School of Dentistry, Shiraz University of Medical Sciences, Zand Avenue, Shiraz 71934, Iran ... sis and treatment planning. (Eur J Esthet Dent 2010 .... a PowerPoint (Microsoft® Office 2003) slideshow .... Child Study Journal 1975;. 5:201-209.
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Evaluation of the Effect of
Corridor Size on Smile Attractiveness Morteza Oshagh Associate Professor, Department of Orthodontics, Member of Orthodontic Research Center, Faculty of Dentistry, Shiraz University, Shiraz, Iran
Najafi H Zarif Assistant Professor, Department of Orthodontics, Member of Orthodontic Research Center, Faculty of Dentistry, Shiraz University, Shiraz, Iran
F Bahramnia Dentist, Private practice
Correspondence to: Dr Morteza Oshagh 4DIPPMPG%FOUJTUSZ 4IJSB[6OJWFSTJUZPG.FEJDBM4DJFODFT ;BOE"WFOVF 4IJSB[ *SBO
370 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
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CLINICAL RESEARCH
OSHAGH ET ALopyrig
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Abstract
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Introduction: An attractive smile helps
TVCKFDU XFSF QBJSFE JOUP QPTTJCMF
people feel more self-confident and
combinations and presented to three
look younger. One of the more contro-
groups: art students, dental students,
versial aspects of smile attractiveness
and lay people, who compared the two
pertains to buccal corridor size. There
images in each pair for smile attractive-
is no previous study by those with ar-
ness. The statistical tests used were
tistic knowledge that has assessed the
8JMDPYPO TJHOFE SBOL UFTU BOE .BOO
esthetic considerations of buccal corri-
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dor size. The purpose of this study was
Results: Minimal and excessive buccal
to observe whether the size of buccal
corridors were the least attractive when
corridors has an impact on smile attrac-
judged by three groups. All groups pre-
tiveness evaluated by lay people, dental
ferred smaller buccal corridors for the
students, and art students.
male subject and larger buccal corridors
Materials and Methods: Colored post-
for the female subject. No significant
treatment
posed
judging differences were found between
smiles of two subjects (one male, one fe-
male and female judges from among art
male) were selected. The maxillary pos-
and dental students.
terior dentitions were digitally altered to
Conclusions: Minimal or excessive buc-
produce different buccal corridor sizes:
cal corridors should be included in the
OBSSPX CVDDBMDPSSJEPS
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problem list during orthodontic diagno-
OBSSPX CVDDBMDPSSJEPS
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sis and treatment planning.
CVDDBM DPSSJEPS
NFEJVNCSPBE
(Eur J Esthet Dent 2010;5:370–380)
photographs
with
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No C t fo rP ub lica tio n te CVDDBM DPSSJEPS
BOE CSPBE ss e n c e buccal corridor). The 5 images of each
371 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
CLINICAL RESEARCH
Q ui
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appearance. The
n
Introduction
arch and extraction in the upper Physical attractiveness plays an impor-
dentition were thought to be the cause
tant role in how we view ourselves and
of the buccal corridor. Others suggested
how we are viewed by others. Dento-
that the anterior-posterior position of the
facial attractiveness is a major determi-
maxilla and the rotation of the maxillary
nant of overall attractiveness. 8JUIJO
molars could be factors influencing the
the face, the mouth and eyes appear to
buccal corridor.
be very important;7 therefore, the mouth
*O 'SVTIBOE'JTIFSEFmOFECVD-
and teeth are considered to be funda-
cal corridors in dentures and believed
mental in facial esthetics. However,
that absence of buccal corridors gave
esthetic perception varies from person
the patient an unnatural “denture” ap-
to person, and between different social
pearance. They stated that the size and
environments.
For the same reasons,
shape of the buccal corridors were unim-
there can be differences of opinion re-
portant, as long as the buccal corridors
garding beauty between lay persons
were noticed. Also, Roden-Johnson et
and professionals.
al stated that buccal corridor spaces did
Smile, defined as a facial expression
not have an effect on the smile rating
characterized by the upward turning of
of orthodontists, general dentists, and
the corners of the mouth, is often an in-
lay people.#VUTUVEJFTGPVOEUIBUMBZ
dicator of pleasure and amusement.
people, dentists, and orthodontists pre-
8FUSVTUTNJMJOHQFPQMFNPSFUIBOOPO
ferred smiles in which their buccal cor-
smiling ones. An attractive smile helps
ridors were minimal.
people to feel more self-confident and
To our knowledge, there is no previ-
to look younger. It can also express and
ous study that has assessed buccal cor-
communicate pleasant emotions. An
ridors and their association with smile
attractive smile is the result of the right
esthetics by persons working in artistic
components,
environments. Therefore, the purpose of
and a good occlusion does not neces-
this study was to observe whether the
interaction of different
smile.
Smile
size of buccal corridors has an impact
attractiveness includes a number of
on smile attractiveness, as evaluated by
important components including: smile
lay people, dental students, and art stu-
arc, gingival marginal levels, and tooth
dents.
sarily mean an attractive
color. One of the more controversial aspects of smile attractiveness pertains to buc-
Material and methods
cal corridor size, defined as the distance between the maxillary posterior teeth (especially the premolars) and the inside
Case selection
of the cheek, which, during smiling,
In this cross-sectional study, two pa-
appear as dark areas. As light passes
tients (one woman, one man) were cho-
posteriorly, it is reduced, and thus gives
sen by two observers (one orthodontist,
the teeth a darker shade and a smaller
POF EFOUBM TUVEFOU GSPN BNPOH
372 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
OSHAGH ET ALopyrig
QSFWJPVT NPOUIT 4FMFDUFE DBTFT
centages of the commissure width. The
displayed the following:
sum of the two ratios for a given image
n beautiful smile: both observers agreed
XPVMEFRVBM5PQSPEVDFUIFWBSZ-
molars were not considered) n no active periodontal disease and no
fo r
on smile attractiveness n completed permanent dentition (third
n
patients who had completed compre-
ing sizes of buccal corridors, each photograph was first digitally scanned (Nikon $PPMTDBO .FMWJMFF /: 64" 5IF resulting images were imported into
periodontal treatment except for rou-
Adobe® Photoshop®WFSTJPO "EPCF
tine scaling and polishing
Systems Inc., San Jose, CA, USA) and
n normal upper-lip length (the normal
projected on a monitor, with two images
distance from subnasal to upper lip
of the same magnification. To preserve
JOGFSJPSJToNN
UIBUJTFRVBMUP
a realistic appearance, it was decided
one third of lower facial height (sub-
to leave the intercanine width unaltered.
nasal to soft tissue
menton)
n no craniofacial anomalies or other pathologies n OPSNBMGBDJBMJOEFYJONBMFBOE
ot
Q ui
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hensive orthodontic treatment within the
No C t fo rP ub lica tio n te smile fullness widths were not possible. ss e n c e Instead, these were calculated as per-
In both images, this width was, on averBHF OFBSMZ PG UIF JOOFS DPNNJTsure width. Five altered images were produced
JOGFNBMF UIFQSPQPSUJPOBMSFMB-
for each of two subjects to produce a
UJPOTIJQ PG GBDJBM IFJHIU OoHO UP JUT
range of smile fullness that caused differ-
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FOUCVDDBMDPSSJEPSSBUJPTOBSSPX CVDDBM DPSSJEPS
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The subjects had colored post-treatment
CVDDBM DPSSJEPS
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photographs with posed smiles. Posed
DPSSJEPS
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smiles were used because they are the
DPSSJEPS
BOE CSPBE CVDDBM DPSSJ-
most repeatable smiles.
dor). These five values were chosen according to Moore et al’s study. These
Image processing and setting
ranges of smile fullness were produced by copying and pasting posterior teeth
Two smile criteria were considered: smile
(premolars) of the same subject. Some
GVMMOFTT BOE CVDDBM DPSSJEPS #VDDBM
artistic editing was needed to maintain
corridor ratio (the distance between the
a realistic look. The only difference be-
maxillary posterior teeth (especially the
tween the altered images of the same
premolars) and the inside of the cheek)
object was the amount of buccal cor-
was measured as the difference between
SJEPS 'JH
the visible maxillary dentition width and
Next, each altered image was paired
the inner commissure width divided by
with another altered image of the same
the inner commissure.
TVCKFDU 5IFSF XFSF QPTTJCMF DPN-
#FDBVTF UIF PSJHJOBM JNBHFT XFSF
binations of pairings for each subject.
made with slight variations in patient-
This series of paired images of the
to-film distances, exact linear measure-
same subject would be displayed to
ments of buccal corridor widths and
the raters. The images were paired be-
373 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
CLINICAL RESEARCH
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Fig 1
Original, broad, medium-broad, medium, medium-narrow, and narrow smile fullness, respectively.
374 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
OSHAGH ET ALopyrig
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Fig 2
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No C t fo rP ub lica tio n te ss e n c e
An example of the actual layout shown to the raters.
375 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
CLINICAL RESEARCH
Q ui
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pyrig No Co t fo rP ub lica tio n warm-upt eslides, ss e n c e
ot
n
cause the raters can easily compare
In three groups, five
them. One randomly identical pairing
TUBSUJOH BU TFDPOET QFS TMJEF BOE
for each subject was selected and dis-
gradually decreasing to 5 seconds per
played between images for evaluation
slide, were included at the beginning of
PG SFMJBCJMJUZ PG SFTQPOTFT QBJSJOHT
the slide show. These five slides were
for each subject). The pairings were
not included in the data analysis. Each
TPSUFESBOEPNMZGPSTFRVFODFBOEMFGUo
PGUIFSFNBJOJOHJNBHFQBJSJOHTXFSF
right positioning (image A and image
shown for 5 seconds each. A 5-second
# 5IFQBJSJOHTXFSFUIFOQMBDFEJOUP
blank slide was placed between each
(Microsoft® 0GmDF
main slide so that participants had
fo r
a PowerPoint
slideshow to display to the raters panel.
enough time to determine their scores.
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The slides were displayed on a laptop
layout shown to the evaluators.
TDSFFO 5PTIJCB4BUFMMJUF "4
Approval for the study was obtained
NBEFJO+BQBOXJUIBJOCSJHIUTDSFFO
from the ethics committee of Shiraz Uni-
for the art students and the lay people.
versity of Medical Sciences. As the eyes
These two groups were divided into sub-
of the cases were not shown in the imag-
HSPVQTDPOTJTUJOHPGUPQFPQMF BOE
es, obtaining an informed consent was
the slides were shown to them in sepa-
not necessary.
rate sessions. The slides were displayed to dental students, using a video projec-
Rating and evaluation of images
UPS /PUFWJTJPO1($96 4IBSQ $PO-
by raters
shohocken, PA, USA), on a white screen, and all of them participated in the study
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at the same time. All raters were instructed to choose
were selected as described below.
the smile they preferred from each pair-
n "SUTUVEFOUT NFO XPNFO
ing and mark their opinion as:
students who were trained in portrait
n JNBHF"JTNVDICFUUFSUIBOJNBHF#
drawing were selected randomly from
n JNBHF"JTCFUUFSUIBOJNBHF#
institutions in Shiraz, Iran, until the
n JNBHF"BOEJNBHF#BSFUIFTBNF
sample size was large enough.
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n %FOUBMTUVEFOUT NFO XPN-
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en) students from the final year of dental school, who were taught smile
A point system based on response to
analysis, were selected. At the end of
each pairings was used to establish a
one of their classes, the authors re-
score for each size of buccal corridor.
RVFTUFE BMM BUUFOEBOU TUVEFOUT UP SF-
For example, if “Image A is much better
main seated and to rate the images.
UIBOJNBHF#wXBTDIPTFOCZBKVEHF
n -BZQFPQMF NFO XPNFO
QPJOUTXFSFBEEFEUPJNBHF"TPWFSBMM
people were selected randomly from
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patients in the waiting-rooms of differ-
UIFPWFSBMMTDPSFGPSJNBHF#*Gi*NBHF
ent departments in the Shiraz Dental
"JTCFUUFSUIBOJNBHF#wXBTDIPTFO
School.
point was added to its overall score and
376 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
OSHAGH ET ALopyrig
no points were added nor deducted.
students better than lay people. There
The mean scores were computed for
were no significant differences between
each combination of images and raters.
male and female judges and subjects in
Descriptive and statistical tests were
all three groups (P
n
fo r
QPJOU XBT EFEVDUFE GSPN UIF PWFSBMM
performed with these mean values. The
Regarding identical pairings, meas-
information from the identical pairings
ure of agreement (Kappa) was statisti-
was isolated and analysed separately.
cally acceptable.
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No C t fo rP ub lica tio n ences between degrees of smilet efullss e n c e ness better than art students, and art
To compare the distributions of mean scores between the two photographs in QBJSJOHT UIF8JMDPYPOTJHOFESBOLUFTU
Discussion
was used. To compare the distributions of mean scores between male and fe-
The present study, which addressed
male judges, and between male and
one of the numerous factors determining
GFNBMFTVCKFDUT UIF.BOO8IJUOFZUFTU
smile esthetics, showed that, generally,
was conducted. In all tests, P
dental students, art students, and lay
was used as the level of statistical sig-
people do not prefer smiles with minimal
nificance.
and excessive buccal corridors for both male and female subjects. For male subjects, they prefer small to medium buc-
Results
cal corridors, and for female subject they prefer medium to large buccal corridors.
Regarding the male subject, art students
It seems that larger buccal corridors are
SBUFECVDDBMDPSSJEPSUIFNPTUBU-
considered to be a female characteris-
USBDUJWF BOE CVDDBM DPSSJEPS UIF
tic. In a study by Moore et al, there
least attractive, but dental students rated
was no significant difference between
CVDDBMDPSSJEPSUIFCFTUBOE
male- and female-evaluated subjects’
buccal corridor the least attractive. Art
scores, and this is not in agreement with
BOE EFOUBM TUVEFOUT SBUFE CVDDBM
the results of from this study. This may
DPSSJEPSUIFCFTUBOECVDDBMDPSSJEPS
be attributed to the cultural and racial
the least attractive in female subjects.
differences with regard to smile esthet-
-BZ QFPQMF SBUFE CVDDBM DPSSJEPS
ics. In the Moore et al study, lay peo-
UIF CFTU JO NBMF TVCKFDUT BOE JO
ple preferred faces with minimal buccal
GFNBMF TVCKFDUT 5IFZ SBUFE CVD-
corridors significantly more than narrow
cal corridor the least attractive in both
smiles. Similarly, in the present study,
genders.
lay people preferred smaller buccal cor-
The data provided no significant dif-
ridors than did dental and art students.
ferences (P CFUXFFO NBMF BOE
However, it must be borne in mind that
female judges or between male and fe-
they used full-face photographs, which
male subjects for each of the images us-
added various complex characteristics
JOHUIF.BOO8IJUOFZUFTU%BUBTIPXFE
of the face and might cause bias in eval-
that dental students could detect differ-
uation of smiles.
377 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
CLINICAL RESEARCH
Q ui
by N ht
pyrig No Co t fo rP ub lica ti te that on thetics. This might be due to the fact ss e n c e
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showing a great number of teeth while
n
Dunn et al offered the opinion that
their definition of buccal corridor size
smiling is more attractive than showing
was based on intercanine width. Also, a
fewer teeth. Although, to some extent,
greater number of subjects, and the use
this is comparable to our results, in their
PGPOMZSBUFSTJO)VMTFZTTUVEZ NJHIU
TUVEZ TVCKFDUTXFSFFWBMVBUFE BOE
account for different results.
this large number of subjects, with great
The present study showed that den-
variety of tooth and lip shape and ar-
tal students preferred smiles with larger
rangement, could cause different re-
buccal corridors, as compared with lay
sults.
people and art students. This is the first
Parekh et al found that both lay people and orthodontists preferred smiles in
study that considered art students’ opinions in the survey.
which the buccal corridor was minimal.
In the present study, lay people were
This is not in agreement with the present
not as discriminating as art students,
results, which indicated that dental stu-
and art students were not as discriminat-
dents preferred greater buccal corridors.
ing as dental students regarding buccal
This may be attributed to the fact that
corridor sizes. As dental students are
the opinion of a graduate orthodontist
trained to focus on smiles, they might
differs from a dental student who may
be expected to detect smaller differ-
have been taught only a little about smile
ences in the size of buccal corridor than
analysis.
lay people. Art students whose major al
demonstrated no dif-
training was in drawing portraits de-
ferences based on the age or gender of
tected the differences between buccal
the raters or between lay persons and
corridors better than lay people, as they
orthodontists. However, in their study on-
pay attention to smile structures in draw-
ly three different buccal corridors were
ing portraits. Therefore, in evaluation of
evaluated, and the greater range of smile
smiles, artistic concepts are also impor-
fullness in the present study might better
tant. These findings are in agreement
resolve natural individual variations.
with Kokich et al, who demonstrated
Gracco et
Martin et al demonstrated that raters’
different perceptions of dental esthetics
gender did not influence the impact of
between general dentists, orthodontists,
buccal corridor on smile attractiveness.
and lay people, and also showed that
In our study, there was no significant dif-
orthodontists are more perceptive than
ference between female and male raters
the other groups.
from art and dental students for any im-
As excessive and minimum buccal
ages. This may be attributed to the fact
corridors were perceived to be less
that trained individuals (dental and art
attractive than average buccal corridors,
students of both genders) had a more
orthodontists should include these in the
comparable range of opinion compared
problem list during orthodontic diagno-
with lay people.
sis and treatment planning.
Roden-Johnson et al and Hulsey
In art and dental student groups,
found that variations of buccal corridor
there was no difference between male
sizes did not have an effect on smile es-
and female judges. The results indicate
378 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3
OSHAGH ET ALopyrig
fo r
Conclusions
affect the perception of buccal corridor
n
that the gender of the judge does not size in these groups. The lack of a gen-
n Minimal or excessive buccal corridors
der difference is in agreement with other
should be included in the problem
studies evaluating smile esthetics, for
list during orthodontic diagnosis and
FYBNQMF #SJTNBO
Dunn et
al,
Grac-
treatment planning.
co et al, and Martin et al, which all
n Dental students are more discriminat-
indicated that male and female judges
ing about buccal corridor changes
had similar opinions. However, it is not in
than art students, and art students are
agreement with Perrett et
al
and Moore
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Q ui
by N ht
No C t fo rP ub lica tio n te ss e n c e
more discriminating than lay people.
et al, who described how females are
n No significant differences are found
more sensitive to changes in factors of
between male and female judges
attractiveness. This might be attributed
from art and dental students in judg-
to cultural and study design differences
ing smile attractiveness with varying
in different studies.
levels of smile fullness. n Lay people and art and dental students prefer smaller buccal corridors for male subjects and larger buccal corridors for female subjects.
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differences in smiling. PsyDIPM#VMM "DLFSNBO+- "DLFSNBO .# #SFOTJOHFS$. -BOEJT JR. A morphometric analysis of posed smile. Clin Orthod 3FT 4BSWFS%.5IFJNQPSUBODF of incisor positioning in the esthetic smile: the smile arc. Am J Orthod Dentofacial 0SUIPQ 1PHSFM."8IBUBSFOPSNBM esthetic values? J Oral MaxilMPGBD4VSH +FOOZ+"TPDJBMQFSTQFDtive on need and demand for orthodontic treatment. Int %FOU+ 1SPGmU83 'JFMET)8+S Sarver DM. Contemporary 0SUIPEPOUJDT FE4U-PVJT .0.PTCZ 'SVTI+1 'JTIFS3%5IF dynesthetic interpretation of the dentogenic concept. J 1SPTUIFU%FOU -PNCBSEJ3&5IFQSJODJQMFT of visual perception and their clinical application to the denture esthetics. J Prosthet %FOU 3PEFO+PIOTPO% (BMMFSBOP R, English J. The effects of buccal corridor spaces and arch form on smile esthetics. Am J Orthod Dentofacial 0SUIPQ 4BSWFS%. "DLFSNBO.# Dynamic smile visualization BOERVBOUJmDBUJPO1BSU Smile analysis and treatment strategies. Am J Orthod Dentofacial Orthop 4BSWFS%. "DLFSNBO.# Dynamic smile visualization BOERVBOUJmDBUJPO1BSU Evolution of the concept and dynamic records for smile capture. Am J Orthod DentoGBDJBM0SUIPQ
influence of negative space in the buccal corridor during smiling. Angle Orthod .BSUJO"+ #VTDIBOH1) #PMFZ+$ 5BZMPS38 .D,JOOFZ585IFJNQBDUPG buccal corridors on smile attractiveness. Eur J Orthod "SOFUU(8 .DMBVHIMJO31 Facial and Dental Planning for Orthodontists and Oral Surgeons. Edinburgh: .PTCZ 4BSWFS%. 1SPGmU83 Special considerations in diagnosis and treatment planning. In: Graber TM, 7BOBSTEBMM3- 7JH,8 (eds). Orthodontics: Current 1SJODJQMFTBOE5FDIOJRVFT FE4U-PVJT .0.PTCZ %VOO8+ .VSDIJTPO%' #SPPNF+$&TUIFUJDT patients’ perceptions of dental attractiveness. J ProsthoEPOU (SBDDP" $P[[BOJ. %&MJB L, Manfrini M, Peverada C, Siciliani G. The smile buccal corridors: esthetic value for dentists and laypersons. 1SPH0SUIPE )VMTFZ$."OFTUIFUJD FWBMVBUJPOPGMJQoUFFUI relationships present in the TNJMF"N+0SUIPE ,PLJDI7&TUIFUJDTBOE anterior tooth position: an orthodontic perspective. Part II: Vertical position. J Esthet %FOU 1FSSFUU%*4ZNNFUSZBOE human facial attractiveOFTT&WPM)VN#FIBW