Perception of smile attractiveness with different orthodontic aligner configurations

To examine the esthetic perception, by laypeople, of smile attractiveness using different configurations of orthodontic aligners and their accessories.

This cross-sectional study included nine standardized photographs of an adult female model presenting an esthetically pleasing smile. The images represented different clinical conditions: natural smile (without aligner or attachments), smile with aligner only, with aligners and attachments, and with aligner combined with elastics, with and without attachments. A total of 193 laypeople, all aged over 18 years, evaluated the attractiveness of each image using a five-point Likert scale. Participants also completed a social media questionnaire assessing their familiarity with aligners, attachments, and their perception of aligner esthetics. Statistical analyses were performed using Chi-square, Fisher's Exact Test, Kruskal-Wallis, analysis of variance, and Tukey's post hoc test, with a significance level set at 5% (P < .05).

The highest esthetic ratings were observed for the natural smile (P = .66, mean = 4.46 ± 0.05), followed by the smile with aligner only (P = .56, mean = 4.27 ± 0.09) and the smile with attachments limited to the anterior teeth, without aligner (P = .36, mean = 4.25 ± 0.11). In contrast, images showing aligner with cuts, elastics and multiple attachments received the lowest attractiveness score (P = .09, mean = 3.38). Although 69.9% reported being familiar with aligners, only 13.9% understood what attachments were. Although 82.9% indicated they would choose aligner treatment, only 39.9% perceived them as completely invisible.

Orthodontic aligners are generally considered an esthetically acceptable treatment option. Simpler configurations, without accessories or with limited anterior attachments, showed attractiveness comparable to the natural smile, whereas multiple accessories negatively affected smile perception.