Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZC31 - ZC35 Full Version

Age and Gender Specific Effect of Lip Form on Maxillary and Mandibular Incisal Display with Lips at Rest in Elderly Indian Population: A Cross-sectional Study


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59973.17290
Renu Kundu, Dipti S Shah

1. PhD Scholar, Department of Prosthodontics and Crown and Bridge, Karnavati School of Dentistry, Gandhinagr, Gujarat, India. 2. Dean and Head, Department of Prosthodontics and Crown and Bridge, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.

Correspondence Address :
Renu Kundu,
H. No.-2453, Sec-1 HUDA, Rohtak, Haryana, India.
E-mail: dr.renukundu@gmail.com

Abstract

Introduction: Maxillary and mandibular incisal display at rest and smile is an integral part of dento-facial aesthetics. Its correlation with lip form and the effect of age and gender has not been studied in elderly Indian population. Dental photography has been given a great importance in prosthodontics and the study of various aesthetic parameters on digitalised photographs can act as additional diagnostic tool.

Aim: To determine correlation between lip form and incisal display in elderly subjects and to determine age and gender related changes.

Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from November 2020 to September 2021. The study sample comprised of digital photographs taken in natural head position of 324 elderly Indian subjects (180 males &144 females) and they were divided into 4 age groups: Group I consisting of 157 subjects aged (31-45 years), Group II consisting of 107 subjects aged (46-55 years), Group III consisting of 47 subjects aged (56-65 years) and Group IV consisting of 13 subjects aged >65 years. The various parameters (lip form, maxillary and mandibular incisal display) were then analysed using Image J (Fiji app) image analysis software. The statistical analysis was done using Pearson correlation (significant when p<0.05), scatter plot, and Independent t-test (significant when p<0.05) and one-way Analysis Of Variance (ANOVA) post-hoc Tukey-Kramer test to compare the parameters of different groups.

Results: The results of this study showed that there is a significant correlation between lip form and maxillary & mandibular incisal display at rest (r=0.388, p=0.001). Females have more incisal display for a particular type of lip form as compared to male subjects. A statistically significant difference was found in maxillary incisal display and lip form between male and female groups (T=-5.934, p-value=0.001 and T=-2.367, p-value=0.019 respectively) but no statistically significant difference was found in mandibular incisor display between male and female groups (T=1.832, p-value=0.068). Hence, females above 30 years of age had more maxillary incisal display as compared to males but almost same mandibular incisal display. Also, straight lip form was more common among elderly male subjects (63.6% as compared to females 36.4%) but females had moderate lip form most commonly (52.1% as compared to males 47.9%). High lip form was reported equally in both male and female subjects with 50% in each group.

Conclusion: It has been concluded from the study that for a particular type of lip form (either straight, moderate or high), females have more average incisal displays as compared to males. A strong correlation exists between lip form and incisal display in elderly Indian population. Hence, lip form can be used as a definitive parameter to determine Incisal displays in prosthetic rehabilitation to get optimum aesthetic outcomes.

Keywords

Aesthetics, Digital photography, Repose, Smile

The pleasant dental aesthetics- smile is an important factor for psycho-social wellbeing of a person which favours his or her social acceptance (1). It is considered as one of the most attractive facial expressions which represent the gesture of a person. Lips and maxillary and mandibular incisal display form the frame of smile and defines the aesthetic zones (2),(3). In modern dentistry, smile aesthetics, is of major importance. In smile aesthetics, factors such as exposure of maxillary and mandibular anterior teeth, outline of vermilion border of lips and type of lip form, gingival display, incisal curvature, ratio and symmetry of maxillary incisors, the presence of gingival and dental asymmetries, and the presence of midline diastema are of great importance (4),(5),(6),(7),(8),(9). All these factors are quite important in fixed dental prostheses for anterior or full mouth rehabilitation, dentures (complete or partial) and implant supported prostheses.

Tooth placement is very critical and likely the greatest contributor to the denture/prostheses look which is “that typical facial appearance common to the most denture wearers” (10),(11),(12). Pound advised to place the teeth back in their original position from which they arose and many others have accepted the authors philosophy, which is widely advocated in the modern prosthodontic literature (11). In a few studies, it was instructed to position the upper central incisor vertically so that 0-2 mm of the incisal edge is visible below the upper lip (11),(13).

But in earlier studies, no consideration was given to the type of lip form and their correlation to maxillary and mandibular incisal display in elderly population. Kim J et al., has given a classification of lip form based on the distance from the highest portion of lower vermillion border of upper lip from a line passing through the commissures of the mouth as straight lip form (0-3 mm), moderate (between 3 mm to 6 mm) and high lip form (more than 6 mm) (14). This study was done in American white population. In a previous study, the correlation between lip form and incisal display in young Indian population has been studied (9), but no study has been done in elderly Indian population. As lip position, type of lip form and the amount of tooth display during smile and speech are very important in prosthodontics (15); therefore, this study was designed to evaluate the age and gender related changes of maxillary and mandibular incisor display related to lip form at rest in elderly Indian population. Primary objective of the study was to determine correlation between lip form and incisal display in male and female elderly subjects and secondarily to determine age related changes. It was hypothesised that, there is no difference in maxillary and mandibular incisal display of male and female subjects for a particular type of lip form; also age has no effect on lip form and incisal display.

Material and Methods

This cross-sectional study was conducted in the Department of Prosthodontic and Crown & Bridge of Karnavati School of Dentistry, Gandhinagar, Gujarat, India from November 2020 to September 2021. The study protocol was approved by the Institutional Ethics Committee of KSD, Gandhinagar (No.KSDEC/17-18/Apr/40). Written informed consent was obtained from all the participants prior to evaluation.

Sample size calculation: was calculated by using the formula:

n= Z2P(1-P)/d2

Where ‘n’ is the sample size, Z=95%, P=13.43% according to Jeelani W et al., and d=0.05. Considering the dropout rate of 10% estimated sample size was 324 (15). Subjects were randomly selected between age group 30 years above and then categorised into 4 groups to see the age related effects.

Inclusion criteria: Subjects with more than 30 years of age,no previous history of orthodontic treatment or maxillofacial surgery, all anterior teeth present, no severe malocclusion and willing to participate in the study were included in the study.

Exclusion criteria: Patients with any missing anterior teeth, prosthodontic work on teeth visible in smile, inability to determine natural head position/neuromuscular in-co-ordination and excessive dental attrition/worn dentition were excluded from the study.

Study Tools

Photographic Room and DSLR Camera with Tripod

A photographic room was used with green background to provide contrast. A DSLR camera (Nikon D3500) with lens AF-P DX NIKKOR 18-55 mm f/3.5-5.6G VR lens and AF-P DX NIKKOR 70-300 mm f/4.5-6.3G ED was used for taking digital photographs. The camera was mounted on a tripod stand and positioned at 5 feet distance from the subject and adjusted to subject’s eye level in natural head position.

Image analysis software (Image J;Fiji app) (16)

The images were then transferred to ImageJ image analysis software which is a Java-based image processing program developed at the National Institutes of Health and the Laboratory for Optical and Computational Instrumentation (LOCI, University of Wisconsin). Image J software can display, process, edit & save and analyse, print 8-bit color and grayscale images and can read many image file formats e.g., Joint Photographic Experts Group (JPEG),Portable Network Graphics (PNG), Graphics Interchange Format (GIF), Tagged Image File (TIFF), BitMaP (BMP), etc.,

Study Procedure

The subjects were photographed with lips at rest in natural head position by following described method of standardisation:

1. A single DSLR camera Nikon D-3500 was used to take all the facial photographs.
2. Distance between the camera and the subject was taken as 5 feet.
3. The camera was mounted on a tripod stand with the lens positioned at patient’s eye level.
4. The subjects were made to sit in natural head position which is the position of the head in a standing up or an erect sitting 32individual, with his/her visual axis oriented horizontally (17).
5. The subjects’ lips were relaxed and captured in repose/rest, which is achieved by asking them to lick their lips and facial surfaces of their upper teeth and then instructing them to part their lips (18).
6. The same illumination was used for photography of each subject.

The facial photographs of the subjects taken were then opened in Image J software (version 1.53 C; Fijji app), and measurements of maxillary and mandibular incisal display and lip form were made digitally for collecting the data. The procedure followed to make measurements was as below: a straight line was drawn passing through the commissures of the lips horizontally and then a perpendicular line to this line was drawn from the highest part of lower vermillion border of the upper lip (Table/Fig 1). A metal scale was placed horizontally on the side of the face of each individual before taking their photographs and a known distance of 10 mm on this scale was used to calibrate the images in the software before making measurements. Maxillary and mandibular incisal display was measured by drawing a straight line from the centre of incisal edge of left upper central incisor to highest portion of lower vermillion border of upper lip and from the centre of incisal edge of left lower central incisor to highest portion of upper vermillion border of lower lip respectively (Table/Fig 1).

Depending upon the vertical distance measured; type of lip form for each subject was determined according to the lip form classification given by Kim J et al., as:

• Straight (Type 1): 0-3 mm
• Moderate (Type 2): between 3 mm-6 mm
• High (Type 3): >6 mm (14).

Statistical Analysis

Participants’ socio-demographic data including age, gender, occupation and education level were gathered by using a questionnaire and measurements made digitally were then analysed statistically using software Statistical Package for Social Sciences(SPSS) version 21.0 (International Business Management (IBM) SPSS version 21.0). The collected data was normally distributed and hence, parametric tests: Pearson correlation, Scatter plots, Student’s t-test and one-way Analysis of Variance (ANOVA), post-hoc Tukey-Kramer test were used to make inter and intra group comparisons (significant when p<0.05).

Results

A total of 324 participants participated in the study, out of which 180 were male and 144 were female subjects. A total of 154 (47.5%) subjects had straight lip form, 144 (44.4%) had moderate and only 26 (8.1%) subjects had high lip form, hence, straight lip form was the most common among elderly Indian population. The average of maxillary and mandibular incisal displays observed in elderly population was 2.26 mm±1.6 SD and 1.29 mm±1.4 SD respectively with more incisal display in female subjects with a mean of 2.82±1.12 SD as compared to male subjects with a mean of 1.8±1.41 SD, respectively (Table/Fig 2). On the basis of age, subjects were divided into 4 groups: Group I (31-45 Years, N=157), Group II (46-55 Years, N=107), Group III (56-65 Years, N=47) and Group IV (above 65 Years, N=13) (Table/Fig 3).

The correlation between type of lip form and maxillary and mandibular incisal display was done with the help of Pearson correlation. The Pearson coefficient value between maxillary incisal display and lip form was r=0.388, p-value=0.001& between mandibular incisal display & lip form was r=0.409 with a p- value=0.001 (significant when p<0.005) which was statistically significant (Table/Fig 4).

Pearson Correlation- strong to moderate as per rule of thumb as r= or <0.3; Average value of lip form measured in mm is taken for comparison with average of maxillary and mandibular incisal display. {One of the subjects had the value of lip form as 9.3 mm and mandibular incisal display as 11.1 mm. As it was high lip form and the patient had more mandibular incisal display, hence the value was more than 10 mm. (as shown in (Table/Fig 5))}. Therefore, incisal display (maxillary & mandibular) showed a positive correlation with lip Form as shown in scatter plot (Table/Fig 5).

The correlation coefficient between incisal display and lip form for male and female subjects’ was r=0.319 and r=0.434, respectively with a p-value=0.001 which was statistically significant. Hence, a positive correlation between lip form and incisal display was found in both male and female groups (Table/Fig 6) as depicted by trend lines on scatter plot. This means that as lip form increases from straight to high, incisal display (both maxillary & mandibular) also increases. So, if a patient with high lip form needs anterior restorations, then more incisal display is kept as compared to straight or moderate lip form.

Independent sample t-test/student’s t-test was used to compare means of incisal display and lip form between groups on gender basis. A statistically significant difference was found in maxillary incisal display and lip form between male and female groups (T=-5.934, p-value=<0.001 and T=-2.367, p-value=0.019, respectively) but no statistically significant difference was found in mandibular incisor display between male and female groups (T=1.832, p-value=0.068) (Table/Fig 7).

Hence, females above 30 years of age had more maxillary incisal display as compared to males but almost same mandibular incisal display. Also, straight lip form was more common among elderly male subjects (63.5% as compared to females 36.4%) but females had moderate lip form most commonly (52.1% as compared to males 47.9%). High lip form was reported equally in both male and female subjects with 50% in each group (Table/Fig 2).

One-way ANOVA test was performed to assess how the study groups’ (on basis of age groups) incisal display is related to each other. Multiple comparisons between various age groups were performed by post-hoc Tukey-Kramer test. No significant difference was found in maxillary incisal display between various groups but a statistically significant difference was found in mandibular incisal display between various age groups as shown in (Table/Fig 8). Subjects above 65 years of age were observed with highest mandibular incisal display and subjects between 31-45 years of age group had minimum mandibular incisal display (Table/Fig 8).

Discussion

One of the primary aim of a prosthodontic treatment is to achieve and maintain facial attractiveness/aesthetics. Smile and facial attractiveness are strongly connected to each other. The smile of a person influences his/her perceived attractiveness and is the important aspect of social interaction (19). In each arena, aesthetics/attractiveness was found to be equally important for both men and women. In modern dentistry, smile analysis and design have become key elements of Prosthodontic diagnosis and treatment planning.

It is difficult to develop an accurate and reproducible method of assessing maxillary and mandibular incisal display at rest and smile that can be adopted universally. Several factors such as age, gender, emotional status, muscle incoordination and circadian rhythms can affect the incisal display at rest (20),(21). Various articles and studies were focused on creating standards for “smile analysis”. Most of the studies that evaluated dental and facial aesthetics used upper and lower gingival exposure, midline and incisal plane tilting, upper and lower incisal visibility etc. This study specifically focused on age and gender specific effects on maxillary and mandibular incisal display and its correlation with lip form in elderly Indian population.

Tjan AH & Miller GD and Peck S & Peck L found that low smile lines are a predominantly male characteristic and a high smile line is predominantly female (22),(23). They found significant sexual dimorphism, i.e., the Gingival Smile Line (GSL) appears to be a female lineament and the low smile line seems to be a male lineament. In the present study also, it was found that average incisal display of females is more as compared to males. Vig RG and Brundo GC conducted a survey that correlates measurements of upper lip type, sex, race, and age of dentulous patients with the amount of exposure of the maxillary and mandibular anterior teeth with the lips gently parted and in the resting position (13). They found that maxillary anterior tooth display was almost twice as often in women as in men, the men displayed much more of the mandibular incisors, and females were found to be twice as likely as males to have a gummy Smile. The results of this study also favour the results of their study. Also, they found that there is gradual reduction in the amount of maxillary central incisor exposure with an increase in age, accompanied by a gradual increase in the mandibular tooth exposure. The results of the present study also confirmed the results of their study.

Lip form measurements thus measured was used to determine the type of lip forms according to Kim J et al., and correlation between lip form and incisor visibility was determined (14). The findings of this study on the age related changes in maxillary and mandibular incisal display confirms the results of previous studies by Padmasree S et al., and Motta AFJ et al., that when the lips were at rest, young people display more of their maxillary incisors as compared to elder people (11),(24). But this study first time studied the type of lip forms and their correlation with incisal display in elderly Indian population.

Female subjects had moderate lip form most commonly as compared to male subjects and a strong correlation exists between lip form and incisal display of both men and women as shown by scatter plots [Table/Fig-5,6]. These findings may have important implications for prosthodontic treatment planning which tend to ignore long-term changes in the incisor-lip relationships (24). The incisor visibility given in complete/partial dentures and anterior aesthetic rehabilitations with either conventional Fixed Partial Denture (FPD) or implants have to be modified according to the age and sex of the patients. If not, then the prostheses will end up in denture/artificial look. A Prosthodontist should understand the age and sex related changes in the facial tissues and the effect of gravity on the lips. As in this study, only correlation between lip form and incisal display has been studied, studies including more parameters like central incisor and canine relation to maxillary lip, incisal edge position, occlusal plane and midline position etc., with large number of subjects can be done.

Limitation(s)

The number of subjects in 65 years or above age group was less; more subjects could have been included. Also, only frontal view photographs were taken, close up view and side profile views can be studied.

Conclusion

Within the limitation of the study, it could be concluded that the most common type of lip form in elderly Indian male is straight lip form and in elderly Indian female is moderate lip form. A significant difference in incisal visibility according to gender was reported. With increasing age, males maxillary incisal display decreased and mandibular incisal display increased. But females with increasing age showed more of maxillary incisors and less of their mandibular incisors. A strong correlation exists between lip form and incisal display in all age and gender groups. Hence, the present study concluded that the range of central incisor visibility varies according to age and lip form, and average values cannot be used as a guide for all cases in clinical practice. The study opens the scope of further research in the subject to substantiate the result of the research.

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DOI and Others

DOI: 10.7860/JCDR/2023/59973.17290

Date of Submission: Aug 31, 2022
Date of Peer Review: Oct 06, 2022
Date of Acceptance: Dec 02, 2022
Date of Publishing: Jan 01, 2023

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 06, 2022
• Manual Googling: Nov 23, 2022
• iThenticate Software: Nov 29, 2022 (24%)

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