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Dental Aesthetics: A Study Comparing Patients’ Own Opinions with Those of Dentists


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Objective: A beautiful smile is perceived as important but the components that contribute to the patient’s concept of a beautiful smile have not been fully investigated. Hence this study aimed to compare the views of patients on their own dental aesthetics with those of a group of dentists. It also assessed the patients’ willingness to undergo aesthetic treatment. Methods: Fifty patients, who ranged in age from 24 to 76 years, completed self-assessment questionnaires. Photographs were taken of these patients, which were subsequently assessed by six dentists using a questionnaire with visual analogue scale to assess each parameter. Results: Significant differences (p < 0.05) were found between the opinions of the dentists and the patients. Older patients were generally more satisfied with their smile than the dentists. Eighty-six percent of the patients were willing to undergo aesthetic treatment, although factors such as the complexity of treatment, time involved, discomfort and financial costs, deterred many. The cost of treatment was the main deterrent. The younger patients were least likely to be put off treatment. Conclusion: Patients’ views of their own smile differed from the dentists’ opinion. Those who were the least satisfied and were most likely to undergo aesthetic treatment were in the younger age groups. Satisfaction increased with age and older patients were less likely to seek the aesthetic treatment.
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Open Journal of Stomatology, 2017, 7, 225-233
ISSN Online: 2160-8717
ISSN Print: 2160-8709
DOI: 10.4236/ojst.2017.74016 April 17, 2017
Dental Aesthetics: A Study Comparing Patients’
Own Opinions with Those of Dentists
Richard John Moon1, Brian James Millar2*
1General Dental Practice, Wetherby, UK
2Restorative Dentistry, King’s College London Dental Institute, London, UK
Objective: A beautiful smile
is perceived as important but the components
that contribute to the patient’s concept of a beautiful smile have not been fully
investigated. Hence
this study aimed to compare the views of patients on their
own dental aesthetics with those of a group of dentists. It also assessed the p
tients’ willingness to undergo aesthetic treatment. Methods: Fifty patients, who
ranged in age from 24 to 76 years, completed self-
assessment questionnaires.
Photographs were taken of these patients, which were subsequently
by six dentists using a questionnaire with visual analogue scale to assess each
parameter. Results: Significant differences (p
< 0.05) were found between the
opinions of the dentists and the patients. Older patients were generally more
satisfied with their smile than the dentists. Eighty-
six percent of the patients
were willing to undergo aesthetic treatment, although factors such
as the
complexity of treatment, time involved, discomfort and financial costs, d
terred many. The cost of treatment was the main deterrent. The younger p
tients were least likely to be put off treatment. Conclusion: Patients’ views of
their own smile differed from the dentists’ opinion. Those who were the least
satisfied and were most likely to undergo aesthetic treatment
were in the
younger age groups. Satisfaction increased with age and older patients were
less likely to seek the aesthetic treatment.
Dental Aesthetics, Self-Assessment, Patient, Dentist
1. Introduction
Patients are increasingly seeking cosmetic dental treatment and an attractive
smile is often considered important to them. Studies have shown that attractive
people are perceived as being more intelligent [1] and more popular [2]. The
How to cite this paper:
R.J. and
, B.J. (2017) Dental Aesthetics: A Stu-
dy Comparing Patients’ Own Opinions with
Those of Dentists
Open Journal of Stom
, 225-233.
January 24, 2017
April 14, 2017
April 17, 2017
Copyright © 201
7 by authors and
Research Publishing Inc.
This work is
licensed under the Creative
Commons Attribution International
License (CC BY
Open Access
R. J. Moon, B. J Millar
importance of the smile in social attractiveness and even skill assessment is
known [3] [4]. Patients who seek the cosmetic dental treatment are often those
who consider themselves to be essentially normal in appearance but wish to
make some improvements [5].
It is important that the prescribing clinician is aware about patient percep-
tions of aesthetics in order to satisfy their aesthetic needs even when the restora-
tions are technically correct [6]. However, aesthetic opinions vary according to
the person making the assessment [6] [7] [8] [9] [10].
Brisman’s study [11] sought the opinions of patients, dental students and den-
tists, reporting that all groups preferred teeth of a similar shape, although the
dentists preferred relatively longer and thinner teeth than the patients. Mehl
(2015) showed a difference between students and dentists and emphasised the
need to teach aesthetics at dental school [7]. Prahl-Andersen’s study [12] com-
pared the opinions of laypeople, general dentists and orthodontists, finding that
the general dentists and orthodontists essentially agreed in their responses but as
a combined group, they were much more critical than the laypeople that were
more likely to accept increased or reverse overjets and mild crowding [12].
et al.
(2016) stressed the need to be aware of the difference in percep-
tion between orthodontists and patient [9]. Others agreed and found orthodon-
tists were found to be more critical than general dentists [10] [13]. Geographic
variation in opinions also exists [8].
Studies have shown that the demand exists for invasive and non-invasive aes-
thetic dental treatment [14]. If such treatment is to be carried out successfully, it
is important that the dentist fulfils or exceeds the patient’s aesthetic expecta-
tions. Some of the investigations have found similarities between patients’ and
dentists’ opinions of beauty, whilst others have found disagreement [11] [12]. If
the dentists are more critical of a patient’s appearance than the patient is, then
there is a risk that they may be over-treated. However, if they are less critical,
then the patient may not be satisfied with the treatment outcome. Both factors
could be relevant in the increasing complexity in managing patient’s aesthetic
concerns. The use of self-perception in assessing patientstreatment needs has
been stressed [15].
The aims of the study were to compare the opinions of dentists on a patients’
dental aesthetics with those of the patients themselves and to assess which fac-
tors influence patients’ demand for treatment. Specific objectives were to look at
age and gender in relation to self perception of dental aesthetics regarding tooth
shape, shade, size, position and the impact of soft tissues and restorations.
2. Materials and Methods
This study was designed to compare dentists’ perceptions of the aesthetic zone
bounded by the lips during a smile matched to those of patients. Seven areas
were assessed: the overall appearance, tooth shape, tooth shade, tooth size, posi-
tion of the teeth, appearance of the gingiva and of any restorations or prosthetic
teeth. The assessment was carried by looking at clinical photographs (Figure 1).
R. J. Moon, B. J Millar
A questionnaire was designed by the authors and evaluated via a pilot study, de-
signed to examine patients’ overall satisfaction with the appearance of their an-
terior teeth (Table 1). Dentists assessed the aesthetics of the smile zone using
photographs and a questionnaire as in other studies [8] [10].
In order to allow the patients time to assess their own dentition they were
asked to complete the questionnaire at home. The subjects assessed the overall
aesthetics as well as tooth shape, the shade of the teeth, tooth size, tooth position
and the soft tissues and the aesthetic impact of any restorations present. Visual
Analogue Scales (VAS) were used and the patients marked the points on the line
Figure 1. Photographic views and information for one of the patient assessments.
Table 1. The questionnaire used in the study.
Patient No. __________
Please mark a point on the line, below the question, indicating how satisfied you are with the
issue covered by that question, ranging from completely unsatisfied , to fully satisfied .
For example:
How happy are you with the overall appearance of the anterior teeth?
How happy are you with the shape of the anterior teeth?
How happy are you with the shade of the anterior teeth?
How happy are you with the size of the anterior teeth?
How happy are you with the position of the front teeth?
How happy are you with the appearance of the gingiva, around the front teeth?
How happy are you with the appearance of any fillings, crowns or denture teeth present
on the anterior teeth? (If none are present, please tick the following box )
R. J. Moon, B. J Millar
that represented their view. Ethical permission for this analysis was not required
at the time of the study (2003).
The patients were randomly selected from the patient list in a private general
dental practice situated in Leeds city centre. The concept of the study was ex-
plained to the patients and those that were happy to participate were given ques-
tionnaires to take home, complete and return to the surgery in a stamp-addressed
The assessing dentists were given a similar questionnaire together with three
photographs of each patient and information regarding the patient’s overjet,
overbite and the shade of the bodies of the central incisors (Figure 1). Scores
were generated from the marked visual analogue scales by measuring the point
at which they were marked. The marked point was measured to the nearest mil-
limetre, where the point lay between whole numbers the score was rounded up.
The lines were 10 cm long and therefore, the measured point gave a “score” out
of 100.
Six dentists assessed the patients: two general practitioners, two orthodontists
and two specialist (restorative or prosthodontic lists) dentists. The mean and
standard deviation of the dentists’ scores were then calculated for each question,
patient by patient. From these figures 95% confidence intervals were calculated.
Where the patient’s own scores fell outside these intervals they were considered
to be significantly different, from those of the dentists assessment of the images
of the patients (t-test, p < 0.05).
In order to confirm repeatability, paired t-tests and an intra-class correlation
coefficient (ICC) were performed on the dental assessors. Five randomly chosen
patients were reassessed. ICCs were calculated for each dentist by comparing the
scores given for all of the questions in the initial assessment and in the reassess-
ment. An overall ICC was also calculated. An ICC above 0.70 is generally con-
sidered acceptable. All statistical analyses were performed by SPSS.
3. Results
Questionnaires were given to 60 patients, 52 of whom replied. Unfortunately 2
of these responses were returned too late to be analysed, therefore 50 patients
were assessed. Of the respondents, 26 were female and 24 male with an age range
from 24 to 76 years. The breakdown of the patients is shown in Table 2.
ICCs together with any associated bias were calculated for each of the assess-
ing dentists. An ICC of 0.700 or greater is considered to indicate a high level of
consistency, the measured ICCs ranged from 0.814 - 0.903 thus the consistency
of the dentists was high.
Table 3 shows those patients who were more satisfied than the assessing den-
tists, whilst Table 4 shows those who were less content. The results are expressed
as percentages of the age group for both male and female respondents.
The final question regarding the appearance of restorations or prostheses caused
the greatest difficulty. In 8 of the 50 assessments at least one the dentists could
not detect restorations. In two cases, the patients gave scores for restorations
R. J. Moon, B. J Millar
Table 2. Breakdown of patients enrolled in the study.
Pt Age Female Male Total in age group
20 - 29 yrs 5 3 8
30 - 39 yrs 4 6 10
40 - 49 yrs 6 1 7
50 - 59 yrs 7 7 14
60 - 69 yrs 2 6 8
70 - 79 yrs 2 1 3
Totals 26 24 50
Table 3. Percentage of age group more satisfied than the assessing dentists.
AGE 20 - 29 yrs 30 - 39 yrs 40 - 49 yrs 50 - 59 yrs 60 - 69 yrs 70 - 79 yrs
Overall 20% 33% 25% 17% 50% 100% 57% 29% 0% 50% 100% 100%
Shape 0% 33% 25% 17% 33% 0% 71% 29% 0% 50% 50% 100%
Shade 0% 0% 0% 0% 67% 100% 14% 43% 0% 33% 50% 100%
Size 20% 33% 25% 17% 50% 100% 43% 29% 50% 33% 50% 100%
Position 20% 33% 0% 33% 50% 100% 29% 43% 0% 33% 50% 100%
Gingiva 20% 67% 25% 0% 33% 100% 29% 43% 0% 33% 50% 100%
Restorations 60% 0% 25% 0% 33% 0% 57% 43% 0% 50% 50% 100%
Table 4. Percentage of age group less satisfied than the assessing dentists.
AGE 20 - 29 yrs 30 - 39 yrs 40 - 49 yrs 50 - 59 yrs 60 - 69 yrs 70 - 79 yrs
Overall 20% 33% 25% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Shape 40% 33% 0% 0% 17% 0% 29% 0% 0% 0% 0% 0%
Shade 40% 67% 50% 67% 0% 0% 14% 14% 0% 0% 0% 0%
Size 40% 33% 0% 0% 0% 0% 0% 14% 0% 0% 50% 0%
Position 20% 0% 0% 33% 0% 0% 0% 0% 0% 0% 0% 0%
Gingiva 60% 33% 0% 50% 17% 0% 14% 0% 50% 0% 0% 0%
Restorations 0% 33% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
that were not present, whilst in another the patient and one of the dentists
scored unrestored teeth. In four of the assessments the patients did not detect
the presence of their restorations. In situations where not all of the dentists
spotted the restorations, the values of those that did, have been used.
The questionnaire also asked how willing the patients would be to undergo
dental treatment in order to improve their appearance. They were given various
options ranging from refusal to have any treatment to acceptance of treatment
no matter how time consuming, costly or uncomfortable. The results are shown
in Table 5.
R. J. Moon, B. J Millar
Table 5. The willingness or otherwise of patients to undertake aesthetic treatment as a percentage of their age group.
AGE 20 - 29 yrs 30 - 39 yrs 40 - 49 yrs 50 - 59 yrs 60 - 69 yrs 70 - 79 yrs
Pts unwilling to undergo aesthetic treatment 0% 33% 0% 17% 33% 100% 0% 0% 0% 17% 50% 0%
Pts willing to undergo treatment with NO provisions 60% 67% 25% 33% 17% 0% 0% 57% 0% 0% 0% 0%
Pts willing to undergo simple treatment only 40% 0% 25% 0% 33% 0% 14% 29% 0% 17% 0% 100%
Pts unwilling to undergo treatment because of time. 0% 0% 0% 17% 0% 0% 29% 0% 0% 0% 0% 0%
Pts unwilling to undergo treatment because of discomfort 0% 0% 25% 17% 0% 0% 43% 0% 50% 17% 50% 0%
Pts unwilling to undergo treatment because of costs 0% 0% 0% 67% 50% 0% 43% 14% 100% 50% 50% 0%
4. Discussion
This study was undertaken to find out whether dentists’ perceptions of the aes-
thetic zone bounded by the lips during a smile matched those of patients. Seven
areas were assessed: the overall appearance, tooth shape, tooth shade, tooth size,
position of the teeth, appearance of the gingiva and of any restorations or pros-
thetic teeth. In all areas significant differences (p < 0.05) were found between the
views of patients and the dentists.
As the study was carried out in a city centre private general dental practice
there will be a sampling bias and, although the patients were randomly selected
from the patient list, they may not represent the general population. Fifty pa-
tients took part in the study 26 women and 24 men, ranging in age from 24 to 76
years old. The small size of the study meant that in some of the age range groups
there were only a very small number of participants.
Six dentists assessed the patients and all proved to be reliable with regard to
their consistency as shown by the calculated intra-class correlation coefficients
(ICC). In general the dentists were more critical than the patients as reported in
other studies and more patients were satisfied with their appearance than were
unsatisfied [13]. For satisfaction with their overall appearance, 40% of the re-
spondents were significantly more content, than the dentists, with their appear-
ance (p < 0.05). Whilst there was no gender bias, as in agreement with other
studies [16], there was a tendency for older patients to be more content. By
comparison only three of the patients (6%) were significantly less satisfied with
their appearance; two of these were in the 20 to 29 year group and the other in
the 30 to 39 year old group.
Tooth shape was considered to be significantly more pleasing by 34% of the
patients, whilst only 12% were significantly less pleased (p < 0.05). In a similar
distribution to “overall appearance”, no sexual bias was found and a greater per-
centage of older patients were happier with their tooth shape than younger ones.
Similar findings were found regarding tooth size, where 36% were signifi-
cantly more satisfied and 10% less satisfied than the assessing dentists (p < 0.05).
Again there was an even split between men and women in the more content
group and although a direct association with age was not found, there was a
tendency for older patients to be more pleased.
R. J. Moon, B. J Millar
The assessment of tooth position again found comparable results, 34% were
significantly more satisfied whereas only 6% were less pleased than the dentists
(p < 0.05). Patients’ opinions on the appearance of their gingiva were not so one
sided with 32% being significantly more content whilst 20% were less satisfied (p
< 0.05). Younger patients again predominated in the less satisfied group of re-
spondents, 70% of them lying in the 20 - 29 and 30 - 39 year old groups.
Nineteen patients significantly differed with the dentists in their views on the
appearance of restorations or prosthetic teeth (p < 0.05). The vast majority were
more content than the dentists and only one was less pleased. No direct associa-
tion was found with age. It would therefore appear that the majority of patients
are either as pleased as or are more pleased than the dentists on the appearance
of their restorations. However, it is possible that the assessing dentists are par-
ticularly critical in this area, as they are looking at the work of other dental prac-
Tooth shade was the area where greatest dissatisfaction was found. Of the 25
patients who significantly disagreed with the assessing dentists (p < 0.05), 12
were unhappy with the shade of their teeth. Self-perception of tooth shade has
been shown to be biased by patients who are unhappy with their body image
overall [17].
One can speculate as to why the younger patients are more self-deprecating.
They may be generally more image conscious and some may have celebrity role
models whom they wish to copy. They may be embarking on new careers and
feel that they need to improve their appearance in order to promote themselves.
Or they may be looking for a partner and thus wish to appear as attractive as
possible. By comparison, the older generations may not be so influenced by to-
day’s “image society”. Perhaps they are more likely to be settled in a job or have
a partner. They may simply have become used to their appearance and are now
quite content with it. Hirsch
et al.
[18] put forward the theory of cognitive dis-
sonance in his study where patients rapidly adapted to dentures whose appear-
ance they initially disliked. It may be that older patients subconsciously ignore
any displeasing features and concentrate on “better” areas. The reasons sug-
gested above as to why younger patients are more discerning may of course ap-
ply to older patients and this may explain the dissatisfaction felt by some of these
patients in this study.
Out of the 50 patients in the study 43 (86%) said that they would undergo
dental treatment in order to improve their appearance. Therefore the desire for
treatment is present amongst the patients. When the study looked at how willing
patients would be to have aesthetic treatment carried out, it was the younger pa-
tients who were happier to have treatment, no matter how much time, discom-
fort or money was involved.
Ten patients would only have treatment if it were relatively simple and they
were evenly spread between both sexes and age groups. Of those patients who
would embark on more complicated treatment, the time involved did not put
many off. However, the thought of pain dissuaded eight of these patients, six of
R. J. Moon, B. J Millar
whom were women. There was no obvious age association.
The potential high cost of treatment was the area that would put most people
off treatment. Thirty four percent of patients said that it would deter them; men
and women shared this concern equally. Again no age association was found,
however none of the patients in the 20 - 29 year old age group said that costs
would put them off.
5. Conclusion
This was a relatively small study carried out in a private, city dental practice in
the north of England and ideally a much larger and more widespread study
should be carried out. However, that said interesting although perhaps not sur-
prising results were recorded. This study found significant differences between
the patients and the dentists in all of the areas that were examined (p < 0.05). In
general, the patients were more satisfied that the dentists with their appearance.
However, a number of patients were less satisfied and these tended to be the
younger ones. Satisfaction with appearance was greater amongst the older pa-
tients. Least satisfaction was found in relation to the shade of the teeth. Eighty-
six percent of the patients were willing to undergo the treatment in order to im-
prove the appearance of their teeth. The issue that would deter most people from
complex treatment was the financial cost, although no members of youngest group
of patients were put off by this.
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... Further analysis of the cost attribute revealed that willingness-to-pay per participants decreases with increasing age. Reduced incomes at an older age (e.g., pension), expensive treatments, or a reduced awareness of aesthetically high-quality as well as prioritization of functionality could be a reason [69][70][71]. Presumably, the older the patient, the more intentional the dentist is in communicating that a dental crown is possibly the last and only alternative for tooth preservation [72]. There may be financial and pragmatic reasons for choosing the SHI standard care alternative. ...
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Introduction: Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care. Methods: We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP. Results: Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant. Conclusion: This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.
... Para o êxito do tratamento integrado de harmoniza-ção do sorriso, a comunicação entre paciente-equipe de saúde é fundamental e deve ser estabelecida em via dupla, no sentido de acolher os desejos do paciente, bem como informá-lo das medidas terapêuticas disponíveis e de suas limitações para o alcance de bons resultados 16,20 . no caso em questão, um tratamento integrado foi necessário, envolveu cirurgia periodontal, clareamento dental e restaurações em resinas compostas. ...
... In the specialised literature there are concrete information about the realization of aesthetic dental treatment such as: measurements, angles, electronic systems for previewing the future appearance, systems used in collaboration with the laboratory of dental technique (digital fingerprint of the oral cavity, CAD / CAM). There are, also, many evasive information about issues such as the exposure of various artworks to understanding the phenomena of contrast, luminosity, shadows, symmetry (Demir, Oktay, & Topcu, 2017;Yu, Cheng, Zhou, & Cheng, 2017), (Moon & Millar, 2017). Our study enters this new direction of investigation. ...
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As a science, facial and dental aesthetics is highly complex, the dentist being compelled to effectively exploit his abilities of reconstructing affected tissues, but also cultivate his aesthetic sense. Nowadays, dentists frequently face the patients high expectations, regarding dental structure and facial reconstruction. Most young patients tend to choose their model from the media, while patients over the age of 50 desire to have teeth like those of youth. It should also be noted that there is no concept of „cosmetic dentistry” as the teeth can only be adjusted in corellation to the face and body appearance. Thus, between physiognomy and the general appearance of the body and of the teeth a state of interdependence is in existence. One of the major errors that leads to endangering the quality of dental treatment and to patient dissatisfaction is the way in which the doctor-patient relationship is managed. If a person opts for an aesthetic treatment it is clear that it is facing a low self-esteem, in this case the dentist needing to address the disorder on two coordinates: an objective interpretation involves the sequencing of reconstructing a morphological and functional dentition and and establishing the issues related to patients notion of „beautiful”. At the same time, aesthetic dental treatment is based on the personality of the individual, the age, sex and patient's systemic diseases. The notion of „divine proportion” makes possible to perform „perfect” dental works that integrate the facial and somatic features, whose basic characteristics are symmetry, balance, continuity.
Aim: The effect of three different veneering techniques (layering, press-over, and CAD/CAM techniques) on the fracture resistance of lithium disilicate crown (LDC). Material and Methods: Thirty lithium disilicate crowns were adhesively cemented on the standardized Epoxy die. LDC was fabricated according to the veneering materials and techniques into three groups ( n = 10): group (LV) layering veneering technique, group (PV) pressed veneering technique, and group DV (CAD/CAM) technique. The specimen was artificially aged through dynamic loading and thermocycling. All specimens were tested for fracture resistance using compressive load. Descriptive statistics of frequency distribution mean and standard deviations were calculated and compared across different groups. ANOVA was used to evaluate the effect of the veneering technique on fracture resistance. Results: The highest load was demonstrated in the DV group (1057.26762±97.04401 N) and the lowest load was found in PV group (762.41229±102.56927 N). Similarly, the highest fracture resistance was observed in group DV (14.65171±1.34484 MPa), and the lowest was found in group PV group (10.56558±1.42141 MPa). Mean values of maximum loads and fracture resistance in veneers fabricated by digital, pressed, and layer veneering techniques showed a significant difference. Conclusion: The CAD/CAM veneered monolithic lithium disilicate crowns demonstrated superior fracture resistance compared to the lithium disilicate crowns fabricated by over-pressing and layering techniques.
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Introduction: Esthetic perceptions could differ between the dentist and his patients among various regions and cultures. Aim: The aims of this study were to evaluate the subjective differences between the dentist and the patient in terms of esthetics of metal-ceramic crowns (MCcs). The study also aims to compare the mesiodistal (MD) and buccolingual (BL) dimensions of the cemented crown with its respective natural antimeric tooth. Materials and methods: A total of 85 patients seeking treatment for a single crown (MC) were treated by the undergraduate students under supervision of respective academic staff. After cementation of the crowns, a 9-point questionnaire was given to patient and different dentists. A treatment cast for every single crown was poured. Then, the MD and BL dimensions of the crowns were compared against their respective antimeric tooth. Results: The dentists and the patients agreed in the range of 50.5 to 90.5%. Least subjective differences were found for the length and width of the cemented crowns. The highest differences were noted for symmetry between the cemented crown and its antimeric natural tooth. A total of 31 to 38% of the patients differed from the dentist's evaluation for shade of the crown, color of the crown at the margin, contour of the crown, and the relationship of the crowns with the surrounding gingiva. The highest MD and BL dimensions were in the cemented crown of canines, while the lowest MD and BL diameters were for the cemented crowns of the lateral incisor crowns. Conclusion: Dentist and patient mostly agreed in terms of length (90%), width (81%) and relation of crown with free gingiva (74%). However, they differed mostly on the symmetry of the cemented crowns. The highest MD dimensions and BL diameter were in the cemented MCcs of canine, while the lowest were with lateral incisors. Clinical significance: While fabricating a dental prosthesis, the dentist must know about patients' perception of esthetics; otherwise both clinical and laboratory efforts would not be enough to satisfy the esthetic needs of the patient even if the restoration is technically correct. Perceptions related to symmetry differ mostly between dentist and patient.
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Aims: To determine the effect of varying the transverse cant of the anterior teeth on orthodontists' and laypeople's perceptions of smile aesthetics, and the influence that smile height has on this perception. Materials and methods: A 20-year-old Chinese female with an aesthetic smile and normal occlusion was chosen and agreed to participate. Digital pictures of her posed smile were taken and manipulated to create three smile height variations: low, medium, or high. Each variation was further manipulated to create varying degrees of transverse anterior tooth cant. Fifty-six laypeople and 40 orthodontists participated as raters of the dental and facial impact of the altered smile images. Results: The orthodontists more commonly and precisely identified the transverse cants of the anterior teeth and the detracting influence on smile aesthetics compared with laypersons. The orthodontists accepted a lesser range of anterior transverse cant. Increased smile heights enhanced the capability of all raters to detect a transverse cant and reduced the acceptable cant range. In addition, an increased smile height worsened the detracting effects of the transverse anterior cant in all raters' perceptions of smile aesthetics. An increased display of teeth and angulation of an anterior cant increased the ability of raters in both groups to detect differences. Conclusion: Transverse cants of anterior teeth can affect orthodontists' and laypeople's perceptions of smile aesthetics. Smile height and incisor display were significant factors that affected the orthodontist's and layperson's perceptions of smile aesthetics, and suggested that a description of the detracting effect of an anterior transverse cant should also consider smile height. Clinical relevance: A transverse occlusal cant is an important aesthetic factor used by clinicians during orthodontic diagnosis and review. It is important to appreciate that there is a difference in perception between orthodontic professionals and patients (laypeople). The extent of this perceptual difference and influencing factors could help the clinician set more appropriate treatment goals.
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Smile esthetics has become a major concern among patients and orthodontists. Therefore, the aim of this study was: (1) To highlight differences in perception of smile esthetics by clinicians, orthodontists and laypeople; (2) To assess factors such as lip thickness, smile height, color gradation, tooth size and crowding, and which are associated with smile unpleasantness. To this end, edited photographs emphasizing the lower third of the face of 41 subjects were assessed by three groups (orthodontists, laypeople and clinicians) who graded the smiles from 1 to 9, highlighting the markers that evince smile unpleasantness. Kruskall-Wallis test supplemented by Bonferroni test was used to assess differences among groups. Additionally, the prevailing factors in smile unpleasantness were also described. There was no significant difference (P = 0.67) among groups rates. However, the groups highlighted different characteristics associated with smile unpleasantness. Orthodontists emphasized little gingival display, whereas laypeople emphasized disproportionate teeth and clinicians emphasized yellow teeth. Orthodontists, laypeople and clinicians similarly assess smile esthetics; however, noticing different characteristics. Thus, the orthodontist must be careful not to impose his own perception of smile esthetics.
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Studied the effects of physical appearance (attractive-unattractive) and perceived attitude similarity (high-low) on self-report and nonverbal measures of interpersonal attraction. The physical attractiveness of female confederates, but not their perceived degree of similarity to the 48 male undergraduate Ss, resulted in a number of significant effects during the experimental session. Self-report measures taken 2-4 wks subsequent to the laboratory interaction revealed that Ss had thought more about their partner in the interim, continued to feel they liked her more, and tended to remember more details of her appearance if she had been attractive rather than unattractive. Again, no effects for perceived attitude similarity were detected. (22 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study estimated the prevalence of negative self-perception of smile because of occlusion abnormalities and investigated their association according to standard clinical criteria. The sample consisted of 1290 randomly selected Brazilian adolescent boys and girls aged 12-16 years. The outcome of interest was dissatisfaction with smile, and data were collected using a standardized questionnaire. Occlusion characteristics were assessed using the dental aesthetic index (DAI). The other study variables were gender, age, and use of dental services. A chi-square test and Poisson multiple regression were used for statistical analysis. Of the 1290 students interviewed and examined, 539 (41.8 per cent) were dissatisfied with their smile; of these, 373 (69.2 per cent) assigned their dissatisfaction to the presence of an occlusal abnormality, and 166 (30.8 per cent) reported reasons other than occlusal abnormalities for their negative self-perception of their smile. In multivariate analysis, the following variables were associated with the outcome of interest: maxillary anterior irregularity [prevalence ratio (PR) = 1.40; 95 per cent confidence interval (CI) = 1.29-1.80], incisal spacing (PR = 1.37; 95 per cent CI = 1.19-1.57), vertical open bite (PR = 1.34; 95 per cent CI = 1.15-1.55), mandibular anterior irregularity (PR = 1.29; 95 per cent CI = 1.14-1.46), permanent anterior teeth missing (PR = 1.21; 95 per cent CI = 1.05-1.39), and incisal diastema (PR = 1.14; 95 per cent CI = 1.01-1.31). The negative self-perception of smile was statistically associated with severity of occlusal disorders according to the DAI scores, which suggests that self-perception should be used together with standard clinical criteria when decisions about orthodontic treatments are made in public health care systems.
One of the most challenging tasks in daily practice when it comes to defining treatment goals and how to attain them is the communication with the patient and the self-reflection of the treating dentist. Failures due to miscommunication are common, especially in esthetic dentistry. The purpose of this study was to evaluate the influence of dental education on students' and dentists' judgment of patients' dental appearance. Based on internationally accepted guidelines about dental esthetics, a questionnaire was developed to measure "dental appearance" (QDA). Eleven items defined a QDA score (0 = "absolutely dissatisfied", 100 = "absolutely satisfied"). The QDA was completed by 29 patients (21 women, 8 men) before and after a complete oral rehabilitation, including restoration of the anterior teeth. Overall, 95 students (1st, 5th, and 10th Semester) and 30 dentists evaluated the patients' esthetics before and after rehabilitation on a visual analog scale (VAS; 0 = "absolutely unesthetic", 100 = "absolutely esthetic"). Students and dentists alike judged a significant esthetic improvement after treatment (P ≤ 0.0001). Significant differences could be found when comparing the students' and dentists' judgment and the patients' self-evaluation (P ≤ 0.05). Since it seems that students judge dental appearance differently from patients' self-assessment, teaching esthetic rules at university should incorporate the aspect of patient feedback in order to avoid misconceptions.
Rosenthal and Jacobson found that a teacher's expectations about a child's behavior strongly influence his actual behavior. Generally, teachers form their first impressions of children, and thus develop their expectations for them, from two sources of information--the children's school record and their physical appearance. In this experiment, teachers were given objective information, presumably about a child's scholastic and social potential, accompanied by a photograph of an attractive or an unattractive boy or girl. It was found that the child's attractiveness was significantly associated with the teacher's expectations about how intelligent the child was, how interested in education his parents were, how far he was likely to progress in school, and how popular he would be with his peers.
In this study, the influence of restoration type, symmetry, and color on the perception of dental appearance was evaluated. An esthetic questionnaire was completed by 29 patients before and after esthetic rehabilitation. In addition, 94 dentists from four countries (Germany, the United Kingdom [UK], China, and Switzerland) evaluated the influence of the above factors using before-and-after rehabilitation pictures. The most invasive treatment was recommended by Chinese dentists, while German, Swiss, and UK dentists recommended comparable treatment options. As for restorative symmetry, restoration type, and color, significant differences could be found among and within the dentists of the four countries (P ± .05).
Purpose: The purpose of this study was to compare patients' and dentists' perception of dental appearance. Materials and methods: Based on internationally accepted guidelines about dental esthetics, a questionnaire was developed to measure "dental appearance" (QDA). Eleven items defined a QDA score (0 = "absolutely dissatisfied" to 100 = "absolutely satisfied"). The QDA was completed by 29 patients (21 women, 8 men) before and after a complete oral rehabilitation that included restoration of the maxillary anterior teeth. Overall, 94 dentists from four countries (Germany, the United Kingdom, China, and Switzerland) evaluated the esthetics before and after rehabilitation on a visual analog scale (VAS: 0 = "absolutely unesthetic" to 100 = "absolutely esthetic"). Results: Patients and dentists of all countries found a significant esthetic improvement after treatment (P ≤ .0001). Significant differences could be found when comparing the evaluation of the dentists from the various countries among one another and with the patients' self-evaluation (P ≤ .05). With the exception of the professional rating of the initial situation, no gender-related differences could be found in any of the test groups. Conclusions: In daily practice, it seems of utmost importance for dentists to incorporate the patients' feedback in order to avoid esthetic treatment failures.
The aim of this research was to test the hypothesis that patients' attitudes toward their body affect their capacity to accurately select their existing natural tooth color. Standard validated psychologic assessments were used to determine a person's perception of body image and experience. Oral images were compared with the patients' perceptions of their natural tooth color, which were then compared with the actual tooth color judged by a dental professional. For the vital body dynamic and disliking body experience subscales, women exhibited a significantly more negative attitude toward their bodies than men (P = .000). Patients with a negative attitude toward their body tended to choose a lighter tooth color. The correlation between patients' and the testing physician's choices of color was r = 0.540 for women and r = 0.746 for men. Unhappiness with body image and experience results in poor perception of a patient's own oral image, which in turn results in a patient perceiving that his or her natural tooth color is lighter than that judged by a dental professional. This has clinical implications when trying to achieve patient satisfaction with dental prostheses.