The loss of maxillary central incisors at an early age has psychological, esthetic, and functional implications. Multiple treatment options are available for replacing missing central incisors. The management demands a multidisciplinary approach involving the orthodontist, prosthodontist, and periodontist. Treatment planning requires consideration of a variety of clinical and nonclinical factors. This clinical report attempts to demonstrate different strategies for the management of unilaterally and bilaterally missing central incisors.

Aim: To determine the co-relationships of the root crown length and occlusal contacts in patients with Class-III skeletal relationship, anterior open-bite, and high mandibular plane angle. Materials and Methods: Study group consisted of 10 untreated Class-III patients with reverse over jet of minimum-2 or more and an anterior open-bite. Control group consisted of untreated patients with average 0-4 mm of over jet and overbite. Dental casts, orthopantomograms, and lateral cephalograms were recorded for measuring the root and crown lengths, occlusal contacts, and mandibular plane angle readings and were analyzed. Results: The root length and the root-crown ratios were reduced from incisors toward the pre-molars in the study group. Occlusal hypofunction was seen associated with the study group. Short dental roots were observed specifi cally with the anteriors. Conclusion: Patients with Class-III skeletal relationship, high mandibular plane angle, and an anterior open-bite have a tendency toward developing short dental roots that can be associated with occlusal hypofunction that is associated with the condition.

A proposal to formulate an orthodontic index specific for the Indian Board of Orthodontics (IBO) to determine the acceptability and degree of difficulty of a cases submitted for the phase III examination was discussed at the College of Diplomates meet (CDIBO). To ascertain the degree of difficulty of a case is very subjective; therefore, the need to quantify the complexity of a case in a standard format is required. To develop a Discrepancy Index for the IBO, 20 Dental and Cephalometric components of a malocclusion and 20 intraoral frontal photographs would have to be evaluated and a weightage score for each component would be assigned. Components such as upper and lower anterior proclination, commonly seen in our Asian population which have been omitted in the commonly used indices such as PAR (Peer Assessment Review) IOTN (Index of Orthodontic Treatment Need) and the ICON (Index of Complexity,Outcome and Need) have been included. The proposed IBO Index would add uniformity and standardization in assessing the degree of difficulty and also the degree of improvement of a case, which would be a beneficial tool for a fair evaluation.

Objectives:(1) To evaluate the influence of the amount of gingival display on smile esthetics and to compare the esthetic perception of six levels of gingival exposure (−3, −1, 0, +1, +3, +5 mm) between orthodontists, maxillofacial surgeons, dental students, and laypersons. (2) To evaluate the most acceptable level of gingival display during smile. Materials and Methods: Twelve adult females (20-30 years of age) were included in the study. A frontal intraoral and a frontal extraoral smile photograph were obtained from each of them. A total of six images were created with different levels of gingival display. Each image was evaluated for its attractiveness by 60 observers. Results: Analysis of variance with post hoc Tukey's correction was the statistics used. The average ratings for gingival display of −3 and +3 mm did not differ across all the observers. Dental students and laypersons gave significantly higher ratings for −1 mm and 0 mm and significantly lesser ratings for +1 mm and +5 mm, when compared to the orthodontists and maxillofacial surgeons. Conclusions: The smile with 0 mm gingival display was considered to be the most esthetic by all observers. Smile with +1 mm gingival display was the second most attractive smile according to the orthodontists and maxillofacial surgeons while for the dental students and laypersons, it was the smile with −1 mm gingival display.

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