Perception of the esthetic impact of mandibular incisor extraction treatment on laypersons, dental professionals, and dental students

Abstract

Objective: To evaluate the degree of perception of laypersons, dental professionals, and dental students regarding dental esthetics in cases with mandibular central incisor extraction.

Materials and methods: Using a smile photograph of a person with normal occlusion and all teeth, modifications were made to reflect the extraction of a mandibular incisor of various compositions and sizes. For this purpose a program specifically for image manipulation (Adobe Photoshop CS3, Adobe Systems Inc) was used. After manipulation the images were printed on photographic paper, attached to a questionnaire and distributed to laypersons, dental professionals, and dental students (n = 90) to evaluate the degree of perception and esthetic using a scale of attractiveness, where 0 = hardly attractive, 5 = attractive, and 10 = very attractive. The differences between examiners were checked by the Mann-Whitney test. All the statistics were performed with a confidence level of 95%.

Results: The results demonstrated the skill of the dental professionals and dental students in perceiving the difference between cases of normal occlusion and cases where an incisor was lacking (P < .05). The photograph in which the lateral incisors were shown to be larger than the central incisor was the one that obtained the highest value among the cases of extraction in all groups of evaluators.

Conclusions: It can be concluded that dental professionals and dental students are more skillful at identifying deviation from normality. In addition, central incisor extraction should always be discarded when there are other treatment options available.

Figure 1

Modified images evaluated - Images 1 (A) With a four incisors. (B) Without any alteration as regards the width of the three remaining incisors. (C) With increase in the three mandibular incisors with the same proportion. (D) With a mesiodistal increase in the central incisor and no alteration in the lateral incisors. (E) Image with a mesiodistal increase in the lateral incisors and the central without any alteration; Images 2 (E) Image with a mesiodistal increase in the lateral incisors and the central without any alteration; (D) With a mesiodistal increase in the central incisor and no alteration in the lateral incisors; (C) With increase in the three mandibular incisors with the same proportion; (B) Without any alteration as regards the width of the three remaining incisors; (A) With four incisors.