Esthetic evaluation of dental and gingival asymmetries.

The aim of this study was to determine which smile asymmetries were less esthetic, dental or gingival. MATERIAL AND METHODS: Laypeople (297), generalists (223), prosthodontists (50) and orthodontists (49), evaluated the esthetics of digitally-modified images taken from the same frontal intra-oral photograph, using the same lips, simulating upper maxillary midline shift, occlusal plane inclination, asymmetric incisal edge and asymmetric gingival migration. The images were later paired into 3 groups. RESULTS: The only ones considered esthetic were the asymmetric incisal edge of the 0.5 mm shorter upper central incisor and the asymmetric gingival migration (2 mm) of the upper central incisor. In the paired images, upper maxillary midline shift vs. occlusal plane inclination, the former was rated less esthetic, while in the asymmetric incisal edge vs. asymmetric gingival migration pair, the latter was considered to be less esthetic. CONCLUSION: Laypeople and generalists consider smiles more attractive. The only images considered esthetic were the asymmetric incisal edge of the central incisor shorter by 0.5 mm and the 2 mm asymmetric gingival migration of the upper central incisor. In the horizontal plane (maxillary midline shift vs. occlusal plane cant), the dental asymmetries were considered less esthetic than the gingival asymmetries. However, in the vertical plane (asymmetric incisal edge vs. asymmetric gingival migration) the opposite was recorded.