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Objectives: To evaluate and compare the influence of posterior gummy smile on the perception of smile esthetics
by orthodontists, general-dentists and laypersons.
Study Design: A frontal photograph of a smile with normal gum exposure was chosen and manipulated digitally
using Adobe Photoshop C3 to generate three further images with posterior gum exposure of 4, 6 and 8mm. These
four images were assessed by the three evaluator groups: orthodontists (n=40), general-dentists (n=40) and laypersons
(n=40). Both orthodontists and dentists had at least ten years professional experience and laypersons were
aged between 40-50 years. The proportion of men to women was 20:20 in each group.
Evaluators awarded a score to the smile esthetics of each image: 1=acceptable, 2=moderately acceptable,
3=unacceptable. Afterwards, each evaluator placed the four images in order of esthetic preference.
Results: No significant differences (p>0.05) were detected between the three evaluator groups for the photo without
posterior gummy smile. The perception of smile esthetics for a the 4mm posterior gummy smile (median for
orthodontists=2, general-dentists= 1, laypersons=1), the 6mm (median for orthodontists=2, general-dentists=1,
laypersons=1) and the 8mm (median for orthodontists=3, general-dentists=2, laypersons=2) was significantly different
between orthodontists and the other two evaluator groups (p<0.0017).
The three evaluator groups coincided in placing the image with the 6mm gum exposure in first place in order of
esthetic preference.
Conclusions: Posterior gummy smile influences the perception of smile esthetics more negatively among orthodontists
than the rest of the groups.
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