title: Esthetic evaluation of implants vs canine substitution in patients with congenitally missing maxillary lateral incisors: Are there any new insights?
abstract: BACKGROUND
  The aims of the study were to determine how a panel of orthodontists, dentists, and laypersons rated the esthetic appeal of dentitions after orthodontic space closure by canine substitution compared with space opening and replacement of missing maxillary lateral incisors by implant-borne crowns and to compare the outcome with the results of a study in the United States in 2005.
  
  
  METHODS
  A series of 9 posttreatment intraoral frontal photographs was presented to 87 orthodontists, 100 general dentists, and 100 laypersons. The photographs represented dentitions with either single-tooth implants or canine substitutions for missing maxillary lateral incisors and dentitions with no missing teeth. Each photograph was rated independently by assigning a number between 1 (best) and 5 (worst) for a series of 7 bipolar adjectives. Two-way analysis of variance and Tukey post hoc tests were performed to assess differences in intragroup and intergroup preferences for the various treatment options. Subsequently, the mean scores were compared with the mean scores in the study from 2005.
  
  
  RESULTS
  Highly significant improvements (P <0.0001) in the esthetic outcome for implants were found in all respondent groups when compared with the study from 2005. To date, orthodontists and dentists rank implants and canine substitution as equally pleasing, but laypersons prefer space closure.
  
  
  CONCLUSIONS
  Perceptions of dental esthetics can vary between dental professionals and laypersons. Investigating each patient's esthetic expectations is thus important, but in the patient's best interest, esthetic and functional aspects should be carefully weighed during comprehensive treatment planning.
authors: Visiting professor, Department of Orthodontics, University of Ferrara, Ferrara, Italy; private practice, Bolzano, Italy. Electronic address: ute.moser@brennercom.net.
authors: Ute
authors: U
authors: Schneider
authors: Visiting professor, Department of Orthodontics, University of Ferrara, Ferrara, Italy; private practice, Bolzano, Italy.
authors: Lorenz
authors: L
authors: Moser
authors: Private practice, Vicenza, Italy.
authors: Marzia
authors: M
authors: Fornasetti
authors: Private practice psychologist and freelance statistician, Ferrara, Italy.
authors: Michele
authors: M
authors: Piattella
authors: Chairman and director, Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy.
authors: Giuseppe
authors: G
authors: Siciliani
mesh_terms: D000328:Adult; D000848:Anodontia / Q000628:therapy*; D001291:Attitude of Health Personnel; D003442:Crowns; D003481:Cuspid; D019250:Dental Implants, Single-Tooth / Q000941:ethics*; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D007180:Incisor / Q000002:abnormalities*; D008297:Male; D008875:Middle Aged; D019516:Orthodontic Space Closure; D010781:Photography; D014087:Tooth Movement Techniques