Original Article

Smile esthetics from odontology students’ perspectives

Pilar Españaa; Beatriz Tarazonab; Vanessa Paredesc

ABSTRACT
Objectives: To analyze the perception of smile esthetics and its alterations in dental degree
students; to determine whether there are differences in that perception among students in different
study years on those courses and between genders; and to determine if the circumstance of having
received prior orthodontic treatment could influence that perception.
Material and Methods: Students (n5192) in different study years of the dental degree course at
the University of Valencia, Spain, analyzed two photographs of a patient in which, by means of
computer software, midline diastema, upper and lower midlines, crown length of the maxillary right
central incisor, occlusal cant, and ‘‘gummy’’ smile were altered. Students assessed the
photographs on a scale from 1 to 10. Statistical analyses for assessing each group’s level of
perception were carried out.
Results: After checking the validity of the study, it was observed that the students’ ability to detect
alterations in smile esthetics did not improve over their degree courses, given that the differences
do not present a linear development. There were no differences between genders and between
those who had or had not undergone an orthodontic treatment.
Conclusions: There are no statistically significant differences between the results of students in
different study years or between genders. The circumstance of having undergone prior orthodontic
treatment is not a determining factor in the ability to perceive such anomalies. (Angle Orthod.
2014;84:214–224.)
KEY WORDS: Smile esthetic; Students; Gummy smile

INTRODUCTION if we understand the principles that govern the balance

between teeth and oral soft tissues when we smile and
Esthetics is a quality of enormous importance in our
what constitutes a symmetrical smile with appropriate
society. Sometimes we, as orthodontists, forget that
proportions between teeth, gums, and lips.1,3–10
facial attractiveness is a factor of interest to everyone
Studies in the literature have analyzed the percep-
and that the ultimate source of esthetic values must be
tion of smile esthetics in non–dental profession-
the general public and not what orthodontists may
als.1,4,7,8,10–17 As for the perception of smile esthetics
believe.1 It is easy to understand how severe malocclu-
in dentistry students and future dental professionals,
sions negatively affect self-esteem; however, the effect
we only found one recent study in the literature9 that
of lesser esthetic problems varies depending on the
compared dentistry students with a group of orthodon-
person and on social and cultural factors.2 It is,
tists. Moreover, we did not find any study on Spanish
therefore, essential to control the ways orthodontic
students. These were the reasons why we decided to
treatments affect dentofacial esthetics, which is possible
undertake a study on dentistry degree students at the
University of Valencia, Spain.
a
Orthodontist, Private practice, Valencia, Spain.
b
Assistant Professor, Department of Orthodontics, Faculty of
The aims of the study were to (1) analyze the
Medicine and Dentistry, University of Valencia, Valencia, Spain. perception of smile esthetics and alterations in
c
Associate Professor, Department of Orthodontics, Faculty of dentistry degree students, (2) determine whether there
Medicine and Dentistry, University of Valencia, Valencia, Spain. are differences in that perception among students in
Corresponding author: Dr Pilar España, Clı́nica Odontológica, different study years, (3) identify whether there are
C/ Gascó Oliag 1 46010, Valencia, Spain
(e-mail: pilarespam@gmail.com) differences in that perception between students of
different genders, and (4) determine whether the
Accepted: June 2013. Submitted: March 2013.
Published Online: August 7, 2013
circumstance of having undergone prior orthodontic
G 2014 by The EH Angle Education and Research Foundation, treatment influenced the perception of smile and its
Inc. alterations.

Angle Orthodontist, Vol 84, No 2, 2014 214 DOI: 10.2319/032013-226.1

SMILE ESTHETICS FROM ODONTOLOGY STUDENTS
Figure 1. Midline diastema was created incrementally between maxillary central incisors. It was widened progressively in 0.5-mm increments.
(A) Control. (B) 0.5 mm. (C) 1 mm. (D) 1.5 mm.
MATERIAL AND METHODS
A cross-sectional descriptive study was carried out and
approved by the Ethics Committee of research into
Humans of the Experimental Research Ethics Committee
of the University of Valencia. Two hundred ten dentistry
degree students at the University of Valencia, Spain,
were randomly selected. The inclusion criteria were that
they were present when the sample was gathered and
that they correctly filled in the questionnaires given to
them. Of the 210 students, 192 met the inclusion criteria
and formed the sample: 112 women and 80 men. Of
these, 121 had previously undergone orthodontic treat-
ment. The mean age was 22.2 years (range 5 18–
36 years old). The population to be studied was selected
by means of nonconsecutive population sampling
(chance does not arise in this selection: volunteers who
fulfilled the inclusion criteria were chosen and recruited
until we reached the number required). The distribution
per study year was 39 first-year, 46 second-year, 30
third-year, 39 fourth-year, and 38 fifth-year students.
Each student filled in a questionnaire with first name
and surname, age, study year, and whether or not they
had undergone orthodontic treatment. In addition,
each student signed a document stating that he or
215
she understood that the study officially complied with
the law on data protection.
Method
Two photographs were used: the first a frontal,
intraoral view, allowed subjects to see the teeth and soft
tissues; the second a frontal extraoral smile view, in
which we included the nose and chin of a female patient
(to eliminate possible confusion variables) treated in the
master of the orthodontics teaching unit of the University
of Valencia. The first intraoral photograph had a clinically
acceptable occlusion so that the digital alterations could
be made from a reference considered normal.
Both photographs were modified using the image
manipulation computer program Gimp (GNU Image
Manipulation Program) version 2.8.2 for Windows (this
software is free from the University of Berkeley). We
thus obtained six groups of photographs in which the
following were gradually modified:
N Group 1. Modification of midline diastema (Figure 1A
through D)
N Group 2. Modification of upper and lower midline
(Figure 2A through H)
Angle Orthodontist, Vol 84, No 2, 2014
216
Figure 2. Upper and lower midline were modified progressively in 0.5-mm right increments. (A) Control. (B) Upper midline 0.5 mm. (C) Upper
midline 1 mm. (D) Upper midline 1.5 mm. (E) Control. (F) Lower midline 0.5 mm. (G) Lower midline 1 mm. (H) Lower midline 1.5 mm. Reference
points for measurements were nose and chin midlines.
N Group 3. Modification of crown length of the maxillary
right central incisor (Figure 3A through D)
N Group 4. Modification of occlusal cant (Figure 4A
through D)
N Group 5. Modification of ‘‘gummy’’ smile (Figure 5A
through D)
N Group 6. Repeated photographs (Figure 2B and F,
3B, 5B)
Group 6 was made up of four photographs, called
standardized photographs, that had already appeared
in the previous groups; these photographs allowed us
to check the validity of the study.
A single observer showed the photographs to
different students for 3 seconds each. The students
were not allowed to have a second look or to compare
one photograph with the other. They had to give a
score for each photograph ranging from 1 to 10 (1 5
little esthetic value and 10 5 high esthetic value). The
Angle Orthodontist, Vol 84, No 2, 2014
ESPAÑA, TARAZONA, PAREDES
photographs were ordered consecutively—not ran-
domly—from the original to the most altered.
Data Analysis
The statistical study was carried out using the
computer software program SPSS version 20.0.0 for
Windows (SPSS, Chicago, Ill). To compare the
reliability or validity of the study, two tests were
undertaken. First, the measurement of reliability or
weighted Kappa for the four photographs of the
repeated series was calculated (with a confidence
interval of 95%) so we could interpret the similarity of
the two results from one same photograph for a single
person. Second, the tests on related samples, the
results of which indicated that the reliability of the study
depended only on some study courses, were under-
taken. After checking that the study was valid, we
undertook the normality and homogeneity of variances
SMILE ESTHETICS FROM ODONTOLOGY STUDENTS
Figure 3. Crown was shortened in 0.5-mm or 1-mm increments by adjusting the level of gingival margin of the maxillary right central incisor.
(A) Control. (B) 0.5 mm. (C) 1.5 mm. (D) 2 mm. Reference points for measurements were the most superior points on the labial gingival margin of
the patient’s adjacent central incisor.
tests and chose analysis of variance (ANOVA) to
analyze the results from each of the groups.
RESULTS
Table 1 shows means and standard deviations
(SDs) for all the photographs depending on dentistry
year (first through fifth). Table 2, shows means and
SDs for prior orthodontic treatment.
Differences in Perception of Smile and Its
Alteration Depending on Study Year (Age)
Before evaluating the differences per study year, we
analyzed whether differences existed by age, as total
homogeneity of age did not exist within each study
year. We used a regression line to determine that this
has no influence. Afterward, we analyzed the study-
year effect as the only factor in the evaluation of the
photographs, using ANOVA analysis for all the groups
of photographs, except group 3, where we used Welch
analysis, as there was no homogeneity of variances.
We observed that statistically significant differences
217
existed in some series of photographs. By analyzing
the standardized group of photographs, we saw that
differences existed per study year among the photo-
graphs 6B and 6C (Table 3). It should be remembered
that if differences exist in the standardized photo-
graphs, the conclusion could be applied to the
nonstandardized photographs.
So as to see the differences between each study
year, we used Tukey analysis, condensed into two
homogeneous groups. The study-year factor was
statistically significant but the Tukey analysis showed
that the difference was nor linear; there only appeared
to be differences between some study years, and the
order of the same varied depending on the photograph
studied.
Differences in Perception of Smile and Its
Alterations Depending on Gender
With regard to differences per gender, we found no
statistically significant differences by ANOVA or by
including the interaction per study year and gender.
Angle Orthodontist, Vol 84, No 2, 2014
218
Figure 4. Occlusal cant was tilted in increments of 1u right. (A) Control. (B) 1u. (C) 2u. (D) 3u.
Differences in Perception of Smile and Its
Alterations Depending on Prior
Orthodontic Treatment
The statistical tests to assess the effect of prior
orthodontic treatment showed some significant results,
at least when studied as a whole. To analyze this in
more depth, we carried out several tests of the
interobserver effects in those photographs for which
we had obtained statistically significant results on
applying the ANOVA test with the study year as factor;
this time we introduced the prior orthodontic treatment
effect as an interaction. Only in one case did we obtain
statistically significant differences (Table 4). Students
in their second and third study year who had not
undergone prior orthodontic treatment were able to
determine slight alterations in smile esthetics. There
were no differences in any other photography.
DISCUSSION
First, and before analyzing the results, we should
take into consideration that in our study, as in most of
Angle Orthodontist, Vol 84, No 2, 2014
ESPAÑA, TARAZONA, PAREDES
those we reviewed, the alterations of teeth and soft
tissues were undertaken using an image-manipulation
computer program and did not truly represent changes
in the mouth of a real patient. However, similar to
Kokich et al.,1 we agree that if we undertake
modifications using the same image and alter a single
variable in each one, this is a reliable method for
evaluating the esthetic perception of smile. Reliability
measurement or weighted Kappa was performed for
the four photographs of the repeated series so we
could interpret the similarity of the two results from a
single photograph for the same individual. In this
instance, students in lower study years provided
different scores for the same photograph.
Differences in Perception of Smile and Its
Alterations Depending on Study Year (Age)
Taking the study year factor as independent
variable, we analyzed all the characteristics of the
smile separately. The results showed statistically
significant differences, although the correlation was
SMILE ESTHETICS FROM ODONTOLOGY STUDENTS
Figure 5. Gingiva-to-lip relationship was increased incrementally to produce a gummy smile. (A) Control. (B) 1 mm. (C) 2 mm. (D) 3 mm. Smile
was altered by progressively moving the upper lip superiorly to alter the distance from lip to gingival margin.
not linear between the different study years. This
clearly showed that the ability to determine alterations
in the smile does not improve as a student moves on to
higher study years.
Group 1: Modification of Midline Diastema
In the case of midline diastema, all students
negatively evaluated its presence. Our results contrast
with those of Kokich et al.,1 where no group negatively
evaluated the presence of the midline diastema when it
was small.
Group 2: Modification of Upper Midline
The deviation from the upper midline was detected
by the students from 1 mm on, and although it was
not completely linear, it was observed that the
students most likely to detect it were in the higher
study years.
219
Group 3: Modification of Lower Midline
On the other hand, deviation from the lower midline
was detected by the students from 0.5 mm on, results
that are in line with the study undertaken by Johnston
et al.,14 but differ from the results of Pinho et al.,4 who
showed that laypeople were not able to detect
alterations in the deviation from the midline.
Group 4: Modification of Crown Length
The results obtained with regard to evaluating the
modification of the gingival margin were detected from
2 mm on by students in all study years, results similar
to those found by Kokich et al.1 and Pinho et al.4
Group 5: Modification of Occlusal Cant
As for alterations of the occlusal plane, the students
in higher study years (from third year on) detected this
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Table 1. Descriptive Statistics (Mean and Standard Deviation [SD]) by Photograph Score Depending on Dentistry Year (First–Fifth)
Photograph Total First Second Third Fourth Fifth
1A (control 1)
Mean 7.79 7.83 8.04 7.40 7.90 7.86
SD 1.32 1.50 1.46 1.33 1.26 1.08
1B (diastema 0.5 mm)
Mean 5.46 6.06 6.08 5.13 5.38 4.93
SD 1.90 1.39 1.94 1.74 2.04 2.04
1C (diastema 1 mm)
Mean 4.29 4.78 4.85 4.17 4.10 3.79
SD 1.89 1.52 1.99 1.88 1.95 1.87
1D (diastema 1.5 mm)
Mean 3.37 4.00 3.23 3.27 3.41 3.14
SD 1.67 1.46 1.77 1.55 1.82 1.69
2A (control 2)
Mean 7.37 7.89 7.73 7.27 7.10 7.07
SD 1.50 1.23 1.40 1.60 1.42 1.65
2B (upper line 0.5 mm)
Mean 6.32 7.11 6.54 6.40 5.93 5.93
SD 1.62 1.32 1.65 1.71 1.58 1.56
2C (upper line 1 mm)
Mean 4.98 5.83 5.31 5.40 4.83 3.86
SD 1.82 1.95 1.74 1.99 1.49 1.43
2D (upper line 1.5 mm)
Mean 4.4 5.11 4.88 4.6 4.31 3.39
SD 1.81 1.64 1.61 2.09 1.71 1.50
2E (control 2)
Mean 7.02 7.00 7.19 7.40 6.83 6.68
SD 1.52 1.33 1.52 1.65 1.61 1.36
2F (lower line 0.5 mm)
Mean 6.20 6.28 7.00 6.47 5.93 5.39
SD 1.64 1.53 1.77 1.76 1.41 1.34
2G (lower line 1 mm)
Mean 5.21 4.94 6.27 5.63 4.76 4.43
SD 1.76 1.86 2.24 1.56 1.12 1.40
2H (lower line 1.5 mm)
Mean 4.65 4.11 5.50 5.27 4.52 3.68
SD 1.99 2.17 2.04 2.13 1.45 1.70
3A (control 1)
Mean 7.65 8.17 7.42 7.43 7.38 8.04
SD 1.48 1.38 1.47 1.50 1.78 1.04
3B (crown length 0.5 mm)
Mean 7.31 7.78 7.46 6.80 7.14 7.61
SD 1.51 1.59 1.3 1.63 1.64 1.26
3C (crown length 1 mm)
Mean 6.47 6.61 6.65 6.40 6.07 6.68
SD 1.54 1.75 1.60 1.69 1.28 1.42
3D (crown length 1.5 mm)
Mean 4.83 5.44 4.96 5.20 4.62 4.14
SD 1.82 1.89 1.71 2.02 1.74 1.56
4A (control 2)
Mean 7.30 7.44 7.54 6.93 7.14 7.54
SD 1.53 1.50 1.39 1.31 1.55 1.86

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SMILE ESTHETICS FROM ODONTOLOGY STUDENTS 221

Table 1. Continued

Photograph Total First Second Third Fourth Fifth

4B (occlusal cant 1u)

Mean 7.03 7.28 7.31 6.43 6.83 7.46
SD 1.32 1.27 1.19 1.19 1.47 1.26
4C (occlusal cant 2u)
Mean 6.53 7.11 6.50 5.90 6.31 7.07
SD 1.46 1.18 1.50 1.30 1.54 1.41
4D (occlusal cant 3u)
Mean 6.21 6.5 6.23 5.87 6.10 6.50
SD 1.54 1.34 1.48 1.57 1.76 1.48
5A (control 2)
Mean 7.02 7.33 7.23 6.63 6.9 7.18
SD 1.52 1.14 1.5 1.69 1.68 1.39
5B (gummy smile 0.5 mm)
Mean 6.30 6.17 6.92 6.57 6.17 5.64
SD 1.72 1.29 1.83 1.41 1.89 1.83
5C (gummy smile 0.8 mm)
Mean 6.16 6.28 6.81 6.50 6.07 5.21
SD 1.74 1.18 1.79 1.61 1.87 1.71
5D (gummy smile 1 mm)
Mean 4.95 4.89 5.65 4.97 5.17 4.11
SD 2.00 2.19 2.17 1.56 1.95 1.99
6A (upper line 0.5 mm)
Mean 5.51 5.39 5.65 6.00 5.21 5.25
SD 1.72 1.97 1.74 1.46 1.86 1.65
6B (lower line 0.5 mm)
Mean 5.63 5.28 6.00 6.2 5.45 5.07
SD 1.74 1.74 2.04 1.24 1.99 1.46
6C (crown length 0.5 mm)
Mean 6.86 6.83 6.88 6.50 6.72 7.39
SD 1.61 1.98 1.63 1.46 1.73 1.29
6D (gummy smile 0.5 mm)
Mean 5.95 5.61 6.31 6.33 5.76 5.61
SD 1.82 1.97 1.89 1.54 1.99 1.75

more easily. Our results concur with those of Geron
and Atalia7 but differ with those of McLeod et al.10
Group 6: Modification of Gummy Smile
In terms of gingival smile analysis, all students
evaluated this as not being esthetically pleasing when
gingival smile exposure was 3 mm or more. Some
students define it as not very pleasant from 2 mm on,
results that coincide with those of Kokich et al., Hunt et
al.,8 and Ioi et al.,9 suggesting that an acceptable gingival
smile would correspond to a gum exposure of up to 2 mm.
Differences in Perception of Smile and Its
Alterations Depending on Gender
With regard to the gender variable, our analysis
showed no significant differences in the ability to
perceive anomalies of smile esthetics between gen-
ders. This was in line with some studies9,15 in contrast
to other studies, such as those of Kokich et al.1 and
Flores-Mir et al.12
Differences in Perception of Smile and Its
Alterations Depending on Prior
Orthodontic Treatment
On analyzing prior orthodontic treatment as the related
factor, we saw that those who had undergone prior
treatment had no greater skill in analyzing smile esthetics,
results that are in line with those of previous studies.8,9
Overall Findings
Finally, we should take into account that there is a
subjective component to esthetics, in that interperson-

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222 ESPAÑA, TARAZONA, PAREDES

Table 2. Descriptive Statistics (Mean and Standard Deviation [SD]) Table 2. Continued
by Photograph Score Depending on Orthodontic Treatment
Photograph Total No Yes
Photograph Total No Yes
1A (control 1) 4B (occlusal cant 1u)
Mean 7.79 7.94 7.70 Mean 7.03 7.02 7.04
SD 1.32 1.25 1.36 SD 1.32 1.06 1.47

1B (diastema 0.5 mm) 4C (occlusal cant 2u)

Mean 5.46 5.32 5.54 Mean 6.53 6.48 6.56
SD 1.90 1.73 2.01 SD 1.46 1.36 1.52

1C (diastema 1 mm) 4D (occlusal cant 3u)

Mean 4.29 4.22 4.33 Mean 6.21 6.18 6.23
SD 1.89 1.75 1.97 SD 1.54 1.37 1.65

1D (diastema 1.5 mm) 5A (control 2)

Mean 3.37 3.34 3.38 Mean 7.02 7.04 7.01
SD 1.67 1.44 1.81 SD 1.52 1.31 1.65

2A (control 2) 5B (gummy smile 0.5 mm)

Mean 7.37 7.24 7.44 Mean 6.30 6.06 6.44
SD 1.50 1.48 1.52 SD 1.72 1.70 1.73

2B (upper line 0.5 mm) 5C (gummy smile 0.8 mm)

Mean 6.32 6.30 6.33 Mean 6.16 5.80 6.38
SD 1.62 1.56 1.67 SD 1.74 1.84 1.66

2C (upper line 1 mm) 5D (gummy smile 1 mm)

Mean 4.98 5.06 4.94 Mean 4.95 4.76 5.07
SD 1.82 1.86 1.81 SD 2.00 2.08 1.95

2D (upper line 1.5 mm) 6A (upper line 0.5 mm)

Mean 4.40 4.32 4.46 Mean 5.51 5.44 5.56
SD 1.81 1.80 1.82 SD 1.72 1.74 1.72

2E (control 2) 6B (lower line 0.5 mm)

Mean 7.02 7.00 7.04 Mean 5.63 5.56 5.67
SD 1.52 1.48 1.54 SD 1.74 1.77 1.73

2F (lower line 0.5 mm) 6C (crown length 0.5 mm)

Mean 6.20 6.02 6.31 Mean 6.86 6.72 6.95
SD 1.64 1.56 1.69 SD 1.61 1.44 1.70

2G (lower line 1 mm) 6D (gummy smile 0.5 mm)

Mean 5.95 5.72 6.09
Mean 5.21 5.20 5.22
SD 1.82 1.83 1.82
SD 1.76 1.75 1.77
2H (lower line 1.5 mm)
Mean 4.65 4.66 4.64
SD 1.99 2.00 2.00
3A (control 1) al variations make it impossible to interpret the results
Mean 7.65 7.72 7.6 obtained in a general way. On the other hand, this
SD 1.48 1.23 1.62 study clearly shows that students on a dentistry degree
3B (crown length 0.5 mm) course have not acquired the ability to determine small
Mean 7.31 7.22 7.37 alterations in smile esthetics during their degree
SD 1.51 1.40 1.58 studies and that it is possibly in postgraduate dentistry
3C (crown length 1 mm) studies where they acquire this skill.
Mean 6.47 6.44 6.48 Studies in the literature have been conducted solely
SD 1.54 1.33 1.66 among laypeople, dentists, orthodontists, or surgeons
3D (crown length 1.5 mm) but not among dental students. The only study we
Mean 4.83 4.82 4.84 found that analyzes the perception of dental students
SD 1.82 1.70 1.89 is the study by Ioi et al.,9 which compared a group of
4A (control 2) students in the last year of dentistry studies with
Mean 7.30 7.22 7.35 orthodontists, but not among students throughout
SD 1.53 1.56 1.53 their college career. Our study demonstrates how a
dental student does not acquire sufficient skill in

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SMILE ESTHETICS FROM ODONTOLOGY STUDENTS 223

Table 3. ANOVA Results to Test Homogeneity of Mean Photograph Score of Group 6 Depending on Study Yeara
Photographs’ Number Interaction Groups Sum of Squares Grade Liberty Mean Square F P Value
F6A_z Intergroup 4.970 4 1.243 2.129 .081
upper line Intragroup 73.527 126 .584
Total 78.498 130
F6B_z Intergroup 6.818 4 1.704 2.854 .026
lower line Intragroup 75.273 126 .597
Total 82.055 130
F6C_z Intergroup 7.426 4 1.856 3.109 .018
upper incisor crown Intragroup 75.231 126 .597
Total 82.657 130
F6D_z Intergroup 2.770 4 .692 1.121 .350
gummy smile Intragroup 77.854 126 .618
Totalgroup 80.624 130
a
Significance was detected for images 6B and 6C (P , .05). Standardized photograph group: F6A_z indicates upper line 0.5 mm modification;
F6B_z, lower line 0.5 mm modification; F6C_z, crown of the upper incisor length 0.5 mm modification; F6D_z, gummy smile 0.5 mm modification.

discriminating differences in dental esthetics during
dentistry studies, and it is not until studies are over that
this visual esthetics skill is gained. This esthetic skill is
mostly acquired during the years when a master’s in
REFERENCES
orthodontics is being undertaken. We, therefore,
believe our study would confirm the results of other
studies demonstrating differences between general
dentists and orthodontists.
CONCLUSIONS
N The ability of students in the dental degree course of
the University of Valencia to detect alterations in
smile esthetics does not improve throughout their
degree studies; however, despite finding statistically
significant differences between different study years,
these did not present a linear development.
N The gender of students in a dental degree course is
not a determining factor in the ability to perceive
esthetic anomalies in a smile.
N Whether a dentistry student has undergone prior
orthodontic treatment is not a determining factor in
the ability to perceive such esthetic anomalies in a
smile.
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Table 4. ANOVA Results to Test Homogeneity (Intersubject Effect) of Mean Photograph F3A_z (Crown Length of the Maxillary Right Central
Incisor, Control Photograph) Score Depending on Study Year and Orthodontic Treatmenta
Source Sum of Squares Type II Grade Liberty Mean Square F P Value
b
Corrected model 11.425 9 1.269 2.530 .011
Intersection 102.864 1 102.864 204.991 .000
Study year 5.502 4 1.375 2.741 .032
Orthodontic treatment .134 1 .134 .267 .606
Study yearc orthodontic 5.594 4 1.398 2.787 .030
Error 60.717 121 .502
Total 175.006 131
Corrected total 72.142 130
a
Significance was detected involving interaction P , .05.
b
P50.05
c
Interaction between study year and orthodontic treatment. Study year like independent variable.

Angle Orthodontist, Vol 84, No 2, 2014

224
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