The Effect of the Mamelon Effect on Upper Incisors on the Perception of Smile Esthetics

This observational, cross-sectional study was designed to investigate the effect of incisal mamelon characteristics on the perception of smile esthetics using digitally modified facial images. The study protocol was approved by the Marmara University Faculty of Medicine Ethics Committee and was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Written informed consent was obtained from the volunteer whose facial photographs were used, as well as from all survey participants.

Study Design and Image Preparation A single volunteer meeting the inclusion criteria (aged 18-65 years; clinically healthy maxillary anterior teeth; proportional tooth dimensions; no restorations, orthodontic anomalies, or pronounced mamelon appearance) was selected. Extraoral smile photographs were captured using a digital single-lens reflex (DSLR) camera under standardized lighting conditions. Both full-face smile and close-up smile images were obtained to reflect different viewing distances relevant to daily social interactions and clinical evaluations.

The original digital image was transferred to a computer environment and edited using image-processing software (Adobe Photoshop CC, Adobe Systems, USA). Digital modifications were limited to the maxillary incisors (central and lateral teeth) while preserving facial symmetry, dental midline, gingival contours, and surrounding oral tissues.

Two main variables were manipulated:

Mamelon length (cervico-incisal extension): 1 mm and 3 mm Mamelon value (brightness level): low value (LV) and high value (HV) Mamelon effects were applied either to the maxillary central incisors alone (2 teeth) or to both central and lateral incisors simultaneously (4 teeth). Using these parameters, digitally modified images were created to simulate different mamelon configurations while maintaining natural tooth anatomy and proportions.