Esthetic effect of orthodontic appliances on a smiling face with and without a missing maxillary first premolar

Introduction In this study, we evaluated the effects of orthodontic appliances and an extracted maxillary first premolar on the esthetic evaluation of a smiling face according to the perceptions of orthodontists and laypeople. Methods Standardized oblique photographs of a young woman with a pleasing smile were taken. The photos were edited by using digital imaging software to produce 10 combinations of presence or absence of orthodontic appliances with either esthetic or metal brackets, rubber bands of different colors, and presence or absence of the maxillary first premolar. Two groups of 50 observers each, 1 of laypeople and the other of orthodontists, evaluated the images and assigned esthetic scores to the smiles according to a visual analog scale. Results The presence of orthodontic appliances and metal brackets, regardless of rubber band color, had no negative effect on the esthetic evaluation of the smile by either group. Appliances with esthetic brackets were significantly less pleasing for laypeople, whereas for orthodontists they did not affect the esthetic evaluation of the smile. The extraction space had a significantly negative effect on the evaluation of the smile, and only orthodontists thought that the appliance minimized its effect. Conclusions The type of bracket used with the orthodontic appliances and a maxillary first premolar extraction space produced different esthetic perceptions in laypeople and orthodontists.