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ORTHODONTISTS’, SENIOR DENTAL STUDENTS’ AND LAYPERSONS’ PERCEPTION OF ESTHETICS OF PATIENTS TREATED ORTHODONTICALLY WITH MAXILLARY CANINE SUBSTITUTION, MAXILLARY PREMOLAR SUBSTITUTION AND LOWER INCISOR EXTRACTION
Noyek, Amanda
Noyek, Amanda
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2025-08
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Oral Biology
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http://dx.doi.org/10.34944/dspace/10587
Abstract
Introduction: Orthodontic treatment can camouflage the unesthetic dentalproblems such as, congenitally missing teeth, impacted teeth, skeletal-dental discrepancies,
or a combination (Canut, 1996; Chawla et al., 2011). Orthodontic canine substitution is a
procedure performed on patients with missing lateral incisors. This is a viable option for
patients who elect not to prosthetically restore the missing teeth. In the process, canine
teeth are moved into the lateral teeth positions, and the premolar teeth are positioned next
to the canines (Kokich & Kinzer, 2005; Mazzini & Torres, 2017). Premolars may replace
canines in conditions of impacted or untreatable pathological canines, where the impacted
canines are determined to interfere with the development of adjacent teeth, or when the
success of surgical exposure and orthodontics is unpredictable (Chawla et al., 2011).
Similarly, lower incisors may be extracted and orthodontically replaced by adjacent teeth
in to camouflage skeletal discrepancies, eliminate a Bolton discrepancy, relieve edge-to-
edge anterior occlusion, correct Class III malocclusion, or to eliminate a severely blocked-
out incisor (Bayram & Ozer, 2007). This study aims to investigate how different groups of
individuals perceive the esthetic results of such treatments.
Materials and Methods: A survey was administered to 15 orthodontists, 15 senior
dental students and 15 laypeople via iPad. The survey requested subject gender and
ethnicity, and used a Likert scale to rate the esthetics of different images of dentition post-
treatment (3 canine substitution, 3 premolar substitution, 3 lower incisor extraction, and 3
control images of non-extraction dentition post-treatment). The Likert scale used was a
continuous sliding scale from 0-10. Post-treatment photographs chosen utilized the frontal
view in maximum intercuspation of patients who were treated at Temple University’s
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Orthodontics Clinic. Median scores were compared across groups using Kruskal-Wallis
tests.
Results: There were no significant differences across all three groups of subjects’
median ratings for all four types of treatment. There were no significant differences in
preferences between genders and ethnicities. For all median ratings except for Canine 2
and Canine 3, all male scores were higher than female scores. For two of three canine
images, females rated them higher than males. The image with the overall highest median
rating across all subjects was Control 1. The camouflage treatment image with the overall
highest median rating is Premolar 3. The camouflage treatment image with the overall
lowest median rating is Canine 3. Though, none of these differences were significant.
Conclusion: Orthodontists, senior dental students, and laypeople had no specific
esthetic preferences. Orthodontic treatment outcomes were equivocally satisfactory for all
surveyed subjects. Gender and ethnicity did not influence the degree of satisfaction. The
orthodontist scores reflected their knowledge of the complexity of the case, whereas, the
dental students paid attention to gingival margin heights and midlines, and color and shape
of teeth. Straightness of teeth was preferred by the laypeople. Orthodontic camouflage
treatment outcomes were equivocally satisfactory for all surveyed orthodontists, senior
dental students, and laypeople, and there were no significant differences across all subjects’
median ratings.
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