REVIEW ARTICLE | June 30, 2021
Application of Nanotechnology in Geotechnical Engineering: A Review
Dr. Basil Obaid Mahdia, Dr. Zaid Hameed Majeed, Eng.Sultan Saadi Hussein, Eng.Zainab Hadi Abbas, Eng.Hasan Haleem Hamood
Page no 143-151 |
10.36348/sjet.2021.v06i06.005
The idea of nanotechnology was first introduced in the 1959 by Richard Feynman in his lecture entitled “There’s Plenty of Room at the Bottom” (R. Feynman, 1960). At the time, the term “nanotechnology” had not yet been coined. This technology made a significant and rapid progress years later. Nano technological achievements provided a modern approach in geotechnics. Each field of science had a specific definition for nanotechnology, and the National Nanotechnology Initiative (NNI) provided a comprehensive definition of nanotechnology (NSTC, 2007). According to NNI, “nanotechnology” is the control, comprehension, and reformation of material based on the hierarchy of nanometers to develop matter with essentially new uses and a new constitution.
ORIGINAL RESEARCH ARTICLE | June 30, 2021
Clinical Profile of Women with Ovarian Tumor Attended a Tertiary Care Hospital in Bangladesh.
Mst. Mosfika Kowsari, Mosammat Nargis Shamima, Md. Shohidul Islam, Monowara Begum, Md. Zalal Uddin
Page no 274-277 |
10.36348/sijog.2021.v04i06.008
Background: Ovary is a very common site for tumors, both benign and malignant which causes great morbidity and mortality. Ovarian tumors most commonly occur in women of childbearing age. The ovarian tumors manifest a wide spectrum of clinical, morphological, and histological features. The proper management of the patients with ovarian tumor directly depends on the clinical profile the respective patients. Aim of the study: The aim of this study was to evaluate the clinical status of ovarian tumor patients attended a tertiary care hospital in Bangladesh. Methods: This cross-sectional observational study was done at Rajshahi Medical College and Hospital, Rajshahi, Bangladesh during the period from December 2017 to November 2019. In total 240 women with ovarian tumor from several age groups were enrolled as the study people. In each case, information about the patient was collected in a prescribed questionnaire after getting written consent from the patients in a preformed consent form. Results: In analyzing the previous family history of cancer, we observed among total participants only 18% (n=43) had the positive family history of cancer. As the habit of using contraceptive methods we found, the highest number of patients were used to Barrier method (20%). Besides this, 15%, 5%, 11% and 2% participant were using injectables (Irregularly), Natural method, OCP irregularly and Calender method as contraceptive methods respectively. In this study, two third of participants were multipara and the rest one third were nullipara. In analyzing the histopathology reports of participants, as some most potential and/or frequent characteristics we observed mucinous cyst, endometrioma, serous cyst adenoma and dermoid cyst were found among 26.67%, 18%, 16.67% and 13.33% participants respectively. Conclusion: From our study we can conclude that, ovarian tumors are most commonly occurred in middle aged women in the middle-income group. Parous women are most vulnerable in condition for affecting ovarian tumor. Clinical profiling of patients may be helpful in treating and preventing ovarian tumor as well as in awareness building on ovarian tumor to mass people.
ORIGINAL RESEARCH ARTICLE | June 30, 2021
Survival of COVID-19 Positive Patients: A Single Centered Comparative Study
Dr. Masum Ahmed, Dr. Kamruzzaman Md. Zahir, Dr. A. J. M. Emrul Kayesh, Dr. Shah Md. Fazlay Rahaman Khan, Dr. Mohammad Shahadat Hoshen, Dr. Anwar Hossain, Dr. Mahmudul Hassan Banna
Page no 176-180 |
10.36348/sjm.2021.v06i06.012
Background: In Bangladesh for the first time, Covid-19 cases were detected in Dhaka city on the 8th March of 2020. Till then the number of Covid-19 patients is being increased. Covid-19 has the ferocious nature of affecting a large number of people within a couple of days. The mortality rate of Covid-19 differs by ages and places. In Bangladesh, we have not enough research-based information regarding the survival rate of Covid-19 positive patients. Aim of the study: The aim of this study was to assess of Covid-19 positive patient survival rate in Bangladesh. Methods: This was a prospective observational study conducted in the Department of Medicine Sher-e-Bangla Medical College Hospital (SBMCH), Barishal, Bangladesh during the period from July 2020 to 31 December 2020. In total 496 suspected Covid-19 patients who attended and completed full treatment tenure from 1 July 2020 to 31 December were selected as the study people for analysis. The study people were divided into two groups. In Group-I only death cases were enrolled and in group-II cured patients were enrolled. Before data collection, properly written consent was taken from all the participants. A pre-designed questionnaire was used in patent data collection. Data were analyzed by MS Office and SPSS version 24.0. Result: The age range of Group I patients was 16-90 which was 13- 90 in Group II. In Group I, the mean (±SD) age of the participants was 49.8±17.8 years, which was 43.9±16.7 years in Group II. We found a significant correlation in comparing the mean (±SD) ages of both groups of patients and the p- value was found 0.016. We observed, in Group I, 26% were Covid-19 positive whereas it was 15% in Group II. In total 3% (n=13) patients had been referred to other hospitals. Finally, in calculating the survival rate of Covid-19 positive patients in this study we found 89% had been survived. Conclusion: In this study, the survival rate of the Covid-19 patient was found lower than that of many other similar studies. Increasing several treatment facilities along with ventilation may reduce the mortality rate of Covid-19 patients in Bangladesh.
ORIGINAL RESEARCH ARTICLE | June 30, 2021
Molar Pregnancy Analysis of 50 Cases
Dr. Shamsun Nahar, Dr Taslima Begum, Dr. Begum Shaira Sharifa, Dr. Jafrin Akhter, Dr Gazi Golam Mostofa, Dr. Apurba Kumar Biwas
Page no 278-281 |
10.36348/sijog.2021.v04i06.009
Background: A molar pregnancy is also known as hydatidiform mole which is a benign tumour that develops in the uterus. It begins when an egg is fertilized but normal viable pregnancy not occurs, rather than the placenta develops into an abnormal mass of cyst. In all cases of molar pregnancy observation is essential to detect the reawakening of chorionic activity. Objectives: The aim of the study was to explore the incidence, clinical presentation, management and outcome of the molar pregnancy in our hospital. Materials & Methods: This prospective study was conducted in Faridpur Medical College Hospital, Faridpur, Bangladesh and Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh. Over a period of one year from August 2005 to July 2006. 50 consecutive patients attended the out-patient’s department (OPDD) of obstetrics & gynaecology and were admitted in the department of obstetrics and gynaecology of these two hospitals during this period, were taken as the study population. All pregnant women who were diagnosed as molar pregnancy were included in the study. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: During this period total 6550 pregnant patients and 420 patients with abortion and 85 ectopic pregnancy were admitted in both of the hospitals 50 of them were suffering from gestational trophoblastic diseases. So, incidence of gestrational trophoblastic disease was 7.08 per thousand pregnancies. Conclusion: Results from this study showed that a small portion of patient of molar pregnancy came for routine follow up. To achieve high cure rate and low chemotherapy rate an effective registration programme and treatment protocol should be established.
ORIGINAL RESEARCH ARTICLE | June 29, 2021
“Cleavage Stage Embryos for Transfer Following in Vitro Fertilisation or Intra-Cytoplasmic Sperm Injection on Clinical Pregnancy Outcome”
Ahmed B, Angel, Sharma S
Page no 269-273 |
10.36348/sijog.2021.v04i06.007
Introduction: Embryo culture allows us to culture embryos to the blastocyst stage. Prolonging the duration of culture to day 5 allows chromosomally competent embryos to develop to the blastocyst stage and permits selection of embryos that have the potential for continued development under embryonic genomic control. Objective: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer. Methods: A randomized, prospective study was conducted in International Fertility Center, Delhi, India on 300 patients aged 25‑40 years undergoing in‑vitro fertilization (IVF)/ intra‑cytoplasmic sperm injection (ICSI) cycle from March 2019 and February 2020. When three or more Grade‑I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, cleavage stage transfer and blastocyst transfer group having 150 patients each. Primary outcomes evaluated were, Clinical pregnancy rate and Implantation rate. The results were analyzed using proportions, standard deviation and Chi‑square test. Results: Both the groups were similar for age, indication and number of embryos transferred. Clinical pregnancies after blastocyst transfer were significantly higher 66 (44.0%) compared to cleavage stage embryo transfer 44 (29.33%) (p< 0.01). Implantation rate for blastocyst transfer group was also significantly higher (p< 0.001). Conclusion: Blastocyst transfer having higher implantation rate and clinical pregnancy rate lead to reduction in multiple pregnancies.
ORIGINAL RESEARCH ARTICLE | June 29, 2021
Two-Dimensional Modeling of Waste Stabilization Pond with Computational Fluid Dynamics
Onosakponome OR, Andy O. Ibeje, Anthony C. Ekeleme, Odenigbo C
Page no 124-132 |
10.36348/sjce.2021.v05i05.004
Waste stabilization ponds (WSP) are used extensively to provide wastewater treatment throughout the world. A review of the literature indicates that, understanding the hydraulics of waste stabilization ponds is critical to their optimization, the research in this area has been relatively limited and that there is a poor mechanistic understanding of the flow behavior that exists within these systems. This explains why there is no generally acceptable model for predicting its performance. The two-dimensional computational fluid dynamics (CFD) model developed in this study was extensively tested on the waste stabilization pond located in the campus of the University of Nigeria, Nsukka which was used as the field pond and also on a laboratory scale waste stabilization pond obtained from literature. Although the model may be solved by several methods, this research was limited to computational method; numerical solution using finite difference method was used in solving the two-dimensional partial differential equations at steady state conditions. In order to validate the quality of the model, its results were compared with the experimental data from the field and the lab-scale ponds. The results obtained were encouraging, prediction of pond performance with measured values shows that correlation coefficient of 0.82 was obtained, representing an accuracy of 82%. The 2-D model was then used in series of investigative studies such as; effect of single inlet and outlet structures at different positions in the pond, effect of multiple inlet and outlets on the pond’s performance, variation of pond performance with depth, effect of short-circuiting on pond treatment efficiency, effect of baffles on pond performance using laboratory-scale pond data and comparison with tracer studies. In all, the results agree with literature.
CASE REPORT | June 28, 2021
Prosthetic Management of Florid Cemento-Osseous Dysplasia: Case Report
Rabeb Bedhief, Chebbi karim, Houda Chraief, Yasmine Tayachi, Jamila Jaouadi
Page no 274-279 |
10.36348/sjodr.2021.v06i06.008
Cemento-osseous dysplasia is a non-neoplastic condition in which a normal bone architecture is replaced with cemento-osseous tissue. It is a benign fibro-osseous lesion of the jaws associated to root apexes and containing amorphous calcifications which would correspond to cementum. They are classified, according to their extent and radiological appearance, into three main groups: peri-apical, Florida and focal cementitious dysplasia. Moreover, two forms can be described for Florida cemento-osseous dysplasia (FCOD): symptomatic, which is the most frequent, and asymptomatic. The treatment differs according to the form. Indeed, in case of symptomatic lesions, surgical management can cause the loss of interrupting substance. It must be completed by a prosthetic rehabilitation that allows the patient to resume his mandibular functions, especially mastication. In our work and through a clinical case, we will highlight the steps of the prosthetic rehabilitation of a loss of non-interruptive mandibular substance following the removal of a bone sequester caused by cemento-osseous dysplasia.
CASE REPORT | June 27, 2021
Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome): A Rare Case Report
Dr. Nighat Sultana, Prof. Jasmine Banu, Dr. Shakeela Ishrat, Dr. Sadia Afrin Munmun, Dr. Mahamuda Yasmin, Dr. Dilruba Akhter
Page no 258-262 |
10.36348/sijog.2021.v04i06.005
The triad of uterine didelphys, obstructed hemivagina and ipsilateral renal anomaly known as OHVIRA syndrome, formerly known as Herlyn-Werner-Wunderlich syndrome, is a rare congenital urogenital malformation. It represents a diagnostic dilemma because of the regular menstruation and nonspecific abdominal pain. We present the case of a 13 year old pubertal girl presenting with severe dysmenorrhea. After evaluation with history and investigations she was diagnosed to have bicornuate uterus with hematometrocolpos, left sided hematosalpinx and left renal agenesis. After laparotomy she was diagnosed to have uterine didelphys with left sided hematometra, hematocolpos and ahematosalpinx due to left sided obstructed hemivagina and left renal agenesis (OHVIRA Syndrome). Surgery was done by abdominoperineal route. She had drainage of hematometra, hematocolpos and hematosalpinx and repair of obstructed hemivagina through perineal route. In conclusion, awareness of such anomaly is a prerequisite to early and prompt diagnosis. Surgery should not to be delayed after diagnosis of OHVIRA syndrome, so that complications can be avoided and reproductive function can be preserved.
ORIGINAL RESEARCH ARTICLE | June 27, 2021
Impact of Microteaching in Enhancing Teaching Skills of Medical College Faculty
Rashmi Ramanathan, Seetharaman Narayanan, Anirudh Mutalik, Jeevithan Shanmugam, L Padmavathy, C Vaishnavi, R Kathiravan
Page no 160-164 |
10.36348/jaep.2021.v05i06.003
Background: A structured faculty training method is needed to effectively train the medical teachers. Microteaching is one of the teacher training techniques for imparting teaching skills to the teachers. This study aims to assess the effect of improvement of teaching skills by self/peer evaluation of microteaching technique. Materials and methods: Thirty faculty from different departments with less than five years of teaching experience participated in the microteaching session. The session was videotaped and played back to the presenter. The presentation was evaluated by the faculty themselves and also by the peers using the checklist (NTTC JIPMER). After obtaining the constructive feedback, the participants were asked to do a repeat session on the same topic within a week and the same procedure was followed. Results: There was a statistically significant improvement of the post mean scores of all parameters assessed when compared to pre mean scores. Post mean score improved by 149% for aroused interest in the topic, 119% for organized materials in logical sequence, 204% for changing the pace of presentation by shifting emphasis and 246% for interaction during presentation. The Pre/Para-clinical faculty performed well when compared to clinical faculty both before and after the feedback. Conclusion: Self-assessment by digital video recording playback and also peer guidance helps to enhance their skills acquisition. Peer microteaching sessions must be conducted for early beginners in the department and introducing microteaching methods in post graduate curriculum would improve the teaching skills. Well-equipped microteaching laboratory is needed for microteaching programmes in all medical colleges.
ORIGINAL RESEARCH ARTICLE | June 27, 2021
Cervical Cancer Screening in Bamako Urban Commune (Commune VI) Mali: Knowledge, Attitudes and Practices of Women
Samaké A, Sylla cheickna, Traoré SO, Keita M, Haidara M, Diallo M, Konaté M, Maiga M, MS Ag Med Elméhdi Elansari, Kassogue D, Soumaila A T, DAO S Z, Samake Hawa
Page no 263-268 |
10.36348/sijog.2021.v04i06.006
The aim was to assess women's knowledge and attitudes towards cervical cancer. Materials and methods: This was a descriptive study of transversal type from March to October 2018, i.e. a period of eight months at the reference health center of commune VI. Results: During the study period from March to October 2018, we registered 100 women who agreed to participate in the study as part of cervical cancer screening. The 18-30 age group was the most represented (64%) with extremes of 18 years and 65 years. The average age was 37.90 ± 0.66 years with extremes of 18 years and 65 years. Multiparous people were the most represented with a rate of 37% of cases. Women in school were the most represented with a rate of 67% of cases. Attitudes aspects: Women were in favour of systematic research into cervical cancer with a rate of 68%. Cervical cancer is known as a serious disease by 53% of women. Practical aspects: Cervical cancer screening was not carried out with a rate of 63% and the most cited reason for this non-practice was the lack of information. Thus, the practice of screening depended on information. Cervical cancer screening was more common in the 18-30 age group. The attitude depended on practice as 52% of women who considered cervical cancer a serious disease were in favour of routine screening. Practice depended on knowledge with a statically significant test. Conclusion: Visual inspection methods are simple, inexpensive tests that are easily acceptable to women and the result is systematic at the end of the examination; allowing for effective detection of precancerous lesions of the cervix. However, more than the majority of the women surveyed had no information on screening.
ORIGINAL RESEARCH ARTICLE | June 26, 2021
Determination of the Prevalence of Substance Abuse among Students in University of Port Harcourt’s Host Communities
Chigozie Njoku
Page no 165-168 |
10.36348/sjm.2021.v06i06.010
Background: Substance abuse refers to the use of all chemicals, drugs and industrial solvents that can produce dependence (psychological and physical). It can also refer to repeated non-medical use of potentially addictive chemical and organic substances. According to UNICEF and WHO, substance abuse includes the use of chemicals in excess of normally prescribed treatment dosage and frequency, even with knowledge that they may cause serious problems and eventually lead to addiction. Hence, this study was done to determine the prevalence of substance abuse among students in University of Port Harcourt host’s communities. Materials & Methods: The study was a descriptive cross-sectional study carried out in ALUU Community in Ikwerre Local Government Area of Rivers State. The study involved 150 volunteers recruited randomly through a multi-staged sampling technique which included secondary school students, undergraduates and post graduates who are 13yrs and above residing in ALUU community while, those who did not give consent were excluded. The data was collected using a self-structured close-ended self-administered questionnaires and data analysis done using SPSS version 25. Results and Discussions: The most frequent age category was 20-24years (42.67%), while the least frequent category was 10-14years. The most frequent gender (sex) was the males (71.33%); the most frequent educational level was undergraduate 84.67%. The study again showed that the most commonly abused substances by students were alcohol 90.57%, Nicotine 39.62%, while the least abused drugs were heroin and cocaine being 1.89% respectively. The prevalence of drug abuse seen in the study was 35.33%. Moreover, the distribution of known acquaintance of persons who abuse drugs was 78.67%. Conclusion: The prevalence of drug abuse seen in the study was 35.33%. Peer group, neighbourhood influence and parents habits of drug/substance abuse were the attributed contributing factors to the prevalence of drug/substance abuse amongst students in Aluu.
CASE REPORT | June 26, 2021
Multicystic Mesenteric Lymphangioma – A Case Report
Dr. Sreelekshmi S N, Dr. S Sankar
Page no 234-236 |
10.36348/sjpm.2021.v06i06.009
Mesenteric cystic lymphangiomas are rare benign lesion of lymphatic system occurring in children. They are common in males with a median age of presentation of 2 years. It can either be asymptomatic or present as acute abdomen when the mass produces intestinal volvulus. It is often confused with mesenteric cyst both clinically and radiologically. The true nature of lesion is revealed on histopathological examination. We report such a case in a 3 year old boy who presented with complaints of abdominal pain and distension, which on evaluation thought to be mesenteric cyst which was excised and turned out to be a cystic lymphangioma in histopathological examination. Establishing the lymphatic nature is also important owing to the development of targeted therapy for aggressive and recurrent lesions. Immunohistochemistry, hence, hold an important role in this characterization and is expected to rise in significance in the future.
ORIGINAL RESEARCH ARTICLE | June 26, 2021
Icacinia Manni Impact on Metabolism in Male Rats
Udokang Nsikak Ephraim, Udom Utibe Godwin, Antai Atim Bassey, Osim Eme Effiom
Page no 159-164 |
10.36348/sjm.2021.v06i06.009
The liver as a major organ of metabolism is one of the first predisposed organs to food chemicals. Icacinia manni tuber, the examined agent in this study has claims of direct and indirect consumption by man as it is observed to be a source of energy which contains high amount of carbohydrates among other nutritional and anti-nutritional constituents. Four (4) weeks old Male Wistar rats were used for this study. They were fed with rat chow from vital feeds and allowed free access to drinking water throughout the experimental period. Icacinia manni tuber was washed with water to remove sand, cut into pieces and sun dried. The dried specimen was extracted with 80% Ethanol. After two (2) weeks of drying, the tuber was reduced into powder. The powder was divided into two parts. One part was macerated in 80% ethanol for 72hrs to give the crude ethanolic extract. The other part was successively macerated for 72hrs in n-hexane and ethanol to give the corresponding gradient fraction of these solvents. The liquid filtrate was concentrated and evaporated to dryness using rotary evaporator. The median lethal dose (LD50) of the extract was estimated using albino Wistar mice by intra peritoneal (ip) route. The rats which weighed between 60 and 100gm were randomly assigned four (4) groups. Group A served as the control and was given distilled water by mouth and allowed liberal food and water throughout the experimental period which was 28 days. Group B, C and D had low, intermediate and high dose of extract. Group B received 1/10 of LD50 by feeding tube i.e. 1/10 x 894.43 mg/kg = 89.44mg/kg. Group C received 2/10 of LD50 by mouth through a feeding tube i.e. 178.88mg/kg. Group D received 3/10 of LD50 by mouth through a feeding tube i.e. 268.32mg/kg. Stock concentration was 50mg/ml. On the twenty-eighth (28th) day, the animals were anaesthetized with chloroform. Blood samples were obtained by cardiac puncture. Serum obtained for biochemical analysis. The livers were harvested for histological analysis. The results showed significant higher levels (p˂0.01) of Mean Total Cholesterol and High Density Lipoprotein in treated rats compared to the untreated rats. Significant lower levels (p˂0.01) of Mean Triglycerides and Low Density Lipoprotein were observed in untreated rats compared to treated rats. The Mean Total Protein, Mean Albumin and Mean Globulin levels for treated rats were significantly lower (p˂0.01) than that of the untreated rats. The histologic photomicrographs of liver of treated rats showed moderate area cellular abnormalities with area of vascular congestion and degeneration, cellular degeneration, vacuolization and pyknotic nuclei as compared to untreated rats. This study shows the hepatotoxicity of Icacinia manni tuber and its associated risk of metabolic syndrome.
ORIGINAL RESEARCH ARTICLE | June 26, 2021
Response of Pepper Seeds Affected by Root Rot Disease (Phytophthora capsici) Towards Application of Secondary Metabolites of Trichoderma sp.
Erma Suriany, Ni’matuljannah Akhsan, Sopialena
Page no 113-129 |
10.36348/sjls.2021.v06i06.001
Basal stem rot disease in pepper caused by P. capsici is the ultimate disease which can lead to the death of the plant. Trichoderma sp. produces secondary metabolite which is effective for controlling this disease. To know the effectiveness of Trichoderma sp. secondary metabolite, the experiment with different concentrations placed in the polybag to control basal stem rot disease in pepper was conducted from March to June 2020 at UPTD Pengembangan Perlindungan Tanaman Perkebunan (P2TP), Plantation Office, East Borneo. A completely randomized design with five treatments and ten replications was applied in this experiment. The data were analyzed using analysis of variance. If there is a significant difference, the test will continue at the least significant difference of 5%. The study entitled “The Growth of Pepper Seeds Attacked by Basal Stem Rot Disease (Phytophthora capsici) on Application of Trichoderma sp. Secondary Metabolite” concluded three main points. First, based on the intensity of disease attack, the average of both shoot internode number and shoot internode length of Trichoderma sp. secondary metabolite was mostly effective to control the disease attack or at MS20 concentration namely 88.06% of the intensity of disease attack. Second, based on the average number of leaves, MS5 concentration was able to control the disease progression by calculating the number of grown leaves, around 75.40 leaves. Last, based on the growth of the plant, the effective use of secondary metabolite was at MS10 concentration with the height of the plant 71.50 cm.
ORIGINAL RESEARCH ARTICLE | June 26, 2021
Esthetic Dental Proportions and Measurements Comprising a Natural Esthetic Smile: A Literature Review
Dr. Tarek Rabi
Page no 270-273 |
10.36348/sjodr.2021.v06i06.007
Aim: To review different methods determining the width and proportion of the maxillary anterior teeth. Materials and methods: The relevant articles were obtained from the databases of PubMed, Medline, Google scholar and Scopus index by searching keywords “Esthetic dental proportion,” “Esthetic dental measurement.” and “Esthetic dental proportion and esthetic dental measurement in smile designing” Results: The present review explains the different methods of esthetic dental proportion and measurements to obtain the adequate width of the maxillary incisors. These play a pivotal role in smile designing. The present review also explains various clinical studies which compared different methods under varied clinical instances and gave proper application of each proportion proposed. The present review also explains the upper smile line and the lower smile line in the smile design to obtain a more esthetically pleasing smile. Conclusion: The method used for determining the adequate method of proportion varies among different individuals based on the clinical aspects. The smile line is an important factor to be considered that comprises a natural esthetic smile.