Influence of orthodontic bracket prescription on smile attractiveness in patients with different sagittal skeletal patterns: A 3-dimensional cross-sectional study

Abstract

The objective of this study was to evaluate the influence of orthodontic bracket prescription on smile attractiveness. Three women were chosen according to their sagittal skeletal pattern: skeletal Class I, II, or III malocclusion. For each, 3 smiling pictures were taken in frontal, oblique, and lateral views. The maxillary arch was then scanned, and a 3-dimensional digital model was constructed on the OrthoAnalyzer software. The information of 3 orthodontic prescriptions, namely Roth, MBT, and Ricketts, was simulated after the virtual placement of orthodontic brackets on 10 maxillary teeth. The simulations were then superimposed on the smile photographs in the 3 views, creating a total of 27 images. Groups of orthodontists, dentists, and laypeople rated the attractiveness of each smile using the visual analog scale. This study included 167 evaluators: 54 orthodontists, 54 dentists, and 59 laypersons. In terms of orthodontic prescription, MBT esthetic scores were 4% lower than Roth scores (P<0.001), and Ricketts scores were 13.6% lower than Roth scores (P<0.001). In terms of skeletal pattern, Class II and III scores were 15.0% and 16.4% lower than Class I scores, respectively (P<0.001). Regarding the smiling view, oblique view scores were 3.1% lower than frontal view scores (P= 0.031), whereas lateral view scores were 8.4% lower than frontal view scores (P<0.001). In contrast to gender and age, the specialty of the evaluators significantly affected the esthetic rating of the smiles. The attractiveness of a smile is affected by the prescription of the brackets. The Roth prescription tends to obtain the most favorable esthetic scores, especially in sagittal smiling images. Profile smiles with excessively proclined incisors are considered unattractive. Different views of the same smile do not get similar esthetic scores because sagittal views are rated the most severely.