Perception of Orthodontic Micro Esthetic Parameters and Their Social Acceptability Threshold: A Cross-Sectional Study

OBJECTIVES This study aimed to evaluate orthodontic patients’ perception of micro esthetic parameters in the maxillary central incisors. METHODOLOGY A cross-sectional observational study was conducted at Rehmat Memorial Hospital, Abbottabad, using non-probability consecutive sampling on 120 participants aged 16-40 years who had no prior orthodontic treatment or professional exposure to dental esthetics. A female patient with clinically ideal micro esthetic features was photographed under standardized conditions. The image was digitally altered to modify individual micro esthetic parameters-width-to-height ratio (60% and 100%), gingival zenith position (1 mm mesial and distal shift), interproximal contact point (1.5 mm apical shift), and axial inclination (5° mesial and distal tilt)-while keeping other features constant. Participants rated the attractiveness of the original and altered images using a 10-point Visual Analog Scale in randomized order. Data were analyzed using one-way ANOVA and stratified by gender. RESULTSThe mean age of participants was 28.99 ± 6.96 years, with 56.7% females. The highest attractiveness scores were given to unaltered images across all parameters: width-to-height ratio (mean 8.92), gingival zenith (8.45), axial inclination (8.00), and contact point (8.06). Altered images received significantly lower ratings (p < 0.001). Male participants generally showed higher tolerance for esthetic variations than females. CONCLUSION Minor alterations in micro esthetic features of maxillary central incisors significantly impact perceived dental attractiveness. Maintaining natural tooth proportions, gingival contours, and contact points is critical in esthetic treatment planning. Gender differences suggest varying esthetic sensitivities that should be considered clinically.