Impact of Central Incisor Attachments on the Smile Perception of Laypeople

Objective To determine how different attachments to the maxillary central incisors during clear aligner treatment influence the esthetic perception of smiles among laypeople. Materials and Methods A total of 179 participants were included in a cross‐sectional visual interview survey using manipulated photographs featuring different types of attachments: no attachment/control (CR), conventional rectangular horizontal (HRA), conventional rectangular vertical (VRA), optimized extrusion (OEA), and optimized root CR (ORCA). The participants rated these images using a digital visual analog scale (VAS). The differences in esthetic ratings were evaluated based on attachment type, sex, and age. Results The CR photograph received the highest esthetic rating, with a mean (standard deviation) score of 97.201 (6.2803); significant differences were observed between the CR and all attachment types ( p < 0.05). The VRA attachment was least favored, with a mean score of 46.4022 (21.3227). The optimized attachments generally scored higher than the conventional attachments. Sex‐based analysis revealed that female evaluators rated photographs of optimized attachments and VRA higher than male evaluators. Age did not significantly affect these results. Conclusion Attachments associated with clear‐aligner treatment decreased the smile’s overall esthetic appeal, as perceived by laypeople. Overall, conventional rectangular attachments negatively affected smile esthetics more than optimized attachments, possibly due to the inherently smaller size of the latter. Female evaluators tolerated the effects of attachment on smile esthetics better than their male counterparts. Future research should explore the effects of different attachment configurations on smiling esthetics.