Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception

Aim: To clinically assess the aesthetics of smile and the possible influencing factors. Materials and methods: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. Results: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from −0.04 to 0.34; p =.12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p =.0342), located in the upper jaw (p =.0223), and corresponding to incisors (p <.0001) and canines (p =.0159) with respect to molars. Conclusions: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.