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Journal of Applied Oral Science

Print version ISSN 1678-7757

J. Appl. Oral Sci. vol.22 no.5 Bauru Sept./Oct. 2014

http://dx.doi.org/10.1590/1678-775720140003 

Original Articles

Perceptions of brachyfacial, mesofacial and dolichofacial individuals with regard to the buccal corridor in different facial types

Matheus Melo PITHON1 

Kayure Rocha da MATA1 

Karina Silva ROCHA1 

Brenda do Nascimento COSTA1 

Fernando NEVES1 

George Caique Gouveia BARBOSA1 

Raildo da Silva COQUEIRO1 

1Departament of Health I, Southwest Bahia State University - UESB, Jequié, Bahia, Brazil.

ABSTRACT

Objective:

Evaluate the esthetic perception and attractiveness of the smile with regard to the buccal corridor in different facial types by brachyfacial, mesofacial and dolichofacial individuals.

Material and Methods:

The image of a smiling individual with a mesofacial type of face was changed to create three different facial types with five different buccal corridors (2%, 10%, 15%, 22% and 28%). To achieve this effect, a photo editing software was used (Adobe Photoshop, Adobe Systems Inc, San Francisco, CA, EUA). The images were submitted to evaluators with brachyfacial, mesofacial and dolichofacial types of faces, who evaluated the degree of esthetic perception and attractiveness by means of a visual analog scale measuring 70 mm. The differences between evaluators were verified by the Mann-Whitney test. All statistics were performed with a confidence level of 95%.

Results:

Brachyfacial individuals perceived mesofacial and dolichofacial types of faces with buccal corridor of 2% as more attractive. Mesofacial individuals perceived mesofacial and dolichofacial types of faces with buccal corridor of 2%, 10% and 15% as more attractive. Dolichofacial individuals perceived the mesofacial type of face with buccal corridor of 2% as more attractive. Evaluators of the female sex generally attributed higher scores than the male evaluators.

Conclusion:

To achieve an enhanced esthetic smile it is necessary to observe the patient’s facial type. The preference for narrow buccal corridors is an esthetic characteristic preferred by men and women, and wide buccal corridors are less attractive.

Key words: Orthodontic treatment; Esthetics; Orthodontics

INTRODUCTION

A balanced and attractive smile is a primordial treatment objective of modern orthodontic therapy4,12,13,15,16,18. Dentofacial appearance is one of the main determinants of physical attractiveness1,8. During interpersonal interaction, individuals' focus is mainly centered on the other person’s eyes and mouth, with little time spent on the other facial characteristics5. In the opinion of the public, the smile appears in second place, losing out only to the eyes as the most important feature in facial attractiveness8.

Understanding the attractiveness of the smile and the buccal corridor space is important, since it provides a hierarchy of esthetic preference10,11. In the smile, bilateral spaces appear between the vestibular surface of the maxillary posterior teeth and the internal mucosa of the cheek, denominated buccal corridor17. Few studies have related the buccal corridor and its influences to different facial patterns. Based on this premise, the aim of the present study was to evaluate the perception of the esthetics and attractiveness of the smile with regard to the buccal corridor in individuals with brachyfacial, mesofacial and dolichofacial types of faces, by three groups of academic personnel, previously identifed according to facial type (brachyfacial, mesofacial and dolichofacial).

MATERIAL AND METHODS

An individual with a mesofacial profle was selected based on a subjective analysis of the problem (Figure 1). The individual received previous orthodontic treatment, in which he presented complete dentition and no rotation in the anterior region. The individual signed an informed consent form stating that he authorized the modifcation of the images to be used in the present study.

Figure 1 Initial frontal picture without any alteration. The patient signed informed consent authorizing the publication of these pictures. 

A front view photograph was taken with a digital camera (Canon Rebel XTI, Tokyo, Japan), with a standardized beam-focus distance. After the image was obtained, a photo editing software (Adobe Photoshop, Adobe Systems Inc, San Francisco, CA, EUA) was used for removal of small imperfections and asymmetries that could influence the evaluation of attractiveness. From the modifcation of this image, two other facial images were obtained (brachyfacial and dolichofacial). Five images were produced for each profle, creating a series of five different smiles: narrow (buccal corridor 2%), medium-narrow (buccal corridor 10%), medium (buccal corridor 15%), medium-wide (buccal corridor 22%), and wide (buccal corridor 28%).

The images were shown by means of the PowerPoint presentation software (Microsoft Offce 2007, Redmond, WA, EUA). In the first stage of evaluation 15 images (5 images X 3 facial types) were randomly organized and numbered from 1 to 15; the presentation time was 10 seconds for each photo (Figure 2). In the second stage of evaluation the images with the same buccal corridor measurement and with the three different facial types (A-brachyfacial; B-mesofacial; C-dolichofacial) were grouped in a single slide, totaling 5 slides. The slides were numbered from 1 to 5 and organized in the following buccal corridor sequence: 15%, 28%, 2%, 10% and 22% (Figure 3). In this category the evaluators had to respond whether they were able to note the difference between the images; which was the image they liked most, and which they liked least; and then give scores to each image. The presentation time for each image was 45 seconds. The evaluators could not return to previous images in any of the categories.

Figure 2 Set of five different smiles in three different facial types. A=brachyfacial; B=mesofacial; C=dolichofacial. The numbers 1, 2, 3, 4, 5 and 6 represent the buccal corridor sizes of corridor buccal 0%, 2%, 10%, 15%, 22% e 28%, respectively (from the left to the right). The patient signed informed consent authorizing the publication of these pictures. 

Figure 3 Set of different facial types with the same size buccal corridor presented in a single image, (A) brachyfacial, (B) mesofacial and (C) dolichofacial. In this case the buccal corridor is 0%. The patient signed informed consent authorizing the publication of these pictures 

A 70 mm long visual analog scale (VAS) was used to evaluate attractiveness. Numbered blocks were connected to the scale printed on white paper. The term “not very attractive” was printed on the left side of the scale and “attractive” on the right.

The image evaluations were performed by three groups of dental students (brachyfacial, mesofacial and dolichofacial type of face), who were previously identifed according to facial type. Group (A) was made up of 50 evaluators with a brachyfacial type of face, Group (B) 50 evaluators with a mesofacial type of face and Group (C) 50 evaluators with a dolichofacial type of face. The evaluators had a mean age of 21.5 years. Before the study began, the sample size was calculated, showing the need to perform the study with a sample ranging from 42 to 65 evaluators. In view of this, it was decided to conduct the study with 50 individuals per group, which would be a median number in that interval. All the evaluators were instructed to judge the attractiveness of the smiles by scores on the VAS.

The data were recorded in a table (Microsoft Offce 2007, Redmond, Wash, EUA) and submitted to statistical analysis by the Exact Fisher, Mann-Whitney and Kruskal-Wallis tests, Analysis of Variance and the Chi-square test. The level of signifcance was established at 5%.

Statistical procedure

The scores given to each image were compared by means of the Kruskal-Wallis test and a comparison between pairs was performed using the Mann-Whitney test. The frequencies of the responses given by the evaluators were compared by means of the Chi-square test. In cases in which the expected frequency was less than five (n=5), Fisher's exact test was used. The level of signifcance adopted was 5% (α=0.05). The data were analyzed in the statistical program BioEstat (version 5.0, Belém, Pará, Brazil).

RESULTS

Of the 150 participants in the study, 56 (37.3%) were male and 94 (62.7%), female. The evaluators with different facial types differed in their judgment about the mesofacial and dolichofacial types of face with buccal corridor of 2%, brachyfacial with buccal corridor of 10% and brachyfacial with buccal corridor of 22% (Table 1). For the other types of face and buccal corridors there was no signifcant difference.

Table 1 Mean and standard deviation ofthe scores given by the evaluators with differentfacial profiles 

Buccal Corridor Size Facial type in the image Facial type of the evaluator Mean Standard Deviation p-Value*
    Brachyfacial 4.10 1.50  
  Brachyfacial Mesofacial 3.54 1.73 0.234
    Dolichofacial 3.67 1.79  
    Brachyfacial 5.45a 1.28  
2% Mesofacial Mesofacial 4.47b 1.76 0.030
    Dolichofacial 5.19ab 1.43  
    Brachyfacial 5.39a 1.43  
  Dolichofacial Mesofacial 4.24b 1.65 0.001
    Dolichofacial 4.37b 1.73  
    Brachyfacial 4.49a 1.60  
  Brachyfacial Mesofacial 3.81b 1.51 0.009
    Dolichofacial 3.43b 1.81  
    Brachyfacial 4.35 1.34  
10% Mesofacial Mesofacial 4.37 1.40 0.131
    Dolichofacial 3.81 1.57  
    Brachyfacial 4.76 1.47  
  Dolichofacial Mesofacial 4.13 1.70 0.160
    Dolichofacial 4.25 1.74  
    Brachyfacial 3.62 1.42  
  Brachyfacial Mesofacial 3.43 1.47 0.761
    Dolichofacial 3.40 1.79  
    Brachyfacial 4.45 1.35  
15% Mesofacial Mesofacial 4.28 1.60 0.082
    Dolichofacial 3.72 1.73  
    Brachyfacial 4.27 1.32  
  Dolichofacial Mesofacial 3.99 1.45 0.449
    Dolichofacial 3.78 1.86  
    Brachyfacial 3.36a 1.55  
  Brachyfacial Mesofacial 3.03ab 1.44 0.035
    Dolichofacial 2.54b 1.59  
    Brachyfacial 3.47 1.44  
22% Mesofacial Mesofacial 3.85 1.39 0.336
    Dolichofacial 3.58 1.41  
    Brachyfacial 3.64 1.58  
  Dolichofacial Mesofacial 3.50 1.55 0.248
    Dolichofacial 3.10 1.52  
    Brachyfacial 2.12 1.26  
  Brachyfacial Mesofacial 2.23 1.25 0.079
    Dolichofacial 1.88 1.56  
    Brachyfacial 2.21 1.62  
28% Mesofacial Mesofacial 2.53 1.41 0.197
    Dolichofacial 2.25 1.51  
    Brachyfacial 3.02 1.35  
  Dolichofacial Mesofacial 3.11 1.35 0.082
    Dolichofacial 2.55 1.38  

*Kruskal-Wallis Test

a,b Values with different superscript letters are significantly different (Mann-Whitney test)

In the analysis of the evaluators with the brachyfacial type of face, there was a difference between the sexes only with respect to the brachyfacial type of face with a buccal corridor of 2% (Table 2). In the analysis of the evaluators with a mesofacial type of face, there was difference between the sexes with respect to the brachyfacial type of face with buccal corridors of 10% and 22%, mesofacial type with buccal corridor of 2% and dolichofacial type with buccal corridors of 2%, 15% and 22% (Table 1). The men and women with a dolichofacial pattern evaluated the buccal corridors of the three types of face analogously.

Table 2 Mean of scores given by evaluators to the facial type of the image according to the buccal corridor size, evaluator's facial type and sex 

Buccal Corridor Size Facial type in the image Facial type of the evaluator Mean Standard Deviation p-Value*
    Brachyfacial 3.21 4.44 0.009
  Brachyfacial Mesofacial 3.34 3.66 0.618
    Dolichofacial 3.80 3.55 0.598
    Brachyfacial 5.12 5.58 0.177
2% Mesofacial Mesofacial 3.67 4.92 0.020
    Dolichofacial 5.05 5.33 0.554
    Brachyfacial 4.96 5.55 0.138
  Dolichofacial Mesofacial 3.51 4.65 0.019
    Dolichofacial 4.41 4.33 0.799
    Brachyfacial 4.11 4.64 0.302
  Brachyfacial Mesofacial 3.14 4.18 0.041
    Dolichofacial 3.36 3.50 0.741
    Brachyfacial 3.93 4.51 0.147
10% Mesofacial Mesofacial 4.10 4.52 0.353
    Dolichofacial 3.78 3.84 0.922
    Brachyfacial 4.64 4.81 0.151
  Dolichofacial Mesofacial 3.64 4.40 0.125
    Dolichofacial 4.08 4.40 0.513
    Brachyfacial 3.25 3.76 0.276
  Brachyfacial Mesofacial 3.14 3.59 0.503
    Dolichofacial 3.29 3.50 0.689
    Brachyfacial 3.96 4.64 0.163
15% Mesofacial Mesofacial 3.82 4.53 0.166
    Dolichofacial 3.73 3.72 0.930
    Brachyfacial 3.96 4.39 0.281
  Dolichofacial Mesofacial 3.39 4.33 0.044
    Dolichofacial 3.72 3.84 0.845
    Brachyfacial 3.18 3.42 0.496
  Brachyfacial Mesofacial 2.42 3.37 0.026
    Dolichofacial 2.71 2.39 0.453
    Brachyfacial 3.07 3.63 0.247
22% Mesofacial Mesofacial 3.62 3.98 0.519
    Dolichofacial 3.59 3.58 0.790
    Brachyfacial 3.18 3.82 0.139
  Dolichofacial Mesofacial 2.87 3.85 0.047
    Dolichofacial 3.11 3.08 0.945
    Brachyfacial 2.18 2.10 0.894
  Brachyfacial Mesofacial 1.78 2.48 0.077
    Dolichofacial 2.19 1.59 0.246
    Brachyfacial 2.57 2.07 0.592
28% Mesofacial Mesofacial 2.29 2.67 0.141
    Dolichofacial 2.40 2.11 0.585
    Brachyfacial 2.57 3.19 0.100
  Dolichofacial Mesofacial 2.73 3.32 0.113
    Dolichofacial 2.62 2.48 0.784

*Mann-Whitney Test

Figure 4 shows a graphic illustration of the means of scores given by evaluators with different facial patterns on the visual analog scale. The individuals with a brachyfacial type of face demonstrated that they found the mesofacial and dolichofacial types with a buccal corridor of 2% more attractive, and evaluated the buccal corridor of 10% as the most attractive for their own facial pattern (Figure 2A). The individuals with the mesofacial pattern demonstrated that they perceived mesofacial and dolichofacial types of faces with buccal corridor of 2%, 10% and 15% to be more attractive. The individuals with a dolichofacial pattern demonstrated that they found the mesofacial type of face with a buccal corridor of 2% more attractive, and evaluated the buccal corridor of 2% and 10% as the most attractive for their own facial pattern (Figure 2C).

Figure 4 Means of scores on the visual analog scale, given by volunteers with the brachyfacial (A), mesofacial (B) and dolichofacial (C) patterns, according to the buccal corridor size and type of face 

Table 3 presents the perception of the evaluators with respect to the differences and preferences for the sets of images presented. The data of all the images showed that the large majority of the participants were able to notice the difference between the photos presented, and there was no signifcant difference among the evaluators with different facial types. Only for image 3 (buccal corridor of 2%), as regards the least preferred photo, there was statistical difference between the groups of evaluators, with the larger proportion of evaluators with a brachyfacial pattern liking photo A (brachyfacial) the least, while the evaluators with mesofacial and dolichofacial patterns liked photos B (mesofacial) and C (dolichofacial) the least.

Table 3 Perception of the participants regarding differences and their preferences in relation to the images presented 

Images Replies Facial type of the evaluator p-Value
  Brachyfacial Mesofacial Dolichofacial  
  Perceive differences  
  Yes 47 (94.0%) 49 (98.0%) 48 (96.0%) 0.871
  No 3 (6.0%) 1 (2.0%) 2 (4.0%)
  Photo I like the most*  
  A 11 (23.4%) 4 (8.2%) 7 (14.6%) 0.205
Image 1 B 9 (19.1%) 7 (14.3%) 6 (12.5%)
  C 27 (57.4%) 38 (77.6%) 35 (72.9%)
  Photo I like the least*  
  A 19 (40.4%) 25 (51.0%) 22 (45.8%) 0.329
  B 20 (42.6%) 22 (44.9%) 22 (45.8%)
  C 8 (17.0%) 2 (4.1%) 4 (8.3%)
  Perceive differences  
  Yes 45 (90.0%) 49 (98.0%) 46 (92.0%) 0.345
  No 5 (10.0%) 1 (2.0%) 4 (8.0%)
  Photo I like the most*  
  A 6 (13.3%) 7 (14.3%) 12 (26.1%) 0.513
Image 2 B 8 (17.8%) 9 (18.4%) 8 (17.4%)
  C 31 (68.9%) 33 (67.3%) 26 (56.5%)
  Photo I like the least*  
  A 23 (51.1%) 21 (42.9%) 18 (39.1%) 0.407
  B 20 (44.4%) 26 (53.1%) 22 (47.8%)
  C 2 (4.4%) 2 (4.1%) 6 (13.0%)
  Perceive differences  
  Yes 46 (92.0%) 46 (92.0%) 47 (94.0%) 1.000
  No 4 (8.0%) 4 (8.0%) 3 (6.0%)
  Photo I like the most*  
  A 8 (17.4%) 10 (21.7%) 8 (17.0%) 0.211
Image 3 B 14 (30.4%) 5 (10.9%) 13 (27.7%)
  C 24 (52.2%) 31 (67.4%) 26 (55.3%)
  Photo I like the least*  
  A 27 (58.7%) 17 (37.0%) 17 (36.2%) 0.043
  B 13 (28.3%) 25 (54.3%) 20 (42.6%)
  C 6 (13.0%) 4 (8.7%) 10 (21.3%)
  Perceive differences  
  Yes 47 (94.0%) 46 (92.0%) 47 (94.0%) 1.000
  No 3 (6.0%) 4 (8.0%) 3 (6.0%)
  Photo I like the most*  
  A 6 (12.8%) 5 (10.9%) 6 (12.8%) 0.287
Image 4 B 13 (27.7%) 6 (13.0%) 6 (12.8%)
  C 28 (59.6%) 35 (76.1%) 35 (74.5%)
  Photo I like the least*  
  A 21 (44.7%) 24 (52.2%) 27 (57.4%) 0.594
  B 21 (44.7%) 20 (43.5%) 16 (34.0%)
  C 5 (10.6%) 2 (4.3%) 4 (8.5%)
  Perceive differences  
  Yes 41 (82.0%) 46 (92.0%) 47 (94.0%) 0.114
  No 9 (18.0%) 4 (8.0%) 3 (6.0%)
  Photo I like the most*  
  A 8 (19.5%) 8 (17.4%) 6 (12.8%) 0.738
Image 5 B 7 (17.1%) 9 (19.6%) 13 (27.7%)
  C 26 (63.4%) 29 (63.0%) 28 (59.6%)
  Photo I like the least*  
  A 16 (39.0%) 22 (47.8%) 22 (46.8%) 0.334
  B 24 (58.5%) 19 (41.3%) 20 (42.6%)
  C 1 (2.4%) 5 (10.9%) 5 (10.6%)

*Answered only by individuals who perceived differences between the images

Exact Fisher Test;

Chi-square

DISCUSSION

The aim of the present study was to analyze the influence of the buccal corridor on the degree of attractiveness of the smile of individuals with different facial types. A large portion of the authors who have investigated the subjects did not divide the evaluators according to their facial pattern3,5-7,9,11. Other related studies analyzed the influence of different sizes of buccal corridor only in short and long faces20. Habitually only the image of the mouth is used as an evaluation parameter2,10,11,17. Some authors have used front view photos of the entire face for this type of study9,19. For Sachdeva19 (2012), the buccal corridor space has minimal influence on the esthetic evaluation of the smile, with other factors being more important, such as the arrangement of the teeth, tooth color, gingival architecture, gingival exposure, and lip thickness.

In the literature, some studies have not considered the entire face, which may interfere in the results, since they do not evaluate the facial pattern and other elements of the face11,17. A limitation of this study is the use of a single image of an individual of the female sex, as it has been demonstrated that the sex of the individual in the photo affects the perception of the attractiveness of the smile3; however, the unisex characteristics of the chosen individual were important for minimal interference in the evaluation. The changes were made with the use of photo editing software, which was shown to be a most useful image manipulation method11,14,18,20. To exhibit the images, a slide presentation software was used, because of the possibility of obtaining a larger number of evaluators in a shorter time interval. The exhibition time of each slide was compatible with the time used in other studies20. The use of a black background between the slides served to detach the evaluator from the previously evaluated image and not influence the evaluation of the next image. The evaluators were not allowed to go back to images already evaluated so that there would be no comparison between them. The five different buccal corridor sizes served to determine the degree of interference of this factor in the esthetics of the smile9,20.

The esthetic value of each image was judged by means of a visual analog scale (VAS). This classifcation scale was designed for minimal restrictions and more freedom to express a style of personal response in a linear manner10,11. The choice of the 70 mm VAS scale was because it is easy to understand and to evaluate each image in a subjective manner, from the least to the most attractive.

This was the first study in which the evaluators and the images were divided into brachyfacial, mesofacial and dolichofacial patterns to verify whether the evaluator’s facial pattern would have an influence on his/her choice. In contrast to the study of Zange, et al.20 (2011), men were more critical than women, and attributed lower scores, except for the evaluators with dolichofacial patterns, who attributed analogous scores. In a study conducted by Abu Alhaija, et al.1 (2011), no signifcant differences were detected between men and women. In spite of the methodological differences, the buccal corridors of 2% and 10% were considered the most esthetically pleasant type in the three facial types among all the groups of evaluators, similar to the results described by Moore, et al.9 (2005). It was found that a wide buccal corridor was considered less attractive than a narrow one1,18, considering that irrespective of the evaluator’s facial type, the highest scores were attributed to the sizes of 2% and 10%, followed by 15 and 22% while the buccal corridor of 28% obtained the lowest scores.

In the individual evaluation of the images, the brachyfacial evaluators assessed the buccal corridor of 10% as the most esthetically pleasant for their own facial type; however, they showed that they perceived the buccal corridor of 2% as more attractive in the mesofacial and dolichofacial types of faces, revealing greater preference for these types of faces. The evaluators with a mesofacial pattern revealed that they found buccal corridors of 2%, 10% and 15% attractive both for their own facial type and for the dolichofacial type, thus showing that they did not fnd the brachyfacial types with the different sizes of buccal core very attractive. The evaluators with a dolichofacial pattern preferred the buccal corridors of 2% and 10% for their own facial type; however, they revealed that they found the mesofacial pattern with a buccal corridor of 2% to be the most attractive.

When analyzing the set of images, the majority of the evaluators in the three groups noted differences with respect to the three types of faces. In this category there was no signifcant difference between the evaluators with different facial types, except for the slide containing buccal corridors of 2%, for the larger proportion of those with a brachyfacial type of face liked the brachyfacial image the least, thus revealing that they found their own facial pattern with this size of buccal corridor less attractive.

Further studies should be conducted on the subject, with a view to evaluating, by means of other methods and parameters, the real influence of the buccal corridor on the esthetics of the smile, particularly in different facial types.

CONCLUSION

By conducting this study, it could be concluded that:

The individuals with a brachyfacial type of face demonstrated that they found the mesofacial and dolichofacial types with a buccal corridor of 2% more attractive, and evaluated the buccal corridor of 10% as the most attractive for their own facial pattern.

Individuals with a mesofacial type of face demonstrated that they perceived mesofacial and dolichofacial types of faces with buccal corridors of 2%, 10 % and 15% to be more attractive.

Individuals with a dolichofacial pattern demonstrated that they found the mesofacial type of face with a buccal corridor of 2% more attractive, and evaluated the buccal corridor of 2% and 10% as the most attractive for their own facial pattern.

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Received: March 30, 2014; Revised: June 04, 2014; Accepted: June 09, 2014

Corresponding address: Matheus Melo Pithon - Centro Odontomédico Dr. Altamirando da Costa Lima - Av. Otávio Santos, 395, sala 705 - Bairro Recreio - 45020-750 - Vitória da Conquista - Bahia - Brazil - e-mail: matheuspithon@gmail.com

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