Smile microesthetics as perceived by dental professionals and laypersons

Abstract

Objectives: To evaluate and compare the perception of different dental professionals and laypersons toward altered gingival characteristics (microesthetics) and to identify those characteristics that are most negatively and positively rated.

Materials and methods: A smiling photograph of a female dental student was selected and digitally manipulated to create changes in different microesthetic parameters. These altered images were rated by the following five groups: 120 orthodontists, 45 periodontists, 49 prosthodontists, 130 general dentists, and 172 laypersons. Smile esthetics scores were calculated, and comparisons between groups were performed using the univariate general linear model.

Results: The presence of black triangles between the upper incisors was the most negatively rated, and the ideal smile was the most positively rated. Significant differences were detected in the rating scores among the different study groups (P < .05). Orthodontists, prosthodontists, and general dentists scored the presence of a black triangle in the smile as the least attractive, whereas periodontists and laypersons perceived the inflamed gingiva and pigmented gingiva as the least attractive, respectively. Dental specialists tended to give the altered smile images lower scores than the laypersons.

Conclusions: The ideal smile and that with black triangles between the upper incisors were rated as the most and the least attractive smiles, respectively. Orthodontists, prosthodontists, and general dentists scored the presence of black triangles in the smile as the least attractive, whereas periodontists and laypersons perceived the inflamed gingiva and pigmented gingiva as the least attractive smiles, respectively. Dental specialists tended to give the altered smile images lower scores than the laypersons.

Keywords: Microesthetics; Perception.

Figure 1.

Control smile photograph.

Figure 2.

Discrepancies in the position of the free gingival margin of upper anterior teeth. (a) Gingival margin of the central incisors is 1.5 mm below that of the lateral incisors. (b) Gingival margin of the lateral incisors is 1.5 mm below its normal position. (c) Gingival margin of the canines is 1.5 mm below its normal position. (d) Gingival margins of the upper central incisors and canines are 1.5 mm below their normal positions (their crowns are 1.5 mm shorter than the control photograph). (e) Asymmetric gingival margins between upper right and left central incisors (0.5 mm).

Figure 3.

Variations in the color and health of the gingiva: (a) normal gingival color, (b) slightly red gingival color, (c) racial pigmentation, (d) inflamed gingiva and interdental papillae.

Figure 4.

Presence of black triangles between the anterior teeth: (a) 2-mm black triangle between the central incisors and (b) 2-mm black triangle between the central incisors and 1-mm black triangle between central and lateral incisors on both sides.

Figure 5.

Gingival zenith is located 1-mm mesial to the midline of central incisors.

Figure 6.

Variations in cant of the occlusal plane: (a) 5-degree occlusal plane cant (mild) and (b) 10-degree occlusal plane cant (severe).