Perceptions of Altered Smile Esthetics: A Comparative Evaluation in Orthodontists, Dentists, and Laypersons

Abstract

Objective. The current investigation was proposed to determine the impression of trained dental professionals and laypeople towards the modified smile esthetics. Materials and Methods. Twenty-six images were randomized in a survey and graded according to attractiveness by the orthodontists, general dentists, and laypeople. Photographs of gingival display, midline diastema, central incisor crown length, and lateral incisor crown width were manipulated with five minor changes in each. For smile arc and buccal corridor, two major changes were incorporated besides the ideal photograph. One-way ANOVA and Post Hoc analysis of the responses were measured for each group. Results. Most evaluators opined that the ideal smile in each category was the most acceptable. Orthodontists were more perceptive and exacting in accepting variations in the smile arc and buccal corridors. Dental professionals and laypeople indicated that either complete absence or a 0.5 mm of alterations in a gingival display, midline diastema, and crown length makes a smile beautiful and pleasant. Changes in crown width were not perceivable by all the three groups. Conclusion. Eastern Arabic laymen are more conscious about alterations in gingival display, midline diastema, and crown length in their smile. Hence, the orthodontist should pay attention to these factors during any orthodontic treatment.

Figure 1

Illustration of alterations in the smile arc. (a) The smile arc is flat with a large gingival display in the posterior region compared to that in the anterior region, where the teeth arrangement aligns with the curvature of the lower lip. (b) An ideal smile arc that is parallel to the curvature of the lower lip. (c) Excessive smile arc causing the lower teeth to be displayed.

Figure 2

Representative photographs illustrating changes in buccal corridor. (a) Presence of excessive buccal corridors (dark corners) are increased in this image. (b) Control smile with ideal buccal corridors. (c) Broad smile with no buccal corridors (Hollywood smile).

Figure 3

Photographs elucidating gingival display on the smile. Gummy smile images were obtained by an incremental raise in the gingiva-lip relationship. (a) Control, (b) 1 mm, (c) 2 mm, (d) 3 mm, and (e) 4 mm.

Figure 4

Photographs demonstrating modifications of a midline diastema. The alterations were done by an increment of 0.5 mm. (a) No alteration (control), (b) 0.5 mm midline diastema, (c) 1 mm diastema, (d) 1.5 mm diastema, and (e) 2 mm diastema.

Figure 5

Photographs showing changes to the crown length of the maxillary left central incisors. Shortening of crown length was achieved by reducing the gingival margin height by 0.5 mm increments. (a) Control, (b) 0.5 mm, (c) 1.0 mm, (d) 1.5 mm, and (e) 2.0 mm.

Figure 6

Photographs displaying alterations to maxillary lateral incisors crown width. Gingival margin maintained the same level, but the width of the maxillary right lateral incisors crown was decreased by an increment of 1 mm. (a) Control, (b) 1 mm, (c) 2 mm, (d) 3 mm, and (e) 4 mm, decrease in the width of the maxillary lateral incisors.

Figure 7

Bar graph representing the smile arc assessment by orthodontists, dentists, and laypersons.

Figure 8

Bar graphs demonstrating the evaluation of the buccal corridor as a smile influencer among orthodontists, dentists, and laypersons.

Figure 9

(a) Line graph representing attractiveness of gummy smile as perceived by orthodontists, dentists, and laypersons as their first choice. (b) Line graph representing attractiveness of gummy smile as perceived by orthodontists, dentists, and laypersons as their second choice.

Figure 10

(a) Line graph illustrating acceptance of midline diastema on an attractive smile as first acceptable choice. (b) Line graph representing acceptance of midline diastema on an attractive smile as second choice.

Figure 11

(a) Line graph representing crown length discrepancy by study population as first acceptable choice. (b) Line graph representing crown length discrepancy by study population as second acceptable choice.

Figure 12

(a) Line graph representing crown width discrepancy by study population as first acceptable choice. (b) Line graph representing crown width discrepancy by study population as second acceptable choice.