Esthetic perception of smiles with different gingival conditions

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.