Evaluation of changes in smile aesthetics with fixed orthodontic treatment

This study was done to evaluate the improvement in the smile aesthetics with fixed orthodontic treatment. The study evaluated the attractiveness of Pre-treatment and Post-treatment posed smile photographs of 70 consecutively treated cases. The evaluation of smile aesthetics in this study was done objectively using the Diagram of Facial Aesthetic Reference and subjectively using the Visual Analogue Scale. In the first part of this study, the Diagram of Facial Aesthetic Reference was drawn on Pre-treatment and Post-treatment photographs to objectively assess the changes in the consonance of the smile arc, the position of the gingival zenith of the anterior teeth relative to each other, the relative height of the incisal edges of the anterior teeth, width of the connector band of the anterior six teeth and the relative tip of the anterior teeth. In the second part of this study, the Visual Analogue Scale was used by five male orthodontists, five male general dentists and five male laymen to subjectively assess the improvement in smile aesthetics between Pre-treatment and Post-treatment photographs. Results of the first part of the study showed that there was improvement in all the parameters with orthodontic treatment in most of the cases. However, some of the cases showed a deterioration of some of the parameters like consonance of the smile arc, position of the gingival zenith relative to each other and relative height of the incisal edges. Results of the second part of this study showed that Orthodontists, General Dentists and Laymen differed in their perception of the smile aesthetics. Orthodontists as a group agreed mostly with their peers on their assessment of smile aesthetics and there was a marked improvement in the smile aesthetics of patients with orthodontic treatment as perceived by Orthodontists, General Dentists and Laymen. The results of this study agree with Annemieke B et al. and Kokich V O et al, that there is difference in the perception of smile between orthodontists, general dentists and laymen. In contrast to our findings, Roden-Johnson et al. did not find any difference in the perception of smile between dentists and laymen. However, this study used only male evaluators. Further studies have to be carried out to compare the difference in the perception of smile between male and female evaluators, which was beyond the scope of this study. Further studies can also be done correlating the type of mechanotherapy like Intrusion Retraction, Extraction-Non-extraction, etc. used during orthodontic therapy and its influence on the aesthetics of smile. The conclusions drawn from this study are: 1. There was improvement in the various parameters influencing smile aesthetics like the consonance of the smile arc, the relative tip of the teeth, the position of the gingival zenith relative to each other, height of the incisal edges of the anterior teeth relative to each other and the width of the connector band as result of orthodontic therapy. 2. There was a difference in the perception of Orthodontists, General Dentists and Laymen when evaluating the attractiveness of smile aesthetics. 3. Compared to their peers, Orthodontists as group had more agreement; General Dentists had less agreement whereas Laymen had the least agreement when evaluating the smile aesthetics. 4. There was substantial improvement in the attractiveness of smile with Orthodontic Therapy as perceived by Orthodontists, General Dentists and Laymen. 5. The Diagram of Facial Aesthetic Reference is a useful tool that can help clinicians to objectively assess the parameters influencing smile aesthetics and take corrective measures, as required. 6. The findings of the study suggest that there is a need to evaluate the smile aesthetics during the Finishing and Detailing stage of Orthodontic Therapy to achieve an optimal result