Contribution of facial components to the attractiveness of the smiling face in male and female patients: A cross-sectional correlation study

Aesthetic assessment of maxillary lateral and canine implant-supported crowns by laypersons and orthodontists

INTRODUCTION

The objectives of this study were to evaluate how laypersons and orthodontists evaluate and rank aesthetic parameters of an implant-supported crown (ISC) on the canine position (ISC-C) and lateral position (ISC-L).

METHODS

A digital survey of 11 cases, 5 ISC-C, 5 ISC-L and 1 control case without ISC, was distributed to 207 laypersons and 296 orthodontists. All cases included one extraoral photograph and three intraoral photographs. The respondents were asked to identify the ISC and to evaluate the aesthetic parameters regarding colour of the implant (CI), shape of the implant (SI) and gingival colour around ISC (GCI). Differences within and between the groups were tested using Chi-2-test and Independent-Samples t-test.

RESULTS

All invited laypersons and 184 orthodontists (62% response rate) answered the survey. Orthodontists (89%) more correctly identified the ISC, regardless of its position, than laypersons (50%) (p < 0.001). Both laypersons (54%) and orthodontists (23%) rated higher proportions of acceptance of CI, SI and GCI in favour for the ISC-L than ISC-C (laypersons: 40%, orthodontists: 10%) (p < 0.001). Assessing each parameter separately, orthodontists rated higher for ISC-L, compared to the ISC-C (p < 0.001). In general, laypersons and orthodontist ranked tooth colour (mean, standard deviation [SD]:8.0,1.5 and 9.0, 1.0) and tooth shape (mean, SD: 8.0, 1.7 and 8.8, 1.2) as aesthetically higher than the gingival colour (mean, SD: 7.2, 2.2 and 8.0, 1.7) (p > 0.001).  Conclusion: Laypersons and orthodontists consider the ISC-L as aesthetically more preferable, compared to the ISC-C.

Smile attractiveness in patients treated with or without 4 premolar extractions: A 36-year follow-up

INTRODUCTION

This study aimed to assess the smile attractiveness in patients treated with or without 4 premolar extractions at a 36-year follow-up.

METHODS

The sample comprised 52 patients with Class I and II malocclusion divided into 2 groups. Group 1 consisted of 15 patients treated without extractions (10 females and 5 males), with a mean pretreatment, posttreatment, and long-term posttreatment (T3) age of 13.2, 15.1, and 49.8 years, respectively. The mean treatment time was 1.9 years, and the mean long-term follow-up period was 34.7 years. Group 2 consisted of 37 patients (25 females and 12 males) treated with 4 premolar extractions, with a mean pretreatment, posttreatment, and long-term posttreatment age of 13.3, 15.7, and 53.6 years, respectively. The mean treatment time was 2.3 years, and the mean long-term follow-up period was 37.9 years. The mean retention time was 2 years for both groups. Frontal smiling photographs were obtained at long-term follow-up. Smile attractiveness was evaluated in an online questionnaire in which the evaluator could rate the smiling photographs with a 10-point scale. The randomly selected evaluator sample consisted of 62 laypeople, 33 dentists, and 89 orthodontists. Independent t tests, 1-way analysis of variance, and Tukey tests were used for intergroup comparisons at P <0.05.

RESULTS

The smile attractiveness on the long term was similar in the groups treated with 4 premolar extractions (4.70 ± 1.35) or without extractions (4.51 ± 1.46). Women and orthodontists were more critical in assessing smile attractiveness than men, dentists, and laypeople.

CONCLUSIONS

After long-term posttreatment, the smile attractiveness was similar in patients treated with 4 premolar extractions or without extractions.

Assessment of Aesthetic Smile Components in Patients With Skeletal Class II Vertical and Horizontal Growth Patterns Compared to Class I Cases

Introduction In orthodontics, having a beautiful smile is very important. It is frequently the main driving force behind people's efforts to enhance their oral health and professional opportunities. Orthodontic and dental treatment planning might benefit greatly when evaluating the aesthetic components of a patient's smile in individuals with varying skeletal growth patterns. In order to help orthodontists achieve the best possible functional and aesthetic results for their patients, the eight elements of a balanced smile are essential to orthodontic therapy. This study aims to evaluate, in comparison to Skeletal Class I Average instances, eight balanced smile components in patients with Skeletal Class II Vertical and Horizontal growth patterns. Methodology A total of 45 patients aged 14-30 were selected from the Orthodontics and Dentofacial Orthopedics Out-Patient Department (OPD). They were divided into three groups: Skeletal Class I Average, Skeletal Class II Vertical, and Skeletal Class II Horizontal cases based on their malocclusion type. Patients were made to smile in response to a joke or social conversation and their photos were analyzed using Photopea software (Photopea Inc., Prague, Czech Republic) to determine the eight components of a balanced smile. Result Three skeletal classes' worth of smile components were examined in this study. Lip line measurements varied greatly; the highest mean measurement was found in the Skeletal Class II Vertical group (p-value < 0.01). There were no noteworthy correlations found between smile arc and upper lip curvature. Measurements of lateral negative space did not show any significant group differences. On the other hand, a significant correlation was seen in smile symmetry, where asymmetrical smiles were more prevalent in Skeletal Classes I and II Vertical groups (p-value is 0.00072). While arch symmetry suggested a potential relationship between the groups, dental midline alignment revealed possible associations. Conclusion Assessing the aesthetic components of smiles in patients with varying skeletal growth patterns, i.e., contrasting Class II Vertical and Horizontal growth patterns with Class I Average cases, provides valuable information about the connection between smile aesthetics and facial skeletal structure. The results suggest that when compared to Class I typical instances, Skeletal Class II Vertical and Horizontal growth patterns may show clear variations in certain aspects of an attractive smile. Comprehending these variations is essential for devising treatment strategies for patients, and additional investigation is needed. In order to obtain optimal aesthetic outcomes, treatment strategies should strive to optimize smile aesthetics while addressing personalized treatment plans that take into account the patient's unique facial features, smiling preferences, and functional requirements.

Perception of maxillary incisor inclination and its correlation with dental cephalometric measurements

OBJECTIVE

To correlate the clinical perception of maxillary incisor inclination from photographs of the smiling face with cephalometric measurements, using conventional incisor axis reference points and crown reference points.

DESIGN

Cross-sectional study.

SETTING

Department of Orthodontics, School of Dentistry, University of Lisbon (Portugal).

PARTICIPANTS

Eight orthodontists.

METHODS

The perception of maxillary incisor inclination of 47 female patients (mean age 23.4 ± 1.5 years) was evaluated by eight orthodontists. The participants' photographs (smiling frontal, smiling three-quarter and smiling profile) were shown to each assessor and a continuous visual analogue rating scale was used to assess the perception of maxillary incisor inclination. Pearson's correlation and linear regression were calculated between each cephalometric measurement and the perception of incisor inclination.

RESULTS

Anatomical crown inclination measurements U1ac-FH (r = 0.854; P < 0.01) and U1ac-SN (r = 0.845; P < 0.01) had the highest correlation values with the assessors' perception of maxillary incisor inclination. Conventional incisor axis measurements showed the lowest correlation values (r = 0.668-0.756).

CONCLUSION

Cephalometric measurements of the labial surface of the anatomical crown of the maxillary incisors showed the strongest correlations with the clinical perception of maxillary incisor inclination from photographs. For optimal aesthetics, the inclination of the labial surface of maxillary incisor crown should be evaluated.

Unveiling why race does not affect the mask effect on attractiveness: but gender and expression do

Studies show that surgical face masks can have both positive and negative effects on attractiveness. Race has been implicated as a moderator of the size of this mask effect. Here, the moderating effects of expression, race and gender are explored. The mask effect was more positive for males than for females, for neutral faces than for smiling faces, and there were differences between the races. Further, the effect of unmasked attractiveness was partialled out for each image, which removed the race effects, but the gender and expression effects remained. It is suggested that racial differences previously observed in the mask effects are a consequence of differences in attractiveness of the faces sampled from those races. Re-analysis of previous research that showed race effects also demonstrates how they are better explained as attractiveness effects rather than race effects. This explanation can provide order to the different findings observed across the literature.

Orthodontic Pain and Dietary Impact Considering Age Groups: A Comparative Study

(1) Background: orthodontic treatment can frequently be associated with discomfort and pain, a significant factor contributing to treatment discontinuation. (2) Methods: This study, conducted on 160 orthodontic patients across different age groups, aimed to explore the influence of age on patients' responses to treatment, particularly regarding changes in dietary patterns and weight loss. The patients were categorized into three age groups and assessed through a questionnaire about pain perception, pain latency, dietary changes, and weight loss associated with orthodontic appliances. (3) Results: Younger patients (6-12 years) reported lower pain levels, shorter pain latency and fewer alterations in dietary habits compared to adults (over 18 years). Females over 18 represented a significant portion of the sample, suggesting a self-driven inclination towards orthodontic treatment for aesthetic reasons. Fixed orthodontic appliances induced more significant pain than removable ones. Adults experienced more changes in dietary habits and weight loss than younger individuals. (4) Conclusions: the results provide valuable insights for orthodontic practitioners aiming to mitigate adverse effects and improve overall patient experience during treatment.

A randomized clinical trial investigating the effect of three vital tooth bleaching protocols on oral health-related quality of life

Objectives

This study aimed to compare changes in oral health-related quality of life (OHRQoL) resulting from three vital tooth bleaching protocols.

Methods

The participants (n = 105) were randomly assigned to one of three vital bleaching treatment groups: home bleaching (HB), in-office bleaching (IOB), or combined bleaching (CB). HB involved the use of custom-made trays and 10% carbamide peroxide for a 14-day treatment period. IOB utilized 37.5% hydrogen peroxide applied in three cycles. CB treatment involved the use of IOB followed by HB. Tooth colour change was evaluated using a shade guide (ΔVS) and a digital spectrophotometry device (ΔES). The Oral Health Impact Profile-14 (OHIP-14) and Oral Impact on Daily Performance-22 (OIDP-22) instruments were used to assess changes in OHRQoL at baseline, 15-days and 6-month recalls. Linear mixed models were used to estimate between- and within-group differences.

Results

All bleaching protocols led to significant improvements in overall OHIP-14 scores at the 6-month recall (p ≤ 0.037). CB and IOB treatments were associated with more substantial positive impacts on overall scores, psychological discomfort, physical disability (CB only), and psychological disability (CB only) compared to HB (p ≤ 0.011). Significant enhancements in OIDP-22 scores were observed in the CB and HB groups at the 6-month recall compared to baseline (p ≤ 0.006), with evidence indicating that these improvements were greater in the CB group compared to the IOB group (p = 0.007).

Conclusion

All bleaching treatments demonstrated a positive impact on OHRQoL. However, the positive impact was most consistent across domains and age groups in the CB group. The positive impact was less pronounced in older age groups.

Cephalometric determinants of facial attractiveness: A quadratic correlation study

INTRODUCTION

This research aimed to determine the nonlinear correlation between lateral cephalometric measurements and facial attractiveness, evaluated in the frontal and profile views. A quadratic correlation was studied, in which the vertex of the function indicates the cephalometric value corresponding to the maximum attractiveness.

METHODS

Frontal and profile facial attractiveness of 60 patients with Class I (n = 20), Class II (n = 20), or Class III malocclusion (n = 20) aged 18-35 years without previous orthodontic treatment was evaluated by 14 laypersons (7 men and 7 women) with a visual analog scale. Soft- and hard-tissue measurements were collected on lateral cephalometric radiographs. Pearson and nonlinear quadratic correlations between the attractiveness of the face and cephalometric measurements were calculated. Maximum attractiveness values (MxAt) were determined for the significant cephalometric variables.

RESULTS

Significant quadratic correlations were found between frontal facial attractiveness and the following variables: Ls-SnPog' (r = 0.45; MxAt = 3.1 mm), Li-SnPog' (r = 0.41; MxAt = 3.8 mm), the ANB angle (r = 0.42; MxAt = 0.2°) and MPA (r = 0.51; MxAt = 31.9°). Profile attractiveness correlated nonlinearly with Ls-SnPog' (r = 0.42; MxAt = 3.2 mm), Li-SnPog' (r = 0.41; MxAt = 3.9 mm) and MPA (r = 0.46; MxAt = 32.4°).

CONCLUSIONS

Significant quadratic correlations were found between facial attractiveness and cephalometric measurements, which were stronger than linear correlations. The maximum attractiveness points indicated a tendency for laypeople to consider a more protrusive lower lip and an ANB angle lower than the norm as the most attractive.

Comparing the esthetic impact of virtual mandibular advancement, bichectomy, jawline, and their combination

INTRODUCTION

The purpose of this study was to compare the effects of mandibular advancement (MA), bichectomy, jawline, and their combination on facial attractiveness. The 3-dimensional (3D) visual sculpting is a method to perform the task.

METHODS

FaceBuilder software, a Blender 2.93 LTS add-on, was used to generate a 3D head and face model of a female patient with Class II Division I malocclusion. MA, bichectomy, jawline, and combination modifications were performed on the model using a 3D virtual sculpting tab, and 4 new head models were created. Five hundred thirteen participants scored lateral and frontal views of the modified and reference models. The Mann-Whitney U, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis.

RESULTS

MA modification received the highest frontal and lateral image scores. The raters found the jawline frontal photograph to be the least attractive. Significant differences were observed between the lateral and frontal attractiveness scores in all modifications except bichectomy. The combination of 3 modifications in both frontal and lateral images received the second-lowest score.

CONCLUSIONS

Facial esthetic modifications receive different attractiveness scores in lateral or frontal evaluations. MA outperforms bichectomy and jawline augmentation in terms of improving facial attractiveness.

The visual perception of aligned and crowded maxillary lateral incisors when smiling via eye tracking

Background

This study aimed to investigate whether the alignment of the teeth while smiling alters the visual perception by laypeople using eye tracking.

Methods

Facial images (two males and two females) were digitally edited to show a smile pattern with aligned teeth and one with crowded teeth. Sixty laypeople were selected to observe the images. The number of fixations, fixation duration, and time until the first fixation were recorded using an eye-tracking system. The results were qualitatively calculated with dot maps. Numerical data were analyzed using an independent Student's t test.

Results

There were no significant differences in fixation duration and the number of fixations in the crowded smile, mainly that of the male. The fixation times for the teeth were significantly different when the participants viewed the male subjects with a crowded smile (P<0.05). Dot maps showed greater attention to the smile with crowded teeth in both genders.

Conclusion

The crowded maxillary incisor smile attracted more visual attention to males from laypeople.

An alternative approach for the surgical correction of unilateral crossbite

This case report aims to describe a modified surgically assisted rapid palatal expansion technique to treat an asymmetrical posterior crossbite with no mandibular shift without causing an interincisal diastema. A clinical patient with an asymmetrical crossbite, large tooth-size-arch length, and Bolton discrepancy is used to illustrate the modified technique. Instead of traditional osteotomies, in this technique, the osteotomy is done between the maxillary right canine and lateral incisor (connecting the piriform aperture to the alveolar process) along with a unilateral LeFort I osteotomy. The expansion forces are produced by the activation of a conventional hyrax appliance. The skeletal unilateral crossbite was corrected without major changes to the opposite side and without causing an anesthetic diastema between the maxillary central incisors. A mandibular incisor extraction produced the space needed to treat the tooth size-arch length and corrected the Bolton discrepancy. This allowed a successful treatment of the problems initially presented by the patient.

The Analysis of Facio-Dental Proportions to Determine the Width of Maxillary Anterior Teeth: A Clinical Study

The present study aimed to analyze mid horizontal facial third proportions, those being the interpupillary, inner intercanthal, and bizygomatic distance modified with golden proportion, The Preston proportion, golden percentage and 70% recurring esthetic dental proportion were used for determining maxillary anterior teeth width. A total of 230 participants took part in this study. The front dental and facial photographs along dental stone cast which were converted to three-dimensional (3D) models were used for evaluation. The mid horizontal facial third proportions showed no significant relationship with maxillary anterior teeth width without modification with dental proportions. Whereas, with modification, no statistically significant difference was found between inner-intercanthal distance by golden percentage and width of central incisors. The bizygomatic distance was greater than intercanine distance. While the interpupillary distance by golden proportion was found to be consistent with intercanine distance in female participants. The modified anterior teeth width was significantly different from measured values, when determined by using the three mid facial proportions with Preston and 70% recurring esthetic dental (RED) proportion. Furthermore, the measured width of maxillary anterior teeth showed no difference when plaster dental casts widths were compared with 3D models. The interpupillary, inner-intercanthal, and bizygomatic distance should not be directly used to determine maxillary anterior teeth width. While maxillary anterior teeth width can be determined by modifying the inner inter-canthal distance with golden percentage and interpupillary distance with golden proportion. Moreover, the midfacial third proportions modified with Preston and 70% recurrent esthetic dental proportion were found to be unreliable for the determination of maxillary anterior teeth widths.

Perception of facial esthetics in young North Indian population

INTRODUCTION:

A person's ability to recognize a beautiful face is innate, but translating this into defined treatment goals is a challenge for clinicians.

AIM:

To determine if faces considered esthetic and pleasing in the young North Indian population (both males and females) exhibit similar cephalometric measurements as used for ideal treatment and successful results.

MATERIALS AND METHOD:

A panel of five judges evaluated a set of one frontal, one frontal during smiling, and one profile extra-oral photograph of 160 students (80 females and 80 males) on a five-point attractiveness scale. For each photographic set, the mean and final scores were calculated. Once the sample was assessed, 60 subjects (30 females and 30 males) with the highest final facial aesthetic score were selected and cephalometric analysis was performed. The obtained data were subjected to statistical analysis using SPSS 20 software.

RESULTS:

Both males and females with class I skeletal jaw bases were found to be attractive. The females with short faces; mild facial convexity and lower lip closer to the esthetic line were found to be attractive. The males with a prominent chin, straight profile, prominent nose, increased upper lip thickness, upper lip length, and lower lip length were found to be attractive.

CONCLUSION:

The faces considered attractive in this study fulfilled most of the cephalometric norms commonly used for the diagnosis and treatment planning except for a few inconsistencies which may be attributed to the gender and demographic origin.

Is the adolescent's esthetic concern associated with anterior occlusal conditions or the malocclusion severity level?

OBJECTIVES

To assess the esthetic impact of anterior occlusal conditions and malocclusion severity levels.

MATERIALS AND METHODS

A population-based cross-sectional study of 700 adolescents aged 15 to 19 years was conducted. The Oral Aesthetic Subjective Impact Scale (OASIS) was used to evaluate the subjective esthetic impact of malocclusion. The Dental Aesthetic Index (DAI) criteria were used to diagnose the anterior occlusal characteristics in isolation and the severity levels of malocclusion. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI).

RESULTS

Of the adolescents, 42% showed negative self-perception of malocclusion. In addition, 15.4% of adolescents had severe malocclusion (DAI 3) and 18.9% very severe malocclusion (DAI 4). Crowding and spacing were shown to be 2.90 (CI: 2.06-4.09) and 2.53 (CI: 1.65-3.86) times, respectively, more likely to cause a negative esthetic impact in adolescents (P < .05). In addition, adolescents with orthodontic treatment need (DAI 2, 3, and 4) were more likely to report a negative esthetic impact (P < .05).

CONCLUSIONS

Anterior crowding and spacing are the conditions that most influence the esthetic concern of adolescents. Adolescents with very severe malocclusion and higher orthodontic treatment need are more likely to report a negative esthetic impact.

Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness

AIM

To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness.

MATERIALS AND METHODS

Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating.

RESULTS

Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative.

CONCLUSIONS

ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

Smile dimensions affect self-perceived smile attractiveness

Facial expressions play a leading role in human interactions because they provide signaling information of emotion and create social perceptions of an individuals’ physical and personality traits. Smiling increases socially perceived attractiveness and is considered a signal of trustworthiness and intelligence. Despite the ample information regarding the social importance of an attractive smile, little is known about the association between smile characteristics and self-assessed smile attractiveness. Here we investigate the effect of smile dimensions on ratings of self-perceived smile attractiveness, in a group of 613 young adults using 3D facial imaging. We show a significant effect of proportional smile width (ratio of smile width to facial width) on self-perceived smile attractiveness. In fact, for every 10% increase in proportional smile width, self-perceived attractiveness ratings increased by 10.26%. In the present sample, this association was primarily evident in females. Our results indicate that objective characteristics of the smile influence self-perception of smile attractiveness. The increased strength of the effect in females provides support to the notion that females are overall more aware of their smile and the impact it has on their public image.

Correlation between facial attractiveness and facial components assessed by laypersons and orthodontists

Background/purpose

Relationship between facial attractiveness and facial components is not completely clear. The aim was to analyze the correlation between facial attractiveness and facial components assessed by laypersons and orthodontists.

Materials and methods

The attractiveness of 100 adult patients (50 males and 50 females with their frontal, lateral, and frontal smiling photos), before orthodontic treatment, was assessed by 24 laypersons and 24 orthodontists using visual analog scale. Pearson correlation coefficient and stepwise regression were used for statistical analysis.

Results

When laypersons assessed, a significant correlation was found between facial attractiveness and the chin (r = 0.671), eyes (r = 0.669), lips (r = 0.585), hair (r = 0.527), teeth (r = 0.338), and nose (r = 0.247); the chin was responsible for 45.1% of the variation in facial attractiveness, the eyes for 14.3%, and the lips for 0.8%. When orthodontists assessed, a significant correlation was found between facial attractiveness and the lips (r = 0.789), eyes (r = 0.646), hair (r = 0.613), chin (r = 0.565), nose (r = 0.264), and teeth (r = 0.221); the lips were responsible for 62.2% of the variation in facial attractiveness, the eyes for 8.2%, the chin for 1.4%, and the hair for 0.5%.

Conclusion

When laypersons evaluate, the chin contributes the most to facial attractiveness, and when orthodontists evaluate, the lips contribute the most. Whether in the evaluation of laypersons or orthodontists, the contribution of teeth to facial attractiveness is significantly less than that of the lips and chin.