O R A L H A B I L I TAT I O N
|DENTAL IMPLANTS FOR L IFE |
R E B E C K A S M I L E S
Kokich software manipulation with permission
Kokich VO, Kokich VG, Kiyak HA.
Perception of dental professionals and laypersons to altered dental
esthetics: Asymmetric and symmetric situations.
Am J Orthod Dentofacial Orthop 2006
Objective and
professional
measures
Experts
Clinical criteria
Professional assessment
Reproducibility
Golden Standard
Detailed
Patient-reported
outcome
measures (PROM)
Subjective
Self-reported
Perceptions
Soft values
Impact on OHRQoL
Brief
Ritter DE et al. 2006 Analysis of the smile photograph, Review
“Optimal facial esthetics is one of the objectives in orthodontic treatment
and an important issue in modern society.”
Review and discuss criterion adopted by dental literature to analyze the
smile, such as:
dental midline, smile line, dental exposure, negative space,
dental proportion, and symmetry.
O B J E C T I V E & P R O F F E S S I O N A L
Magne and Belser
Oxford Press
O B J E C T I V E & P R O F F E S S I O N A L
Magne and Belser
Systematic review of parameters and methods for the
professional assessment of aesthetics in dental
implant research
Benic GI, Wolleb K, Sancho-Puchades M, Hämmerle CHF.
J Clin Periodontol 2012
• Mucosa aesthetics
• Reconstruction aesthetics
• Mucosa and reconstruction aesthetics
O B J E C T I V E & P R O F F E S S I O N A L
Jemt (1997) Papilla Index
Furhauser et al (2005) Pink Esthetic Score
Mesial, distal papilla, soft tissue level,
coulor, contour, alveolar process deficiency
O B J E C T I V E & P R O F F E S S I O N A L S E S T H E T I C
M E A S U R E S
Meijer et al (2005) Implant Crown Esthetic Index
Belser et al (2009) Pink and White Esthetic Score (PES/WES)
Dueled et al (2009) Esthetic Outcome Objective Score
Papillas, level of facial mucosa, mucosa texture and color,
tooth form, colour, surface texture, translucency, characterization
O B J E C T I V E & P R O F F E S S I O N A L S E S T H E T I C
M E A S U R E S
|ESTHET ICS |
A G A P B E T W E E N PAT I E N T S A N D P R O F F E S S I O N
Patient-reported outcome measures (PROM)
orthodontits dentists lay people
Gingiva-to-lip distance 2 3 4
Occlusal plane asymmetry 1 1 3
Maxillary midline deviation 4 - -
Kockich 1999
Development of OES
Larsson, John, Bondemark,
Nilner, List 2009-2010
Development of OES
Larsson, John, Bondemark,
Nilner, List 2009-2010
Component Matrixa
.855 .299
.732 .611
.887 .096
.913 -.209
.928 -.175
.776 .042
.803 -.356
.940 -.192
Utseende
Prof il
Mun
Tandrad
Form
Färg
Tandkött
Overall - Upplevelse
1 2
Component
Extraction Method: Principal Component Analysis.
2 components extracted.a.
Total Variance Explained
5.880 73.501 73.501 5.880 73.501 73.501
.712 8.899 82.400 .712 8.899 82.400
.497 6.211 88.611
.356 4.453 93.064
.226 2.825 95.889
.176 2.200 98.089
.089 1.110 99.199
.064 .801 100.000
Component
1
2
3
4
5
6
7
8
Total % of Variance Cumulativ e % Total % of Variance Cumulativ e %
Initial Eigenvalues Extraction Sums of Squared Loadings
Extraction Method: Principal Component Analysis.
Exploratorisk faktoranalys
factor
Latent root criterion (eller eigenvalue over 1)
The first factor accounted for 73,5% of the variance
variables
Expolratory factor analysis
Unidimensionality for the OES
5. Measurement model (dimensionality) Exploratory factor analysis (n=119)
Aesthetically
compromised
Functionally
disabled
OAS Item Patients
I
Ctrl
III
Patients
II
Ctrl
IV
I vs III I vs
II
II vs
IV
Mean SD Mean SD Mean SD Mean SD P P P
Face 4.8±2.3 7.1±2.2 6.6±2.2 6.8±2.3 <0.001 0.005 0.599
Profile 5.6±2.1 6.7±2.6 6.6±2.0 6.5±2.7 0.057 0.046 0.866
Mouth 4.3±2.4 7.0±2.7 5.8±2.2 6.7±2.4 <0.001 0.016 0.178
Tooth alignment 3.2±2.4 6.2±2.7 6.3±2.4 6.2±2.5 <0.001 <0.001 0.747
Tooth shape 4.1±2.3 6.4±2.6 6.7±2.3 6.5±2.5 0.010 <0.001 0.586
Tooth color 4.3±2.4 5.6±2.2 6.6±2.4 5.1±2.1 0.052 0.001 0.431
Gingiva 5.0±2.5 6.9±2.5 7.0±1.8 6.7±2.4 0.006 0.001 0.803
Overal impression 4.1±2.6 6.7±2.5 6.8±2.0 7.1±2.1 <0.001 <0.001 0.653
Summary score 31.4±
12.3
45.9±
15.2
45.7±
10.7
45.5±
14.2
<0.001 <0.001 0.967
Summary score and discriminative validity of the Orofacial Esthetic Scale
(OES).
Aesthetically
compromised
Functionally
disabled
OAS Item Patients
I
Ctrl
III
Patients
II
Ctrl
IV
I vs III I vs
II
II vs
IV
Mean SD Mean SD Mean SD Mean SD P P P
Face 4.8±2.3 7.1±2.2 6.6±2.2 6.8±2.3 <0.001 0.005 0.599
Profile 5.6±2.1 6.7±2.6 6.6±2.0 6.5±2.7 0.057 0.046 0.866
Mouth 4.3±2.4 7.0±2.7 5.8±2.2 6.7±2.4 <0.001 0.016 0.178
Tooth alignment 3.2±2.4 6.2±2.7 6.3±2.4 6.2±2.5 <0.001 <0.001 0.747
Tooth shape 4.1±2.3 6.4±2.6 6.7±2.3 6.5±2.5 0.010 <0.001 0.586
Tooth color 4.3±2.4 5.6±2.2 6.6±2.4 5.1±2.1 0.052 0.001 0.431
Gingiva 5.0±2.5 6.9±2.5 7.0±1.8 6.7±2.4 0.006 0.001 0.803
Overal impression 4.1±2.6 6.7±2.5 6.8±2.0 7.1±2.1 <0.001 <0.001 0.653
Summary score 31.4±
12.3
45.9±
15.2
45.7±
10.7
45.5±
14.2
<0.001 <0.001 0.967
Summary score and discriminative validity of the Orofacial Esthetic Scale
(OES).
Aesthetically
compromised
Functionally
disabled
OAS Item Patients
I
Ctrl
III
Patients
II
Ctrl
IV
I vs III I vs
II
II vs
IV
Mean SD Mean SD Mean SD Mean SD P P P
Face 4.8±2.3 7.1±2.2 6.6±2.2 6.8±2.3 <0.001 0.005 0.599
Profile 5.6±2.1 6.7±2.6 6.6±2.0 6.5±2.7 0.057 0.046 0.866
Mouth 4.3±2.4 7.0±2.7 5.8±2.2 6.7±2.4 <0.001 0.016 0.178
Tooth alignment 3.2±2.4 6.2±2.7 6.3±2.4 6.2±2.5 <0.001 <0.001 0.747
Tooth shape 4.1±2.3 6.4±2.6 6.7±2.3 6.5±2.5 0.010 <0.001 0.586
Tooth color 4.3±2.4 5.6±2.2 6.6±2.4 5.1±2.1 0.052 0.001 0.431
Gingiva 5.0±2.5 6.9±2.5 7.0±1.8 6.7±2.4 0.006 0.001 0.803
Overal impression 4.1±2.6 6.7±2.5 6.8±2.0 7.1±2.1 <0.001 <0.001 0.653
Summary score 31.4±
12.3
45.9±
15.2
45.7±
10.7
45.5±
14.2
<0.001 <0.001 0.967
Summary score and discriminative validity of the Orofacial Esthetic Scale
(OES).
|OES|
O R O FA C I A L E S T H E T I C S C A L E
Larsson et al 2010
•Throughly described development
•7 direct esthetic items and an eight global item
•Does not measure psychosocial aspects of
impaired orofacial esthetics
•Unidimensionality
•Psychometric tests in 119 patients
•Can be recommended to use together with other
instruments, such as OHRQoL scales.
N O R M AT I V E VA L U E S F O R O E S
Larsson et al 2014
N =1344
Normative values in the general Swedish population
Only 10% ”very satisfied” OE
Mean 50,3 of 70 – most people impaired esthetics
Tooth color” lowest score – 1 out of 5 reports satisfaction of
their tooth color
Oral och general health are related to orofacial esthetics
|OES|
N O R M AT I V E VA L U E S F O R O E S
Larsson et al 2014
”considered an important step in standardisation, and the
developed norms provide a frame of reference in the general
population to interpret the Orofacial Esthetic Scale scores.”
OES AND DENTAL ANXIETY
Carlsson & Hakeberg et al 2014
”the need to address the
esthetic aspects of dental
status in patients with DA ”
Psychometric properties of the Croatian version of the Orofacial
Esthetic Scale. Persic et al. Int J Prosthod 2011
Ongoing co-laboration with
Holland and a Dutch version of OES Westlear P, Larsson P et al
A chinese version of OES and its psychometric
properties Zhao Y, He SL 2013
German version of OES. Ongoing project Reissman
O E S P R O J E C T S A N D P U B L I C AT I O N S
Patient reported esthetic outcome of orthognatic
treatment Bengtsson M & Larsson P et al
O E S P R O J E C T S A N D P U B L I C AT I O N S
Esthetic outcome of single implant treatment after 15
years Winitsky N, Jemt T & Larsson P et al
Evaluation of ceramic restorations in the esthetic zone
in specialist clinics and general practitioners. Larsson P,
Nilner K et al
Orofacial esthetics and Dental Anxiety Carlsson V & Hakeberg et al 2014
Influence of different prosthodontic treament options Persic
S, Celebic A 2014
Thomas, age 47
OES as clinical outcome measure
in the clinic / clinical quality measure
OES score pre-treatment: 11
OES score post-treatment: 59
OES score pre-treatment: 21 OES score post-treatment: 65
OES score pre-treatment:12 OES score pre-treatment: 59
OES score pre-treatment: 19 OES score post-treatment: 60
OES score pre-treatment: 10 OES score post-treatment: 58
If you meet someone without a smile. Give her yours!