Dentists are constantly asked to make decisions as to the optimum anterior tooth shape and position when restoring badly damaged dentitions. However little guidance is available to help dentists achieve this ideal. Objectives: determine dentists' esthetic preferences for the maxillary anterior teeth as influenced by various esthetic factors and determine if choices were related to experience, gender and training of the dentist. Methods: after obtaining IRB exemption approval, images of the six maxillary anterior teeth were computer-manipulated to produced 5 groups each with 4 slight variations of a common esthetic issue (embrasure size, central angulation, lateral angulation, lateral length and central width-to-height ratio). The images were randomly ordered on a web page which contained a form asking for demographic data and fields asking for a ranking of the images (http://www.dent.ohio-state.edu/restsurvey/appearance/). Approximately 10,000 e-mails asking to access the website were sent to dentists' addresses randomly selected from a commercial database (FaxMarketing Corp, Aventura, FL). Nonrespondents received one reminder. The responses were tabulated and analyzed with Wilcoxon sign rank tests with Bonferonni adjustment of p (a=0.05). Results: 228 valid replies (2.3% response) were received. There were statistically significant differences (p<0.05) for all groups. Preferences were for reduced over increased embrasures, slight distal inclinations over mesial for both centrals and laterals and slightly shorter laterals over longer. The 0.77 w-h ratio was ranked highest by 65% of dentists, then 0.85, 0.73 and 0.89 worst. The variables of year of graduation, gender, professional activity, generalist or specialist, or number of patients were not significantly correlated with the choices (p>0.05). Conclusions: most dentists were consistently able to select among esthetic options but this ability was not directly related to training, gender or experience.

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