RESEARCH ARTICLE Layperson's Esthetic Preference to the Presence or Absence of the Interdental Papillae in the Low Smile Line: A Web-based Study Mark N. Hochman DDS 1 | Stephen J. Chu DMD, MSD, CDT 2 | Bruno Pereira da Silva DDS, PhD 3 | Dennis P. Tarnow DDS 4 1 Stony Brook School of Dental Medicine, Private Practice: Periodontics, Implant Dentistry and Orthodontics, New York, New York 2 Ashman Department of Periodontology and Implant Dentistry, Department of Prosthodontics, New York University College of Dentistry, Private Practice: Prosthodontics, New York, New York 3 Department of Periodontology, University of Seville School of Dentistry, Seville, Spain 4 Director of Implant Education, Columbia University College of Dental Medicine, New York, New York Correspondence Stephen J. Chu, Ashman Department of Periodontology and Implant Dentistry, Department of Prosthodontics, New York University College of Dentistry, Private Practice: Prosthodontics, New York, NY. Email: schudmd@gmail.com Abstract Purpose: To determine the layperson's esthetic preference to the visual display (pres- ence) or lack thereof (absence) of the interdental papillae during minimum smiling or the low smile line patient type. Materials and Methods: Two hundred lay-people were shown three-paired smile images indicative of a low gingival smile line patient type in which the vermillion border of the maxillary lip covered the mid-facial gingiva of the anterior teeth. The three images differed only with respect to [1] presence of interdental papillae, [2] absence of the interdental papilla (“black triangle”), or [3] absence of the interdental papillae (replaced with a long restorative contact area). The three images were paired in multiple groupings; group-1 consisted of a comparison of the presence of interdental papillae vs the lack of the inter- dental papillae “black triangle, ” group-2 compared the long restorative contact compared to the presence of the interdental papillae and Group-3 compared the long restorative contact replacing a missing papilla to the absence of the interdental papillae “black trian- gle. ” The comparisons were designed to determine the subjective preference of lay indi- viduals between these groupings. Results: Ninety-eight percent of lay-people demonstrated a preference to the pres- ence of the interdental papillae in the smile (image 1) when compared to its absence (“black triangle”; image 2) with a low smile line. Seventy percent preferred the visual display of the interdental papillae, that is, pink tissues (image 1), compared to the absence of the interdental papillae replaced with a long contact area (image 3), that is, white restorative materials, when viewing a low gingival smile line. And when com- paring the absence of the interdental papillae “black triangle” to a long contact area, 92% of lay-people preferred a long contact area vs the absence of the interdental papillae with a “black triangle” with a low smile line. Conclusions: The visual display [presence] of the interdental papillae, that is, pink tis- sues, is notably preferred to the absence of the interdental papillae when replaced by either a “black triangle” or long contact area in the commonly known low smile line. This emphasizes the need to assess the Interdental Smile Line (ie, visual display of interdental papillae during smiling) in all patients and the importance to preserve Received: 4 January 2019 Revised: 7 March 2019 Accepted: 14 March 2019 DOI: 10.1111/jerd.12478 J Esthet Restor Dent. 2019;31:113–117. wileyonlinelibrary.com/journal/jerd © 2019 Wiley Periodicals, Inc. 113