Introduction

The concept of beauty is wide and individual; therefore, the assessment of beauty is extremely subjective. Esthetics play a substantial role in people’s lives, and facial appearance has a deep influence on personal attractiveness and self-esteem. The human face is considered the most important individual factor concerning attractiveness.^[1] The criteria to determine the esthetics as acceptable or unacceptable varies according to social and cultural values, and this standard has changed across history.^[2] It is important to understand that the perception of dentofacial esthetics should consider the esthetic parameters of the patients and the society in which they belong.^[3], ^[4] This appreciation of beauty is also influenced by individual factors, such as sex, ethnicity, education, and the influence of marketing and media. ^[5], ^[6]

In recent years, increased emphasis has been placed on esthetics in dentistry.^[7] The quest for excellent dentofacial esthetics is a reality in contemporary society. ^[8] There is evidence to support the notion that the aesthetics of the mouth has a significant effect on the way we develop a first impression of another person. ^[9] Social attractiveness is influenced by a variety of different smile-related factors, hence the smile is one of the most essential human facial expressions that enhance the reward value of an attractive face. In esthetic viewpoint, the profile and frontal views of the same smile were not rated similarly; the former was rated higher than the later. ^[10] Labio-lingual inclination of the maxillary incisors also plays a major role in profile smile attractiveness. Facial profile disharmonies in the antero-posterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. ^[11]

Aim

To evaluate the esthetic effects of maxillary incisor inclination with regard to different mandibular position in male and female subject’s smile profile.

Objectives

To determine the preferred tooth position in the smile profile of subject with regard to different mandibular positions in male and female and to elucidate whether the profession and sex played a role in the assessment of the preferred maxillary incisor inclination in growing and non-growing individual.

Materials and Method

Statistical analysis

Image	Position of mandible	Angulation of incisors	Inclination of incisor
I A	Protruded (+4mm)	-10degree	Palatal
I B	Protruded (+4mm)	-5 degree	Palatal
IC	Protruded (+4mm)	0 degree	Normal
I D	Protruded (+4mm)	+5 degree e	Labial
IE	Protruded (+4mm)	+10 degree	Labial
2A	Normal	-10 degree	Palatal
2B	Normal	-5 degree	Palatal
2C	Normal	0 degree	Normal
2D	Normal	+5 degree	Labial
2E	Normal	+10 degree	Labial
3A	Retruded (-4mm)	-10 degree	Palatal
3B	Retruded (-4mm)	-5 degree	Palatal
3C	Retruded (-4mm)	0 degree	Normal
3D	Retruded (-4mm)	+5 degree c	Labial
3E	Retruded (-4mm)	+10 degree	Labial

Table 1 Each profile with its corresponding mandibular position and labiolingual inclination of maxillary incisors

Result

One hundred sixty-two assessors participated in this study. The statical analysis showed there was significant difference.

Comparison between male and female, female rated high mean of 2.7+/- 0.8 with significant difference P>0.031.

Comparison between the responses on male and female subjects in the first set which is protruded mandible, it was found that ID has significant difference with P=0.002. ([Figure 3] ), Where in female 1D rated most pleasant profile with the mean value of 3.7+/-0.4 rated high.

Comparison between the responses on male and female subjects in the second set which is normal mandible, it was found that 2C, 2D have significant difference with P=0.040 & P=0.011 respectively. ([Figure 5]), Where in Male 2C rated most pleasant profile with the mean value of 3.5+/-0.4 rated higher than female with the mean value 3.2+/-0.3.

Female rated most pleasant profile in 2D with mean value of 3.6+/-0.1 than male with mean value of 3.1+/-0.1.

Comparison between the responses on male and female subjects in the third set which is retruded mandible, it was found that 3B, 3C & 3D have significant difference with P=0.021, P=0.004 & P=0.037 respectively. ([Figure 6]), Where in female 3D rated most pleasant profile with the mean value of 3.7+/-0.1 rated higher than male with mean value of 3.4+/-0.1.

Discussion

Esthetically pleasing faces generally have good proportions, facial balance, and harmony, and yet differences often emerge in the interpretation of these concepts.^[12], ^[13], ^[14] Smile attractiveness is a multifactorial process that can easily be achieved by proper positioning of the maxillary incisors. Both the inclination and the bodily position of these teeth should be favorable to ensure maximum facial harmony. In this study, we developed a series of facial profile photographs based on the original ideal profile of growing and non growing subjects to be evaluated by different groups of orthodontists, dental professionals and lay people. By altering the mandibular position and the maxillary incisor inclination in the smiling profiles, we tried to determine the most desirable and the least favorable of the forementioned combinations as a whole and to elucidate whether the mandibular position and the rater's professions are the key factors in ranking the preferred incisor inclination.

There were significant differences between the male and female subjects’ perception of facial profiles and dental esthetics. A straight profile was preferred in male subjects, and a mild convex profile was preferred in the female subjects. ([Figure 4], [Figure 5], [Figure 6]).

People who subscribe to traditional sex stereotypes tend to assume that women with a mild convex profile are more beautiful, kind, naïve, and weak, and less socially dominant. By contrast, people tend to see men as more firm, alert, strong, and coordinated. Many studies have suggested that masculinity and femininity are significantly shaped by culture. ^[15], ^[16]

In the study of Ghaleb et al, dentists, orthodontists, and laypeople preferred an increase of 5⁰ in a labial direction in the smiling profile; this agrees with the ratings of the orthodontic and other panel members in our study. On the other hand, photographs with 10⁰ and 15⁰ of lingual inclination had the lowest scores in all panels in the study of Ghaleb et al; this is comparable to the results of our study panels. For the extreme lingual inclinations (15⁰ and 10⁰), the orthodontists gave significantly lower scores than did the dentists and laypeople. The image with the 15⁰ labial inclination was deemed esthetically acceptable only by the orthodontists. These results agree with our study in which the panel members gave the lowest scores to the extreme lingual inclination. ^[17]

In our study inclination of maxillary teeth rated differently in all three sets of photographs. Labial inclination of 5⁰ higher than the lingual inclination. Lingual and labial inclination with 10⁰ rated low in both subjects.

Conclusion

In this study women with a mild convex profile are more beautiful and men with straight profile consider to be esthetically more pleasant and the effects of mandibular position on the preferred incisor inclination was assessed, labial inclination was considered as attractive as compared with lingual inclination; In a patient with mandibular deficiency where camouflage treatment is indicated, a lingual inclination of the maxillary incisor can compromise esthetics and should be avoided by maintaining appropriate torque during incisor retraction.

Conflict of Interest

The authors declare that they have no conflict of interest.

Source of Funding

None.