A study of smile aesthetic perception among dental professionals, patients and parents towards impacted maxillary canine treatment options.

OBJECTIVE: To evaluate the smile aesthetics of the different treatment options for impacted maxillary canines as perceived by orthodontists, dentists, patients and parents. DESIGN: Cross-sectional survey. SETTING: Four rater groups were selected to complete the questionnaire consisting of an orthodontist group, a general dental practitioner group, a patient group consisting of patients aged 11-18 years who were considered to be 'Gillick competent' and a parent group consisting of parents/guardians who accompanied the patients to their orthodontic appointments. METHOD: Four digitally manipulated images were created to imitate different treatment options available for the treatment of ectopic maxillary canines including: alignment of the impacted maxillary canine; substituted premolars; retained deciduous canines; or gaps present. The images were embedded into piloted questionnaires. Each participant completing the questionnaire was asked to mark the visual analogue scale (VAS) beneath each image according to their perception of attractiveness of each image. Quantitative scoring of the perceived attractiveness of the smile was assessed by one calibrated assessor measuring the distance from the start of the scale to the marked cross placed on the VAS. A two-way ANOVA (mixed between-within subject's ANOVA) was used to compare perception of differences in smile aesthetics. RESULTS: There were significant differences found in the VAS between the groups (P = 0.002) and between the treatment options (P < 0.001) There was no statistically significant difference found between the aligned canines and substituted premolars images by the patient (P = 0.2) or parent group (P = 0.5). All groups most disliked the treatment option where gaps were present at the end of treatment. CONCLUSION: The patient and parent groups showed similar perception in smile aesthetics for aligned canines and substituted premolars and all groups showed a strong dislike to the presence of gaps. The orthodontist group showed the most critical aesthetic perceptions.