Managing unilateral or bilateral absence of the maxillary lateral incisor represents a complex and costly clinical challenge that demands meticulous planning to achieve predictable and esthetically pleasing results. This systematic review investigated how perceptions of esthetics differ among orthodontists, general dentists, other dental specialists, and non-dental individuals, as such variations may influence therapeutic choices. Electronic searches were conducted across multiple databases—EBSCO, PubMed, ScienceDirect, the Cochrane Library, and Google Scholar—using a Boolean-based keyword combination: “(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists).” Review papers and case reports were excluded. Thirteen studies were included for qualitative evaluation using a modified ROBINS-I tool, while eleven met the inclusion criteria for quantitative synthesis (p < 0.05), divided into “space opening versus space closure” and “no remodeling, dental remodeling, and combined dental–gingival remodeling” categories. The meta-analysis, based on mean differences and effect sizes (α = 0.05; 95% CI; Z = 1.96), demonstrated that opinions regarding the most esthetic approach to managing lateral incisor agenesis remain inconsistent even within the dental community. Additionally, gingival contouring was generally considered less important than modifications of tooth morphology alone. Given the heterogeneity of the methodologies employed in the reviewed studies, no definitive consensus could be drawn. Therefore, individualized discussions with patients are strongly recommended in ambiguous cases to determine the most appropriate plan while avoiding unnecessary or excessive treatment.
