Objective: To investigate whether there is any difference in the perception of altered smile esthetics among dentist, students and layperson. Study Design: Comparative cross sectional study. Place and Duration of Study: Armed Forces Institutes of Dentistry Rawalpindi, from Jan to Jun 2019. Methodology: A total of 120 individuals were selected among which 40 were dentists, 40 were students and 40 lay persons to evaluate smile on given questioner. An individual was photographed in frontal posed smile using a digital camera at natural head position. The photograph was digitally manipulated with minor changes and only desired area of face was framed using Adobe Photoshop CC 2018 software to generate a control and ideal smile. Series of photographs were generated by doing modifications to evaluate five variables including Smile arc, Gingival display, Buccal corridor, Midline shift and Midline diastema. The each group was also asked to rate attractiveness each picture on 5 points Visual Analog Scale (VAS) from 1- Most attractive to 5- Least attractive. Results: The p-value was for midline diastema and midline shift was <0.01. Most of the study population was females 75 (62.5%) and the mean age of participants was 27.51 ± 5.42. Significant difference was observed at VAS in flat smile arc, nil buccal corridor, mid-line shift and midline diastema by study groups. Conclusion: Perception of midline diastema and midline shift differs significantly among dentists, students and lay persons.
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