Space closing versus space opening for bilateral missing upper laterals - aesthetic judgments of laypeople: a web-based survey

J Orthod. 2016 Jun;43(2):137-46. doi: 10.1080/14653125.2016.1145880. Epub 2016 Apr 18.


Objective: To investigate the opinions of laypeople regarding the aesthetic outcome of treating patients with developmental absence of both maxillary lateral incisors using either orthodontic space closure (OSC) or space opening and prosthetic replacement (PR).

Design: Cross sectional, web-based survey.

Methods: A panel of five orthodontists and five restorative dentists examined post-treatment intra-oral images of 21 patients with developmental absence of both upper lateral incisors. A consensus view was obtained about the 10 most attractive images (5 OSC; 5 PR). The 10 selected images were used in a web-based survey involving staff and students at the University of Sheffield. In the first section, the participants were asked to evaluate the attractiveness of the 10 randomly arranged single images using a 5-point Likert scale. In the second section, an image of OSC was paired with an image of PR according to their attractiveness ranking by the clinician panel, and the participants were asked to indicate which of the two images they preferred.

Results: The survey received 959 completed responses with 9590 judgements. The images of OSC were perceived to be more attractive (mean rating 3·34 out of 5; SD 0·56) compared with the images of PR (mean rating 3·14 out of 5; SD 0·58) (mean diff 0·21; P < 0·001). Female and staff judges tended to give higher attractiveness ratings. Both females and males preferred the OSC images closing in 3 out of 4 paired images.

Conclusion: Space closing was perceived to be more attractive than space opening by lay people. The findings have implications for advising patients about the best aesthetic outcome when both maxillary lateral incisors are missing.

Keywords: Orthodontics; aesthetics; hypodontia.

MeSH terms

  • Anodontia
  • Cross-Sectional Studies
  • Esthetics, Dental*
  • Female
  • Humans
  • Internet
  • Judgment*
  • Male
  • Smiling*
  • Surveys and Questionnaires