Effect of posterior gingival smile on the perception of smile esthetics

Abstract

Objectives: To evaluate and compare the influence of posterior gummy smile on the perception of smile esthetics by orthodontists, general-dentists and laypersons. Study Design: A frontal photograph of a smile with normal gum exposure was chosen and manipulated digitally using Adobe Photoshop C3 to generate three further images with posterior gum exposure of 4, 6 and 8mm. These four images were assessed by the three evaluator groups: orthodontists (n=40), general-dentists (n=40) and laypersons (n=40). Both orthodontists and dentists had at least ten years professional experience and laypersons were aged between 40-50 years. The proportion of men to women was 20:20 in each group. Evaluators awarded a score to the smile esthetics of each image: 1=acceptable, 2=moderately acceptable, 3=unacceptable. Afterwards, each evaluator placed the four images in order of esthetic preference. Results: No significant differences (p>0.05) were detected between the three evaluator groups for the photo without posterior gummy smile. The perception of smile esthetics for a the 4mm posterior gummy smile (median for orthodontists=2, general-dentists= 1, laypersons=1), the 6mm (median for orthodontists=2, general-dentists=1, laypersons=1) and the 8mm (median for orthodontists=3, general-dentists=2, laypersons=2) was significantly different between orthodontists and the other two evaluator groups (p<0.0017). The three evaluator groups coincided in placing the image with the 6mm gum exposure in first place in order of esthetic preference. Conclusions: Posterior gummy smile influences the perception of smile esthetics more negatively among orthodontists than the rest of the groups. Key words:Aesthetics, gummy smile back, orthodontists, dentists, laypersons.

Esthetics and smile‐related characteristics assessed by laypersons

“…A few studies have focused on the influence of posterior gingival display on smile attractiveness, with results similar to the present study . Rodriguez‐Martinez et al demonstrated that excessive posterior gingival display compromised smile attractiveness. Crawford et al reported a correlation between position of the posterior gingival margin and smile esthetics.…”

“…Another previous study, however, reported a contradictory finding of no correlation between anterior gingival display and smile esthetics . A few studies have focused on the influence of posterior gingival display on smile attractiveness, with results similar to the present study . Rodriguez‐Martinez et al demonstrated that excessive posterior gingival display compromised smile attractiveness.…”

“…18 A few studies have focused on the influence of posterior gingival display on smile attractiveness, with results similar to the present study. 28,36,37 Rodriguez-Martinez et al 36 Previous studies have analyzed the frequencies of different smile patterns of Rubin classification in general populations, 29,39,40 but no previous study has explored the preference of smile patterns as it relates to smile attractiveness. In this study, laypersons' esthetic preference of smile pattern was analyzed and results revealed that commissure smile is deemed attractive for males (P 5 .015), but not significantly so for females.…”

Determining the localization of premolar zenith positions according to the gingival line

“…Significant differences were found among the four teeth group (14,15,24,25) and the median value for all teeth tested was 1.32 mm. When comparing the FPM with SPM according to distance of GZ to ZL, there was statistically difference between groups (P < 0.001), and SPM exhibited higher values than FPM.…”

“…[14] In addition to this, posterior gummy smile plays an important part in perceived smile esthetics. [15] Aesthetic considerations in smile design have focused mainly on the anterior teeth region and in parallel to this, Chu et al concluded that the GZL in an AC direction of lateral incisors relative to the gingival tangential zenith line joining adjacent CI and canine was approximately 1 mm under healthy conditions [9] and Hochman et al [3] concluded that the importance of maxillary anterior dental papillae display during dynamic smiling should not be left undiagnosed. However, many subjects may display PMs or even first and second molars as well [16] and in parallel to this, Kapagiannidis et al [12] evaluated frequency of tooth and gingival display in the PM region.…”