Does the presence of maxillary central incisor edge asymmetry influence the perception of dentofacial esthetics in video analysis?

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Abstract
Objective: To investigate the influence of incisal edge asymmetry of the maxillary central incisors on dentofacial esthetics among orthodontists, prosthodontists, and laypersons using video analysis. Materials and Methods: Full-face films of a 52-year-old afro-descendant woman displaying various levels of incisal wear in the esthetic zone were captured. An acrylic resin mockup was made of the maxillary anterior region, enabling the reproduction of an attractive smile and restoring tooth wear. Four different levels of incisal asymmetry between the upper central incisors in 0.5 mm increments were prepared from this mockup. A film was made for each level of asymmetry (0.5, 1.0, 1.5, and 2.0) and one with no asymmetry, with the patient repeating a sentence, totaling five films. After a pilot study and sample calculation, the films were evaluated by 138 examiners: 46 orthodontists, 46 laypeople, and 46 prosthodontists. Each examiner evaluated the dentofacial esthetics of each film using visual analog scales. Data collected were statistically analyzed. Results: Highest scores were awarded to the film with no asymmetry between upper centrals and the one with 0.5 mm of asymmetry. The asymmetries of 1.5 mm and 2.0 mm had the lowest scores from all three groups. Conclusions: The results of this video analysis indicate that asymmetries equal to or greater than 1.0 mm between the upper central incisors edges jeopardize dentofacial esthetics.

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