ORIGINAL ARTICLE

The effects of buccal corridor spaces and arch

form on smile esthetics
Dustin Roden-Johnson,
a
Ronald Gallerano,
b
and Jeryl English
c
Houston, Tex
Purpose: An attractive, well-balanced smile is a paramount treatment objective of modern orthodontic
therapy. The purpose of this study was to determine the effects of buccal corridor spaces (BCS) and arch
form on smile esthetics as perceived by laypeople, general dentists, and orthodontists. Material: Photo-
graphs of 20 women treated by 2 orthodontists were collected: 1 group had narrow tapered or tapered arch
forms, and the other had normal to broad arch forms. Photographs of 10 untreated women served as a
control sample. All photographs showed the subjects smiling. The photographs were digitized and evaluated
for BCS. Then, photographs with BCS were altered to eliminate the dark triangular areas, and those without
BCS were altered by the addition of dark triangular areas at the lateral aspects of the smile. The altered
photographs were randomized into a survey with the 30 original photographs. Three groups of raters
(dentists, orthodontists, and laypeople) used a visual analogue scale to rate the photographs. Results: There
was no signicant difference in smile scores related to BCS for all samples and for all viewers. Dentists rated
broader arch forms as more esthetic than untreated arch forms. Orthodontists rated broader arch forms as
more esthetic than narrow tapered arch forms and untreated arch forms. Lay people showed no preference
of arch form. Conclusions: This study demonstrates that the presence of BCS does not inuence smile
esthetics. However, there are differences in how dentists, orthodontists, and laypeople evaluate smiles and
in what arch form each group prefers. (Am J Orthod Dentofacial Orthop 2005;127:343-50)
A
n attractive, well-balanced smile is a para-
mount treatment objective of modern ortho-
dontic therapy. Extensive studies on facial
features have resulted in the establishment of norms
that orthodontists use as guidelines to evaluate facial
forms and to direct therapy.
Research supporting these established norms has
been directed more to the lateral view of the face, and
most of the knowledge that dictates the position of teeth
has derived from these lateral cephalometric studies.
However, Mackley
1
has demonstrated that a prole is
not a reliable predictor of the appearance of a persons
smile. Because the frontal aspect of soft and hard tissue
treatment analysis has not been given as much atten-
tion, orthodontists have quite often limited themselves
to observations obtained from a 2-dimensional lateral
image and have neglected how the facial musculature
coordinates with the dentition.
The study of frontal facial form dates back to the
Egyptians, who depicted ideal facial esthetics as the
golden proportion. This concept has been described
extensively in classical art and orthodontic literature.
Beside the golden proportion, other disciplines in
dentistry have incorporated miscellaneous frontal mea-
surements. Prosthodontists especially have taken inter-
est in this aspect when considering the placement and
selection of the anterior teeth in denture patients.
2,3
In
1914, Williams
4
concluded that the shape and angula-
tion of the anterior teeth are dictated by the frontal
shape of the patients face to provide a harmonious
appearance. His philosophy of proper tooth selection
the inversion of the patients frontal face form has
remained popular for more than 85 years.
Wylie
5
emphasized that the goal of orthodontic
treatment should be to attain the best possible esthetic
result, both dentally and facially. He also noted that
these qualities should be judged not only in repose but
also in animation. Although the smile is what most
laypeople use to judge treatment success,
6
orthodontic
treatment to correct dysfunction might conict with the
dictates of facial harmony.
7
There seems to be a lack of
research supporting frontal facial appraisal. This decit
of knowledge perhaps contributed to Hulseys nding
that patients who had received orthodontic treatment
From the University of Texas Health Science Center at Houston, Dental Branch
Department of Orthodontics, Houston, Tex.
a
Orthodontic resident.
b
Associate clinical professor.
c
Chairman and graduate program director.
Reprint requests to: Dr Dustin Roden-Johnson, University of Texas Health
Science Center at Houston, Dental Branch Department of Orthodontics, 6516
M. D. Anderson Blvd, Suite 371, Houston, TX 77030; e-mail, Dustin.D.Roden-
Johnson@uth.tmc.edu.
Submitted, November 2003; revised and accepted, February 2004.
0889-5406/$30.00
Copyright 2005 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2004.02.013
343
had signicantly lower smile scores than subjects with
untreated normal occlusion.
8
Research is scarce supporting certain aspects of
frontal facial analysis, but there is not a total void. A
few investigators have conducted in-depth studies of
frontal facial form and what characteristics are consid-
ered esthetically desirable. Studies have shown the
muscular mechanics involved in the expression of a
smile and the esthetic dimensions with which one might
appraise the face.
7,9,10
Specic aspects of the smile
have been related to esthetics, and it has been found
that how the teeth relate to the curvature of the lip and
the amount of gingival display can also affect the
esthetics of the smile.
8,11-13
On comparing frontal facial features in repose and
animation, Rigsbee et al
9
concluded that, in an attrac-
tive smile, the upper lip elevated to reveal 10 mm of
maxillary incisors, the mouth increased to 130% of its
original width, and the lips separated approximately 12
mm; in general, women have more facial animation
than men, and orthodontically treated subjects dis-
played more maxillary incisors and gingivae than the
untreated group. In this study, there was no mention as
to what aspect of the smile contributed to facial
esthetics; however, great attention was given to the
facial mechanics of the smile.
In 1992, Peck et al
11
described how orthodontists
and surgeons are conditioned to see high gingival smile
lines as undesirable and concluded that the gingival
smile line is not inuenced by upper lip length, incisor
crown height, mandibular plane angle, or palatal plane
angle. They noted that the biological mechanisms of the
gingival smile line are inuenced by anterior vertical
maxillary excess, greater muscular capacity to raise the
lip, and supplemental factors, such as excessive overjet
and overbite. Peck and Peck
13
also noted that the
location of the gingival smile line largely depended on
the subjects sex. On average, the smile line in women
is 1.5 mm higher than in men.
According to Dierkes,
7
the beauty of the face can be
broken down into horizontal, vertical, and transverse
components, and all of these must harmonize with the
contours of the face to produce a beautiful smile. He
also stated that when these components of esthetics are
contemplated, arch width is rarely a consideration, but
he pointed out that altering the arch width in turn
changes the gingival smile line, which is the relation-
ship of the upper lip to the gingival line of the maxillary
incisors.
Hulsey
8
found the height of the upper lip in relation
to the maxillary central incisors to be signicantly
important to an attractive smile. He demonstrated that
the most attractive smiles are those with the upper lip at
the height of the gingival margin of the maxillary
central incisors. The lower lip, according to Hulsey,
8
also inuences the attractiveness of a smile. It is more
desirable to have the curvature of the lower lip follow
the curvature of the incisal edges of the maxillary
anterior teeth. Sarver
12
recently called attention to this
curvature, dubbing it the smile arc. He pointed out
that an orthodontically treated patient who meets all
criteria of an orthodontic success could still have an
unattractive smile. Hulsey
8
suggests that a reason for
the unattractive appearance of orthodontically treated
patients might be the attening of the smile arch to
achieve acceptable occlusion.
The distance between the lateral junction of the
upper and lower lips and the distal points of the canines
during smiling is known as the buccal corridor. As
light passes posteriorly, it is reduced and thus gives the
teeth a darker shade and therefore a smaller appear-
ance.
14
The inuence of the buccal corridor on smile
esthetics has been noted by some investigators to be of
no esthetic consequence, whereas others believe that it
is unattractive. Only a few studies have determined the
esthetic value of the buccal corridor space (BCS). In
1995, Johnson and Smith
15
found that variables related
to the buccal corridors or other measures of the width
of the mouth during a smile showed no relation to
extraction esthetics. Similarly, Gianelly,
16
on examin-
ing the arch width of patients receiving extraction and
nonextraction treatment, found no differences in arch
width between the 2 treatment protocols and noted that
extraction does not produce BCS. Hulsey
8
also ob-
tained similar results when he compared the attractive-
ness of orthodontically treated and untreated smiles. He
examined the buccal corridors as a ratio: distance
between the maxillary canines/distance between the
corners of the smile. He then observed that the pattern
of the scatter plot diagram showed that the buccal
corridor ratio was not related to the smile scores.
Currently, orthodontists can choose between sev-
eral types of archwires. Most of the wires are pre-
formed arch forms that can alter the width of the
patients arch form. There has been some debate
concerning the use of various arch forms, in terms of
their long-term stability.
17-19
It has long been estab-
lished that mandibular intercanine width returns to its
original dimension and often contracts further when the
patient is no longer in retention. However, we have
noted little evidence supporting the role of arch form in
smile esthetics. Dierkes
7
suggested that the wider arch
form can improve esthetics in certain facial forms but
also warned that it can change the smile line, which
might affect facial esthetics. In that study,
7
he did not
compare arch widths but, instead, demonstrated how
American Journal of Orthodontics and Dentofacial Orthopedics
March 2005
344 Roden-Johnson, Gallerano, and English
changing the arch width might alter the attractiveness
of a smile.
Beauty truly is in the eye of the beholder, and what
is desirable to one might not be so to another. Dia-
mond
20
reported that what a person nds attractive has
much to do with the qualities of the surrounding
population; other environmental factors, such as edu-
cation, are also involved. As dental professionals, we
must realize that this could have a great impact on the
services provided to a patient because the concept of
beauty might not be congruent between the patient and
the doctor. Concerned with this, Wylie
5
astutely wrote
that the laymans opinion of the human prole is every
bit as good as the orthodontists and perhaps even better
since it is not conditioned by orthodontic propaganda.
Kokich et al
21
demonstrated that general dentists,
orthodontists, and laypeople detect specic dental dis-
crepancies at varying deviations. Orthodontists were
more perceptive to altered dental esthetics than general
dentists, and general dentists were more perceptive than
laypeople. The investigators made it clear that, when a
specic dental quality is examined by orthodontists,
general dentists, or laypeople, a varying degree of
deviation is necessary to warrant the deviation to
detract from the esthetics of the person being evaluated.
However, this study did not determine whether there
are differences in what each group deems attractive.
Brisman
21
had results similar to those of Kokich
et al when he compared the drawings and photographs
of maxillary central incisors of varying shape, symme-
try, and proportion. In this study, he surveyed general
dentists, dental students, and laypeople and discovered
that the preferences in each group in relation to shape,
symmetry, and proportion differed signicantly.
There is a difference not only between what various
groups consider esthetic but also in what is considered
esthetic for different subjects according to their age,
sex, and race. Evidence suggests that the esthetic
components for men, women, and various races are not
entirely the same. Frush and Fischer
3
pointed out that
women tend to present a softer appearance than men
and should therefore be given a softer, rounder, and
more delicate dental appearance. Rigsbee et al
9
found
that women have greater facial animation than men
when smiling. Women also tend to show more of the
maxillary incisors at rest and in animation than do
men.
23
Age also has an effect on the architecture of a
smile because, with age, the upper lip tends to conceal
more of the maxillary incisors, with a concomitant
greater degree of mandibular incisor display.
3
In their study comparing the perceptions of dentists
and laypeople, Kokich et al
21
used photographs of
smiles that were altered with 1 of 8 common anterior
esthetic discrepancies in varying degrees of deviation.
To limit error, the investigators adjusted a specic
anatomical feature in the photograph to create a new
image. They asked the person being surveyed to score
the 2 photographs at different times and compared the
ratings of the 2 smiles. This allowed the investigators to
make deviations in the image and understand the
inuence of the deviation on esthetics.
Some investigators have noted a difference in how
laypeople and dentists evaluate smiles.
21,22
There are
also differences in smile esthetics related to sex, age,
and race.
3,9,21,23
To ascertain the variation of the
concept of smile esthetics as it relates to the width of
the treated arches, we surveyed orthodontists, general
dentists, and laypeople, using only 15- to 30-year-old
females as subjects for evaluation.
MATERIAL AND METHODS
Posttreatment frontal smile photographs and study
models of 20 female patients were obtained from 2
orthodontic ofces. Because of some variation in the
structure of a smile according to age, sex, and race, we
focused on the esthetics of female subjects 15 to 30
years of age. This was done to limit the scope of the
variables and to decrease the dilution of the results. Ten
patients were selected from each orthodontic ofce, and
mandibular study models were categorized by arch
form according to the Rocky Mountain Arch Form
Template. One orthodontists patients represented nar-
row tapered and tapered (NT) arch forms, and the
others patients represented normal to broad arch forms
(NB).
A sample of 10 orthodontically untreated female
subjects from the University of Texas Health Science
Center at Houston Dental Branch with Class I molar
occlusion and good anterior alignment volunteered to
have perioral photographs taken while smiling. Impres-
sions of these volunteers were also obtained to verify
acceptable occlusion and classify arch forms.
The photographs from all groups were standardized
with Adobe Photoshop (Adobe Systems, San Jose,
Calif). The images were converted to black and white
and then cropped to include only the perioral region. To
standardize size and resolution, each picture was con-
verted to approximately 5 2.5 in, with 1000 pixel
resolution.
Once the perioral photographs had been standard-
ized, they were evaluated for BCS. In images of
patients with BCS, the spaces were digitally removed:
teeth-like images were placed in the distal aspect to the
most visible tooth in the lateral aspects of the smile
(Fig 1), thereby eliminating the dark space between the
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 127, Number 3
Roden-Johnson, Gallerano, and English 345
dentition and the lateral commissures of the mouth in
the smile position.
In images of patients without BCS, teeth were
digitally removed from the distal aspects of the denti-
tion where the teeth met with the lateral commissures of
the smile (Fig 2). These alterations created the appear-
ance of dark triangular spaces in the lateral aspects of
the smile.
After these alterations, the 30 original photographs
and the 30 digitally altered images were then randomly
assorted, numbered, and placed in an 8.5 11-in
survey binder. The binder contained 60 black and white
perioral photographs of combined altered and unaltered
samples. To reduce error, we used some of the same
techniques as Kokich et al
21
; each person surveyed was
asked to evaluate the esthetics of the same smile
twice1 digitally altered and the other not.
A visual analogue scale score sheet was created
with a 10-cm bar, as shown in Figure 3. The evaluator
was then asked to score the smile according to his or
her preference for what is more or less attractive and
given the following instructions: Please complete the
following survey by evaluating the smiles for the
esthetic value of teeth and lip appearance. Disregard
facial blemishes, any variation in teeth shade, or picture
quality. The purpose of this survey is for you (the
evaluator) to assess the attractiveness of the entire smile
and how the teeth appear within the lips. The smiles are
to be graded using the scales from unattractive to
attractive. You may place your mark anywhere on the
scale but do so in a vertical fashion. Please examine
several smiles in the book rst to calibrate yourself for
the evaluation process but once you have started please
do not ip back and please do not compare any of the
photos or scores to one another.
The survey was distributed to 20 orthodontists, 20
dentists, and 20 laypeople. Because it has been found
that older subjects are more aware of dental character-
istics than younger ones, all evaluators in this study
were between the ages of 28 and 64 years. The scores
were measured manually with digital calipers and
entered onto an Excel spread sheet (Microsoft Corpo-
ration, Redmond, Wash). One-way analysis of variance
(ANOVA), 2-way ANOVA with Tukey post hoc anal-
ysis, and 4-way ANOVA (rater source corridor
modify) were used to evaluate the data collected.
RESULTS
The results of our survey are shown in the tables.
The subsets represent statistically signicant differ-
ences between groups. All numbers that fall within 1
subset have no signicant differences, nor do the
Fig 1. A, Original photograph of patient with BCS. B, Digitally altered photograph, in which BCS
was eliminated.
Fig 2. A, Original photograph of patient without BCS. B, Digitally altered photograph, in which BCS
was added.
American Journal of Orthodontics and Dentofacial Orthopedics
March 2005
346 Roden-Johnson, Gallerano, and English
numbers that overlap from 1 subset to the next. Only
the numbers in different subsets that do not overlap
have signicance. Of the 30 raw images that were
collected, 14 showed BCS and 16 did not. The NT
group and the control group each had 6 smiles that
displayed BCS. The NB group had 2 smiles that
displayed BCS in the unaltered form.
Table I shows the means for the groups in homo-
geneous subsets of the 1-way ANOVA with Tukey post
hoc analysis, showing the differences between the
raters. Orthodontists scored the survey differently than
did dentists and laypeople and on average delivered a
lower score. There was no signicant difference in how
dentists and laypeople scored the survey.
Table II shows the means for the groups in homo-
geneous subsets of the 1-way ANOVA with Tukey post
hoc analysis, showing the differences between the
sources of the pictures. There were signicant differ-
ences in how the pictures from the 3 sources were
scored by the surveyed groups collectively. According
to the data shown, the highest scores were received by
the NB sample of smiles, and the control (nontreated)
sample received the lowest scores.
Table III shows the means for the groups in
homogeneous subsets of the 2-way ANOVA with
Tukey post hoc analysis, showing the differences be-
tween raters with the consideration of source. There
were several differences in how the groups of raters
scored the different sources of smile photographs.
Orthodontists preferred NB arch forms over the control
and NT arch forms but did not differentiate between NT
or control smiles. Dentists also preferred NB arch
forms over the control, but there were no signicant
difference in how the dentists scored the sample of NT
relative to control or NB. The laypeople did not score
any of the 3 groups of smiles obtained differently.
Table IV shows the means for the groups in
homogeneous subsets of the 1-way ANOVA with
Tukey post hoc analysis, showing the differences in
how the raters scored BCS. All of the means are
represented in 1 subset, thus showing that no group of
raters differentiated between the presence or absence of
BCS relative to smile esthetics.
Table V shows the means for the groups in homo-
geneous subsets of the 1-way ANOVA with Tukey post
hoc analysis, showing the differences in how the raters
scored for the digital alteration (modication). Al-
though all means are not expressed in 1 subset, no one
group of raters scored modication differently.
DISCUSSION
Espeland and Stenvik
6
noted that most young adults
give more attention to how their anterior teeth appear
than to occlusion. Thus, one must ask why so much
science has been devoted to function and not to
appearance. This is not to say that function should not
be an imperative treatment goal but rather that esthetics
should be given equal consideration. This study exam-
ined the effects of BCS and arch form, to contribute to
the empirical data about frontal facial appraisal.
Buccal corridor spaces have been discussed in the
literature for some time and have been described by
several investigators as undesirable.
14,16,24,25
Other in-
vestigations have noted that BCS do not have a rela-
tionship to smile esthetics; this study supports these
ndings.
8,15
This investigation is unique in that each
smile was evaluated twice, once with BCS and once
without BCS, thus reducing error associated with se-
lecting representative populations of each group. The
results might also reect that the digital alterations were
not signicant enough to produce a noticeable effect on
smile esthetics. As described by Kokich et al,
21
there is
a threshold level that a digital alteration must exceed
for the viewer to detect it. If enough teeth are deleted
from the lateral aspects of the smile, there would be
some detraction from smile esthetics, but the smile
would probably appear unnatural. In this study, each
investigator evaluated the altered and unaltered photo-
graphs side by side and collectively agreed on an
adequate degree of alteration.
Recently, attention has been paid to the perceptions
of laypeople and dentists when comparing altered
esthetics.
21,22
This study also demonstrates a difference
in how dentists, orthodontists, and laypeople evaluate
smiles. Here, orthodontists rated the smiles differently
from laypeople and dentists, with the latter 2 groups
expressing no difference in their esthetic scoring. This
might be because most orthodontists have received
more formal training on smile esthetics than laypeople
and dentists or have been biased with the recent
emphasis on broader arch forms. However, it does not
indicate that the orthodontists perceptions are more
astute than those of laypeople or dentists. It is more
likely that orthodontists perceptions have been skewed
Fig 3. Visual analogue scale used to evaluate esthetic value of smile photographs.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 127, Number 3
Roden-Johnson, Gallerano, and English 347
by their training, as stated by Wylie.
5
Orthodontists
tend to adopt a treatment philosophy and use subjective
evaluation when treating patients. If the orthodontists
perception of esthetics is not congruent with the pa-
tients perception, then the result might not be accept-
able to the patient, even if the patients function is
improved.
22
Hulsey
8
supported this notion when he
found that patients who had received orthodontic treat-
ment received signicantly lower smile scores. Per-
haps, in the study conducted by Hulsey,
8
the survey
panels ideas of esthetics deviated enough from the
orthodontists that the treated patients were deemed
more unattractive than the untreated. Johnson and
Smith
15
found, on examining smile esthetics after
orthodontic treatment with and without extraction of 4
rst premolars, that there was a difference in smile
scores in the patients selected from the 2 orthodontists,
but there was no difference in extraction versus nonex-
traction patients. In other words, the group surveyed
showed a predilection for 1 orthodontists patients over
the other. Perhaps arch forms could have been the
delineating factor, but this was not evaluated in their
study.
Contrary to Hulsey, this study indicated that both
treated groups received signicantly higher smile
scores than the untreated group.
8
The NB arch forms
received higher scores than did the NT arch forms
when all scores from the 3 groups were combined.
However, on closer examination of the surveyed
groups score differential, there was less distinction
between the treated and untreated smile scores.
Orthodontists tended to prefer the NB smiles over the
NT and untreated, and this might be attributed to bias
associated with the orthodontists in this study. A
poststudy interview with these orthodontists found
Table I. Means for groups in homogeneous subsets of
1-way ANOVA with Tukey post hoc analysis, showing
differences between raters
Rater
Subset
1 2
Orthodontists 47.9
Dentists 49.8
Lay people 50.7
Signicance 1 1
Table II. Means for groups in homogeneous subsets of
1-way ANOVA with Tukey post hoc analysis, showing
differences between sources of pictures
Source
Subset
1 2 3
Control 46.9
NT 49.2
NB 52.3
Signicance 1 1 1
Table III. Means for groups in homogeneous subsets of
2-way ANOVA with Tukey post hoc analysis, showing
differences between raters with consideration of source
Rater source
Subset
1 2 3
Orthodontists control 44.7
Orthodontists NT 46.4 46.4
Dentists control 46.6 46.6
Laypeople control 49.7 49.7
Dentists NT 50 50
Laypeople NT 51.1
Laypeople NB 51.2
Orthodontists NB 52.7
Dentists NB 52.8
Signicance .9 .186 .35
Table IV. Means for groups in homogeneous subsets of
1-way ANOVA with Tukey post hoc analysis, showing
that there are no differences in how raters scored for
presence or absence of BCS
Rater corridor Subset
Orthodontists present 47.7
Orthodontists not present 48.2
Dentists present 49.6
Dentists not present 50
Laypeople present 50.6
Laypeople not present 50.8
Signicance .057
Table V. Means for groups in homogeneous subsets of
1-way ANOVA with Tukey post hoc analysis, showing
differences in how raters scored for presence or absence
of digital alteration (modication)
Rater modication
Subset
1 2
Orthodontists not present 47.4
Orthodontists present 48.5 48.5
Dentist not present 49.8 49.8
Dentist present 49.8 49.8
Laypeople not present 50.6
Laypeople present 50.8
Signicance .242 .312
American Journal of Orthodontics and Dentofacial Orthopedics
March 2005
348 Roden-Johnson, Gallerano, and English
that most used normal to broad arch forms when
treating their patients. A follow-up study surveying a
more representative sample of orthodontists nation-
wide would be indicated to determine whether there
is a predilection for all orthodontists to treat patients
with a broader arch form. To shed some light on this
question, G&H Wire Company and Rocky Mountain
Orthodontics, which produce the 5 arch forms that
were used to grade the subjects nal casts, were
asked what percentage of wires of each shape they
sold. Rocky Mountains .016 .022-in stainless
steel wires in normal and ovoid arch forms accounted
for 72% of total sales, whereas the tapered and
narrow tapered represented only 24%. For .017
.025-in wires, the tapered and narrow tapered ac-
counted for 27% of sales, whereas the normal and
ovoid accounted for 61%. Only 8% of total wires
sold by G&H were in the Bioform arch shape, which
very closely matches Rocky Mountains pentamor-
phic forms. Of that 8%, the narrow tapered and
tapered were equally matched with the normal and
ovoid. The G&H wire with the highest sales (61%)
was the Trueform 1, which is very close to the
normal arch form. Clearly, orthodontists purchase
more of the broader arch forms; this substantiates the
preference of the orthodontists who participated in
this study.
The dentists surveyed for this study had no
preference of arch form but did prefer treated sub-
jects over untreated ones. It is apparent that dentists
were sensitive to the alignment of the teeth but not to
the width of the arch form as related to the smile.
Laypeople were even less perceptive to a smiles
arch form and alignment, expressing no predilection
for any smile group. Our results show that orthodon-
tists were more perceptive to variations in the smiles
than dentists, who were more perceptive than lay-
people.
There was no difference in how the groups scored
the altered and unaltered photographs; this demon-
strated that the photographic alteration did not detract
from the natural appearance of the smile. This supports
the results of the pilot study.
26
Further research is needed to determine what
people nd to be esthetically pleasing. From this
study, it is apparent that more orthodontists prefer
broader arch forms; however, according to Nojima et
al,
27
narrow to narrow tapered forms are more
prevalent in whites. Are orthodontists routinely using
broad arch forms in practice, and, if so, are they the
pretreatment forms of the patients? It has been
suggested that arch forms have a tendency to return
to their original shapes,
18
so is the routine use of
broader arch forms setting up a generation for more
relapse? A long-term study of arch forms that were
changed from narrower to broader and the correla-
tion of relapse at 10 years or more posttreatment
would answer this question. Certainly, Charles
Tweed
28
found that the fuller smiles that Angle
advocated relapsed enough to need retreatment. Are
we doomed to repeat history?
CONCLUSIONS
1. Orthodontists, dentists, and laypeople evaluate smiles
differently.
2. Orthodontists prefer normal to broad arch forms
over untreated and narrow to tapered arch forms.
3. Dentists prefer treated patients over untreated ones
but make no distinction in their preference of arch
form in treated patients.
4. Laypeople have no preference between treated or
untreated arch forms.
5. The presence or absence of BCS had no effect on
the ratings of the smiles in any of the 3 groups.
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Editors of the International Journal of Orthodontia (1915-1918),
International Journal of Orthodontia & Oral Surgery (1919-1921),
International Journal of Orthodontia, Oral Surgery and Radiography (1922-1932),
International Journal of Orthodontia and Dentistry of Children (1933-1935),
International Journal of Orthodontics and Oral Surgery (1936-1937), American
Journal of Orthodontics and Oral Surgery (1938-1947), American Journal of
Orthodontics (1948-1986), and American Journal of Orthodontics and Dentofa-
cial Orthopedics (1986-present)
1915 to 1931 Martin Dewey
1931 to 1968 H. C. Pollock
1968 to 1978 B. F. Dewel
1978 to 1985 Wayne G. Watson
1985 to 2000 Thomas M. Graber
2000 to present David L. Turpin
American Journal of Orthodontics and Dentofacial Orthopedics
March 2005
350 Roden-Johnson, Gallerano, and English