title: The influence of lip form on incisal display with lips in repose on the esthetic preferences of dentists and lay people.
abstract: BACKGROUND
  Information is lacking for viewer preferences for incisal display with lips in repose.
  
  
  OBJECTIVE
  The purpose of this online survey was to establish measurement parameters to classify and define a lip form and to evaluate the influence of lip form on dentists' and laypersons' preferences for the amount of incisal display with lips in repose.
  
  
  METHODS
  Computer-generated male and female models were created using 3 different lip forms each, straight, moderate, and high. Three images of these models (frontal full face, zoomed-in frontal around the mouth, and oblique zoomed-in image of the mouth) were arranged in an interactive survey that was disseminated on the Websites Facebook, Instagram, DentalTown and by word-of-mouth. Respondents manipulated the incisal display of all 3 images in unison, using a slide bar, and the resulting incisal display was measured in millimeters and served as the primary dependent measure. Survey demographic data were obtained from an online survey site. Data were assessed for skewness, kurtosis, and outliers and analyzed with 5-way ANOVA: 2 sex levels for model, 2 levels for sex of respondent, 3 levels for lip height, 3 levels for occupation, and 5 levels of ethnicity, with multiple comparisons corrected with Bonferroni adjustments and post hoc comparisons performed using the Scheffé test (α=.05 for all comparisons).
  
  
  RESULTS
  A total of 1039 individuals consented to the study. A final sample size of 687 respondents was obtained after excluding 352 who failed to complete the survey. The results indicated that lip form affected the esthetic perception of incisal display significantly (P<.001), with a preference for a greater amount of incisal display corresponding with increasing lip forms. Sex of the model was also significant, with greater incisal display being preferred for female faces. A significant difference was found for respondents' ethnicity, with African Americans generally preferring smaller incisal displays than other ethnic groups. No other main effects were found to be statistically significant. Only 2 interactions were shown to be statistically significant. Post hoc tests examining the interaction between lip form and sex of model showed a preference for greater incisal displays for female faces with high lip forms. A 3-way interaction was observed between lip form, sex of respondent, and occupation.
  
  
  CONCLUSIONS
  Significant differences were identified for the 3 different lip forms for both sexes of models. As the lip form changed from straight to moderate to high, there was a preference for increased incisal display. Incisal display preferences for male and female models were the same for all respondents, except for the high lip form, for which a greater amount of incisal display was preferred for the female model. Sex and occupation of respondent failed to produce main effects. Respondents' ethnicity was shown to be statistically significant, with African Americans generally preferring shorter incisal displays.
authors.affiliation: Captain, United States Army Dental Corps and Chief of Prosthodontics, Tripler Army Medical Center, Honolulu, Hawaii. Electronic address: jee.y.kim4.mil@mail.mil.
authors.forename: Jee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Professor, Department of Psychological Sciences, Augusta University, Augusta, Ga.
authors.forename: Richard
authors.initials: R
authors.lastname: Topolski
authors.affiliation: Professor, Uniformed Services University, US Army, Fort Gordon, Ga; and Dental Research Analyst, DENTAC, Fort Gordon, Ga.
authors.forename: Douglas
authors.initials: D
authors.lastname: Dickinson
authors.affiliation: Colonel, United States Army Dental Corps and Director, Prosthodontics Residency, Fort Gordon, Ga.
authors.forename: Van
authors.initials: V
authors.lastname: Ramos
mesh_terms: D004955:Esthetics, Dental; D005006:Ethnicity; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007180:Incisor; D008046:Lip / Q000033:anatomy & histology*; D008297:Male; D012737:Sex Factors; D012904:Smiling