Laypersons and dentists' perception of smile esthetics in spacing between maxillary central and lateral incisors teeth: a cross-sectional study
DOI:
https://doi.org/10.14393/BJ-v41n0a2025-62120Keywords:
Dental Esthetics, Lateral Diastema, Midline Diastema, Teeth Morphology.Abstract
A smile is an important component of facial attractiveness. However, perceptions of gaps between adjacent teeth, known as diastema, may vary among different individuals and regions depending on cultural or other factors. This study aimed to evaluate perceptions of midline diastema and lateral diastema among individuals of different ages, genders, education levels, and occupations. A cross-sectional study based on a survey with manipulated pictures was conducted at the Department of Prosthodontics, Islamic International Dental Hospital and College, Islamabad, Pakistan, from 1 March to 31 May 2020. The surveyed population included dentists and laypeople and comprised 198 (44.4%) men and 248 (55.6%) women with a mean age of 30.52±13.46 years. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 23.0 (IBM Corporation, Armonk, USA) for Microsoft Windows. The statistical hypothesis test and chi-square test were used to validate significant differences (p≤0.05). Of the 446 participants who completed the survey, 384 (86.09%) preferred a midline diastema of 0mm, and 320 (71.74%) preferred a lateral diastema of 0mm. Approximately 71.71% of the male and 83.6% of the female participants preferred a maxillary midline diastema of 0mm. A significantly (P≤0.05) greater percentage of dentists (91.12%) than laypeople (70.40%) rated a midline diastema of 0mm as most attractive. The negative perceptions of midline and lateral diastema appear to be related to their location and width. The participants rated a diastema of 0mm more attractive than a diastema of 1.5mm or 2mm.
References
ABU-HUSSEIN, M., and WATTED, N. Maxillary midline diastema–Aetiology and orthodontic treatment-clinical review. IOSR J Dent Med Sci. 2016, 15(6), 116-30.
ABU-HUSSEIN, M., WATTED, N., and ABDULGANI, A. An interdisciplinary approach for improved esthetic results in the anterior maxilla diastema. IOSR J Dent Med Sci. 2015, 14(12), 96-101.
ADIGUN, A., YEMITAN, T., and UTI, O. Relationship between maxillary midline diastema width and labial frenum attachment in a sample of Nigerian adolescents: A cross-sectional study. Nigerian Journal of Medicine. 2022, 31(3), 274-279. https://doi.org/10.4103/NJM.NJM_28_22
AHIAKU, S., and MILLAR, B. J. Maxillary midline diastemas in West African smiles. international dental journal. 2023, 73(2), 167-177. https://doi.org/10.1016/j.identj.2022.06.020
AHMED N, et al. Analysis of Lower Facial Third and Dental Proportions to Predict Maxillary Anterior Teeth Width in the Pakistani Population. Symmetry. 2022, 14(4), 723. https://doi.org/10.3390/sym14040723
ALHAMMADI, M. S., et al. Perception of facial, dental, and smile esthetics by dental students. Journal of esthetic and restorative dentistry. 2018, 30(5), 415-426. https://doi.org/10.1111/jerd.12405
AL-SEHAIBANY, F., et al. Perception of Saudi Mothers about Maxillary Midline Diastemas among Children with Mixed Dentition-A Cross-sectional Study. Journal of Clinical & Diagnostic Research, 2021, 15(2). https://doi.org/10.7860/JCDR/2021/45872.14477
ALTHAGAFI, N. Esthetic smile perception among dental students at different educational levels. Clinical, cosmetic and investigational dentistry. 2021, 163-172. https://doi.org/10.2147/CCIDE.S304216
ARAÚJO, C. V. D. S., et al. Should midline diastema in mixed dentition be an aesthetic concern? Orthodontics & Craniofacial Research. 2023, 26(3), 331-337. https://doi.org/10.1111/ocr.12613
BOLAS-COLVEE, B., et al. Relationship between perception of smile esthetics and orthodontic treatment in Spanish patients. PloS one. 2018, 13(8), e0201102. https://doi.org/10.1371/journal.pone.0201102
CARNEIRO, D. P. A., et al A. Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics. 2022, 161(3), 390-395. https://doi.org/10.1016/j.ajodo.2020.09.031
CHAVES, P. R. B., KARAM, A. M. and MACHADO, A. W. Does the presence of maxillary midline diastema influence the perception of dentofacial esthetics in video analysis? The Angle Orthodontist. 2021, 91(1), 54-60. https://doi.org/10.2319/032020-200.1
CHO, V. Y., et al. Eye movement analysis of children’s attention for midline diastema. Scientific reports. 2022, 12(1), 7462. https://doi.org/10.1038/s41598-022-11174-z
CHRAPLA, P., PARADOWSKA-STOLARZ, A. and SKOSKIEWICZ-MALINOWSKA, K. Subjective and Objective Evaluation of the Symmetry of Maxillary Incisors among Residents of Southwest Poland. Symmetry. 2022, 14, 1257. https://doi.org/10.3390/sym14061257
COUSINEAU, K., AL TALIB, T., & HASSAN, N. A. Retrospective evaluation of the prevalence of diastema among an adult population. Open Journal of Stomatology. 2022, 12(6), 175-182. https://doi.org/10.4236/ojst.2022.126017
GOMES, G. H., et al. Interdisciplinary esthetic approach in clinical dental rehabilitation. Journal of Conservative Dentistry. 2021, 24(5), 519. https://doi.org/10.4103/jcd.jcd_441_21
HASAN, H. S., AL AZZAWI, A. M., and KOLEMEN, A. Pattern of distribution and etiologies of Midline diastema among Kurdistan-region Population. Journal of clinical and experimental dentistry. 2020, 12(10), e938. https://doi.org/10.4317/jced.57122
LOPES, S. Midline diastema: A brief overview of its aetiology and management. BDJ Student. 2022 29(3), 26-27. https://doi.org/10.1038/s41406-022-0334-7
MOTAMEDIAN, S. R., et al. Comparison of pleasant and unpleasant smile characteristics in the perception of the laypeople in an Iranian population. American Journal of Orthodontics and Dentofacial Orthopedics 2023, 164(6), 766-773. https://doi.org/10.1016/j.ajodo.2023.04.022
ONYEJAKA, N. K., et al. Knowledge and perception of midline diastema among adolescents in Enugu, South Eastern Nigeria. African Journal of Medicine and Medical Sciences. 2021, 50, 451-457.
OUSEHAL, L., et al. Perception of altered smile esthetics among Moroccan professionals and lay people. The Saudi dental journal. 2016, 28(4), 174-182. https://doi.org/10.1016/j.sdentj.2015.12.004
REIS, P. M. P., et al. Effect of maxillary median diastema on the esthetics of a smile. American Journal of Orthodontics and Dentofacial Orthopedics. 2020, 158(4), e37-e42. https://doi.org/10.1016/j.ajodo.2020.07.028
REVILLA-LEÓN, M., et al. Esthetic dental perception comparisons between 2D-and 3D-simulated dental discrepancies. The Journal of Prosthetic Dentistry. 2020, 124(6), 763-773. https://doi.org/10.1016/j.prosdent.2019.11.015
ROMERO, M. F., et al. A multidisciplinary approach to the management of a maxillary midline diastema: A clinical report. The Journal of prosthetic dentistry. 2018, 119(4), 502-505. https://doi.org/10.1016/j.prosdent.2017.06.017
RUNTE, C. and Dirksen, D. Symmetry and Aesthetics in Dentistry. Symmetry. 2021, 13, 1741. https://doi.org/10.3390/sym13091741
SABRI, N. A. B. M., et al. Smile Attractiveness and Treatment Needs of Maxillary Midline Diastema with Various Widths: Perception among Laypersons, Dental Students, and Dentists in Malaysia. International journal of dentistry. 2023, 1(2023): 9977868. https://doi.org/10.1155/2023/9977868
SĘKOWSKA, A., CHAŁAS, R., and DUNIN-WILCZYŃSKA, I. Width of dental arches in patients with maxillary midline diastema. Folia morphologica. 2018, 77(2), 340–344. https://doi.org/10.5603/FM.a2017.0099
SINGH, K., and CHAUDHARY, R. Evaluation of prevalence of midline diastema among known population. Journal of Applied Dental and Medical Sciences. 2022, 8, 2.
SRIPHADUNGPORN, C., and CHAMNANNIDIADHA, N. Perception of smile esthetics by laypeople of different ages. Progress in orthodontics. 2017, 18, 1-8. https://doi.org/10.1186/s40510-017-0162-4
TANAKA, O., et al. Laypeople's and dental students' perceptions of a diastema between central and lateral incisors: Evaluation using scanpaths and colour‐coded maps. Orthodontics & craniofacial research. 2020, 23(4), 493-500. https://doi.org/10.1111/ocr.12401
THAKUR, S., et al. Assessment of prevalence of midline diastema in a known population. Journal of Advanced Medical and Dental Sciences Research. 2020, 8(1). https://doi.org/10.21276/jamdsr
VASQUES, W. F., et al. Composite resin CAD-CAM restorations for a midline diastema closure: A clinical report. The Journal of Prosthetic Dentistry. 2022, 127(2), 206-209. https://doi.org/10.1016/j.prosdent.2020.07.022
WANG, C., et al. Esthetics and smile‐related characteristics assessed by laypersons. Journal of Esthetic and Restorative Dentistry. 2018, 30(2), 136-145. https://doi.org/10.1111/jerd.12356
WITT, M., and FLORES-MIR, C. Laypeople's preferences regarding frontal dentofacial esthetics: periodontal factors. The Journal of the American Dental Association. 2011, 142(8), 925-937. https://doi.org/10.14219/jada.archive.2011.0299
YEMITAN, T. A., et al. Prevalence and Perception of Maxillary Midline Diastema in Africa: A Scoping Review. West African Journal of Orthodontics. 2020, 9(1), 26-31.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Abdullah Alqarni, Muhammad Aamir Ghafoor Chaudhary, Muhammad Haseeb Rana, Muhammad Qasim, Imran Khalid, Shashit Shetty Bavabeedu, Shan Sainudeen, Mukhatar Ahmed Javali, Gotam Das, Abdul Ahad Ghaffar Khan
This work is licensed under a Creative Commons Attribution 4.0 International License.
