title: The role of the posed smile in overall facial esthetics.
abstract: OBJECTIVE
  To evaluate the role of the posed smile in overall facial esthetics, as determined by laypersons and orthodontists.
  
  
  METHODS
  Twenty orthodontists and 20 lay evaluators were asked to perform six Q-sorts on different photographs of 48 white female subjects. The six Q-sorts consisted of three different photographs for each of two time points (pre- and posttreatment), as follows: (1) smile-only, (2) face without the smile, and (3) face with the smile. The evaluators determined a split-line for attractive and unattractive images at the end of each Q-sort. The proportions of attractive patients were compared across Q-sorts using a Wilcoxon signed-rank test for paired data. The evaluators also ranked nine facial/dental characteristics at the completion of the six Q-sorts.
  
  
  RESULTS
  Evaluators found the pretreatment face without the smile to be significantly more attractive than the face with the smile or the smile-only photographs. Dissimilar results were seen posttreatment; there was not a significant difference between the three posttreatment photographs. The two panels agreed on the proportion of "attractive" subjects but differed on the attractiveness level of each individual subject.
  
  
  CONCLUSIONS
  The presence of a malocclusion has a negative impact on facial attractiveness. Orthodontic correction of a malocclusion affects overall facial esthetics positively. Laypeople and orthodontists agree on what is attractive. Overall facial harmony is the most important characteristic used in deciding facial attractiveness.
authors.affiliation: Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI 48109-1078, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Havens
authors.forename: James A
authors.initials: JA
authors.lastname: McNamara
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Sigler
authors.forename: Tiziano
authors.initials: T
authors.lastname: Baccetti
mesh_terms: D000293:Adolescent; D004955:Esthetics, Dental; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008310:Malocclusion / Q000473:pathology / Q000628:therapy; D015588:Observer Variation; D009970:Orthodontics; D023861:Photography, Dental; D011779:Q-Sort; D012904:Smiling / Q000502:physiology*; D018709:Statistics, Nonparametric