Analysis of Aesthetic Preferences Regarding Gingival-Dental Color Combinations

It is our view that the color of teeth and gingiva needs to be analyzed conjointly, given their close anatomical interrelation and the lack of research on perceptions of this chromatic combination.

To determine aesthetic preferences concerning the chromatic combination of ceramic gingival specimens and acrylic teeth and analyze the influence of age and sex.

A sample of 120 participants responded to a survey, in which each participant first selected the three "ad hoc" ceramic gingival specimens whose color they considered the most attractive from seven Vita Lumex AC Gingiva colors (231-237). Each participant then allocated a score from 1 to 10 for the chromatic combination of each of the three ceramic gingival specimens chosen in combination with each of the three acrylic teeth (maxillary central incisor, maxillary lateral incisor, and maxillary canine) in the three most frequent colors in the reference population (1M1, 3M1, and 2L1.5). The questionnaire also collected data on age and sex. Statistical analysis of the results was conducted using SPSS (v.28) software.

Participants most frequently chose gingival shade 232 as their first preference (80.8%), shade 233 was most frequently placed in second position (75%), and most participants selected shade 235 as their third preference (58.3%). The highest rated gingiva-tooth shade combination was 232-1M1 (mean score 7.9), followed by 232-3M1 (mean score 7.3). The only significant difference (p < 0.05) between men and women was between the mean scores allocated for the 232-3M1 combination, which was rated higher by women than men. Statistically significant differences were found between the mean scores allocated by different age groups for the 233-3M1, 233-2L1.5, and 235-1M1 combinations. Younger participants scored the first two shade combinations lower, while the opposite was true for the last combination.

When establishing aesthetic preferences, gingival color takes priority over dental color when both structures are visible in combination. Preferences regarding the most attractive gingival shades are focused on only two colors (232 and 233). A substantial majority of participants rated the 232-1M1 gingival-dental shade combination most highly. Practically no significant differences were identified between the mean scores allocated for gingival-dental color combinations according to sex. Age made a greater difference to results, although both variables had only a modest impact.

Producing a combined gingival-dental shade guide would be useful, enabling the patient to provide their complete aesthetic vision, particularly in clinical situations where gingival tissue needs to be restored in patients with high smile lines. Manufacturers need to improve their gingival shade ranges, due to the limited number available, their disparity with natural gingival color, and the fact that patients do not like most shades on offer. A large percentage of aesthetic preferences focused on a limited number of gingival-dental color combinations, with lighter dental shades combined with the gingival shades that best approximate natural gingival color considered the most aesthetic. Age has more influence on gingival-dental color preferences than sex, although both factors have only a modest impact. For high smile lines, patients prioritize gingival color within the gingival-dental chromatic combination, since the preference for a certain shade of gingival specimen is maintained, irrespective of tooth color, indicating a stable chromatic hierarchy.