Objective The aim of this study was to assess the aesthetic judgements made by lay people and professionals relating to an asymmetric maxillary central incisors' gingival margin position. Setting Multi‐center institutional study. Materials and Methods A high‐quality intra‐oral photograph of a previously treated case was manipulated (six images). Parents of children undergoing conventional orthodontic treatment (PCT), parents of children undergoing combined surgical‐orthodontic treatment for a unilateral impacted maxillary central incisor (PI) and professionals (dental and orthodontic specialists) were asked to evaluate and rank the images in terms of aesthetics and provide free‐text responses to support their rankings (least and most attractive). All data was analysed statistically with regressions at 5% and a thematic analysis of the free‐text responses was performed. Results The responses from 120 participants (mean age 42.2 years; Standard Deviation SD 8.6 years; 62.2% female) were analysed (30/group). Image E (symmetrical gingival margins with the lateral incisor gingival margins 0.5–1.0 mm below both the gingival margin of the maxillary canine and central incisor which are at the same level in relation to each other) was ranked the most attractive (60.8%). The presence of an asymmetric gingival margin between the maxillary central incisors was rated the least attractive (Images D and F; 30.9% and 39.2%, respectively). The highest and lowest mean ranking scores (adjusted for gender) were Image E (5.12 points; 95% CI: 4.76–5.48 points) and F (1.83 points; 95% CI: 1.57–2.10 points) A similar trend was evident within groups. The PCT group scored Image D the lowest (2.17 points; 95% CI: 1.72–2.62 points). Gender influenced the ranking of the images. Themes to support the ranking of the most attractive image were related to the importance of overall symmetry. Themes to support the ranking of the least attractive image were based on overall asymmetrical (uneven) appearance ( n = 117). Conclusion An asymmetric gingival margin position between the maxillary central incisors negatively influences the rating/perception of attractiveness by lay persons and professionals.
Seehra et al. (2026) studied this question.