Objective: To determine the influence of the occlusal plane angle on smile attractiveness as perceived by a group of adult orthodontic patients and dentists. Materials and Methods: The first stage utilized a laboratory approach to record changes in vertical tooth position at different occlusal plane angles using a maxillary model mounted on an articulator. In the second stage, photographic manipulation was undertaken, using data from stage 1, to produce a computerized prediction of the appearance of the smile at differing occlusal plane angles (0, 5, 10, 15, and 20 degrees). Finally, the five developed photographs were assessed by participants. Results: Alterations in the occlusal plane angle did affect relative smile attractiveness for both patients (n = 66) and dentists (n = 66). For patients, the 10 degree smile was rated better than the 0 and 20 degree smiles (P <.01); for dentists, the 15 degree smile was rated better than the 0 and 20 degree smiles (P <.01). The 5, 10, and 15 degree smiles were indistinguishable for patients, and the 10 and 15 degree smiles were indistinguishable for dentists. Conclusion: Changing the occlusal plane angle does affect relative smile attractiveness. However, patients were more tolerant of these changes than dentists. This suggests that large changes in the occlusal plane angle would affect relative smile attractiveness, and small changes are unlikely to affect smile attractiveness.
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