title: Quantification of the esthetics of dentists' before and after photographs.
abstract: OBJECTIVE
  The purpose of this study was to measure dentists' before and after restorative treatment photographs to identify four metrics to describe the esthetic improvement: (a) central incisor width-to-height ratio; (b) central-to-lateral incisor width ratio; (c) lateral incisor-to-canine width ratio; and (d) lateral incisor percentage offset.
  
  
  METHODS
  Internet searches for "before after" and "veneers" and "prosthodontic" were used to obtain 198 before and after photographs of patient treatments showing the restoration of the six maxillary anterior teeth with porcelain veneers, crowns or a combination. The four metrics were measured using Adobe Photoshop. Groups were compared with repeated measures ANOVA followed by a post hoc Tukey-Kramer test with the variables of "Before or After Treatment"; "Treatment Type" (veneers, crowns or a combination) and "General Dentist or Prosthodontist".
  
  
  RESULTS
  Mean central incisor width-to-height ratio was 91.7% before treatment, 80.8% after; mean central-to-lateral incisor width ratios were 69.9% and 64.7%; mean lateral incisor-to-canine width ratios were 85.3% and 81.4% and lateral incisor percentage offsets were 9.6% and 8.7%. There were significant (p<0.05) differences for before and after treatment for all variables except central-to-lateral incisor width ratio. Differences between specialist and general dentist were not statistically significant.
  
  
  CONCLUSIONS
  On average, esthetic prosthetic treatment resulted in reduced central incisor width-to-height ratio, increased proportional width of the mesially positioned tooth of adjacent anterior teeth and reduced lateral incisor offset. The mean values of treatments by GPs and prosthodontists were not statistically significantly different.
  
  
  CONCLUSIONS
  Knowledge of dentists' optimal restorative treatments provides insight on the esthetic outcome of extensive prosthodontic therapy.
authors.affiliation: Division of Restorative and Prosthetic Dentistry, The Ohio State University, College of Dentistry, Columbus, OH 43210-1267, USA. rosenstiel.1@osu.edu
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Rosenstiel
authors.forename: Maria
authors.initials: M
authors.lastname: Pappas
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Pulido
authors.forename: Robert G
authors.initials: RG
authors.lastname: Rashid
mesh_terms: D000704:Analysis of Variance; D003116:Color / Q000592:standards*; D017267:Dental Prosthesis Design / Q000592:standards / Q000706:statistics & numerical data*; D003793:Dental Restoration, Permanent / Q000379:methods; D003801:Dental Veneers / Q000592:standards / Q000706:statistics & numerical data*; D004955:Esthetics, Dental / Q000706:statistics & numerical data*; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology; D015588:Observer Variation; D023861:Photography, Dental; D017797:Prosthesis Coloring / Q000592:standards / Q000706:statistics & numerical data*; D011476:Prosthodontics / Q000592:standards* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016896:Treatment Outcome