The relationship of tooth shade and skin tone and its influence on the smile attractiveness

Objective The purpose of this clinical study was to determine if skin tone and tooth color had the same influence on smile attractiveness. Materials and Methods A woman's smile photograph was digitally manipulated to create a range of images with varying colors. The skin shade was modified to create four tones (p1: light, p2: light medium, p3: medium dark, p4: dark) using the L'Oreal True Illusion shade as a guide. The tooth shade was modified in four different tones: A1, A2, A3, A4 using the VITAPAN Classical shade guide to produce 16 images. A sample of 328 participants rated each image for attractiveness by means of a visual analog scale (VAS). Comparison among groups was performed with a 2-way ANOVA adjusted for multiple comparisons with the Bonferroni test (alpha = .05). Results Image (p3-a1) showed the highest VAS values, while image (p1-a4) obtained the lowest, (Bonferroni Test: a1 vs a2, a3, a4 P < .001; p3 vs p1, p2, p4 P < .001). Analysis performed for age, sex, level of education, and laypeople/dentists were not statistically significant (P > .05). Conclusions Variations in tooth and skin tone can significantly influence the perception of smile attractiveness. In the tested conditions, a brighter tooth shade significantly affected the attractiveness of the smile independently from skin tone. Clinical Significance Understanding patient and dentist perception of the attractiveness of a smile with the important role-played by skin tone, may help clinicians to better identify teeth shade, helping delivery of tailored prostheses and esthetic restorations.