title: The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study.
abstract: OBJECTIVE
  To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis.
  
  
  METHODS
  Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement.
  
  
  RESULTS
  Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75.
  
  
  CONCLUSIONS
  The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rotundo
authors.forename: Michele
authors.initials: M
authors.lastname: Nieri
authors.forename: Daniele
authors.initials: D
authors.lastname: Bonaccini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mori
authors.forename: Elena
authors.initials: E
authors.lastname: Lamberti
authors.forename: Domenico
authors.initials: D
authors.lastname: Massironi
authors.forename: Luca
authors.initials: L
authors.lastname: Giachetti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franchi
authors.forename: Piero
authors.initials: P
authors.lastname: Venezia
authors.forename: Raffaele
authors.initials: R
authors.lastname: Cavalcanti
authors.forename: Elena
authors.initials: E
authors.lastname: Bondi
authors.forename: Mauro
authors.initials: M
authors.lastname: Farneti
authors.forename: Vilma
authors.initials: V
authors.lastname: Pinchi
authors.forename: Jacopo
authors.initials: J
authors.lastname: Buti
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000473:pathology; D003970:Diastema / Q000473:pathology; D004955:Esthetics, Dental / Q000145:classification* / Q000706:statistics & numerical data; D005145:Face / Q000033:anatomy & histology; D005260:Female; D005882:Gingival Diseases / Q000473:pathology; D019214:Gingival Overgrowth / Q000473:pathology; D005889:Gingival Recession / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010859:Pigmentation Disorders / Q000473:pathology; D012904:Smiling; D014070:Tooth / Q000033:anatomy & histology; D014071:Tooth Abnormalities / Q000473:pathology; D014075:Tooth Discoloration / Q000473:pathology; D055815:Young Adult