Objectives: Purpose of this study was to evaluate the esthetic effect of minor changes in incisor angulation for anterior restorations using a questionnaire posted on the internet. Methods: The jury consisted of internet-users visiting the homepage of Kiel University, Department of Prosthodontics. A pop-up window led to a questionnaire to assess the users¢ well-being (Beltz-Test, Germany). Then they were asked to evaluate the attractiveness of seven computer-manipulated images by using visual-analog-scales (0=very unattractive; 100=very attractive). The color images showed a standardized smiling female mouth with lips revealing the upper teeth. Different standardized angulations (9° mesial) of the incisors (tooth 12–22) were performed. Only judges with normal well-being and completed questionnaires were accepted. For statistical analysis multiple comparisons using the Wilcoxon signed rank test adjusted with Bonferroni-Holm procedure were conducted. Results: After establishing the study in the internet for six weeks 280 judges joined the evaluation; 150 judges (67 women, 83 men, mean age 36±12) were included in analysis. The judges consisted of non-academics (49%), students (18%) and academics (33%; therefrom 13% dentists, 20% others). The results [median (first; third quartile)] showed statistically significant (p£0,05) that symmetrical incisors with ideal axes [68 (48; 88)] as well as minor changes in the angulation of one [64 (45; 80)] or both lateral incisors [64 (40; 80)] are esthetically more attractive than the angulation of one [45 (30; 63)] or both central incisors [25 (15; 41)] or the combination of one angulated lateral and one angulated central incisor [38 (23; 63)]. Conclusion: An internet evaluation seems to be a useful method to examine assessment of dental appearance. In order to achieve the most positive esthetic effect of anterior restorations, the central incisors should be restored with ideal axes and symmetrically. The angulation of the lateral incisors may be adapted slightly to individual needs.

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