Abstract
Managing excess anterior spacing is a common problem in dental practice. During orthodontic or restorative treatment planning, clinicians must decide how to distribute this space. However, few reports are available in the dental literature about the attractiveness and esthetic impact of anterior spaces other than midline diastemas. The purpose of this study was to compare the esthetic perception of 4 different anterior diastemas, including simian diastemas (symmetrical diastemas between lateral incisor and canine), diastemas suggested by Frush and Fisher (asymmetrical diastemas between lateral incisor and canine and between central and lateral incisor), and by Lombardi (slight midline diastema and 2 larger diastemas between central and lateral incisors), and a midline diastema. A picture of a young woman's smiling face was modified by using photoediting software to create the 4 previously mentioned diastemas. The resulting pictures were presented to laypersons questioned in French public places. The participants were asked to rank the pictures from most to least attractive, then to rate them with a mark from 1 to 10. One hundred and five participants completed the questionnaire. The median ranks and scores attributed to the pictures from most to least attractive were as follows: simian diastemas, 1 and 8; Frush and Fisher diastemas, 2 and 7; Lombardi diastemas, 3 and 5; and midline diastemas, 4 and 4, respectively. The hierarchy (simian diastemas>Frush and Fisher diastemas>Lombardi diastemas>midline diastemas) could be established statistically for the scores (P=.03, P<.001, and P<.001, respectively) but not for the ranks when adjusting on subjects' sex and age (P=.11, P=.03, and P=.06, respectively). The results showed an esthetic hierarchy of anterior diastemas. The negative perception of anterior diastemas seems to mainly be related to the presence and width of a midline diastema. These results can guide clinical decisions for patients with excess anterior spacing.
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