Investigating visagism’s role in bridging dentofacial aesthetics and psychological temperament – A cross-sectional study

Abstract Context: Visagism proposes that dentofacial morphology can be designed to reflect an individual’s psychological temperament, offering a conceptual framework for personalized smile design; however, empirical validation of this correlation remains limited. Aims: To investigate the association between smile aesthetics, classified according to the principles of visagism, and self-reported psychological temperament. Settings and Design: This cross-sectional observational study included 120 dentate individuals aged 18–30 years with well-aligned maxillary anterior teeth. Materials and Methods: Psychological temperament was determined using a validated 50-item self-report questionnaire, classifying participants as choleric, sanguine, melancholic, or phlegmatic. Independently, standardized frontal photographs of each participant’s smile were analyzed for tooth morphology, long-axis inclination, and embrasure line pattern to assign an aesthetic temperament, with assessors blinded to questionnaire outcomes. Statistical Analysis Used: Concordance between the two classifications was analyzed using the Pearson Chi-square test, Cramér’s V, and Cohen’s kappa. Results: Sanguine (50.00%) and melancholic (45.00%) temperaments predominated on questionnaire assessment, whereas melancholic (51.67%) and sanguine (36.67%) predominated on photographic assessment. A statistically significant association was observed between the two methods ( χ 2 = 112.92, P < 0.001), with a strong effect size (Cramér’s V = 0.69) and moderate-to-substantial agreement (Cohen’s κ =0.56, P < 0.001). Conclusions: A strong and statistically significant concordance was observed between self-reported psychological temperament and temperament inferred from maxillary anterior tooth morphology, lending empirical support to the principles of visagism as a framework for individualized, personality-congruent smile design.