An esthetic evaluation of unilateral canine substitution for a missing maxillary lateral incisor.

OBJECTIVES: The aim of this study is to determine whether variation in size, morphology, and color of a unilateral substituted maxillary canine has influence on the dentogingival attractiveness perceived by dental professionals and laypeople. MATERIALS AND METHODS: A frontal clinical photograph of a patient with unilateral canine substitution was used as standard picture. Five different series were created by modification of following parameters with a raster graphics editor (Photoshop CS 6): (1) width, (2) color, (3) gingival margin height, and (4) crown tip morphology of the substituted canine and (5) the gingival margin height of the neighboring first premolar. For each parameter, the photograph deviating the most from the standard photograph, was combined into a final series. Four groups of examiners (orthodontists, periodontists, dentists, and laypeople) were asked to rank the photographs from most to least attractive. RESULTS: One hundred seventy-four examiners ranked the photographs in order of attractiveness. Overall, a darker canine color (mean rank 4.36 +/- 1.03) and a more pronounced canine tip morphology (mean rank 3.47 +/- 1.11) were significantly ranked as most unattractive (P < .05). The gingival height of the neighboring premolar was ranked as least unattractive by all groups of examiners (mean rank 1.30 +/- 0.74). CONCLUSIONS: Darker canine color and a pronounced tip morphology of a substituted canine are rated as the most unattractive by dental professionals and laypeople. CLINICAL SIGNIFICANCE: The present study showed that the canine color and crown tip morphology are important parameters when considering unilateral canine substitution, both for professionals and laypeople. There is a general preference in favor of canines with a light color and a reduced incisal tip.