Esthetic Perceptions Associated with Gingival Color Changes in Broad Smiles

Little is known about how controlled changes in gingival color affect the esthetic perception of broad smiles. This study evaluated how gingival color modifications affected esthetic ratings and whether responses varied by evaluator gender and age. Two photographs of broad smiles (one male and one female model) were digitally modified to create four versions per model: natural gingival color, increased L* (lighter gingiva), increased a* (redder gingiva), and either increased b* (more yellowish gingiva) in the female model or decreased L* (darker gingiva) in the male model. Two hundred participants rated the eight images on a 0–10 scale. Paired-samples t-tests and Cohen’s d were used. For both models, images with natural or lighter gingiva received higher ratings than the other versions. Redder gingiva received significantly lower ratings than the original, with a larger effect in the male model (d = 0.94) than in the female model (d = 0.33). Darker (male) and more yellowish (female) gingiva also received lower ratings (d = 0.90 and d = 0.88, respectively). In descriptive subgroup analyses, unfavorable color changes tended to receive lower ratings among female evaluators and participants younger than 60 years; however, between-group differences were not formally tested. Gingival color significantly influenced the esthetic perception of the two broad-smile photographs evaluated.