title: Esthetic evaluation of dental and gingival asymmetries.
abstract: The aim of this study was to determine which smile asymmetries were less esthetic, dental or gingival.
  
  
  METHODS
  Laypeople (297), generalists (223), prosthodontists (50) and orthodontists (49), evaluated the esthetics of digitally-modified images taken from the same frontal intra-oral photograph, using the same lips, simulating upper maxillary midline shift, occlusal plane inclination, asymmetric incisal edge and asymmetric gingival migration. The images were later paired into 3 groups.
  
  
  RESULTS
  The only ones considered esthetic were the asymmetric incisal edge of the 0.5 mm shorter upper central incisor and the asymmetric gingival migration (2 mm) of the upper central incisor. In the paired images, upper maxillary midline shift vs. occlusal plane inclination, the former was rated less esthetic, while in the asymmetric incisal edge vs. asymmetric gingival migration pair, the latter was considered to be less esthetic.
  
  
  CONCLUSIONS
  Laypeople and generalists consider smiles more attractive. The only images considered esthetic were the asymmetric incisal edge of the central incisor shorter by 0.5 mm and the 2 mm asymmetric gingival migration of the upper central incisor. In the horizontal plane (maxillary midline shift vs. occlusal plane cant), the dental asymmetries were considered less esthetic than the gingival asymmetries. However, in the vertical plane (asymmetric incisal edge vs. asymmetric gingival migration) the opposite was recorded.
authors.affiliation: Instituto Superior de Ciências da Saúde-Norte, CESPU, Instituto de Investigacão e Formação Avançada em Ciências e Tecnologias da Saúde (IINFACTS), Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal.
authors.forename: Liliana
authors.initials: L
authors.lastname: Fernandes
authors.affiliation: Instituto Superior de Ciências da Saúde-Norte, CESPU, Instituto de Investigacão e Formação Avançada em Ciências e Tecnologias da Saúde (IINFACTS), Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal. Electronic address: teresa.pinho@iscsn.cespu.pt.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pinho
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003766:Dental Occlusion; D003815:Dentists / Q000523:psychology; D004955:Esthetics, Dental; D005260:Female; D005792:General Practice, Dental; D005881:Gingiva / Q000033:anatomy & histology*; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology*; D008046:Lip / Q000033:anatomy & histology; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology; D000066792:Orthodontists / Q000523:psychology; D010781:Photography; D011476:Prosthodontics; D012737:Sex Factors; D012904:Smiling
keywords: Asymmetric smile; Laypeople; Professionals; Smile esthetics; Smiling