Quintessence Journals

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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

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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

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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

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problem list during orthodontic diagno-

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sis and treatment planning.

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(Eur J Esthet Dent 2010;5:370–380)

photographs

with

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BOE CSPBE ss e n c e buccal corridor). The 5 images of each


CLINICAL RESEARCH

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appearance. The

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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-

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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

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OSHAGH ET ALopyrig

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centages of the commissure width. The

displayed the following:

sum of the two ratios for a given image

n beautiful smile: both observers agreed

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molars were not considered) n no active periodontal disease and no

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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

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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

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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

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for each of two subjects to produce a

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range of smile fullness that caused differ-

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The subjects had colored post-treatment

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photographs with posed smiles. Posed

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smiles were used because they are the

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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

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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

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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.

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#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-


CLINICAL RESEARCH

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Fig 1

Original, broad, medium-broad, medium, medium-narrow, and narrow smile fullness, respectively.


OSHAGH ET ALopyrig

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Fig 2

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An example of the actual layout shown to the raters.


CLINICAL RESEARCH

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pyrig No Co t fo rP ub lica tio n warm-upt eslides, ss e n c e

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cause the raters can easily compare

In three groups, five

them. One randomly identical pairing

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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

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the slide show. These five slides were

for each subject). The pairings were

not included in the data analysis. Each

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right positioning (image A and image

shown for 5 seconds each. A 5-second

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blank slide was placed between each

(Microsoft® 0GmDF

main slide so that participants had

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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.

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Approval for the study was obtained

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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-

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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

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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-

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ing and mark their opinion as:

students who were trained in portrait

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drawing were selected randomly from

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institutions in Shiraz, Iran, until the

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sample size was large enough.

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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.

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For example, if “Image A is much better

main seated and to rate the images.

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people were selected randomly from

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patients in the waiting-rooms of differ-

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ent departments in the Shiraz Dental

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School.

point was added to its overall score and


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

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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

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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

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considered to be a female characteris-

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tic. In a study by Moore et al, there

least attractive, but dental students rated

was no significant difference between

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male- and female-evaluated subjects’

buccal corridor the least attractive. Art

scores, and this is not in agreement with

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the results of from this study. This may

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be attributed to the cultural and racial

the least attractive in female subjects.

differences with regard to smile esthet-

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ics. In the Moore et al study, lay peo-

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ple preferred faces with minimal buccal

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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.


CLINICAL RESEARCH

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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

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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


OSHAGH ET ALopyrig

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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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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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THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY 70-6.&t/6.#&3t8*/5&3

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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