Influence of maxillary incisor display and facial pattern on smile attractiveness in adult women: perceptions of orthodontists and laypeople

Abstract

To evaluate the effect of facial pattern and maxillary incisor display on smile attractiveness in adult women as perceived by orthodontists and laypeople. Standardized frontal photographs of a 50-year-old woman were used in this observational study. Images were modified digitally to simulate three facial patterns (brachyfacial, mesofacial, and dolichofacial) and four levels of maxillary incisor display (25%, 50%, 75%, and 100%), in addition to a nonsmiling image. Smile attractiveness was rated by 134 evaluators (67 orthodontists and 67 laypeople) using a five-point Likert scale. Intergroup comparisons were performed with Mann–Whitney U -tests, and intragroup comparisons with Friedman and Durbin–Conover tests ( P < .05). Intrarater reliability was assessed with weighted kappa statistics. Greater maxillary incisor display (75% and 100%) received higher attractiveness scores from both groups regardless of facial pattern. Reduced display (25%) received the lowest ratings. Orthodontists assigned lower scores than laypeople under limited incisor exposure conditions. Facial pattern had limited influence and was significant only at 100% incisor display. Maxillary incisor display significantly influenced smile attractiveness, with 75% and 100% exposure rated most attractive. Reduced display was less favored, particularly by orthodontists. Facial pattern had limited influence, indicating that incisor display was the primary determinant of smile attractiveness.