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| Year : 2012 | Volume
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| Issue : 2 | Page : 295 |
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| Perception of smile esthetics among Indian dental professionals and laypersons |
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Santosh Kumar, Sumit Gandhi, Ashima Valiathan
Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
Click here for correspondence address and email
| Date of Submission | 28-Jun-2011 |
| Date of Decision | 28-Jul-2011 |
| Date of Acceptance | 08-Feb-2012 |
| Date of Web Publication | 3-Sep-2012 |
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 Abstract | | |
Introduction : Patients' perceptions and expectations regarding their appearance play a significant role in treatment planning. The purpose of this study was to compare the perceptions of orthodontists, general dentists, and laypersons regarding smile esthetics after symmetrical and asymmetrical alterations in anterior teeth and their supporting tissues.
Materials and Methods: Alterations were made in the crown length, crown width, midline diastema, and gingiva-to-lip relationship of the maxillary anterior teeth in the close-up photograph of a woman's smile. The attractiveness of the smile in the original image and in each of the modified images were assessed by orthodontists (n=40), dentists (n=40), and laypersons (n=40) and scored using a visual analog scale (VAS). The mean VAS scores were calculated for each photograph. ANOVA was used for comparisons between photographs and between groups. To determine threshold levels at which each group discriminated between esthetic and less esthetic dental features were determined by one-way ANOVA (F-test) followed by Newman-Keul's range test.
Results : Orthodontists were found to be more critical when evaluating smile images compared to general dentists and laypersons. Symmetrical or asymmetrical alterations in the mesio-distal width of the lateral incisor of up to 2 mm was not perceived as unesthetic by general dentists and laypersons.
Conclusion: Laypersons are more accepting of minor variations in anterior tooth size and alignment than orthodontists. Keywords: Esthetics, perception, smile
How to cite this article:
Kumar S, Gandhi S, Valiathan A. Perception of smile esthetics among Indian dental professionals and laypersons. Indian J Dent Res 2012;23:295 |
How to cite this URL:
Kumar S, Gandhi S, Valiathan A. Perception of smile esthetics among Indian dental professionals and laypersons. Indian J Dent Res [serial online] 2012 [cited 2023 Mar 22];23:295. Available from: https://www.ijdr.in/text.asp?2012/23/2/295/100456 |
Physical attractiveness is an important social issue in our culture and the face is one of its key features. [1] Facial attractiveness and smile attractiveness appear to be strongly connected to each other. The fact is that in social interactions attention is mainly directed towards the mouth and eyes of the speaker's face. The mouth is the center of communication in the face, and the smile plays an important role in facial expression and appearance. [2] Sabri [3] has described eight components of the balanced smile. An esthetically pleasing smile is not only dependent on components such as tooth position, size, shape, and color, but also on the amount of gingival display and the framing of the lips. [4] All of these components should form a harmonic and symmetric entity.
Esthetic perception varies from person to person and is influenced by each person's personal experience and social environment. Miller [5] stated that the trained and observant eye readily detects asymmetry or what is out of balance and out of harmony with its environment. For this reason, professional opinions regarding facial esthetics may not coincide with the perceptions and expectations of patients or laypeople. [6]
Several studies confirm that dentists and laypersons judge facial esthetics differently. [7],[8],[9] Dental professionals have been sensitized to observe and evaluate features that do not seem to influence the general public. One of the factors influencing the observer's perception is the symmetry of the smile. An earlier study found that the symmetry of the smile was positively associated with a 'good smile;' asymmetric smiles were not given high smile scores. [10] An asymmetric smile can be due to various factors, e.g., difference in tooth size, tooth shape (a central or lateral incisor that is shorter or narrower than the contralateral tooth), unequal papillary height, etc. [11]
Individuals within a given culture or society embrace common definitions for facial and physical attractiveness. [12] It is also true that standards of beauty change over time and across cultures. The various cultures of the world, past and present, may differ widely in their standards of beauty. [13] There may be unique cultural preferences that identify the attractive smile, and perception of smile esthetics may vary in different populations. To the best of our knowledge, to date, only one study (by Krishnan et al. [14] ) has been published that evaluates perception of smile esthetics in the Indian population.
The purpose of this study was to evaluate the differences in the perception of smile esthetics by orthodontists, general dentists, and laypersons of Indian origin and also to test the hypothesis that asymmetric alterations in the smile are perceived as less attractive than symmetric alterations.
| Materials and Methods | |  |
The study included three groups of evaluators: Orthodontists (n=40), general dentists (n=40), and laypersons (n=40). Each group had equal number of male and female participants (20 males and 20 females). Laypersons were selected from among the patients visiting the OPD of our dental college hospital. This group consisted of people working in different professions unrelated to dentistry. The mean age of the orthodontists was 29.4 years, the mean age of the general dentists was 27.2 years, and the mean age of the laypersons was 31.3 years.
We first selected a photograph of an ideal Indian female smile. The smile image was modified in different ways using Adobe® Photoshop® (V7, Adobe Systems, San Jose, CA, USA). First, the nose and chin were digitally eliminated to remove any bias due to these facial features. The close-up of the lips and teeth was modified in five ways (two symmetrical and three asymmetrical), as described in the text below. These modifications were chosen based on their relatively high frequency in the population and their clinical significance to the smile.
Alteration group 1: Midline diastema [Figure 1], [Figure 2], [Figure 3], [Figure 4] and [Figure 5]
A midline diastema was created incrementally between the maxillary central incisors. It was widened progressively in 0.5-mm increments. The measurements were made at the interproximal contact points between the central incisor crowns. | Figure 2: Diastema (group 1): Progressive increase in diastema in increments of 0.5 mm
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 | Figure 3: Diastema (group 1): Progressive increase in diastema in increments of 0.5 mm
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 | Figure 4: Diastema (group 1): Progressive increase in diastema in increments of 0.5 mm
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 | Figure 5: Diastema (group 1): Progressive increase in diastema in increments of 0.5 mm
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Alteration group 2: Gingival exposure [Figure 6], [Figure 7], [Figure 8], [Figure 9] and [Figure 10]
Gingival exposure was altered to produce a 'gummy smile' by progressively moving the upper lip in 1-mm increments. The labial gingival margins of the maxillary central incisors were used as reference points for these measurements. | Figure 7: Gingiva-lip distance (group 2): Progressive increase in gingiva-lip distance in increments of 1 mm
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 | Figure 8: Gingiva-lip distance (group 2): Progressive increase in gingiva-lip distance in increments of 1 mm
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 | Figure 9: Gingiva-lip distance (group 2): Progressive increase in gingiva-lip distance in increments of 1 mm
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 | Figure 10: Gingiva-lip distance (group 2): Progressive increase in gingiva-lip distance in increments of 1 mm
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Alteration group 3: Asymmetrical crown length [Figure 11], [Figure 12], [Figure 13], [Figure 14] and [Figure 15]
The crown length of the maxillary left central incisor was altered by adjusting the level of the gingival margin, thereby shortening the length of the crown, in 0.5-mm increments. The reference point used for these measurements was the most superior point on the labial gingival margin of the patient's adjacent central incisor. The most common variation in incisor crown width is usually associated with the size of the maxillary lateral incisors; hence the alterations of crown width were made to the maxillary lateral incisor. | Figure 12: Crown length shortened (group 3): Progressive decrease in crown length in increments of 0.5 mm
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 | Figures 13: Crown length shortened (group 3): Progressive decrease in crown length in increments of 0.5 mm
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 | Figure 14: Crown length shortened (group 3): Progressive decrease in crown length in increments of 0.5 mm
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 | Figure 15: Crown length shortened (group 3): Progressive decrease in crown length in increments of 0.5 mm
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Crown width was altered in two ways:
Alteration group 4: Symmetrical width of the lateral incisors [Figure 16], [Figure 17], [Figure 18], [Figure 19] and [Figure 20]
Both maxillary lateral incisors were reduced in 0.5-mm increments. | Figure 17: Bilateral crown width reduction (group 4): Progressive decrease in crown width (symmetric alteration) in increments of 0.5 mm
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 | Figure 18: Bilateral crown width reduction (group 4): Progressive decrease in crown width (symmetric alteration) in increments of 0.5 mm
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 | Figure 19: Bilateral crown width reduction (group 4): Progressive decrease in crown width (symmetric alteration) in increments of 0.5 mm
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 | Figure 20: Bilateral crown width reduction (group 4): Progressive decrease in crown width (symmetric alteration) in increments of 0.5 mm
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Alteration group 5: Asymmetrical width of a lateral incisor [Figure 21], [Figure 22], [Figure 23], [Figure 24] and [Figure 25]
The right maxillary lateral incisor crown width was decreased progressively in increments of 0.5 mm. | Figure 22: Unilateral crown width reduction (group 5): Progressive decrease in crown width (asymmetric alteration) in increments of 0.5 mm
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 | Figure 23: Unilateral crown width reduction (group 5): Progressive decrease in crown width (asymmetric alteration) in increments of 0.5 mm
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 | Figure 24: Unilateral crown width reduction (group 5): Progressive decrease in crown width (asymmetric alteration) in increments of 0.5 mm
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 | Figure 25: Unilateral crown width reduction (group 5): Progressive decrease in crown width (asymmetric alteration) in increments of 0.5 mm
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There were a total of 25 images in the study. All the 25 images were developed into 3.5 × 5-inch prints and then arranged randomly in a photo album that different variables were presented on every page of the photo album. Each photograph was assigned a code (e.g., midline diastema was assigned code 'X'), which was written beneath the photograph).
Questionnaires were provided to the evaluators. The attractiveness of the smile in the original image and in each of the modified images was assessed by the three groups and scored using a 10-point visual analog scale (VAS) with '0' indicating the least attractive smile and '10' the most attractive smile. Evaluators were also asked their opinion on which component (lip, teeth, gingiva, or all) of the smile were given consideration when assessing smile's attractiveness. To test the reproducibility of the test, 20 evaluators selected randomly in each group were asked to rate the photographs again after a 2-week interval.
Analysis of data
The paired t-test was used to determine the reproducibility of the test results. The mean VAS scores were calculated for each photograph in the three groups.
ANOVA was used to assess how the evaluator groups rated each level of alterations done in the photographs.
The threshold levels of significant difference at which each group discriminated between aesthetic and less aesthetic dental features were determined by one-way ANOVA (F-test) followed by the Newman-Keul's range test. P<.05 was considered statistically significant.
| Results | | |
There was no significant difference in the ratings of males and females in each group; hence an overall rating for each evaluator group regarding each alteration was obtained. The repeat evaluation after 2 weeks showed that there was good reproducibilty of the results. The VAS score for alteration groups 1-5 given by orthodontists, dentists, and laypersons are shown in [Table 1], [Table 2], [Table 3], [Table 4] and [Table 5]. The results suggest that orthodontists were more critical than dentists and laypersons when evaluating smile esthetics. | Table 1: Mean visual analog scores for altered images in alteration group 1
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 | Table 2: Mean visual analog scores for altered images in alteration group 2
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 | Table 3: Mean visual analogue scores for altered images in alteration group 3
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 | Table 4: Mean visual analog scores for altered images in alteration group 4
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 | Table 5: Mean visual analog scores for altered images in alteration group 5
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The threshold levels at which each group could distinguish between esthetic and less esthetic dental features are shown in [Table 6]. | Table 6: Threshold levels of significance difference (mm) for altered images
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All three groups of evaluators found diastema to be unesthetic at a threshold level of 1.5 mm. For gingival-lip exposure orthodontists were tolerant of up to 2 mm of gingival exposure before rating it as unattractive. On the other hand, laypersons and general dentists' ratings did not show any significant differences for all the four alterations in gingival-lip distance, suggesting that they are more tolerant of a 'gummy'smile.' Unilateral crown length shortening of greater than 1.5 mm than contralateral tooth was perceived as unesthetic equally by all three groups of raters.
Symmetrical alterations in mesio-distal width of the lateral incisor of up to 2.0 mm was not perceived as unesthetic by the orthodontists. Asymmetrical alterations in the mesio-distal width of the lateral incisor showed a lower threshold level (1.5 mm) compared to symmetrical alterations (2.0 mm).
General dentists and laypersons showed no differences in the threshold level for the symmetrical and asymmetrical alterations in crown width. In other words, both these groups of raters were not able to detect the alterations produced in the crown width of the maxillary lateral incisor of up to 2 mm.
| Discussion | | |
In the present study, four components of the balanced smile - crown height, crown width, gingiva-lip ratio, and tooth alignment (diastema) - were altered to observe how these changes affected smile esthetics in the perception of orthodontists, dentists, and laypersons. These alterations were chosen based on the frequency and more easily perceived by the people. [10]
Scott et al. [15] have shown that variations in the vermillion heights of the upper and lower lips have highly significant influences on the perception of attractiveness. To minimize these possible confounding influences, the current study used the approach of generating different alterations in the same smile image, unlike in Kokich et al.'s study [10] where photographs of seven different smiling women were used to rate seven esthetic discrepancies. The present study also assessed the relative influence of different smile components (lip, gingiva, and teeth) on the three groups of evaluators while judging smile images. The results showed that all these components were given equal importance while assessing the smile photographs.
Three groups of evaluators, orthodontists, dentists, and laypersons, were used in the present study. Both sexes were equally represented in all three groups, and the mean ages of the evaluators in the three groups were not significantly different. There was no statistically significant difference in the mean scores given by male and female subjects within a group and hence their mean scores were clubbed and an overall mean score was obtained for each group. This is in contrast with the findings of Geron and Wasserstein [16] where the females were found to be more tolerant of upper gingival exposure. This difference in the results between the two studies may probably be attributable to variations in esthetic perceptions in different populations.
In this study, the threshold for unattractiveness for midline diastema was found to be less in orthodontists and dentists compared to laypersons. Orthodontists and dentists rated the diastema unattractive when it was 1-1.5 mm wide, whereas for laypersons the threshold was found to be 1.5-2 mm. Thus, from the results of present study, it appears that diastema may not be objectionable if it is less than 1 mm. These results are in agreement with the findings of Kokich et al. [10] In adults, tooth-size discrepancies and excessive vertical overlap of the incisors are the most common factors in the development of diastemas. [17] Midline diastema is also seen in orthodontic patients who may experience some relapse or space reopening after the orthodontic appliances is removed. Possible therapeutic approaches include restorative orthodontics, prosthodontics, surgery, and various combinations of the above. [17] Treatment is mainly for esthetic and psychological reasons, rather than functional ones. When we improve anterior dental esthetics either orthodontically or restoratively, we probably unnecessarily sensitize our patients and make them more aware of minor esthetic problems. [10] The results of this study show that laypeople accept a wider range of deviation as compared to dentists; dentists, therefore, must be careful that they do not impose their own beauty norms upon patients.
Alteration in gingival-to-lip distance was done to determine when a 'gummy smile' becomes unattractive. Our results showed that orthodontists rated 2 mm of gingival exposure as unattractive, whereas general dentists and laypersons did not show any threshold for unattractiveness. These results suggest that orthodontists have been conditioned to see a 'gummy smile' as undesirable, although some gingival display is certainly acceptable to most people and even considered by some as giving a youthful appearance. [18],[19] It is noteworthy that some marginal gingival display is not as objectionable to laypeople as orthodontists may imagine. [20]
With aging, less of the maxillary anterior teeth show and with loss of tonicity in the facial muscles, the lip will move less. So, as the people get older, they show less gingiva on smiling. The amount of gingival display on smiling that is acceptable esthetically can vary widely; therefore, treatment of this esthetic issue should be performed judiciously. In broad terms, it is better to treat a 'gummy smile' less aggressively, because aging will naturally diminish this characteristic. A 'gummy smile' is often considered more esthetic than a smile with less tooth display. [21]
A crown length shortening of more than 1.5 mm was perceived as unattractive equally by all the three groups. Recent investigations have found that laypeople did not detect asymmetric crown length unless one crown was 1.5-2.0 mm shorter than the other. [10],[22] This study results also corroborate that 1.5 mm is the limit of acceptability for this variable. Supra-eruption, crowding, trauma, and severe bruxism may produce vertical discrepancy of the anterior teeth, which can compromise the anterior dental esthetics. The different treatment modalities available for this condition jnclude crown lengthening, orthodontic extrusion or intrusion, and restoration of the shorter tooth. [23] When a patient has a unilateral discrepancy, the clinician should identify the cause so as to determine what treatment should be recommended. The present study results suggest that some therapeutic approaches to correct asymmetries of gingival margins of the maxillary central incisors of between 0.5 and 1.5 mm might reflect an exaggerated concern of the dental specialist rather than a real esthetic need. However, such procedures might be justifiable when fully discussed with the patient, because any treatment should respect the patient's self-image and wishes. An orthodontic treatment coupled with restorative procedures might give better esthetic results than restorative procedures alone or other esthetic dental procedures. [24],[25] An added advantage of orthodontic tooth movement is that the supporting tissues, bony structure, periodontal ligament, and soft-tissue components move along with the teeth, which minimizes the need of periodontal esthetic surgery later on.
In clinical situations, one frequently encounters patients with a tooth (central/lateral incisor) that is shorter or narrower than the contralateral one. To determine whether such an asymmetric alteration in crown size and shape is perceived as unaesthetic, one of the alterations we made in the original image was progressive reduction in the mesio-distal width of the lateral incisor. The threshold level of unattractiveness for symmetrical and asymmetrical alteration in the lateral incisor crown width was found to be 2.0 mm and 1.5 mm, respectively, for the orthodontists. General dentists and laypeople were unable to find any significant differences in asymmetric and symmetric crown discrepancy of the maxillary lateral incisors up to 2 mm. The orthodontists in the present study were more critical than the other two groups while judging symmetrical and asymmetrical crown width alteration and they also perceived asymmetric alterations as more unesthetic than symmetric alterations. Thus our hypothesis stands true for the orthodontists group but not for the dentists and laypersons groups.
Kokich et al. [10] have reported that asymmetric alterations make teeth more unattractive to not only dental professionals but also to the lay public. However, in the present study this was true of the perception of the orthodontists only. The alterations in crown width done in this study are smaller (2 mm) compared to that in the study by Kokich et al. [10] (4 mm). General dentists and laypersons may have been unable to appreciate small alterations in crown width of up to 2 mm, whether symmetrical or asymmetrical, unlike orthodontists who are trained and much more experienced in the evaluation of smiles.
Considering the above results, in patients with minor (up to 2 mm) discrepancies in the crown width, whether symmetric or asymmetric, restoration is probably not necessary and can be ignored during the treatment. If the difference is 2.0 mm or greater, the best choice is restoration of the malformed tooth to its correct dimension. If sufficient space exists, a composite restoration may be placed before orthodontic treatment. However, in most situations there is insufficient space to restore the malformed lateral incisor. Therefore, orthodontics is often necessary to create space to build up a peg-shaped lateral incisor. During the orthodontic movement, the peg lateral incisor should be positioned nearer the central incisor than the canine since the contour of the mesial surface of the lateral incisor is relatively flat and the distal surface more convex. This position should create the most optimal situation for resin build-up reconstruction, limiting the restorative procedure to one surface only. It will also allow the preservation of the optimal soft tissue papilla contour and maintenance of a flat emergence profile on the mesial surface that matches well with the adjacent incisors. [26]
This study reveals that experienced orthodontists are more sensitive to any alteration in smile esthetics than the lay public, a finding that is not in agreement with that of the study done on an Indian population by Krishnan et al. [14] This lack of concordance may be because of the differences in the group size and selection criteria. The results of this study give a general idea of the layperson's perception of smile esthetics (though applicable only to a female smile). The esthetic perception of a smile is very personal and varies according to the sensibility of each subject. [27] Thus, to get the best treatment results and maximize patient satisfaction, the ideal approach would be to customize treatment to meet each patient's individual perception of smile esthetics.
One limitation of this study is that it was carried out on participants of Indian origin only. Perception of smile esthetics may vary in different population groups. [28] Hence we recommend that a study comparing perceptions of smile esthetics among different population groups be undertaken to get a clearer picture.
| Conclusions | | |
- Orthodontists were found to be more critical than general dentists and laypersons when scoring altered dental esthetics.
- The perception of orthodontists differed from the perceptions of laypersons and dentists regarding symmetrical and asymmetrical alterations of crown width of maxillary lateral incisor. Thus, our proposed hypothesis is true for the orthodontists group but not for the dentists and laypersons groups.
Orthodontists must remember that a mild amount of alteration in dental esthetics is acceptable to the layperson, and the patient's own perception of smile esthetics must be given due importance before any treatment is contemplated.
| References | | |
| 1. | Flores-Mir C, Silva E, Barriga MI, Lagravere MO, Major PW. Layperson's perception of smile aesthetics and facial views. J Orthod 2004;31:204-9. 
[PUBMED] |
| 2. | Van der Geld P, Oosterveld P, Van Heck G, Kuijpers-Jagtman AM. Smile attractiveness. Self-perception and influence on personality. Angle Orthod 2007;77:759-65.
[PUBMED] |
| 3. | Sabri R. The eight components of a balanced smile. J Clin Orthod 2005;39:155-67.
[PUBMED] |
| 4. | Langolis J, Kalakanis L, Rubenstein A, Larson A, Hallam M, Smoot M. Maxims or myths of beauty? A meta-analytic and theoretical review. Psychol Bull 2000;126:390-423.
|
| 5. | Miller CJ. The smile line as a guide to anterior esthetics. Dent Clin North Am 1989;33:157-64.
[PUBMED] |
| 6. | Albino JE, Tedesco LA, Conny DJ. Patient perceptions of dental-facial esthetics: Shared concerns in orthodontics and prosthodontics. J Prosthet Dent 1984;52:9-13.
[PUBMED] |
| 7. | Pogrel MA. What are normal esthetic values? J Oral Maxillofac Surg 1991;49:963-9.
|
| 8. | Bell R, Kiyak HA, Joondeph DR, McNeill RW, Wallen TR. Perceptions of facial profile and their influence on the decision to undergo orthognathic surgery. Am J Orthod 1985;88:323-32.
[PUBMED] |
| 9. | Prahl-Andersen B, Boersma H, Van der Liden FP, Moore AW. Perceptions of dentofacial morphology by laypersons, general dentists, and orthodontists. J Am Dent Ass 1979;98:209-12.
|
| 10. | Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: Asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop 2006;130:141-51.
[PUBMED] |
| 11. | Gill DS, Naini FB, Tredwin CJ. Smile aesthetics. Dent Update 2007;34:152-8.
[PUBMED] |
| 12. | Ilffe AH. A study of preferences in feminine beauty. Br J Psychol 1960;51:267-73.
|
| 13. | Patnaik VV, Singla RK, Bala S. Anatomy of 'A beautiful face and smile'. J Anat Soc India 2003;52:74-80.
|
| 14. | Krishnan V, Daniel S, Lazar D, Asok A. Characterization of posed smile by using visual analog scale, smile arc, buccal corridor measures, and modified smile index. Am J Orthod Dentofacial Orthop 2008;133:515-23.
|
| 15. | Scott CR, Goonewardene MS, Murray K. Influence of lips on the perception of malocclusion. Am J Orthod Dentofacial Orthop 2006;130:152-62.
[PUBMED] |
| 16. | Geron S, Wasserstein A. Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. Angle orthod 2005;75:778-84.
|
| 17. | Huang WJ, Creath CJ. The midline diastema: A review of its etiology and treatment. Pediatr Dent 1995;17:171-9.
[PUBMED] |
| 18. | Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod 1992;62:91-100.
[PUBMED] |
| 19. | Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1999;11:311-24.
[PUBMED] |
| 20. | Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent 1978;39:502-4.
[PUBMED] |
| 21. | Sarver DM, Ackerman MB. Dynamic smile visualization and quantification: Part 1. Evolution of the concept and dynamic records for smile capture. Am J Orthod Dentofacial Orthop 2003;124:4-12.
[PUBMED] |
| 22. | Pinho S, Ciriaco C, Faber J, Lenza MA. Impact of dental asymmetries on the perception of smile esthetics. Am J Orthod Dentofacial Orthop 2007;132:748-53.
[PUBMED] |
| 23. | Garber DA, Salama MA. The aesthetic smile: Diagnosis and treatment. Periodontol 2000 1996;11:18-28.
|
| 24. | Chay SH, Rabie AB. Repositioning of the gingival margin by extrusion. Am J Orthod Dentofacial Orthop 2002;122:95-102.
[PUBMED] |
| 25. | Zachrisson BU. Repositioning of the gingival margin by extrusion and intrusion. World J Orthod 2003;4:72-7.
|
| 26. | Kokich V, Spear F. Guideline for managing the orthodontic-restorative patient. Seminar in Orthodontics 1997;3:3-20.
|
| 27. | Reis SA, Abrão J, Capezolla LF, Claro CA. Análise facial subjetiva. Rev Dental Press de Ortodon Ortop Facial 2006;11:1-21.
|
| 28. | Tedesco LA, Albino JE, Cunat JJ, Slakter MJ, Waltz KJ. A dental-facial attractiveness scale. Part II. Consistency of perception. Am J Orthod 1983;83:44-6.
|
Correspondence Address:
Santosh Kumar
Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.100456
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24], [Figure 25]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Figure 13] |
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| Belen Bolas-Colvee,Beatriz Tarazona,Vanessa Paredes-Gallardo,Santiago Arias-De Luxan,Nagendra Kumar Kaushik | | PLOS ONE. 2018; 13(8): e0201102 | | [Pubmed] | [DOI] | | | 12 |
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| Belen Bolas-Colvee,Beatriz Tarazona,Vanessa Paredes-Gallardo,Santiago Arias-De Luxan,Nagendra Kumar Kaushik | | PLOS ONE. 2018; 13(8): e0201102 | | [Pubmed] | [DOI] | | | 13 |
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| Lorena Marques Ferreira de Sena,Lislley Anne Lacerda Damasceno e Araújo,Arthur Costa Rodrigues Farias,Hallissa Simplício Gomes Pereira | | Dental Press Journal of Orthodontics. 2017; 22(2): 77 | | [Pubmed] | [DOI] | | | 14 |
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| Lorena Marques Ferreira de Sena,Lislley Anne Lacerda Damasceno e Araújo,Arthur Costa Rodrigues Farias,Hallissa Simplício Gomes Pereira | | Dental Press Journal of Orthodontics. 2017; 22(2): 77 | | [Pubmed] | [DOI] | | | 15 |
Perception of smile esthetics by laypeople of different ages |
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| Chompunuch Sriphadungporn,Niramol Chamnannidiadha | | Progress in Orthodontics. 2017; 18(1) | | [Pubmed] | [DOI] | | | 16 |
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| Chompunuch Sriphadungporn,Niramol Chamnannidiadha | | Progress in Orthodontics. 2017; 18(1) | | [Pubmed] | [DOI] | | | 17 |
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| Stefano Del Monte,Kelvin I. Afrashtehfar,Elham Emami,Samer Abi Nader,Faleh Tamimi | | The Journal of Prosthetic Dentistry. 2017; 118(6): 717 | | [Pubmed] | [DOI] | | | 18 |
Lay preferences for dentogingival esthetic parameters: A systematic review |
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| Stefano Del Monte,Kelvin I. Afrashtehfar,Elham Emami,Samer Abi Nader,Faleh Tamimi | | The Journal of Prosthetic Dentistry. 2017; 118(6): 717 | | [Pubmed] | [DOI] | | | 19 |
Perceptions of Altered Smile Esthetics: A Comparative Evaluation in Orthodontists, Dentists, and Laypersons |
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| Amjad Al Taki,Mohammed Khalesi,Muftah Shagmani,Islam Yahia,Fatma Al Kaddah | | International Journal of Dentistry. 2016; 2016: 1 | | [Pubmed] | [DOI] | | | 20 |
Perceptions of Altered Smile Esthetics: A Comparative Evaluation in Orthodontists, Dentists, and Laypersons |
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| Amjad Al Taki,Mohammed Khalesi,Muftah Shagmani,Islam Yahia,Fatma Al Kaddah | | International Journal of Dentistry. 2016; 2016: 1 | | [Pubmed] | [DOI] | | | 21 |
Laypeoplećs perceptions of frontal smile esthetics: A systematic review |
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| Simone Parrini,Gabriele Rossini,Tommaso Castroflorio,Arturo Fortini,Andrea Deregibus,Cesare Debernardi | | American Journal of Orthodontics and Dentofacial Orthopedics. 2016; 150(5): 740 | | [Pubmed] | [DOI] | | | 22 |
Laypeoplećs perceptions of frontal smile esthetics: A systematic review |
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| Simone Parrini,Gabriele Rossini,Tommaso Castroflorio,Arturo Fortini,Andrea Deregibus,Cesare Debernardi | | American Journal of Orthodontics and Dentofacial Orthopedics. 2016; 150(5): 740 | | [Pubmed] | [DOI] | | | 23 |
Orthodontists’ and laypeople’s perception of smile height aesthetics in relation to varying degrees of transverse cant of anterior teeth |
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| Huang Shiyan, Qian Xu, Xu Shuhao, Rao Nanquan, Li Xiaobing | | Australasian Orthodontic Journal. 2016; 32(1): 55 | | [Pubmed] | [DOI] | | | 24 |
Varying Perception of Smile Esthetics-A Deviation from the Norm: A Pictorial Questionnaire-based Survey |
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| Sneha Ketan Gada | | International Journal of Prosthodontics and Restorative Dentistry. 2015; 5(3): 68 | | [Pubmed] | [DOI] | | | 25 |
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Psychometric properties of the Albanian version of the Orofacial Esthetic Scale: OES-ALB |
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| Venera Bimbashi,Asja Celebic,Gloria Staka,Flurije Hoxha,Sanja Peršic,Nikola Petricevic | | BMC Oral Health. 2015; 15(1) | | [Pubmed] | [DOI] | | | 30 |
Psychometric properties of the Albanian version of the Orofacial Esthetic Scale: OES-ALB |
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perception of smile esthetics varies between patients and dental professionals when recession defects are present |
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| musskopf, m.l. and da rocha, j.m. and rösing, c.k. | | brazilian dental journal. 2013; 24(4): 385-390 | | [Pubmed] | | | 32 |
Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present |
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Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present |
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| Marta Liliana Musskopf,Jose Mariano da Rocha,Cassiano Kuchenbecker Rosing | | Brazilian Dental Journal. 2013; 24(4): 385 | | [Pubmed] | [DOI] | |
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