Evaluation of the Effect of Changing Gingival Features on Individuals’ Perception of Smile Aesthetics

Background: Smile aesthetics significantly influence social perception, self-esteem and professional opportunities. While dental aesthetics traditionally focused on tooth morphology, periodontal factors particularly gingival features are increasingly recognized as critical determinants of smile harmony. This study aimed to quantify the impact of specific gingival alterations on layperson aesthetic perception. Methods: 150 patients were included in the study (82 women, 68 men; mean age 27.69 ± 6.12 years) who evaluated 34 digitally modified smile photographs depicting gingival recession (1-3 mm), papillary defects (black triangles) and hyperpigmentation using a Q-sort method. Statistical analysis was performed using SPSS 26, with significance set at p < 0.05. Results: Papillary defects (3 mm black triangles between central incisors) received the lowest aesthetic scores (-3.25 ± 1.24), followed by gingival recession ≥2 mm (-2.88 ± 1.13). Hyperpigmentation had minimal impact (mean scores: -0.15 to +0.50). Gender differences were significant: women rated 3 mm lateral recession lower than men (-0.82 vs. 0.07; p = 0.003), while men rated 1 mm lateral recession higher than women (1.01 vs. 1.83; p= 0.004). Conclusion: Papillary defects and recession ≥2 mm are the most detrimental to smile aesthetics. Current treatments for papillary defects lack standardization, highlighting the need for evidence-based protocols. Preventive strategies and early intervention are critical for maintaining periodontal aesthetics.