This current study investigated which angle of canine inclination (angle between canine tooth axis (CA-line) and the line between the lateral canthus and the ipsilateral labial angle (EM-line)) is perceived to be most attractive in a smile. The second objective was to determine whether laymen and dental experts share the same opinion. A Q-sort assessment was performed with 48 posed smile photographs to obtain two models of neutral facial attractiveness. Two sets of images (1 male model set, 1 female model set), each containing seven images with incrementally altered canine and posterior teeth inclinations, were generated. The images were ranked for attractiveness by three groups (61 laymen, 59 orthodontists, 60 dentists). The images with 0° inclination, that is CA-line (maxillary canine axis) parallel to EM-line (the line formed by the lateral canthus and the ipsilateral corner of the mouth) (male model set: 54·4%; female model set: 38·9%), or -5° (inward) inclination (male model set: 20%; female model set: 29·4%) were perceived to be most attractive within each set. Images showing inward canine inclinations were regarded to be more attractive than those with outward inclinations. Dental experts and laymen were in accordance with the aesthetics. Smiles were perceived to be most attractive when the upper canine tooth axis was parallel to the EM-line. In reconstructive or orthodontic therapy, it is thus important to incline canines more inwardly than outwardly.

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There is very little literature on the overall management of adolescent traumatic amputation, specifically of the lower extremity. We present a case involving an adolescent patient involved in an industrial farm tractor rollover with substantial crush and degloving injuries requiring bilateral lower extremity amputations. The patient was initially assessed and acutely managed in the field before arriving at an adult level 1 trauma center having two right lower extremity tourniquets already applied and a pelvic binder in place. During his hospitalization, he was revised to bilateral above-knee amputations that required multiple debridements prior to being transferred to a pediatric trauma center due to the extent of the soft tissue injury and need for flap coverage. Our adolescent patient presented with an uncommon injury mechanism resulting in significantly mangled lower extremities highlighting the importance of a multidisciplinary approach in all aspects of the patient’s prehospital, intrahospital, and posthospital care.