title: Choosing the esthetic angle of the face: experiments with laypersons and prosthodontists.
abstract: BACKGROUND
  Most faces are not symmetrical, and this complicates the task of aligning the anterior segment of the teeth for the restorative dentist, orthodontist, or oral and maxillofacial surgeon. The dental literature provides conflicting advice regarding guidelines for aligning the anterior teeth.
  
  
  OBJECTIVE
  The purpose of this study was to determine the sensitivity of laypersons to variations in the alignment of the anterior segment within a symmetrical face, and to investigate which guidelines were preferred by laypersons and prosthodontists when aligning this segment.
  
  
  METHODS
  Lay participants (21) were shown a series of 25 modified images of faces on a computer screen and asked to indicate 'noticeability' of tilt and, with another series of 19 images, preference for angulation of the anterior segment. Prosthodontists (14) were shown a further set of 7 images and asked to use a Clinometer to select an appropriate angle. Statistical comparisons were performed with multinomial goodness-of-fit tests and repeated measures ANOVA, followed by Sidak multiple comparisons tests (α=.05).
  
  
  RESULTS
  The average angle at which the tilt of the anterior segment within a symmetrical face became noticeable to the laypersons was approximately 1 degree. No significant correlation (P=.15) was found between the laypersons' choice of angle for the anterior segment and the angle of the eyes, lips, or horizon, but an angle of 0 degrees was chosen significantly more often than the other angles offered (P<.001). The prosthodontists generally chose an angle close to zero.
  
  
  CONCLUSIONS
  The results suggest that the threshold tilt within a symmetrical face, for noticeability by laypersons, is about 1 degree, and that for both laypersons and prosthodontists, the most important guideline is not any individual facial feature or the horizon but the face as a whole.
authors.affiliation: Melbourne Dental School, The University of Melbourne, Victoria, Australia. donbehrend@ozemail.com.au
authors.forename: Donald A
authors.initials: DA
authors.lastname: Behrend
authors.forename: John K
authors.initials: JK
authors.lastname: Harcourt
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Adams
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D059925:Anatomic Landmarks; D002508:Cephalometry; D003815:Dentists; D004955:Esthetics, Dental; D005145:Face / Q000033:anatomy & histology*; D005146:Facial Asymmetry / Q000523:psychology*; D005260:Female; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011476:Prosthodontics; D014796:Visual Perception