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When male and female patients, dental students, and dentists evaluated
drawings and photographs of maxillary central incisors of varying
shape, symmetry, and proportion, it was found that the preferences of
dentists and patients differed significantly.
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Symmetry
Any concept of esthetics must consider symmetry.s
In another field, Furtwangler9 wrote: "Symmetry refers to the regularity or balance in the arrangement
of forms and objects. There are two kinds of symmetry, horizontal or running symmetry, and radiating or bilateral symmetry." Horizontal symmetry
occurs when the design shows similar elements
from left to right in a regular sequence. This type of
symmetry is psychologically predictable and comfortable but tends to be monotonous. l The dentition
approaches horizontal symmetry when all the teeth
have the same shape; that is, when they look like
central incisors. Radiating symmetry results when'.
the design extends from a central point and the left
and right sides are mirror images. Elongating the
central incisors and narrowing the lateral incisors
will exaggerate the effect of radiating symmetry.
According to the Academy of Denture Prosthe'ADA. Vol.l00.Man:h 1980 345
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Proportion
Proportion is another important concept of esthetics. We will consider the relationship between the
length and width of.the tooth. The average maxillary
central incisor has a length-to-width ratio of 10:9.
Yet, the recommended proportion in dental
anatomy and for dental laboratory technici~s is
10.5:8.5. 12.13 This discrepancy can only be explained by the empirically derived impression that
elongating the central incisor will result in a more
esthetically pleasing arrangement. It has also been
suggested that the cervical mesial-to-distal dimension be widened from 6.5 to 7 mm. This reduces the
taper of the tooth; a squarer incisor is created.
When the central incisor is elongated, it approaches an interesting length-to-width proportion,
3:5. Artists, architects. and psychologists have
found that people prefer lines and areas that can be
divided approximately in the ratio of 1 to 0.618, or
approximately 3 to 5. The Greeks may have used this
proportion in art and architecture. It was studied by
Fibonacci, a 13th century Italian mathematician,
and is currently used in designs by commercial artists. I 4-16 Dentists have also written about the golden
proportion. t.17 Levin even developed a grid that relates central incisors, lateral incisors, canines, and
premolars in a 3:5 proportion. IS
Study objectives
The evaluations described in this paper have tried to
answer, with respect to symmetry. proportion, and
shape of teeth, these questions:
-Is there a shape of teeth (square, tapered, or
ovoid) that is preferred?
-Is symmetry preferred?
-Is radiating symmetry preferred to horizontal
symmetry?
-Are elongated teeth with a length-to-width ratio
of 3:5 (the golden mean) preferred?
-Are dentists and dental students' concepts of
esthetic appearance similar to those of patients?
-Are square teeth considered masculine. are tapered ovoid teeth considered feminine, and do
Methods
Preferences of patients, dentists, and dental students with respect to shape, proportion, and sYmmetry of maxillary incisors were investigated by
analyzing their choices in a series of studies. The patients were white, middle-class men and WOIllen
who lived in the greater New York area. Ages ranged
from 20 to 70 years; none of the patients wore dentures. The dental practitioners and students were
men. The dentists had a minimum of three years'
experience. The students were seniors at New York
University College of Dentistry. Totals of 112 dentists, 215 dental students, 695 female patients, and
399 male patients were used for the different
studies. No participant answered more than three of
the nine surveys.
Studies 1 and 2 evaluated the preferences of the
four groups to variations in drawings of basic shapes
and photographs of variously shaped maxillary
teeth. Study 3 evaluated preferences to photographs
of two set-ups of so-called masculine or feminine
teeth. Studies 4, 5, and 6 evaluated preferences to
drawings and photographs of teeth of the same
shape but with different length-to-width proportions. Studies 7 and 8 evaluated preferences to draw- .
ings and photographs of teeth of different symmetry
but which had the same shape and proportion.
Study 9 evaluated preferences to teeth of varying
combinations of shapes and symmetry but with the
same proportions.
Data and illustrations for the nine studies are
found on the following five :oages. Discussion follows Study 9.
Participants were asked to list their choices as:
best, second best, third. and so forth. A weighted
score for each reply was obtained by totaling the
scores of the respondents in each group (dentists,
dental students, and male and female patients). First
choice was given a weight of 1, second choice was
weighted as 2, third choice was weighted as 3, and
so forth. The lower the total score, the more favorable the response.
By ranking the weighted replies, we attempted to
test the consistency of the replies among the four
groups. The closer the weighted score was to 1, 2, or
3. the more consistent were the replies to the test
within the group. Complete consistency rarely occurred within each group; often, the weighted
scores for two of the choices were close.
Differences in weighted totals for the four groupS
in each study were tested for statistical significance
by the chi-square test. This tests whether the differences in weighted rank scores among groups of
subjects were statistically significant or could have
occurred by chance.
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Table 1 Mean scores and rankings of preferences of four groups of respondents (male
and female patients, dental students and practitioners) for basic shapes of teeth as seen in
Study 1 (Fig 1).
Group
MalePatieots (0 = 80)
Ovoid
Squar"
Triangle
Female patients (n = 118)
Ovoid
Square
Triangle
Students (n = 68)
Ovoid
Square
Triangle
Dentists (n = 27)
Ovoid
Square
Triangle
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First
choice
Second
choice
Third
choice
Mean
score
Rank
41
37
2
36
35
9
3
8
69
1.52
1.64
2,84
1
2
3
40
56
22
10
12
96
1.51
1,68
2.Bl
1
2
3
14
42
12
1
13
54
1,24
2,00
2,76
1
2
3
4
20
3
1.15
1,96
2.89
1
2
3
68
50
53
13
2
23
4
3
24
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Fig 1 Basic square, ovoid, and triangular
forms that were shown to participants. All
dentists chose ovoid fonn as first preference.
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Table 2 Mean scores and rankings of preferences of four groups for basic shapes of teeth as seen in photographs of maxillary central
incisors in Study 2 (Fig 2).
Shape
of tooth
A.
B.
C.
Note: x'
Male patients
(n = 80)
Square
ovoid
Ovoid
Tapered
ovoid
= 7.15;
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Mean
score
Rank
1.80
Second
1.63
First
1.65
2.55
First
Third
1.66
2.71
Second
Third
Mean
Rank
score
Dentists
(n = 27)
Students
(n = 68)
Mean
1.93
Rank
Second
Mean
score
2.11
Rank
Second
1.43
2.64
First
Third
1.37
2.52
First
Third
scor~
df - 8; P> .05.
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Female patients
(n = 118)
Fig 2 Photographs of maxillary central incisors that were closely associated in form with
drawings shown in Figure 1. A, square ovoid;
B, ovoid; and C, tapered ovoid. Ovoid was first
choice, especially of dentists.
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Female
patients
(n = 100)
Male
dentists
(n = 25)
Male
students
(n = 40)
%.
60
40
69
31
68
32
64
58
42
65
35
68
32
60
40
78
12
10
74
10
80
20
96
4
36
16
x' = 1.41; df =
tx'
tx'
3; P> .05 .
= 1.18; df = 3; P > .05.
- 3.66; df = 3; P > .05.
lOne dentist thought set-up B was more masculine because it looked uneven and irreglliar.
Fig 3 Photographs used to evaluate concept that square ovoid central incisors (A) are masculine
and tapered ovoid central incisors (B) are feminine. Female patients preferred square ovoid shape (A).
Lengthto-width
proportion
A. 3;2
B. 5:4
C.9:10
D.2:1
E. 4:3
Male patients
(n = 70)
Mean
score
Rank
1.69
2.87
4.29
4.61
1.54
Second
Third
Fourth
Fifth
First
Female patients
(n - 1(0)
Mean
score
Rank
1.98
2.74
3.99
4.64
1.65
Students
(n = 55)
Second
Third
Fourth
Fifth
First
Dentists
(n = 25)
Mean
score
Rank
Mean
score
1.84
2.82
4.67
4:32
1.35
Second
Third
Fifth
Fourth
First
1.92
2.80
4.88
4:04
1.36
Rank
Second
Third
Fifth
Fourth
First
> .05.
Fig 4 Drawings used to evaluate length.to-width proportion of teeth. Drawings A to E are square
ovoids with same widths but different lengths. Shape E, with iength-to-width ratio of 4:3, was first
choice of all groups, but dentists preferred teeth that were more elongated.
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Table 5
(Fig 5) in Study 5.
Male patients
(n = 75)
Lengthto-width
proportion
Female patients
(n = 125)
Students
(n = 50)
Dentists
(n = 29)
Mean
score
Rank
Mean
score
Rank
Mean
score
Rank
3.80
1.63
2.07
2.50
Fourth
First
Second
Third
3.66
1.58
2.16
2.60
Fourth
First
Second
Third
3.88
1.54
2.26
2.32
Fourth
First
Second
Third
A. 9:10
B.5:4
C. 10:9
D.4:3
Mean
score
4.00
1.58
2.21
2.21
Rank
Fourth"
First
Second (tied)
Second (tied)
"Unanimous preference.
Nole: X'
= 3.852; df = 9:
P > .05.
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Fig 5 Drawings of pairs of central incisors used to evaluate preferences in length-ta-width proportions. Drawing B-with length-ta-width proportion of5:4 (proportion presented in manuals for dental
laboratory technicians)-was most favored. Drawing A was unanimously rejected by dentists although highly favored by patients.
Study 5: Proportions in pairs, drawings. Study 5 compares four drawings of pairs of central incisors (Fig
5). Drawing A represents central incisors with a length-to-width ratio of
9:10. This is the average proportion
of deciduous central incisors 19 and
corresponds with shape C in Study 4.
Drawing B, in which the length to
width, 5:4, corresponds to shape B in
Table 6 Mean scores and rankings of preferences of four groups for various proportions of maxillary teeth as seen in photographs of
set-ups (Fig 6) in Study 6.
Male patients
(n = 70)
Lengthto-width
proportions
Mean
A. 10:9
B. 5:4
C. 3:2
Female patients
(n = 110)
Students
(n - 85)
Dentists
(n = 54)
score
Rank
Mean
score
Rank
Mean
score
Rank
Mean
score
Rank
2.64
1.46
Third
First
Second
2.47
1.39
2.14
Third
First
Second
2.68
1.59
1.53
Third
Second"
First"
2.97
1.64
1.39
Third
Second
First
1.90
dt -
6; and P
< .02.
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Fig 7 Drawings ofteeth used to evaluate preferences ofvarious forms of symmetry: A. horizontal symmetry; B.
asymmetry; and C. radiating symmetry. Dentists and dental students preferred radiating symmetry and rejected
horizontal symmetry. Patients found horizontal symmetry pleasing.
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Table 7 Mean scores and rankings of preferences of four groups for varying symmetry
of maxillary teeth as seen in drawings (Fig 7) in Study 7.
Variants
A. Horizontal
symmetry
B. Asymmetry
C. Radiating
symmetry
Male patients
(n = 80)
Mean
score
Rank
1.56
Second
2.98
1.46
Female patients
(n = 130)
Mean
score
Rank
First*
1.57
Third
First
2.86
1.57
Third
First'
Students
(n = 80)
Mean
score
2.41
2.44
1.15
Rank
Secondt
Thirdt
First
Dentists
(n = 40)
Mean
score
Rank
2.90
Third
1.83
1.27
Second
First
prefher(eF~ces)
~f fsourdgroups for various degrees of radiating and horizontal symmetry as seim in
.g 8 on lu y 8.
Male patients
(n = 126)
Symmetry
df -
9; P
Mean
score
1.70
2.18
2.74
3.38
Rank
First
Second
Third
Fourth
Female patients
(n = 169)
Mean
score
Rank
1.56
First
2.18
Second
2.93
Third
3.33
Fourth
Students
(n = 94)
Mean
score
2.28
1.37
3.90
2.45
Dentists
(n = 44)
Mean
score
2.75
1.59
3.98
1.68
Rank
Second
First
Fourth
Third
Rank
Third
First
Fourth
Second
< .001.
Fig 8 Photographs of four set-ups in which arch of radiating symmetry is varied. A, horizontal
symmetry; B, radiating symmetry, degree 1 (1,t03 mm); C, radiating symmetry, degree 3, (3 to4 mm);
and D, radiating symmetry, degree 3, (m.ore than 4 mm). Patients preferred B, foll_ed by C; dentists
preferred C, followed by D, then B.
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_______________________
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;able 9 Mean scores and rankings of preferences of four groups. for teeth with
shape and symmetry as seen in photographs of anterior maxillary teeth (Fig 9)
Study 9.
.
Variations
of shape and
symmetry
Set-up
Set-up
Set-up
Set-up
Set-up
A
B
C
0
E
Mean
score
Rank
Second'
Fifth
Second'
First
Fourth
2.15
4.88
2.15
1.90
3.92
Mean
score
1.88
4.92
2.54
1.67
3.99
Rank
Second
Fifth
Third
First
Fourth
Mean
score
Rank
3.65
3.84
1.96
2.43
3.12
Fourth
Fifth
First
Second
Third
Mean
score
4.71
2.97
1.55
3.28
2.49
III
Rank
Fifth
Third
First
Fourth
Second
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Discussion
Our studies dealt with only a few of the factors that
can affect esthetic appearance. Other variables include shade, size, arch form, and shape of the lips.
The arrangement of teeth is important and different
effects can be created from only one mold of
teeth 21.22; yet our surveys show that dentists' and patients' concepts of esthetic appearance may differ.
Although dentists and patients have the same preferences for the shape of maxillary anterior teeth, the
Summary
Drawings and photographs of shape, symmetry, and
proportion of maxillary central incisors were evaluated by 112 dentists, 215 dental students, 399 male
patients, and 695 female patients. A significant difference was found between the evaluations of patients and dentists; the preferences of dental students were between those of patients and dentists.
Male and female patients had similar opinions.
The author thanks Dr. Larry Garfinkle. associate professor, department
of removable prosthodontics, New York University College of Dentistry,
for statistical evaluation and organization of the paper, Dr. Elias Karnoff,
assistant professor, department of dental materials, New York University
College of Dentistry, for the photographs; and Dr. Timothy Wong, instructor, department of operative dentistry, for the artwork.
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