Quantification of the Esthetics of Dentists' Before and After Photographs

Dentists often post “before and after” photographs of patient treatments as promotional material on their websites, with an unattractive smile being transformed into an attractive one. Objectives: to measure the photographs to identify four metrics: a, Central incisor width-to-height ratio; b, Central–to-lateral incisor width ratio; c, Lateral incisor-to-canine width ratio; and d, Lateral incisor percentage offset to describe the esthetic improvement. Methods: Internet searches for “Before After” and “Veneers” and “Prosthodontic” were used to obtain 199 before and after photographs of patient treatments showing the restoration of the six maxillary anterior teeth with porcelain veneers, crowns or a combination. The four metrics were measured using Adobe Photoshop. Groups were compared with repeated measures ANOVA followed by a post-hoc Tukey-Kramer test with the variables of "Before or After Treatment"; "Treatment Type" (veneers, crowns or a combination); "Left or Right side"; and "General Dentist or Prosthodontist". Results: Mean central incisor width-to-height ratio was 91.3% before treatment, 80.4% after; mean central–to-lateral incisor width ratios were 69.8% and 68.6%; mean lateral incisor-to canine width ratios were 85.1% and 81.2% and lateral incisor percentage offsets were 9.7% and 8.7%. There were significant (p<0.05) differences for before and after treatment for all variables except central–to-lateral incisor width ratio. Differences between specialist and general dentist were not statistically significant. Conclusions: On average, esthetic prosthetic treatment resulted in reduced central incisor width-to-height ratio, increased proportional width of the mesially positioned tooth of adjacent anterior teeth and reduced lateral incisor offset. The mean values of treatments by GPs and Prosthodontists were not statistically significantly different.