21 January 2022

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Smile microesthetics as perceived by dental professionals and laypersons

Davide Elsido

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Smile esthetics can be divided into macroesthetics (the relationships of teeth to each other, to soft tissues, and to facial characteristics), miniesthetics (the correlation of lips, teeth, and gingiva), and microesthetics (fine structures of dental and gingival esthetics). These factors determine the final attractiveness of the orthodontically finished smile. The esthetics of the smile has an important influence on the perception of an individual’s appearance and personality. Smile esthetics demand a balance between factors related to both teeth and the gingiva. Positioning of teeth in the confines of the gingival architecture has a tremendous impact on smile esthetics. Gingival factors include shape, contour, level, and symmetry of the gingival margins and zeniths, the color and health of the gingiva, and position of the interdental papilla, among others. The assessment of perceived smile esthetics is of utmost importance as it helps in the planning of treatment and determines what is most likely to be considered as good appearance. An interdisciplinary approach is usually required to improve gingival esthetics, which involves cooperation between an orthodontist, periodontist, and prosthodontist. 

Many studies have investigated the perceptions of laypersons and dental professions to altered dental characteristics; however, only a few have investigated the impact of altered gingival factors on smile attractiveness. A recent article published in the Angle Orthodontist investigated this aspect. 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.

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. 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.