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Volume 4, Issue 9, September – 2019 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Evaluation of Refashioned Dental Exquisites-


A Comparative Study between Dental Professionals
and Laypersons in India
1.
Anu Babu, Bds( Public Health Dentistry)
2.
Suganya P, Mds 1st Year ( Public Health Dentistry)
3.
Prabu D, Hod (Public Health Dentistry)
4.
Sunayana, Reader (Public Health Dentistry)
5.
Rajmohan, Reader (Public Health Dentistry)
6.
Bharathwaj, Lecturer (Public Health Dentistry)

Abstract:- by their smile. An ugly smile spoils the will power of the
person. This has, indeed, been the quest of orthodontists the
 Introduction world over to provide that ideal makeover for those who
Smile is the best and the most beautiful way to are less fortunate and perfectly align their dentition.[3] In
solve many problems. A perfect smile provides more some instances, the opinion of dental professionals does not
self-confidence and inspiration to lead a successful life. correlate with the prediction of laypersons. It is a known
A Dental professional can easily detect the types of fact that the orthodontist’s perception often differs from
smile discrepancies that outfit one’s appearance. that of other professionals and laypersons. This fact has
already been well established. However, we find that these
 Aim established parameters have been carried out among the
This study aims to evaluate how well dental western population. For these parameters to be acceptable
professionals and laypersons can detect the for the Indian population, it is necessary to find out whether
discrepancies of a smile. these smile parameters established for the western
population were acceptable for the Indian population as
 Materials and Methods well. [3] Hence, this study is aimed at evaluating the opinion
Comparative questionnaire survey was conducted of general dentists and laypersons in addition to
using a Pro-forma which contained demographic data orthodontists and also to predict how well they can detect
and 20 altered photographs comparison using the one- the dental discrepancies.
way analysis of variance (ANOVA) test for comparison
between all groups; post hoc test for multiple II. MATERIALS AND METHODS
comparisons between all the groups was also employed.
A comparative questionnaire survey was conducted
 Results among 20 -40 years old individuals in Chennai. The
Laypersons were more critical in identifying the samples were divided into 3 groups:
discrepancy in crown width and orthodontist showed a GROUP 1: Laypersons – 50 individuals.
higher threshold level for the unattractive crown length, GROUP 2: General dentists –50 individuals.
dentists were found to be more critical in identifying the GROUP 3: Orthodontists – 36 individuals.
discrepancies in papillary height and less critical in
identifying the midline diastema. The sample size was calculated using the formula and
was assigned randomly to each group. Since this is a short
Keywords:- Exquisites, Smile, Discrepancies. study, IRB is not required. The clinical approval was
obtained from the Department of Public Health Dentistry,
I. INTRODUCTION SRM Dental College, Ramapuram, Chennai.

The term ‘Aesthetics’ derives from Greek and it This study Pro-forma contained demographic data
meant for beauty (exquisite). There are two dimensions on along with 20 sets of photographs. The captured
aesthetics one is objective and the other one is subjective. photographs contain part of the face restricted to that of
[1]
There is a hierarchy in determining the exquisite chin below and ala of the nose above to decrease the
perception of an individual which vary from person to compounding factors. The survey was conducted by
person. The face is the dominant factor to determine dental personal interview during the period 2011- 2012 in
exquisite whereas 34% of eyes and 31% of mouth also Chennai city.
plays a major role.[2] The facial look is the most vital to
admire and attract the neighbours and also plays an
important role during a first impression. Every person
desires to appear exquisite and this is achieved and decided

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Volume 4, Issue 9, September – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The photographs were adopted from the study done 20 refashioned smile photographs (five variants each
by Mayuri Thomas, Rajesh Reddy and B. Jayabharath of the four aesthetic parameters) were randomly grouped so
Reddy on the topic “perception differences of altered dental that intra and inter parameter variations were minimized.
aesthetics by dental professionals and laypersons”. Copies of the questionnaire were distributed among all the
three groups.
In the above-mentioned study, the photographs
showing the smile of the subjects were captured, while they A visual analogue scale (VAS) graded from 1 to 10
were in relaxed positions using a digital camera. The was used for the ratings and is presented below the
photographs were taken at a distance of 60 cm away from questionnaire. The scale progresses on one end to the other
the subject. The captured photographs contain part of the from ''very pleasing'' to ''unpleasing.'' Each person was
face restricted to that of chin below and ala of the nose asked to mark a location along with the scale based on their
above to decrease the compounding factors. There was no prediction of dental aesthetics.
zooming done. The images were altered following four
aesthetic parameters based on Kokich’s approach: The VAS scores rated by all the groups were
• Length of the crown analyzed to find out the mean and standard deviation of all
• Width of the crown twenty altered smile Photographs. These were used for the
• Midline diastema statistical comparison using the one-way analysis of
• Papillary height variance (ANOVA) test for comparison between all groups;
post hoc test for multiple comparisons between all the
The three above groups rated each of the four groups was also employed.
aesthetic parameters mentioned earlier, where each
aesthetic parameter consisted of five variants that were III. RESULTS
morphed using the Adobe Photoshop. Each smile was
intentionally altered for all those parameters, which were The statistical tests used were ANOVA and post hoc
most common in anterior aesthetic discrepancies that also tests. Initially, the mean was found of each group and an
depend on the clinical importance and their frequency ANOVA test performed to compare all parameters between
related with a smile. the groups, and later the Mann-Whitney test (post hoc) was
used to predict the correlation of parameters within each
The length of the crown of the upper central incisor group.
was refashioned and reduced to 0.5 mm by altering the
gingival margin level. Then the alteration of crown width An ANOVA test was conducted in all groups to
was done to a lateral incisor, as it is the most common predict the level of deviation related to groups. Significant
tooth, which is affected by the size of the tooth. The width overall tests were followed with post hoc multiple
of the lateral incisor was reduced in increments of 1 mm comparisons to test hypotheses. Multiple comparisons were
while maintaining the level of marginal gingiva. The wide done at each variation to evaluate the deviation level
area of the crown between the inter-proximal point of discriminated at each group between aesthetic and minimal
contact was measured. dental aesthetic features.

The spacing between the two upper incisors is known The assessment for all the four parameters has shown
as the midline diastema. The widening of space up to 0.5 a significant difference in perception by all three groups.
mm was done then the inter-proximal point of contact The multiple comparison tests showed the difference in
between the crown of central incisors was measured. perception within the groups (TABLE 1) describes the
standard deviation and mean of all the four parameters
Height of papilla was refashioned symmetrically (TABLE 2) shows ANOVA test of all four parameters
between the teeth of upper anterior by lengthening the between groups, and (TABLE 3) denotes post hoc test of
inter-proximal point of contact up to 0.5 mm gingivally all four parameters between and within the groups.
between all the teeth of upper anterior. So that the natural
shape of papilla and tooth was maintained. The distinct variables under each dependent factor
(Crown Length, etc.,) are summarized to get the combined
score as shown below.

Crown Width Score = VAR1+VAR5+VAR9+VAR13+VAR17


Crown Length Score = VAR2+VAR6+VAR10+VAR14+VAR18
Papillary Height Score = VAR3+VAR7+VAR12+VAR16+VAR20
Midline Diastema = VAR4+VAR8+VAR11+VAR15+VAR19

The combined score variables are taken to further analysis. parameters within the groups. (Groups: 1– Layperson, 2 –
The statistical tests used were ANOVA and post hoc tests. Dentist, 3 – Orthodontist)
Initially, the mean was found for each group and an ANOVA
test is performed to compare all the parameters between the The below table explores the descriptive statistics of
groups and later post – hoc test was used to compare the dependent variables concerning each group.

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Volume 4, Issue 9, September – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

95% Confidence
Std. Std. Interval for Mean
N Mean Minimum Maximum
Deviation Error
Lower Upper
Bound Bound
1 50 24.40 4.68 0.66 23.07 25.73 11 30
2 50 27.54 6.29 0.89 25.75 29.33 15 44
CROWNWIDTH
3 36 31.81 6.20 1.03 29.71 33.90 20 47
Total 136 27.51 6.39 0.55 26.43 28.60 11 47
1 50 16.44 5.13 0.73 14.98 17.90 9 26
2 50 24.20 7.24 1.02 22.14 26.26 7 34
CROWNLENGTH
3 36 25.36 4.70 0.78 23.77 26.95 14 35
Total 136 21.65 7.10 0.61 20.45 22.86 7 35
1 50 37.52 7.59 1.07 35.36 39.68 16 47
2 50 31.14 7.56 1.07 28.99 33.29 14 43
PAPILLARY HEIGHT
3 36 32.28 5.43 0.91 30.44 34.12 20 40
Total 136 33.79 7.60 0.65 32.50 35.08 14 47
1 50 36.48 5.51 0.78 34.91 38.05 24 47
2 50 28.88 5.62 0.80 27.28 30.48 17 44
MIDLINE
3 36 34.22 3.32 0.55 33.10 35.35 27 41
Total 136 33.09 6.04 0.52 32.06 34.11 17 47

Table 1:- Descriptiv

Hypothesis: There is no significance between the groups in scoring the parameters.


Alternative Hypothesis: There is significance between the groups in scoring the parameters.
Level of Significance: 0.05

Sum of Squares Df Mean Square F Sig.


Between Groups 1147.912 2 573.956
CROWNWIDTH Within Groups 4356.059 133 32.752 17.524 0.00
Total 5503.971 135
Between Groups 2178.132 2 1089.066
CROWNLENGTH Within Groups 4630.626 133 34.817 31.28 0.00
Total 6808.757 135
Between Groups 1129.094 2 564.547
PAPILLARY HEIGHT Within Groups 6663.722 133 50.103 11.268 0.00
Total 7792.816 135
Between Groups 1506.959 2 753.479
MIDLINE Within Groups 3421.982 133 25.729 2.285 0.370
Total 4928.941 135
Table 2:- Anova Test

Hypothesis: There is no mean difference between the groups in scoring the parameters.
Alternative Hypothesis : There is a mean difference between the groups in scoring the parameters.
Level of Significance: 0.05

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Volume 4, Issue 9, September – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

LSD 95% Confidence Interval


Dependent Variable (I) GROUP (J) GROUP Mean Difference (I-J) Std. Error Sig. Lower Bound Upper Bound
1 2 -3.140* 1.145 0.007 -5.4 -0.88
3 -7.406* 1.251 0 -9.88 -4.93
CROWNWIDTH
2 1 3.140* 1.145 0.007 0.88 5.4
3 -4.266* 1.251 0.001 -6.74 -1.79
1 2 -7.760* 1.18 0 -10.09 -5.43
3 -8.921* 1.29 0 -11.47 -6.37
CROWNLENGTH
2 1 7.760* 1.18 0 5.43 10.09
3 -1.161 1.29 0.37 -3.71 1.39
1 2 6.380* 1.416 0 3.58 9.18
3 5.242* 1.547 0.001 2.18 8.3
PAPILLARY HEIGHT
2 1 -6.380* 1.416 0 -9.18 -3.58
3 -1.138 1.547 0.463 -4.2 1.92
1 2 1.100 1.014 0.370 -3.59 5.61
3 1.258 1.109 0.443 -2.06 4.45
MIDLINE
2 1 -0.600 1.014 0.273 -1.61 1.59
3 -1.342 1.109 0.554 -4.54 -0.15
*. The significant difference of mean is 0.05

Table 3:- Multiple Comparisons

 Crown Width:
The laypersons were more critical in identifying the  Midline Diastema:
discrepancy in this esthetic parameter than the other groups The Dentist showed less threshold level to be
(Mean of 24.40 and S.D. of 4.68) [Table 1]. The ANOVA unattractive (mean of 28.88 and S.D of 5.62) [Table 1].
table explains that there is no significant difference in mean From the ANOVA table, this parameter rejects the null
between groups. (Sig. value is 0.00 <0.05 i.e. Null hypothesis at 5% level of significance, whereas all other
hypothesis was accepted at the significance level of 5%) parameters were accepted hypothesis with significance
[Table 2] The multiple comparison tests also evidenced that value lesser than the level of significance i.e. there is
there is no significant value between all the three groups significance between the groups in scoring this parameter.
[Table 3]. The post – hoc test also strongly proves that there is much
significance between the Laypersons, Dentists and
 Crown Length: Orthodontists in scoring the Midline Diastema.
The orthodontists showed a higher threshold level for
the unattractive crown length than the other groups (Mean IV. DISCUSSION
of 25.36 and S.D of 4.70) [Table 1]. The ANOVA table
explains that there is no significant difference in mean This study examined the attractiveness with regards
between groups. to the length of the crown, the width of the crown, midline
diastema, height of papilla. The visual analogue scale was
(Sig. value is 0.00 <0.05 i.e. Null hypothesis was provided for the judges to rate the attractiveness in a simple
accepted at the significance level of 5%) [Table 2] . The and rapid method. Discrepancies in the crown length have
post – hoc test showed a rejection of the Null hypothesis been discussed in the literature for some time and several
between the Dentists and the orthodontists. (Mean investigators have described them unattractive. The
difference is -1.167 with sig. value 0.37(>0.05)) i.e. the discrepancy between the midline of dentition and face was
scores between Dentists and orthodontists were similar for 2mm among laypersons and was less aesthetic according to
crown length parameter. the study conducted by Johnston C et al., [1999][4]. The
present study shows that Orthodontists identified the
 Papillary Height: unattractive crown length discrepancies than the other
In this parameter, Dentists were found to be more groups. This supported the results of previous studies
critical in providing the scores than the other groups. conducted by O.Kokick et al.,2006 [5] Vinod Krishnan et
(Mean of 31.14 and S.D of 7.56). [Table 1]The null al.,2008 Gul-e-Erum et al.,2008 studies concluded that
hypothesis was accepted at the significance level of 5% crowns with shorter length were found less aesthetically
since the Sig. Value is 0.00 (<0.05). There was no appreciated. [6], [7] Another aesthetic parameter reviewed in
statistically significant difference among groups in scoring this study was the width of the lateral incisors. The study
this parameter. However, the multiple comparison tests showed that all three groups could equally identify bilateral
show that the Dentists and Orthodontists were scored discrepancies in this parameter. This result was matching
similarly for the papillary Height parameter. (Mean with the previous study results obtained by O. Kokick et
Difference of -1.138 and Sig. value of 0.463) [Table3]. al., 2006 [5] and others. This report notified the tooth

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Volume 4, Issue 9, September – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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