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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 568-573
Effect of the gingival display on posed smile with different facial forms: A comparison of dentists and patients concepts


1 Department of Orthodontics and Dentofacial Orthopedics, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
2 Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India

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Date of Submission04-Apr-2011
Date of Decision25-Nov-2011
Date of Acceptance03-Feb-2012
Date of Web Publication19-Feb-2013
 

   Abstract 

Aim: The aim of this study was to evaluate and compare the importance of amount of gingival display on smile esthetics and facial attractiveness in males and females with different facial forms by orthodontists as well as lay person.
Materials and Methods: Frontal photographs of 18 male and female patients (9 male and 9 female) each, at a posed smile, seeking treatment in the Department of Orthodontics and Dentofacial Orthopedics were obtained. The photographs were divided in 3 groups based on their facial forms (Short face, Average face and Long face) and were altered by moving the dentition within the lip frame of the captured photograph to bring about different gingival display at smile. The pictures were divided into six groups with gingival exposures of 0 mm, 1 mm, 2 mm, 3 mm, 4 mm and 5 mm. The pictures were rated for attractiveness by four sets of evaluators - male and female Orthodontists and male and female lay evaluators. The statistical analysis methods used for the study included Mean score calculation, standard deviation and
Analysis of variance: [test (Mono- Variance)]. The Student t test (two tailed, independent) has been used to find the significance of rating scores between lay person and orthodontist, and also between males and females evaluators.
Results: No significant difference in ratings of gingival display in the 3 groups of photographs was noted by lay person and orthodontists. The results point to the fact that the influence of amount of gingival display on smile esthetics was independent of the facial form. It was also observed that gingival display of 0 mm to 2 mm was acceptable to both the lay person and the orthodontists.
Conclusion: As the amount of gingival display increased, the ratings for facial attractiveness by both orthodontists and lay person decreased. Higher scores were given by both orthodontists and lay person for photographs which showed gingival display of 0-2 mm, suggesting this value to be most acceptable.

Keywords: Facial form, gingival display, perception, smile esthetics

How to cite this article:
Akhare PJ, Daga A. Effect of the gingival display on posed smile with different facial forms: A comparison of dentists and patients concepts. Indian J Dent Res 2012;23:568-73

How to cite this URL:
Akhare PJ, Daga A. Effect of the gingival display on posed smile with different facial forms: A comparison of dentists and patients concepts. Indian J Dent Res [serial online] 2012 [cited 2020 Jan 24];23:568-73. Available from: http://www.ijdr.in/text.asp?2012/23/5/568/107328
Esthetics in orthodontics has been defined mainly in terms of profile enhancement; however, when lay people were asked about the role of an orthodontist, they usually answered vaguely regarding the creation of beautiful smiles. [1] Although orthodontic treatment is primarily based on occlusal relationships, greater attention has been now paid to enhancing dentofacial characteristics to produce optimal facial esthetics. Most people now evaluate the outcome of the orthodontic treatment not only by their smiles but also by the overall enhancement in their facial appearance. [2] In some people, the smile at its fullest exposes the gingiva superior to the maxillary anterior teeth. This anatomical feature is called as the gingival smile line [3],[4]

The smile line has been divided into three types:(1) Low smile line (2) Average smile line (3) High smile line. A "low smile line" displays less than 75% of the clinical crown height of the maxillary anterior teeth, an "average smile line" reveals 75% to 100% of the maxillary anterior clinical crown height, and a "high smile line" exposes a band of continuous maxillary gingiva. Among these three categories, there was a sex difference in the smile line frequency: Low smile line is predominantly a male characteristic while high smile line is predominantly a female characteristic. [5]

Aesthetic perception of smiles varies from person to person, and is influenced by their personal experience and social environment. For this reason, professional opinion regarding evaluation of smile esthetics may not coincide with the perception and expectation of patients or lay people, [6],[7] Gender and level of education also has an impact on esthetic perception. [8] Females are less tolerant to upper gingival exposure on smile than males, therefore, additional efforts are required in female patients to achieve esthetic results. [9]

Individuals with different facial types namely Dolicocephalic, Mesocephalic and Brachycephalic, have different parameters for facial esthetics. Adequate attention has not been given to smiles with different gingival display in the different facial types. The thickness and length of lips vary with long and short face, and different facial forms show different soft tissue drapes. [10]

Aim of the study

  • To evaluate the role and importance of amount of gingival display on smile esthetics and facial attractiveness in different facial forms.
  • To elucidate the differences between professionals and laymen in the perception of smile with different amount of gingival display in males and females.
  • To evaluate the influence of sex (male and female evaluators) on the perception of smile in males and females with different amount of gingival display.

   Materials and Methods Top


Frontal photographs of eighteen male and female patients (9 male and 9 female) each, at a posed smile, seeking treatment at the Department of Orthodontics and Dentofacial Orthopedics were used for the study. The photographs were taken with a Canon Power Shot SD - 600 Digital camera (Canon Inc, Japan). All the photographs were taken in the portrait mode of the camera with a fixed distance of 100 cm from the subject. Apart from the built in flash of the camera, umbrella flashes were also used for the illumination of the subject. The photographs were further divided in to 3 groups based on their facial forms (Short face, Average face and Long face). [7],[10],[11] The captured images of all the 3 groups were manipulated using image processing software (Adobe Photoshop® CS 2). These photographs were altered by moving the gingiva within the lip frame of the captured photograph to bring about different gingival display at smile.The manipulated pictures were further divided into six groups with gingival exposure of 0 mm being the first group and 5 mm gingival exposure as the last group. The gingival display was measured using a scale, which was a part of the software.

The pictures of all these groups were randomized and then rated for attractiveness by four sets of evaluators (15 each):

  1. Male Orthodontists
  2. Female Orthodontists
  3. Male lay Evaluators
  4. Female lay Evaluators
The evaluators were asked to score the photographs on an esthetic scale of 0 to 9 with 0 being the least attractive and 9 being the most attractive.Thus, a total of 60 questionnaires including a total of 6480 images were evaluated for the study [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] and [Figure 7].
Figure 1: Images edited with Photoshop

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Figure 2: Gingival display long face (male)

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Figure 3: Gingival display average face (male)

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Figure 4: Gingival display short face (male)

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Figure 5: Gingival display long face (female)

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Figure 6: Gingival display average face (female)

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Figure 7: Gingival display short face (female)

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Statistical Analysis

The statistical analysis methods used for the study included the Mean score calculation, standard deviation and analysis of variance [ANOVA test (Mono- Variance)]. Student t test (two tailed, independent) was used to find the significance of the rating scores between the lay person and the orthodontists and also between the males and females.


   Results Top


A total of 108 images were evaluated (54 male and 54 female) by 60 evaluators (30 orthodontists and 30 lay persons).

Mean, standard deviation and analysis of variance test (analysis of variance)

It revealed that there was no statistically significant difference amongst short face, average face and long face individuals in terms of facial attractiveness with varying amounts of gingival display.

Student t test (two tailed, independent)

This test has been used to find the significance of rating scores between lay person and orthodontist and also between males and females as mentioned below:

Layperson versus orthodontist

There was no statistically significant difference in rating among lay person and orthodontist for all images with gingival display of 0 mm, 1 mm and 2 mm, except for the photographs listed below:

  • Male average face with 0 mm of gingival display.
  • Male short face with 0 mm of gingival display.
  • Female average face with 0 mm of gingival display.
  • Female short face with 2 mm of gingival display.
However, there was a statistically significant difference in rating among layperson and orthodontist for all images with gingival display of 3 mm, 4 mm and 5 mm, expect for the photographs listed below:

  • Male average face with 5 mm of gingival display.
  • Female short face with 5 mm of gingival display.
Male versus female

There was no statistically significant difference in rating among male and female evaluators for all images except for the image listed below:

  • Female short face with 3 mm of gingival display.
Correlation coefficient

The correlation coefficient was done to find the correlation, if any, between the gingival display and the scores given by the evaluators.It was found that there was a negative correlation for gingival display on facial attractiveness i.e. as the gingival display increased, the ratings given by both, the laymen and orthodontists decreased.(Scores: 0 - least attractive; 9 - most attractive)


   Discussion Top


Smile plays an important role in the orthodontic diagnosis and the treatment planning, and it seems to play a central part in self-perception and social image. [3] Some amount of gingival display on the smile is certainly acceptable and in many cases, is even esthetic and youthful appearing. Conversely a complete lack of gingival display is not as attractive.Males as a group, show less of maxillary incisors and some of the mandibular incisors at smiling than do females. An average smile line in a woman is 1.5 mm higher than in a man [4] .Researchers in the previous studies have tried to evaluate the influence of gingival display, [9],[12] midline deviation, [13],[14] buccal corridor space, [15],[16],[17] smile arc [17],[18] and other factors in the smile esthetics. Researchers have also tried to evaluate the differences in the perception of orthodontists and the laypeople, [13],[14],[16],[17],[18],[19] and males and females of smile esthetics. [8],[9],[14],[15],[17],[20] Individuals with different facial forms have different soft tissue drapes. The thickness and length of lips also vary with different facial types. [10]

Comparison of ratings of orthodontists and lay person

Student t test was used for comparing the ratings of orthodontists and lay person and this suggested that orthodontists and lay person have similar perceptions about the influence of gingival display up to 2 mm, on the smile and facial attractiveness.This compares favorably with the study done by Kokich et al. who compared perception of the lay person and orthodontists on gingival exposure on smiling. [14] However, there was a statistically significant difference in rating among layperson and orthodontist for all images with gingival display of 3 mm, 4 mm and 5 mm. This suggested that as the amount of gingival display increases, orthodontists are more critical in evaluating its influence on smile attractiveness. This influence may be attributed to professional training of the vocations involved in assessing a smile [Graphs 1-6]. [Additional file 1]

Comparison of ratings of male and female evaluators

Student t test was used for comparing the ratings of male and female evaluators. There was no statistically significant difference in rating among male and female evaluators, suggesting that gender of the evaluators has no influence on ratings of facial attractiveness [Graphs 7-12]. [Additional file 2]

Correlation of gingival display and ratings of evaluators on facial attractiveness

The correlation coefficient was done to find the correlation if any, between gingival display and scores given by the evaluators.It was found that there was a negative correlation for gingival display on facial attractiveness i.e. as the gingival display increased, ratings decreased both among the orthodontists and the laymen.This finding is in agreement with the observations of Geron. S and W. Atalia who studied the influence of sex on the perception of smile with different gingival displays, and Hunt et al. who studied the effect of gingival exposure during the smile on facial attractiveness as perceived by the lay person. [9],[12]

Photographs that received high scores

An attempt was made to find the photographs that received high scores among all 3 groups (long face, average face and short face).There was no single photograph that received significantly higher scores than the rest. However higher attractiveness score was given to photographs with gingival display of 0 mm, 1 mm and 2 mm.This suggests that gingival display of 0 mm, 1 mm and 2 mm is acceptable to both the orthodontists and the lay person [Graph 13]. [Additional file 3]


   Conclusion Top


  • There was no significant difference in the ratings of gingival display in the three groups of photographs (Short face, Average face and Long face), indicating that the influence of amount of gingival display on smile esthetics is independent of the facial form.
  • There was no significant difference in ratings between lay person and orthodontists for gingival display of 0 mm, 1 mm and 2 mm, suggesting that gingival display of 0 mm to 2 mm was acceptable to both the lay person and orthodontists.
  • There was a significant difference in the ratings between the lay person and the orthodontists for gingival display of 3 mm, 4 mm and 5 mm, suggesting that the orthodontists were more critical in assessing smile esthetics with increase in the gingival display.
  • As the amount of the gingival display increased, the ratings for facial attractiveness by both, the orthodontists and lay person, decreased. This suggested that both the agreed that as the amount of gingival display increased during smiling, the facial attractiveness decreased.
  • Higher scores were given by both the orthodontist and lay person for photographs which showed a gingival display of 0 mm, 1 mm and 2 mm, suggesting that the gingival display of 0 mm, 1 mm and 2 mm is most acceptable. However, they did not agree for any specific photograph which could be termed as "most attractive" or "least attractive".
  • There was no significant difference in the ratings between male and female evaluators, indicating that gender of the evaluators had no influence on the rating of the facial attractiveness.


 
   References Top

1.Sarver MD, Ackerman BM. Dynamic smile visualization and quantification: Part 1. Evolution of the concept and dynamic records for smile capture. Am J Orthod Dentofacial Orthop 2003;124:412-5.  Back to cited text no. 1
    
2.Isiksal E, Hazar S, Akyalcin S. Smile esthetics: Perception and comparison of treated and untreated smiles. Am J Orthod Dentofacial Orthop 2006;129:816-7.  Back to cited text no. 2
    
3.Tarantilli VV, Halazonetis JD, Spyropoulos NM. The spontaneous smile in dynamic motion. Am J Orthod Dentofacial Orthop 2005;128:812-4.  Back to cited text no. 3
    
4.Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod 1992;62:91-100.  Back to cited text no. 4
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5.Tjan AH, Miller GD. The JG Some esthetic factors in a smile. J Prosthet Dent 1984;51:24-8.  Back to cited text no. 5
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6.Albino JE, Tedesco LA, Conny DJ. Patient perceptions of dentalfacial esthetics: Shared concerns in orthodontics and prosthodontics. J Prosthet Dent 1984;52:9-13.  Back to cited text no. 6
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7.Pogrel MA. What are normal esthetic values. J Oral Maxillofac Surg 1991;49:963-9.  Back to cited text no. 7
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8.Flores C, Silva E, Barriga MI, lagvere MO, Major PW. Lay person's perception of smile aesthetics in dental and facial views. J Orthod 2004;31:204-9.  Back to cited text no. 8
    
9.Geron S, Atalia W. Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. Angle Orthod 2005;75:778-84.  Back to cited text no. 9
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10.Blanchette EM, Nanda SR, Currier FG, Ghosh J, Nanda SK. A longitudinal cephalometric study of the soft tissue profile of shortandlongface syndromes from age 7 to 17 years. Am J Orthod Dentofacial Orthop 1996;109:116-31.  Back to cited text no. 10
    
11.Peck S, Peck H. A concept of facial esthetics. Angle Orthod 1970;40:284-318.  Back to cited text no. 11
    
12.Hunt O, Johnston C, Donald B, Stevenson M. The influence of maxillary gingival exposure on dental attractiveness ratings. Eur J Orthod 2002;24:199-204.  Back to cited text no. 12
    
13.Kokich OV, Kiyak AH, Shapiro AP. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1999;11:311-24.  Back to cited text no. 13
    
14.Kokich OV, Kokich GV, Kiyak AH. Perceptions of dental professionals and laypersons to altered dental esthetics: Asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop 2006;130:141-51.  Back to cited text no. 14
    
15.Moore T, Southhard AK, Casko SJ, Qian F, Southhard ET. Buccal corridors and smile esthetics. Am J Orthod Dentofacial Orthop 2005;127:208-13.  Back to cited text no. 15
    
16.Johnson RD, Gallerano R, English J. The effects of buccal corridor spaces and arch form on smile esthetics. Am J Orthod Dentofacial Orthop 2005;127:343-50.  Back to cited text no. 16
    
17.Parekh MS, Fields WH, Beck M, Rosensteil S. Attractiveness of variations in smile arc and buccal corridor space as judged by orthodontists and laymen. Angle Orthod 2006;76:557-63.  Back to cited text no. 17
    
18.Sarver MD. The importance of incisor positioning in the esthetic smile: The smile arc. Am J Orthod Dentofacial Orthop 2001;20:98-111.  Back to cited text no. 18
    
19.Soh J, Chew TM, Chan HY. Perceptions of dental esthetics of orthodontists and laypersons. Am J Orthod Dentofacial Orthop 2006;130:170-6.  Back to cited text no. 19
    
20.Sabri R. Eight components of a balanced smile. J Clin Orthod 2005;39:155-67.  Back to cited text no. 20
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Correspondence Address:
Pankaj J Akhare
Department of Orthodontics and Dentofacial Orthopedics, VSPM's Dental College and Research Centre, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.107328

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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