Presented By: Dr.

Parag Ghodake
Guided By: Dr. Amrita Puri
 1. Introduction
2. Eight components of balanced smile
i. Lip Line
ii. Smile Arc
iii. Upper Lip Curvature
CONTENT iv. Lateral Negative Space
S: v. Smile Symmetry
vi. Frontal Occlusal Plane
vii. Dental Components
viii. Gingival Components
3. Conclusion
4. Cross References
 In orthodontic treatment, esthetics has traditionally been
associated with profile enhancement.

Both the Angle classification of malocclusion and the

cephalometric analysis have focused attention on the profile,
INTRODUCT without considering the frontal view.
ION:
Even though patients come to us mainly to improve their smiles,
the orthodontic literature contains more studies on skeletal
structure than on soft-tissue structure, and the smile still receives
relatively little attention.
 • The widely known popular saying "The smile is our
business card" must always be respected and
considered, since there is scientific evidence that the
INTRODUCT smile as the most important element in the context of
dentofacial esthetics.
ION:
• The purpose of this article is to review the eight major
components of the smile and discuss their impact on
orthodontic diagnosis and treatment planning.
Eight
compone
nts of
balanced
smile:
1. Lip Line
The lip line is the amount of vertical tooth exposure in smiling—in other words, the
“height of the upper lip relative to the maxillary central incisors.”

In high smile where complete length of incisors is exhibited along with some amount
of gingival display.
 In Average smile, 75–100%of upper incisors and inter dental papilla is displayed.

In low smile line, <75% of the maxillary incisors in the full smile is displayed.
Because female lip lines are an average 1.5mm higher than male lip lines, 1-2mm of
gingival display at maximum smile could be considered normal for females.

The starting point of a smile is the lip line at rest, with an average maxillary incisor
display of 1.91mm in men and nearly twice that amount, 3.40mm, in women.

With aging, there is a gradual decrease in exposure of the maxillary incisors at rest
and, to a much lesser degree, in smiling.

 This steady decline in maxillary tooth exposure at rest is accompanied by an increase

in mandibular incisor display.
 It is important to differentiate between the Posed smile and the Spontaneous smile.

 A posed smile is the voluntary expression

 A spontaneous smile, by contrast, is involuntary,
made when introduced to someone, or
natural, and driven by emotions.
when taking a passport photograph or
orthodontic records.
 A posed smile is repeatable; studies have
 With all the muscles of facial expression
found little difference among numerous
involved, a spontaneous smile always has more
consecutive photographs of posed smiles
by the same individuals. lip elevation than a posed smile.

“Most studies refer to the posed smile because it is reproducible and can therefore
be used as a reference position.”
1. Commissure Smile/ Mona Lisa Smile

2. Social Smile

3. Spontaneous Smile
The
amount of 1. Upper Lip Length
vertical 2. Lip Elevation
exposure 3. Vertical Maxillary Height
in smiling 4. Crown Height
depends
5. Vertical Dental Height
on the
6. Incisor Inclination
following
six factors.
1.Upper Lip
Length
The average lip length at rest, as measured from subnasale
to the most inferior portion of the upper lip at the midline, is
about 23mm in males and 20mm in females.
Lip length should be roughly equal to the commissure height, which is the
vertical distance between the commissure and a horizontal line from
subnasale.
 A short lip length relative to commissure height results in an unesthetic, reverse-resting upper lip line.

 It is not easy to alter commissure height, but lip lengthening is possible with lip surgery, either as a
single procedure or in combination with a Le Fort I osteotomy.
2.Lip Elevation
In smiling, the upper lip is elevated by about 80% of
its original length, displaying 10mm of the maxillary
incisors.

 Women have 3.5% more lip elevation than men.

 Actually, there is considerable individual variability in

upper lip elevation from rest position to the full smile,
ranging from 2-12mm, with an average of 7-8mm.
 If a gingival smile is caused by a hypermobile lip, it would be a mistake to correct it with
aggressive incisor intrusion or maxillary impaction surgery, because that would result in
little or no incisor display at rest and thus make the patient look older.

 Excessive lip elevation should therefore be recognized as a limiting factor.

 Likewise, if a low lip line is due to a hypomobile lip
(Fig. 4), extensive incisor extrusion would result in an
overbite with excessive incisor display at rest.
 3. Vertical
Maxillary Height
When upper lip length and mobility are normal, a
gingival smile with excessive incisor display at rest can
be attributed to vertical maxillary excess.

 This kind of “skeletal” gingival smile is generally

associated with excessive lower facial height.

Conversely, a low lip line with no incisor display at rest

is “skeletal” when associated with inadequate lower
facial height due to a vertically deficient maxilla.
 4. Crown Height
• The average vertical height of the maxillary central
incisor is 10.6mm in males and 9.8mm in females.
• A short crown can be due to attrition or excessive
gingival encroachment.
• If there is little or no incisor display at rest, but the
lip line is normal in smiling, the crown height can be
increased incisally with cosmetic dentistry.

• A gingivectomy or a crown-lengthening procedure

with crestal bone removal is recommended when
short clinical crowns are associated with a gingival
smile and a normal incisor display at rest.
 5. Vertical Dental Height

• As mentioned earlier, the incisor exposure at rest, rather than the overbite, determines the
vertical position of the incisal edge, all other factors being equal.

• Therefore, a deep bite should be corrected by maxillary incisor intrusion in a patient with
excessive incisor display at rest, but in a patient with a normal lip line at rest the treatment should
be posterior extrusion and/or lower incisor intrusion .

• The opposite applies to an open bite, which should be corrected by maxillary incisor extrusion if
there is inadequate incisor display at rest, but with posterior intrusion and/or lower incisor
extrusion if the lip line is normal at rest.
 6.Incisor
Inclination
 Proclined maxillary incisors, whether in a Class II, division 1

malocclusion or in a Class III compensation, tend to reduce the incisor

display at rest and in smiling. Fig.A

 On the other hand, uprighted or retroclined maxillary incisors, as seen

in Class II, division 2 malocclusion or after orthodontic retraction

without torque control, tend to increase the incisor display. Fig.B

 Maxillary incisor inclination can best be assessed on profile and

oblique smiling photographs, which should become standard

orthodontic records.
2. Smile Arc
• The smile arc is the relationship between a hypothetical curve drawn along the edges of the maxillary
anterior teeth and the inner contour of the lower lip in the posed smile.

• The curvature of the incisal edges appears to be more pronounced for women than for men, and
tends to flatten with age. The curvature of the lower lip is usually more pronounced in younger
smiles.
• Smile arcs of three types:
1. Consonant- the curvature of the maxillary incisal edges coincides.

2. Straight- maxillary incisal edges are flat.

3. Non-consonant- the maxillary incisal edges are either flat or reversed relative to the curvature of
the lower lip.
The smile arc can be unintentionally flattened during orthodontic treatment by any or all of
the following three techniques.

1. Overintrusion of Maxillary Incisors:

• If the maxillary incisors are overintruded to correct an overbite or a gingival smile without
considering or monitoring the incisor-lip position at rest, the smile arc may be flattened.

2. Bracket Positioning

• The same bracket heights should not be used for parallel, flat, and reverse smile arcs. If
optimal smile arc esthetics are to be achieved, the bracket positions must take into
account the relationship of the incisal edges to the lower lip curvature for each individual
patient.
In a reverse smile arc, for example, the brackets should be positioned
higher than usual on the maxillary central incisors and progressively lower
on the lateral incisors and canines.

3. Cant of the Occlusal Plane

• Extraoral forces, intermaxillary elastics, and orthognathic surgery can affect the cant
of the occlusal plane.

• If the maxillary occlusal plane is canted upward anteriorly, for instance, the incisal
edges will move away from the lower lip, resulting in a nonconsonant smile arc.

• Conversely, if the occlusal plane has an excessive clockwise tilt, the upper incisal
edges will be covered by the lower lip, making the smile arc less attractive.
• Other factors that can affect the smile arc are attrition due to shortening of the
central incisors, habits such as thumbsucking, excessive posterior vertical growth
(mostly seen in brachyfacial patterns), and the lower lip musculature.

• Maxillary incisor inclination affects not only the lip line, but the smile arc as well,
when the curvature of the incisal edges does not coincide with the border of the
lower lip in smiling (Fig. A).

Fig. A
3. Upper Lip Curvature
• The upper lip curvature is assessed from the central position to the corner of the
mouth in smiling.
• It is upward when the corner of the mouth is higher than the central position (fig.A),
straight when the corner of the mouth and the central position are at the same
level(fig.B), and downward when the corner of the mouth is lower than the central
position. (Fig.C)
• Upward and straight lip curvatures are considered more esthetic than downward lip
curvatures.

• In a nonorthodontic population with normal occlusions, upward lip curvatures were

rare (12%), but straight (45%) and downward (43%) lip curvatures were almost
equally prevalent.

• Because it is a muscle-driven position, upper lip curvature is not subject to alteration

by orthodontic therapy.

• A downward lip curvature could therefore be considered a limiting factor in

achieving an optimal smile.
4. Lateral Negative Space

• The transverse dimension of the smile is also referred to as “transverse dental

projection”.

Lateral negative space is the buccal corridor between the posterior

teeth and the corner of the mouth in smiling.
• Although the prosthodontic literature describes a smile lacking buccal
corridors as unrealistic-looking and denture-like, orthodontists refer to
buccal corridors as “negative” spaces to be eliminated by transverse
maxillary expansion.
• A first molar-to-first-molar smile is often advocated in orthodontics, but is considered
evidence of a poorly constructed denture in prosthodontics.

• In studies measuring the number of teeth displayed in the smiles of young subjects with
normal occlusions, those displaying the first molars were ranked the highest esthetically.
• A first molar display was found in only 3.7% of one sample, however, with most of the
subjects (57%) displaying only the second premolars.

Reference: . Dong, J.K.; Jin, T.H.; Cho, H.W.; and Oh, S.C.: The esthetics Of Smile: The review of some recent studies, Int. J. Prosthod.
12:9-19, 1999.
• In fact, nonextraction treatment with maxillary expansion does not necessarily improve
the attractiveness of the smile.

• “Research has shown that premolar extraction does not lead to arch constriction or a
widening of buccal corridors.”

• Archform also affects the transverse dimension of the smile: A broad arch is more likely
to fill the buccal corridors than a narrow and constricted arch.

• In addition, buccal corridors are heavily influenced by the anteroposterior position of

the maxilla relative to the lip drape. Moving the maxilla forward will reduce the negative
space because a wider portion of the arch will come forward to fill the intercommissure
space.
 5. Smile Symmetry

• Smile symmetry, the relative positioning of the corners of the mouth in the
vertical plane,can be assessed by the parallelism of the commissural and pupillary
lines.

• Although the commissures move up and laterally in smiling, studies have shown a
difference in the amount and direction of movement between the right and left
sides.
 A large differential elevation of the upper lip in an
asymmetrical smile may be due to a deficiency of
muscular tonus on one side of the face (Fig. 12).

 Myofunctional exercises have been recommended to

help overcome this deficiency and restore smile
symmetry.

 An oblique commissural line in an asymmetrical smile

can give the illusion of a transverse cant of the maxilla
or a skeletal asymmetry.
 6. Frontal Occlusal Plane

 The frontal occlusal plane is represented by a line running from the tip of the right canine to the tip

of the left canine.

 A transverse cant can be caused by differential eruption of the maxillary anterior teeth or a skeletal asymmetry

of the mandible.

 This relationship of the maxilla to the smile cannot be seen on intraoral images or study casts, and smile

photographs can also be misleading.

 Therefore, clinical examination and digital video documentation are

essential in making a differential diagnosis between smile asymmetry,

a canted occlusal plane, and facial asymmetry.

 Having the patient bite on a tongue blade or a mouth mirror in the

premolar area during the clinical examination is a good way to

recognize an asymmetrical cant of the maxillary frontal occlusal

plane.
 7. Dental Components

The first six components of the smile considered the relationship between the teeth and
lips and the way the lips and soft tissue frame the smile.

 A pleasant smile also depends on the quality and beauty of the dental elements it contains
and their harmonious integration.

Dental components of the smile include the size, shape, color, alignment, and crown
angulation (tip) of the teeth; the midline; and arch symmetry.

The dental midline is an important focal point in an esthetic smile.

A practical and reliable method of locating
the facial midline, which normally coincides
with the dental midline, is to use two
anatomical landmarks: nasion and the base
of the philtrum, known as the “cupid’s
bow”, in the center of the upper lip.
 Arch symmetry is also important in achieving a balanced smile, which is why
cases with peg-shaped or missing lateral incisors are particularly challenging.
 Other factors that can disturb the continuity of the dental composition
include midline diastemas and a lack of interproximal contacts.
 Proportion Between Anterosuperior
Teeth:
• This feature is widely considered in Dentistry and it is based on the golden ratio initially
proposed by Levin in 1978.

• According to the author, in frontal view, there exists a width proportion of teeth seen in
perspective.

• This fact is shown by Fig.in which visible lateral incisor width accounts for 62% of central
incisor width, while canine width accounts for 62% of lateral incisor width.
 8. Gingival Components
• The gingival components of the smile are the color, contour, texture, and height of the
gingivae.
• Inflammation, blunted papillae, open gingival embrasures, and uneven gingival margins
detract from the esthetic quality of the smile.
 The space created by a missing papilla above the central incisor contact point, referred to as a

“black triangle”, may be caused by root divergence, triangular teeth, or advanced periodontal

disease.

 Orthodontic root paralleling and flattening of the mesial surfaces of the central incisors, followed

by space closure, will lengthen this contact area and move it apically toward the papilla.
  The gingival margins of the central incisors are normally at the same
level or slightly lower than those of the canines, while the gingival
margins of the lateral incisors are lower than those of the central
incisors.

 Gingival margin discrepancies may be caused by attrition of the

incisal edges, ankylosis due to trauma in a growing patient, severe
crowding, or delayed migration of the gingival tissue.

 The gingival margins can be leveled by orthodontic intrusion or

extrusion or by periodontal surgery, depending on the lip line, the
Classic: leveled canine and central incisor margins, with
lateral incisor margin slightly below crown heights, and the gingival levels of the adjacent teeth.
 Conclusion:
In summary, an optimal smile is characterized by an upper lip that reaches the
gingival margins, with an upward or straight curvature between the philtrum
and commissures; an upper incisal line coincident with the border of the lower
lip; minimal or no lateral negative space; a commissural line and occlusal frontal
plane parallel to the pupillary line; and harmoniously integrated dental and
gingival components.

The eight components of the smile should be considered not as rigid boundaries,
but as artistic guidelines to help orthodontists treat individual patients who are
today, more than ever, highly aware of smile esthetics.