Perception of Smile Attractiveness Based on Upper Dental Midline Shift and Gingival Display Among Dental Professionals and General Population: A Questionnaire-Based Study

Aim To assess and compare the perception of smile attractiveness based on upper dental midline shifts and gingival display among dental professionals and the general population. Methodology A cross-sectional questionnaire-based study was conducted after obtaining ethical approval (SRGCDS/2025/105). A total of 106 participants aged 20-50 years were recruited, comprising 27 dental professionals and 79 members of the general population. A standardized high-resolution smile photograph was digitally altered to simulate varying upper dental midline shifts (0, 1.5, and 3 mm) and gingival display levels (0, 2, and 4 mm). Participants evaluated the attractiveness of the images through a structured online questionnaire, selecting their responses from predefined options for each image. Data were analyzed using SPSS version 20.0 with descriptive statistics, chi-square tests, analysis of variance (ANOVA), and Cohen's kappa for reliability. A <i>P</i>-value < 0.05 was considered statistically significant. Results Smiles with minimal midline deviation and 0-2 mm gingival display were rated most attractive. Dental professionals were significantly more critical of midline shifts and excessive gingival display compared to the general population (<i>P </i>= 0.04). They more frequently identified 3 mm deviations as unattractive, requiring correction, and associated them with long-term impacts (<i>P </i>= 0.03). Both groups rated the 4 mm gingival display least attractive. Over half of the participants (60, 56.6%) prioritized correcting both midline and gingival discrepancies simultaneously. Conclusions Perceptions of smile attractiveness are influenced by both upper dental midline alignment and gingival display. Dental professionals demonstrate greater sensitivity to deviations than the general population. Recognizing these perceptual differences is essential for clinicians to align treatment goals with patient expectations, thereby enhancing aesthetic and functional outcomes in orthodontic treatment.