Aesthetic evaluation of profile incisor inclination

The objectives of this study were to evaluate (1) the impact of maxillary incisor inclination on the aesthetics of the profile view of a smile, (2) to determine the most aesthetic inclination in the profile view of a smile and correlate it with facial features, and (3) to determine if dentists, orthodontists, and laypeople appreciate differently incisor inclination in smile aesthetics. A smiling profile photograph of a female subject (22 years of age) who fulfilled the criteria of soft tissue normative values and a balanced smile was obtained. The photograph was manipulated to simulate six lingual and labial inclinations at 5 degree increments to a maximum of 15 degrees. The seven photographs were randomly distributed in a binder to three groups of raters (30 dentists, 30 orthodontists, and 30 laypeople) who scored the attractiveness of the photographic variations using a visual analogue scale. Comparison of the mean scores was carried out by repeated analysis of variance, univariate tests, and multiple Bonferroni comparisons. The results showed a statistically significant interaction between the rater's profession and the aesthetic preference of incisor inclination (P = 0.013). The profile smile corresponding to an increase of 5 degrees in a labial direction had the highest score among all professions and among male and female raters. Orthodontists preferred labial crown torque; dentists and laypeople did not appreciate excessive incisor inclination in either the lingual or the labial directions. The most preferred smile matched with a maxillary incisor inclined 93 degrees to the horizontal line and +7 degrees to the lower facial third.