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      Relationship between perception of smile esthetics and orthodontic treatment in Spanish patients

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          Abstract

          One of the main objectives of orthodontic treatment is to achieve an esthetic smile. This study set out to analyze differences in the perception of smile esthetics among patients before and after receiving orthodontic treatment. 250 Spanish patients analyzed a single photograph in which, by means of computer software, midline diastema, black triangle, gingival margin of the left central incisor, and gingival (“gummy”) smile were altered. Each patient analyzed these images before and after undergoing orthodontic treatment. Patients scored the photographs on a scale from 1 to 10. Statistical analyses of each group’s level of perception were carried out, identifying significant differences in evaluations before and after treatment, and in relation to subjects’ gender and age. Patients presented significant differences in the esthetic perception of midline diastema and gummy smile anomalies after they had completed orthodontic treatment. Gender influenced the perception of smile esthetics, whereby women were significantly more critical of midline diastema, black triangle and gingival margin of the upper central incisor than men. The age variable also showed significant differences in the perception of midline diastema and black triangle anomalies. The perception of smile esthetics of some dental anomalies changes as a result of orthodontic treatment. Gender influences the perception of some of the dental anomalies studied.

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          Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations.

          Previous studies evaluated the perception of laypersons to symmetric alteration of anterior dental esthetics. However, no studies have evaluated the perception of asymmetric esthetic alterations. This investigation will determine whether asymmetric and symmetric anterior dental discrepancies are detectable by dental professionals and laypersons. Seven images of women's smiles were intentionally altered with a software-imaging program. The alterations involved crown length, crown width, midline diastema, papilla height, and gingiva-to-lip relationship of the maxillary anterior teeth. These altered images were rated by groups of general dentists, orthodontists, and laypersons using a visual analog scale. Statistical analysis of the responses resulted in the establishment of threshold levels of attractiveness for each group. Orthodontists were more critical than dentists and laypeople when evaluating asymmetric crown length discrepancies. All 3 groups could identify a unilateral crown width discrepancy of 2.0 mm. A small midline diastema was not rated as unattractive by any group. Unilateral reduction of papillary height was generally rated less attractive than bilateral alteration. Orthodontists and laypeople rated a 3-mm distance from gingiva to lip as unattractive. Asymmetric alterations make teeth more unattractive to not only dental professionals but also the lay public.
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            Comparing the perception of dentists and lay people to altered dental esthetics.

            This study was designed to determine the perceptions of lay people and dental professionals with respect to minor variations in anterior tooth size and alignment and their relation to the surrounding soft tissues. Smiling photographs were intentionally altered with one of eight common anterior esthetic discrepancies in varying degrees of deviation, including variations in crown length, crown width, incisor crown angulation, midline, open gingival embrasure, gingival margin, incisal plane, and gingiva-to-lip distance. Forty images were randomized in a questionnaire and rated according to attractiveness by three groups: orthodontists, general dentists, and lay people; 300 questionnaires were distributed. The response rate was 88.2% for orthodontists, 51.8% for general dentists, and 60.6% for lay people. The results demonstrated threshold levels of noticeable difference between the varying levels of discrepancy. A maxillary midline deviation of 4 mm was necessary before orthodontists rated it significantly less esthetic than the others. However, general dentists and lay people were unable to detect even a 4-mm midline deviation. All three groups were able to distinguish a 2-mm discrepancy in incisor crown angulation. An incisal plane cant of 1 mm as well as a 3-mm narrowing in maxillary lateral incisor crown width were required by orthodontists and general dentists to be rated significantly less esthetic. Lay people were unable to detect an incisal plane asymmetry until it was 3 mm, or a lateral incisor narrowing until it reached 4 mm. Threshold levels for open gingival embrasure and gingiva-to-lip distance were both at 2 mm for the orthodontic group. Open gingival embrasure became detectable by the general dentists and lay people at 3 mm, whereas gingiva-to-lip distance was classified by these groups as noticeably unattractive at 4 mm. The results of this study show that orthodontists, general dentists, and lay people detect specific dental esthetic discrepancies at varying levels of deviation, which may aid the dental professional in making specific treatment recommendations.
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              Perceptions of Jordanian laypersons and dental professionals to altered smile aesthetics.

              The purposes of this study were to rate the attractiveness of different smile variables, to compare the perception of Jordanian laypeople, general practitioners, and orthodontists to altered smile aesthetics, and to identify the threshold where different variables begin to impair smile aesthetics. A smiling photograph of a female dental student was selected and digitally manipulated to create changes in buccal corridor space (BCS), the amount of gingival display, and the midline diastema. These altered images were rated by three groups of Jordanians: 200 laypeople (100 females and 100 males), 200 general practitioners (100 females and 100 males), and 160 orthodontists (40 females and 120 males). Smile aesthetics scores were calculated and comparisons between groups were performed using the univariate general linear model. The results showed that profession and gender affected BCS and midline diastema attractiveness ratings (P<0.001). Wide BCSs, a gingival display of more than 2 mm, and the presence of a midline diastema of any size were rated as unattractive by all groups.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: Investigation
                Role: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 August 2018
                2018
                : 13
                : 8
                : e0201102
                Affiliations
                [1 ] Department of Orthodontics, Faculty of Dentistry, University European of Valencia, Valencia, Spain
                [2 ] Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
                [3 ] Department of Orthodontics, Faculty of Dentistry, Cardenal Herrera University (UCH-CEU), Valencia, Spain
                Kwangwoon University, REPUBLIC OF KOREA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-8144-5439
                Article
                PONE-D-18-10804
                10.1371/journal.pone.0201102
                6089430
                30102694
                77ba0744-f406-434c-b3b3-17b5fc3db31c
                © 2018 Bolas-Colvee et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 April 2018
                : 9 July 2018
                Page count
                Figures: 8, Tables: 2, Pages: 12
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Oral Medicine
                Orthodontics
                Biology and Life Sciences
                Psychology
                Attitudes (Psychology)
                Social Sciences
                Psychology
                Attitudes (Psychology)
                Biology and Life Sciences
                Anatomy
                Digestive System
                Teeth
                Incisors
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Teeth
                Incisors
                Biology and Life Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Incisors
                Medicine and Health Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Incisors
                People and Places
                Population Groupings
                Age Groups
                People and Places
                Population Groupings
                Ethnicities
                European People
                Spanish People
                People and Places
                Population Groupings
                Ethnicities
                Hispanic People
                Spanish People
                Medicine and Health Sciences
                Oral Medicine
                Dentistry
                Research and Analysis Methods
                Research Assessment
                Reproducibility
                Computer and Information Sciences
                Computer Software
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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