Assessment of gingival symmetry with digital measuring tools and its reproducibility

Objective: The aim of this study was to investigate the accuracy of digital measuring tools to measure the position of gingival zeniths and to assess its reproducibility between different examiners. Materials and methods: A total of 108 subjects were photographed at the Louisiana State University School of Dentistry. The settings, positioning of the digital camera, and subjects' Frankfurt levels were standardized. A photograph was taken of the six anterior maxillary teeth of each subject, and their corresponding free gingival margins. Digital caliper measurements were taken intraorally from the zenith to the incisal edge of the right maxillary central incisor. A reference line was drawn across the screen on each image at the level of the zenith of tooth 8. Three calibrated examiners then measured the distance from the reference line to the zeniths of the other five anterior maxillary teeth. Results/conclusions: There was no statistically significant difference between the examiners regarding any of the measurements. Central incisors were at the same level in 84.24% of the subjects, and lateral incisors were within 0.5 mm of central incisors in only 58% of the subjects. Canine zeniths were within 0.5 mm of each other in 43% of the subjects. Only 28% of the subjects presented with zeniths of tooth 6 to tooth 11 within 0.5 mm of each other. Lateral incisors were at or beneath the line drawn from central incisors to cuspids in 90.8% of the subjects. Standardized digital photography taken with the aid of a stadiometer and used to evaluate esthetic parameters allowed for reproducible measurements.