# Perception of Altered Smile Esthetics by Orthodontists, General Dentists, and Laypeople: -

## TL;DR

This study compares how orthodontists, dentists, and laypeople rate the attractiveness of altered smiles, focusing on factors like gingival margin position, golden ratio, and smile arc.

## Contribution

The study introduces a novel comparison of esthetic perception across three distinct groups using systematically altered smile images.

## Key findings

- Equal gingival margins for central and lateral incisors were rated most attractive.
- Wider golden ratios (80%) were consistently preferred across all groups.
- Laypeople favored flat and reverse smile arcs more than dental professionals.

## Abstract

Considering the significance of creation of a consonant smile arc and gap of
information on the role of smile arc, gingival margin position, and the
golden ratio in smile esthetics, this study assessed the perception of
laypeople, general dentists, and orthodontists from altered smile esthetics.

This descriptive study was conducted in 2019 with three rater groups:
orthodontists (n=31), general dentists (n=49), and laypeople (n=61). A
standardized frontal-view smile photograph of a female subject was digitally
altered using Photoshop (version 19) to create images differing in (a)
gingival margin position (four variations), (b) golden ratio (62%, 70%, and
80%), and (c) smile arc curvature (five variations). Raters, blinded to the
alterations, evaluated each image’s attractiveness using a 10-point Likert
scale. Due to non-normal data distribution, Kruskal–Wallis, Mann–Whitney,
and Friedman tests were used for analysis (α=0.05).

The highest overall attractiveness ratings were given to the image with equal
gingival margins for central and lateral incisors (M=7.16 ± 2.04), followed
by the lateral margins 1 mm below the centrals (M=7.04 ± 2.01). Wider golden
ratios (80%) were rated more attractive across all groups. Laypeople rated
flat and reverse smile arcs significantly higher than general dentists and
orthodontists (P.05). No significant gender-based differences were observed
in any category.

The three rater groups had the same opinion regarding the smile
attractiveness of most altered images except for the reverse smile arc,
which was only favored by the laypeople.