Raw data for a study of smile aesthetic perception amongst dental professionals, patients and parents towards impacted maxillary canine treatment options

Published: 16 November 2020| Version 1 | DOI: 10.17632/m5npy78mnd.1
Leonie seager


Objective To evaluate the smile aesthetics of the different treatment options for impacted maxillary canines as perceived by orthodontists, dentists, patients and parents. Design Four digitally manipulated images were created to imitate different treatment options available for the treatment of ectopic maxillary canines including; alignment of the impacted maxillary canine, substituted premolars, retained deciduous canines or gaps present. The images were embedded into piloted questionnaires. Setting Four rater groups were selected to complete the questionnaire consisting of an Orthodontist group, a GDP group, a Patient group consisting of patients between the ages of 11 and 18 who were considered to be ‘Gillick competent’ and a Parent group consisting of parents/guardians who accompanied the patients to their orthodontic appointments. Method Each participant completing the questionnaire was asked to mark the visual analogue scale underneath each image according to their perception of attractiveness of each image. Quantitative scoring of the perceived attractiveness of the smile was assessed by one calibrated assessor measuring the distance from the start of the scale to the marked cross placed on the VAS scale. A two-way ANOVA (mixed between-within subject’s ANOVA) was used to compare perception of differences in smile aesthetics. Results There were significant differences found in the VAS between the groups (p = 0.002) and between the treatment options (P=<0.001) There was no statistically significant difference found between the aligned canines and substituted premolars images by the patient (p = 0.2) or parent group (p = 0.5). All groups most disliked the treatment option where gaps were present at the end of treatment. Conclusion The patient and parent group showed similar perception in smile aesthetics for aligned canines and substituted premolars and all groups showed a strong dislike to the presence of gaps.


Steps to reproduce

The photographic database at the researching hospital department was reviewed by the author and departmental Orthodontic Consultants to identify photographs of patients who had completed appropriate treatment. Images were digitally manipulated using Adobe Photoshop software (Adobe Photoshop, San Jose, Calif) on the baseline image using the layer function of the software so that all images were identical except for specific changes made in the canine region. The manipulated post de-bond extra-oral frontal smile view photographic image was then incorporated into the study questionnaire. Ethical approval was granted via proportionate review from the National Research Ethics Committee Northwest Lancaster (Reference 15/NW/0678) and was also approved by the Research and Development Departments at the Royal Stoke University Hospital (Reference ID 770 URCRN ID: N/A CSP) as well as the Birmingham Community NHS Trust Research & Innovation Department (Reference BCHCDent174243.NonPort). A power analysis to calculate the sample size required for the study rater groups was done using data collected from pilot questionnaires. Four different groups of participants were recruited and asked to complete the piloted questionnaire. The orthodontist and GDP groups were recruited at professional events whilst the patient and parent groups were recruited when they attended for their routine orthodontic appointments. Positive written consent to take part in the study. All participants were recruited consecutively and the questionnaires completed anonymously. The questionnaires were printed from the same inkjet laser printer on 100gsm paper to produce high quality photo images with realistic colour and contrast. Only one treated case was displayed on each page. To ask the study question, a visual analogue scale of 100 mm was placed underneath each image and the participants were asked to place a mark on the scale according to their perception of attractiveness of each image. This scale was labelled on the left by the descriptor “very unattractive” and on the right “very attractive”. The design and layout of the questionnaire was very specific and all laid out identically. The cover page of the questionnaire contained all the necessary instructions for the participant and an example of how to mark the VAS scale was also available in order to ensure standardization was maintained when completing the questionnaire. Quantitative scoring of the perception of attractiveness of each smile was measured by one assessor measuring the distance from the most extreme left point of the line to the marked cross on the VAS using a digital caliper.


University of Birmingham, Royal Stoke University Hospital


Evidence-Based Orthodontics