{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:48:30Z","timestamp":1775040510208,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The objective was to determine if asymmetric facial features, nasal and chin deviations, affect the perception of attractiveness of a dental midline angulation, and if it is consistent among both dentists and laypeople. It was also analyzed if factors, such as the sex, age group of the participants and the dentist\u2019s area of operation are relevant in their assessment. Methods: A cross-sectional study, approved by the Ethics Committee of Fernando Pessoa University. From a symmetrical facial model (SFM) image, a natural-looking asymmetrical face was created. Based on this asymmetric facial model six images were created, with different directions and degrees of inclination of the dental midline. In total, 236 laypersons and 242 dentists completed the online questionnaire where they rated the self-perception of attractiveness of the eight images (VAS scale from 0 to 10). Non-parametric comparisons (IBM\u00a9 SPSS Statistics vs. 27.0, p &lt; 0.05). Results: The results showed a significant difference in the perception of attractiveness between laypeople and dentists. This finding was consistent regarding every image, except for the SFM. The factors, sex of the people participating and dentist\u2019s area of operation, seemed only to contribute to a significant difference in the perception when it came to the SFM. The perceived attractiveness of the images, for dentists and laypersons, did not differ by age group of the participant, apart from images 6 and 8. Conclusions: Dentists are more rigorous about dental midline inclinations than laypersons. The perception of attractiveness was affected by the age group and sex of the participants and the dentist\u2019s area of operation.<\/jats:p>","DOI":"10.3390\/ijerph182412904","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T09:52:29Z","timestamp":1638870749000},"page":"12904","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Impact of Dental Midline on Asymmetric Faces: Perspective of Laypersons and Dentists"],"prefix":"10.3390","volume":"18","author":[{"given":"Joana Meneses","family":"Martins","sequence":"first","affiliation":[{"name":"FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4372-7309","authenticated-orcid":false,"given":"Liliana Gavinha","family":"Costa","sequence":"additional","affiliation":[{"name":"FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0015-4400","authenticated-orcid":false,"given":"Ana Lidia","family":"Carvalho","sequence":"additional","affiliation":[{"name":"FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1774-1337","authenticated-orcid":false,"given":"Maria Concei\u00e7\u00e3o","family":"Manso","sequence":"additional","affiliation":[{"name":"FP-I3ID, FP-ENAS, FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2430-1241","authenticated-orcid":false,"given":"Sandra","family":"Gavinha","sequence":"additional","affiliation":[{"name":"FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"given":"Mariano","family":"Herrero-Climent","sequence":"additional","affiliation":[{"name":"Porto Dental Institute, 4150-518 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2832-5902","authenticated-orcid":false,"given":"Blanca","family":"R\u00edos-Carrasco","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Universidad de Sevilla, 41009 Seville, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8031-6176","authenticated-orcid":false,"given":"Carlos","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"},{"name":"Porto Dental Institute, 4150-518 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1089-279X","authenticated-orcid":false,"given":"Paulo","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004 Porto, Portugal"},{"name":"Porto Dental Institute, 4150-518 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Subjectivity and complexity of facial attractiveness","volume":"9","author":"Amico","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1177\/0301006618813035","article-title":"Beauty Is in the Eye of the Beholder: The Appraisal of Facial Attractiveness and Its Relation to Conscious Awareness","volume":"48","author":"Tsikandilakis","year":"2019","journal-title":"Perception"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.ajodo.2005.09.027","article-title":"The enigma of facial beauty: Esthetics, proportions, deformity, and controversy","volume":"130","author":"Naini","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4193\/Rhino12.111","article-title":"The golden ratio in facial symmetry","volume":"51","author":"Prokopakis","year":"2013","journal-title":"Rhinol. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1093\/asj\/sjw271","article-title":"Discriminative Thresholds in Facial Asymmetry: A Review of the Literature","volume":"37","author":"Wang","year":"2017","journal-title":"Aesthetic Surg. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.prosdent.2018.03.023","article-title":"The facial flow concept: An organic orofacial analysis\u2014The vertical component","volume":"121","author":"Silva","year":"2019","journal-title":"J. Prosthet. Dent."},{"key":"ref_7","first-page":"12940555","article-title":"The effect of axial midline angulation on dental esthetics","volume":"73","author":"Thomas","year":"2003","journal-title":"Angle Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1590\/2176-9451.19.4.136-157.sar","article-title":"10 commandments of smile esthetics","volume":"19","author":"Machado","year":"2014","journal-title":"Dent. Press J. Orthod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/idj.12574","article-title":"Psychosocial impact of dental aesthetics on dental patients","volume":"70","author":"Campos","year":"2020","journal-title":"Int. Dent. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"805","DOI":"10.14219\/jada.archive.2007.0269","article-title":"Patients\u2019 satisfaction with dental esthetics","volume":"138","author":"Geiger","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/0022-3913(79)90065-9","article-title":"A study of the relationship of the dental midline to the facial median line","volume":"41","author":"Miller","year":"1979","journal-title":"J. Prosthet. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S0022-3913(84)80097-9","article-title":"Some esthetic factors in a smile","volume":"51","author":"Tjan","year":"1984","journal-title":"J. Prosthet. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0022-3913(73)80013-7","article-title":"The principles of visual perception and their clinical application to denture esthetics","volume":"29","author":"Lombardi","year":"1973","journal-title":"J. Prosthet. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2319\/040710-195.1","article-title":"Influence of orthodontic treatment, midline position, buccal corridor and smile arc on smile attractiveness","volume":"81","author":"Janson","year":"2011","journal-title":"Angle Orthod."},{"key":"ref_15","first-page":"1","article-title":"Discord Between the Facial and Maxillary Midline and Intermaxillary Midline Among the Population of Asir, Saudi Arabia","volume":"19","author":"Khan","year":"2019","journal-title":"Pesquisa Brasileira em Odontopediatria e Cl\u00ednica Integrada"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1708-8240.1999.tb00414.x","article-title":"Comparing the Perception of Dentists and Lay People to Altered Dental Esthetics","volume":"11","author":"Kokich","year":"1999","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_17","first-page":"132","article-title":"Changes in smile parameters as perceived by orthodontists, dentists, artists, and laypeople","volume":"9","author":"Fida","year":"2008","journal-title":"World J. Orthod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/jerd.12347","article-title":"Layperson\u2019s perception of axial midline angulation in asymmetric faces","volume":"30","author":"Silva","year":"2018","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S1073-8746(98)80016-9","article-title":"Evaluation of dental midline position","volume":"4","author":"Beyer","year":"1998","journal-title":"Semin. Orthod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.11607\/prd.1618","article-title":"Laypersons\u2019 perception of facial and dental asymmetries","volume":"33","author":"Silva","year":"2013","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.ajodo.2013.06.020","article-title":"Face symmetry assessment abilities: Clinical implications for diagnosing asymmetry","volume":"144","author":"Jackson","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/12904\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:42:41Z","timestamp":1760168561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/12904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,7]]},"references-count":21,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182412904"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182412904","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,7]]}}}