Esthetic smile preferences and the orientation of the maxillary occlusal plane

The anteroposterior orientation of the maxillary occlusal plane has an important role in the creation, assessment, and perception of an esthetic smile. However, the effect of the angle at which this plane is visualized (the viewing angle) in a broad smile has not been quantified.

The purpose of this study was to assess the esthetic preferences of dental professionals and nondentists by using 3 viewing angles of the anteroposterior orientation of the maxillary occlusal plane.

After Institutional Review Board approval, standardized digital photographic images of the smiles of 100 participants were recorded by simultaneously triggering 3 cameras set at different viewing angles. The top camera was positioned 10 degrees above the occlusal plane (camera #1, Top view); the center camera was positioned at the level of the occlusal plane (camera #2, Center view); and the bottom camera was located 10 degrees below the occlusal plane (camera #3, Bottom view). Forty-two dental professionals and 31 nondentists (persons from the general population) independently evaluated digital images of each participant's smile captured from the Top view, Center view, and Bottom view. The 73 evaluators were asked individually through a questionnaire to rank the 3 photographic images of each patient as 'most pleasing,' 'somewhat pleasing,' or 'least pleasing,' with most pleasing being the most esthetic view and the preferred orientation of the occlusal plane. The resulting esthetic preferences were statistically analyzed by using the Friedman test. In addition, the participants were asked to rank their own images from the 3 viewing angles as 'most pleasing,' 'somewhat pleasing,' and 'least pleasing.'

The 73 evaluators found statistically significant differences in the esthetic preferences between the Top and Bottom views and between the Center and Bottom views (P<.001). No significant differences were found between the Top and Center views. The Top position was marginally preferred over the Center, and both were significantly preferred over the Bottom position. When the participants evaluated their own smiles, a significantly greater number (P< .001) preferred the Top view over the Center or the Bottom views. No significant differences were found in preferences based on the demographics of the evaluators when comparing age, education, gender, profession, and race.

The esthetic preference for the maxillary occlusal plane was influenced by the viewing angle with the higher (Top) and center views preferred by both dental and nondental evaluators. The participants themselves preferred the higher view of their smile significantly more often than the center or lower angle views (P<.001).