Thomas Mourgues

Background and Clinical Significance: Treating severe skeletal Class III malocclusions in adults who refuse orthognathic surgery remains challenging. Orthodontic camouflage offers a non-surgical option to improve occlusion and esthetics. Case Presentation: A 26-year-old male with a full bilateral Class III malocclusion and anterior crossbite was treated following the “Sagittal First” philosophy. The Carriere^® Motion 3D Class III appliance was used for mandibular distalization, combined with active maxillary aligners and Class III elastics. After 32 months, a stable Class I occlusion with proper overjet, overbite, and improved sagittal balance was obtained. Cephalometric analysis showed clockwise mandibular rotation and satisfactory dentoalveolar compensation. Conclusions: Combining the Carriere^® Motion 3D appliance with clear aligners can successfully camouflage severe skeletal Class III malocclusions in adults, providing a predictable and esthetic non-surgical alternative.

Background: To evaluate the impact of the SmileView (SV) simulation on smile esthetic perception and its influence on motivation to undertake orthodontic treatment. Methods: A longitudinal study was conducted with 51 subjects in Madrid, Spain. Participants had an initial smile photo taken (T0) and a simulated image generated by SV (T1). They rated, on a 1–10 scale, the general perception of their smile and specific variables (width, alignment, color, gingival exposure, and shape) at both T0 and T1. Intention to pursue orthodontic treatment was recorded. Data were analyzed with SPSS 28.0. Results: Smile perception improved significantly postsimulation (T0: 5.84 ± 2.12; T1: 7.00 ± 2.61; p = 0.038), with notable gains in alignment ( p < 0.001), color ( p = 0.004), and shape ( p = 0.008). No significant changes were found for width ( p = 0.143) or gingival exposure ( p = 0.721). Subjects with negative perception at T1 were influenced mainly by tooth shape ( p = 0.033). Those with improved perception were driven by alignment, color, and shape. Intent to undergo orthodontic treatment decreased slightly (49.0%–45.0%). Influenced subjects were mostly women, aged 41, with higher education and socioeconomic status. While alignment, color, and shape influenced decision changes, perceived increase in smile width emerged as the strongest independent predictor of treatment intention. Conclusion: SV improves smile perception but has limited influence on treatment motivation without clinical guidance.

Objective: This thesis aims to digitally study the natural longitudinal evolution of clinical crown height in maxillary and mandibular central incisors and first molars between 8 and 18 years of age. Methods: A total of 31 subjects (17 females and 14 males) were selected for the study. Their plaster study models were converted to digital format using a three-dimensional scanner. Digital anatomical landmarks were placed on the central incisors and first molars of all dental arches. The clinical crown height of the central incisors and first molars was then analyzed digitally and longitudinally, based on the position of the marginal gingiva on the vestibular surface of the teeth in question. Results: The clinical crown height of maxillary and mandibular central incisors and first molars increased significantly with age (p-value < 0.001) from 8 to 18 years. On average, the clinical crown height increased by 1.5 mm for the upper central incisors and 0.8 mm for the mandibular central incisors. The clinical crown height of the upper first molar increased on average by 2.7 mm and 2.1 mm for mandibular first molars. Conclusions: The clinical crown height of maxillary and mandibular central incisors and first molars appears to continue increasing beyond 18 years of age. These results suggest that the position of the marginal gingiva on the buccal surface of the teeth is not stable at 18 years of age.

Smile aesthetics are increasingly prioritized in dental practice, with accurate orthodontic assessment and treatment planning being crucial for optimal outcomes. This study evaluates Invisalign^® SmileView™ (SV), an AI-based tool that simulates post-treatment smiles, focusing on its ability to present potential orthodontic outcomes to patients. Background/Objectives: This research aims to study whether SV can simulate predictable orthodontic results and if it makes anatomical modifications to the teeth. Additionally, it will evaluate whether SV displays smiles that conform to the orthodontic criteria described in the literature. Finally, the study will analyze whether the software can align the dental with the facial midline. Methods: A total of 51 subjects were recruited in Madrid, Spain. The operator took a frontal photograph of the subjects with a social smile (T0), following the application’s instructions. Subsequently, the subjects followed the steps to modify their smile (T1), resulting in a new image of the subject with a different smile. The following variables were collected, analyzed, and compared with the standards defined in the literature: smile width, vertical exposure of the maxillary central incisor, width of the maxillary central and lateral incisors, proportion of the maxillary lateral incisor width to the central incisor, anterior gingival exposure level, position of the upper and lower dental midlines relative to the facial midline. Results: 58% of the sample showed dental expansion, with an excessive expansion (>5 mm) observed in 8%. In the maxillary arch, 5.9% of incisors exceeded predictable aligner movement (>1.5 mm), with 3.9% showing excessive extrusion and 2% excessive intrusion. For the lateral incisors, the mesiodistal size was reduced less than 0.5 mm in 31.4% of cases, with excessive interproximal reduction (>0.5 mm) in 5.9%. Additionally, 62.7% of cases would require multidisciplinary treatment due to an increase in size. SV centered the upper midline in 77.9% of these cases. Among the sample, the upper midline was initially centered in 74.5% of subjects, and SV maintained it centered in 84.2% of these subjects. Conclusions: SV tends to generate simulations of broader smiles, which are mostly achievable through aligner treatments, from an orthodontic perspective, and showed high predictability regarding the vertical movements of the incisors that can be achieved with aligners. Moreover, it adjusted the mesiodistal size of the upper incisors in its simulations and demonstrated the ability to identify and correct deviations of the dental midlines relative to the facial midline.

Background: The objective of this study was to compare the facial pattern according to Steiner’s cephalometric analysis with other facial measurement methods (Ricketts, Björk-Jarabak, and McNamara). Methods: 200 patients from a university orthodontic clinic were studied. Measurements were taken using Ricketts, Steiner, Björk-Jarabak, and McNamara methods. Results were compared using standard deviation proportions. Results: Significant differences were found between Steiner’s method and the gold standard. No differences were observed between mixed and permanent dentition groups. Errors were noted in facial type classification: 54.8% in the brachyfacial group, 80% in the mesofacial group and 14.5% in the dolichofacial group. Conclusion: The mandibular angle of Steiner tends to make a diagnosis more towards the dolichofacial type compared to other methods. A protocol is proposed to adjust the value of the mandibular angle of Steiner to the other three methods in a Spanish population.