Perception of adults' smile esthetics among orthodontists, clinicians and laypeople

OBJECTIVE: Smile esthetics has become a major concern among patients and orthodontists. Therefore, the aim of this study was: (1) To highlight differences in perception of smile esthetics by clinicians, orthodontists and laypeople; (2) To assess factors such as lip thickness, smile height, color gradation, tooth size and crowding, and which are associated with smile unpleasantness. METHODS: To this end, edited photographs emphasizing the lower third of the face of 41 subjects were assessed by three groups (orthodontists, laypeople and clinicians) who graded the smiles from 1 to 9, highlighting the markers that evince smile unpleasantness. Kruskall-Wallis test supplemented by Bonferroni test was used to assess differences among groups. Additionally, the prevailing factors in smile unpleasantness were also described. RESULTS: There was no significant difference (P = 0.67) among groups rates. However, the groups highlighted different characteristics associated with smile unpleasantness. Orthodontists emphasized little gingival display, whereas laypeople emphasized disproportionate teeth and clinicians emphasized yellow teeth. CONCLUSION: Orthodontists, laypeople and clinicians similarly assess smile esthetics; however, noticing different characteristics. Thus, the orthodontist must be careful not to impose his own perception of smile esthetics.

研究目的：微笑美学（smile esthetics）已成为患者与正畸医师（orthodontists）共同关注的核心议题。本研究旨在实现两大目标：（1）阐明临床医师（clinicians）、正畸医师与普通民众（laypeople）对微笑美学的认知差异；（2）评估与微笑不悦感相关的影响因素，涵盖唇厚度、微笑高度、色彩梯度、牙齿尺寸及牙齿拥挤（crowding）等。
研究方法：为此，本研究选取41名受试者，对其面部下三分之一区域的编辑后照片开展评估。评估分为三组：正畸医师组、普通民众组与临床医师组，要求受试者将微笑按1至9分进行评分，并标记出引发微笑不悦感的特征。本研究采用Kruskal-Wallis检验（Kruskal-Wallis test）结合Bonferroni检验（Bonferroni test）分析组间差异，同时对与微笑不悦感相关的主要影响因素进行了系统描述。
研究结果：三组的微笑评分无显著统计学差异（P=0.67），但三组所关注的与微笑不悦感相关的特征存在明显分化：正畸医师更侧重于牙龈暴露量过少，普通民众更关注牙齿比例失调，而临床医师则更在意牙齿发黄。
研究结论：正畸医师、普通民众与临床医师对微笑美学的整体评估结果相近，但各自所侧重的美学缺陷特征存在显著差异。因此，正畸医师需警惕将自身的微笑美学认知强加于患者的情况。