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Updated: Jun 18, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
The role of the posed smile in overall facial esthetics
David C Havens1, James A McNamara, Lauren M Sigler
1Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI 48109-1078, USA.
Objective:
To evaluate the role of the posed smile in overall facial esthetics, as determined by laypersons and orthodontists.
Materials And Methods:
Twenty orthodontists and 20 lay evaluators were asked to perform six Q-sorts on different photographs of 48 white female subjects. The six Q-sorts consisted of three different photographs for each of two time points (pre- and posttreatment), as follows: (1) smile-only, (2) face without the smile, and (3) face with the smile. The evaluators determined a split-line for attractive and unattractive images at the end of each Q-sort. The proportions of attractive patients were compared across Q-sorts using a Wilcoxon signed-rank test for paired data. The evaluators also ranked nine facial/dental characteristics at the completion of the six Q-sorts.
Results:
Evaluators found the pretreatment face without the smile to be significantly more attractive than the face with the smile or the smile-only photographs. Dissimilar results were seen posttreatment; there was not a significant difference between the three posttreatment photographs. The two panels agreed on the proportion of "attractive" subjects but differed on the attractiveness level of each individual subject.
Conclusions:
The presence of a malocclusion has a negative impact on facial attractiveness. Orthodontic correction of a malocclusion affects overall facial esthetics positively. Laypeople and orthodontists agree on what is attractive. Overall facial harmony is the most important characteristic used in deciding facial attractiveness.
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