Objective

To evaluate the effect magnitude of different parameters on smile attractiveness.

Materials and methods

A reference and 13 images were produced by manipulating 13 parameters. Image rating was performed with a 4-point Likert scale from least attractive (1) to most attractive (4). Image raters included laypeople, dental students, dentists, and dental specialists. Friedman and Wilcoxon image were used for estimate of effect size. Parameters were classified into small (0.10- < 0.30), medium (0.30- < 0.5), or large (≥0.50).

Results

A total of 1040 people participated with good consistency (α = 0.861), and moderate reliability (0.64–0.7). The reference image had the highest rank (laypeople:11.79, dental background: 12.55). For effect size; gingival margin level (−0.11, −0.01), teeth width proportion (−0.09, −0.10), inverted smile arch (−0.09, −0.21), commissure line cant (−0.15, −0.17) and low smile (−0.24, −0.23) had small effect size; occlusal plane cant (−0.36, −0.49), midline cant (−0.36, −0.48), and midline shift (−0.37, −0.49) had medium effect size; diastema (−0.55, −0.54) and color (−0.56, −0.56) had large effect size for the laypeople and dental groups. High smile (−0.42, −0.51), incisor edge symmetry (−0.46, −0.54) had medium effect size in laypeople group and large effect size in the dental group. Width to length tooth proportion (−0.26, −0.39) had small effect size in the laypeople group and medium effect size in the dental group.

Conclusions

Smile parameters had different effect magnitude on smile attractiveness and were classified into small, medium, or large parameters. Neither laypeople nor professionals have a collective judgment on what constitutes a beautiful smile.

Clinical significance

This study investigated the effect magnitudes of 13 smile parameters and presented a small, medium, and large smile parameters classification. It should provide the clinician with an insight into the expected effect each parameter has on the smile.