Comparison of Esthetic Preferences between General Dentists and Lay Persons towards Digitally Altered Smile Aesthetics

Introduction A smile is a vital element of nonverbal communication and plays a key role in shaping an individual’s self-esteem.¹ Creating a harmonious and attractive smile presents an ongoing challenge for dental practitioners. Over the years, various guidelines have been established to help clinicians achieve aesthetically pleasing outcomes. However, the perception of what constitutes an ‘attractive smile’ is highly subjective, often varying across different cultures, populations, and even from person to person.² Dental professionals play a crucial role in identifying the acceptable limits of deviation in the aesthetic parameters that contribute to a pleasant smile.³ with the growing emphasis on smile enhancement, patient expectations regarding dental aesthetics have risen significantly. While dentists typically evaluate smiles using objective criteria—such as buccal corridor spaces (BCS), midline alignment, presence of diastemas, tooth shape and color harmony, and the proportion between lips and gingiva—patients’ perceptions are often shaped by more subjective influences. These may include cultural background, socioeconomic status, age, and societal opinions.⁴ Given these differences, it is essential for clinicians to recognize and incorporate patients’ aesthetic preferences when planning treatment to ensure optimal satisfaction.⁵ Numerous studies have explored how dental professionals and laypersons differ in their evaluation of smile esthetics.⁶ For instance, Kokich et al.⁷ examined how orthodontists, general dentists, and laypeople in the United States perceived both symmetrical and asymmetrical variations in teeth and gingival features. Similar research has been carried out in Middle Eastern countries such as Dubai,⁸ Jordan,⁹ and Saudi Arabia.¹⁰ Despite these efforts, significant gaps remain in the literature—particularly in understanding the degree of discrepancy between patient and provider perceptions, the role of buccal corridor spaces, and the influence of social and environmental factors on smile esthetics. Dentofacial aesthetics play a fundamental part in modern dental practice, as seen by people’s rising requests for more cosmetic and aesthetic reasons.11 For most persons, improving facial and smile attractiveness is the main motivating factor for receiving orthodontic treatment .12 As the mouth is the center of communication in the face, the smile plays an important role in facial expression and appearance. According to neurological control, there are two types of smiles: involuntary (spontaneous), which is associated with emotion and voluntary (posed), which is not usually associated with emotions.11 The orthodontist's concern is related to the posed smile. In orthodontics, facial and smile aesthetics are largely considered during the diagnosis and also the treatment planning.12 The re-emergence of the soft tissue paradigm in clinical orthodontics has made smile analysis a key element in diagnosis and treatment planning (Ackerman and Ackerman 2002).13 Because facial aesthetics are such an important component of the diagnosis and treatment-planning process, the orthodontist must be aware of what society considers optimal facial attractiveness. The smile aesthetics can be divided into macro aesthetics (the relationship of teeth to each other, to soft tissues and facial characteristics), mini aesthetics (the correlation of lips, teeth and gingiva) and micro aesthetics (fine structures of dental and gingival esthetics).14 The subject of smiles is important for orthodontists because most laypeople use smiles to judge the treatment's success.15 The perception of facial and dental aesthetics has often been assessed using the Visual Analog Scale (VAS), a simple and reliable evaluation tool. Additional methods for analyzing dental aesthetics include photographs, videos, 3D stereo photogrammetry, and eye-tracking technologies.¹¹ The objective of this study was to evaluate and compare the influence of digitally altered smile features—specifically buccal corridor space, midline diastema, gingival display, and midline shift—on facial esthetic perception, as judged by general dentists and laypersons.