© 2020, Springer Medizin Verlag GmbH, ein Teil von Springer Nature. Background: This study collected 68 smiling photos of cases taken to American Board of Orthodontics clinical exam and were considered as successfully treated. Materials and methods: A panel of 52 raters from different specialties and laypeople were asked to rate the smile attractiveness on a scale from 1–10 and to also choose what components made the smile less attractive. Simple descriptive statistics were used to determine the mean, standard deviations, and quartiles of the smile attractiveness. Multilinear regression (MLR) analysis was used to examine the relationship of smile attractiveness when the variables of age, professional experience, and gender of the raters were considered. Receiver operating characteristic (ROC) was created to correlate the association between smile attractiveness and the perfect smile. Results: The mean rating of each picture ranged from 3.42 ± 1.83 (least attractive smile) to 8.46 ± 1.59 (most attractive smile). The overall mean for smile attractiveness was 6.23 ± 1.09; additionally, it was found that problematic teeth, gum, and lips reduce the smile attractiveness score by 1.7, 1.7, and 1.2, respectively. Conclusion: The study showed that only 2 out of 68 American Board of Orthodontics treatment finishes had an attractive and perfect smile.