Conclusion Minimal tooth size should be taken into account during restorative treatment planning, and excessive tooth proportions should be considered esthetically problematic.Background The lightness of teeth and the distances of the upper and lower lip from the maxillary cervical and incisal lines are factors that correlate with smile attractiveness. Purpose This study investigates the degree of association of the above factors with smile attractiveness and evaluates the possible effect of evaluators' gender, age, occupation, and education level on the perception of smile attractiveness. Materials and methods An almost perfect smile of an adult Caucasian female was altered to create various smile images with differences in lightness of teeth and upper and lower lip positions. The images were randomly assembled in three slides of four, seven, and five images each and presented to 130 participants to evaluate the most attractive smile (MAS) and the least attractive smile (LAS). Data collected were analyzed for differences between gender, age, occupation, and education level as regards the evaluation of the MAS and LAS using the chi-square test with a significance level of α = 0.05. Results Statistical analysis showed that the smile images in L1 and L2 were equally considered to be the most attractive smiles. The chi-square test indicated no differences between all groups (P > 0.05). Percentages for the most attractive smiles for the lower lip positions were almost equal for most positions of the upper lip, with differences only between age groups (P > 0.05). The least attractive smiles were those with the upper lip position at 3 mm above the cervical line, with differences only between occupation groups (P less then 0.001). Conclusion The results of this study indicate that lightness of teeth positively affects smile attractiveness. Lower lip positions with a distance of 0 to 1 mm from the maxillary incisal line are considered more attractive. Upper lip distances were strongly associated with smile attractiveness. https://www.selleckchem.com/products/gdc6036.html Gender, occupation, and education level did not differently affect the perception of attractiveness due to lower lip positions, but age did.A digital smile diagnosis based on Digital Smile Design (DSD) concepts reinforces the predictability and precision of orthodontic and multidisciplinary cases as it allows more accurate planning from an esthetic point of view. The intention of this clinical case series was to verify the relationship between the ideal and adapted smile in three orthodontic multidisciplinary cases treated using the Invisalign system in order to have a better understanding of the correlation between the several smile components. The ideal smile construction requires face, lips, gingival tissue, and tooth analysis and evaluation, as well as the appreciation of how all these aspects occur together. When the ideal smile line is not achievable in difficult clinical situations, the treatment goal would be an adaptation to the same line that supports a more predictable movement range. These DSD and orthodontic concepts should be primarily applied, since all intermediate involvement, as well as the final outcomes, are essentially planned from the beginning in clear aligner treatments. The presented case series allowed the authors to understand the importance of these digital diagnostic tools in dealing with certain particularities in orthodontic clear aligner treatments, both at the beginning and during the refinement/finishing stages.It is common knowledge that dental implants should not be inserted in adolescents, before completion of skeletal growth, because they behave as ankylosed teeth and remain in a fixed position while the surrounding bone and teeth are still developing, with consequential worsening esthetic damage. However, there is growing evidence that this phenomenon may continue throughout life in a large number of adult patients, although with a great variability in onset, progression, and extent. Infraocclusion and interproximal contact loss are the more common complications, and the majority of clinically significant cases are located in the anterior maxilla. The esthetic impact is mostly minimal, but in some cases the patient's smile may be severely compromised. Therefore, adult patients need to be informed when dental implants are considered to replace anterior missing teeth.An unfavorable relationship between the form and dimension of the dental arch and the number, dimension, and shape of the existing teeth can pose several esthetic, biologic, and functional problems. In this article, the various restorative options are discussed based on clinical and scientific evidence Gap closure and substitution of missing teeth restorative transformation of substituted teeth into homologous teeth with odontoplasty, direct composite, etched pieces or porcelain veneers. Gap opening and tooth replacement with all-ceramic adhesive bridges, including pontic site development. Gap distribution and restorative compensation with direct composite restorations, etched pieces or porcelain veneers. Gap shifting and restorative compensation with all-ceramic adhesive bridges, composite, etched pieces or veneers. Gap compensation by reconstructive compensation without orthodontics. The reconstructive tools including composite restorations, ceramic veneers, and adhesive bridges are discussed, and numerous cases are presented to illustrate the concepts.New digital technologies have significantly improved patient treatment modalities, especially in interdisciplinary cases. Tooth morphology can be modified at different stages of orthodontic treatment. Defining and achieving the final tooth form at the beginning or during the treatment can help the orthodontist to move teeth into the correct position quickly and more easily. The reshaping of anterior teeth can be obtained using digital technologies and CAD/CAM procedures. Composite resins are preferred to ceramics because they can be modified and adjusted whenever necessary. The parameters to assess the timing of restorative intervention are related to the age of the patient, degree of tooth eruption, and space availability in the interproximal area, especially if an additive approach is indicated to enlarge teeth.Bilateral or unilateral congenitally missing maxillary lateral incisors is a common clinical situation that requires an interdisciplinary approach. It is often complicated by the presence of narrower teeth. Occlusal, periodontal, and esthetic considerations will influence the decision to close the space for a canine-lateral substitution or to open the space for a prosthodontic replacement of the missing lateral incisor. The team should define the proper dental position to provide a stable occlusion and dental esthetics obtained with a minimally invasive preparation. The restorative approach should provide a long-term functional and esthetic solution in the transitional period from adolescence to adulthood, reversible for future possible interventions.In patients with missing maxillary anterior teeth, orthodontic space closure is an evidence-based, effective treatment option probably the best if the goal is long-term periodontal health. Nowadays, this approach is possible in all malocclusions as the first step of an interdisciplinary approach, which aims not only at an optimum esthetic and functional result, but moreover at reducing the -invasiveness of the subsequent restorative treatment. Space closure should be considered the first alternative in growing patients and when the gingival margins are visible. This essay presents the rationale for space closure and provides clinical tips for interdisciplinary treatment planning and finishing.Classical Chinese poetry is a jewel in the treasure house of Chinese culture. Previous poem generation models only allow users to employ keywords to interfere the meaning of generated poems, leaving the dominion of generation to the model. In this paper, we propose a novel task of generating classical Chinese poems from vernacular, which allows users to have more control over the semantic of generated poems. We adapt the approach of unsupervised machine translation (UMT) to our task. We use segmentation-based padding and reinforcement learning to address under-translation and over-translation respectively. According to experiments, our approach significantly improve the perplexity and BLEU compared with typical UMT models. Furthermore, we explored guidelines on how to write the input vernacular to generate better poems. Human evaluation showed our approach can generate high-quality poems which are comparable to amateur poems.Traumatic ventricular septal defects due to penetrating cardiac injury are uncommon. Transthoracic echocardiography is an essential tool in diagnosis. Options for closure include either surgical or percutaneous repair. We present a case of a trauma-related ventricular septal defect in a young patient that was successfully repaired by using a percutaneous approach. (Level of difficulty Intermediate.).The Lennox-Gastaut syndrome is a devastating early-onset epileptic encephalopathy, associated with severe behavioural abnormalities. Its pathophysiology, however, is largely unknown. A de novo mutation (c.G358A, p.D120N) in the human GABA type-A receptor β3 subunit gene (GABRB3) has been identified in a patient with Lennox-Gastaut syndrome. To determine whether the mutation causes Lennox-Gastaut syndrome in vivo in mice and to elucidate its mechanistic effects, we generated the heterozygous Gabrb3+/D120N knock-in mouse and found that it had frequent spontaneous atypical absence seizures, as well as less frequent tonic, myoclonic, atonic and generalized tonic-clonic seizures. Each of these seizure types had a unique and characteristic ictal EEG. In addition, knock-in mice displayed abnormal behaviours seen in patients with Lennox-Gastaut syndrome including impaired learning and memory, hyperactivity, impaired social interactions and increased anxiety. This Gabrb3 mutation did not alter GABA type-A receptor trafficking or expression in knock-in mice. However, cortical neurons in thalamocortical slices from knock-in mice had reduced miniature inhibitory post-synaptic current amplitude and prolonged spontaneous thalamocortical oscillations. Thus, the Gabrb3+/D120N knock-in mouse recapitulated human Lennox-Gastaut syndrome seizure types and behavioural abnormalities and was caused by impaired inhibitory GABAergic signalling in the thalamocortical loop. In addition, treatment with antiepileptic drugs and cannabinoids ameliorated atypical absence seizures in knock-in mice. This congenic knock-in mouse demonstrates that a single-point mutation in a single gene can cause development of multiple types of seizures and multiple behavioural abnormalities. The knock-in mouse will be useful for further investigation of the mechanisms of Lennox-Gastaut syndrome development and for the development of new antiepileptic drugs and treatments.The North European species of Elaphomyces section Elaphomyces (Eurotiales, Pezizomycotina) are studied. Three new species, E. citrinopapillatus, E. pusillus, and E. roseoviolaceus are introduced and verified by morphology and sequence data from ITS, nuclear LSU, mitochondrial SSU, and β-tubulin. A lectotype for Elaphomyces granulatus is selected. Elaphomyces granulatus and E. muricatus are epitypified with sequenced material from the Femsjö region in South Sweden. Elaphomyces striatosporus is epitypified with sequenced material from the vicinity of the type locality in Norway. A key to all species of Elaphomyces occurring in Denmark, Norway, and Sweden is provided.