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Smile line and facial esthetics.

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IJDSR Volume 29 (3) July 2011
IJDSR
SMILE LINE AND FACIAL ESTHETICS
*Dr. Shekhar Bhatia, **Dr. Shivani Kohli, ***Dr. P.N. Tandon, ****Dr. Abhinay Agarwal

ABSTRACT
Smile plays a major role in how we perceive ourselves, as well as the impression we make on the people around us.
Smile is dependent on the musculature and the presence of the teeth. It requires evaluation of a patient's
expectations, diagnosis of pre-existing problems and careful planning of treatment. Esthetic dentistry involves a
certain attitude as well as artistic ability and technical competence. Esthetics of the smile have reviewed work on
5 aspects of the esthetics which involves attractiveness of the smile, effect of aging on the smile, oral conditions
and the smile, personality and smile exercises which will be discussed in the article.

KEY WORDS: Smile Line, Incisal plane, Lipline,
Facial esthetics
INTRODUCTION
The science of esthetics literally means “the science
of beauty in nature and arts”. Beauty in itself is a
combination of reality and personal perception. Since
the mouth is one of the focal points of the face, it
comes as no surprise that a smile plays a major role in
how we perceive ourselves, as well as the impression
we make on the people around us. A charming smile
can open doors and knock down barriers that stand
between you and a fuller, richer life1. Esthetic
dentistry involves a certain attitude as well as artistic
ability and technical competence. Tooth color is
obviously essential in the final result, but esthetic
treatment planning should never be devised around
shading improvements alone. Our ultimate goal, as
clinicians is to achieve a pleasing composition in the
smile-to create an arrangement of the various esthetic
elements to proper proportion or relation according to
known principles.2
HISTORY
The dentolabial smile, where the teeth are seen behind
the lips, starts to emerge in the first decades of the
20th century. This is attributed to an increased
emphasis of awareness of the body and art of
cosmetics due to the evolution of social life and the
change in habits and manners. Teeth began to play an
increasingly important role as more attention was
paid to the face, which exhibited more open and
unrestricted expressions. The resulting emphasis on
dental treatment and care also created an interest in
the improvement of the esthetics of the smile. Ancient
Japanese proudly displayed black teeth and the
Mayans flashed a jadeite-studded smile testify to an
apparently deep-seated urge to decorate the body.
Although the intent of these ancient attempts at
cosmetic dentistry was strictly ornamental, there
were both beneficial and side effects. Smile is
evidenced since very early days. A smile on the face
of a statue of an early king of Arab is noted in the art of
Sumer. Aboucaya noted in his thesis that the smile
was absent or not very marked in early works of art
and, when present, was almost always labial.3
DISCUSSION
The smile line is an imaginary line running from the
incisal edges of the maxillary incisors and coinciding
with the curvature of the lower lip. When the incisal
plane is not parallel with the curvature of the lower lip
then flat, eccentric or reversed smile lines are evident.
The anterior and lateral negative spaces act as a
border to the dental elements, with the lips
representing the picture frame. Anterior negative
space is evident during both speech and laughter,
while bilateral negative spaces should be evident
during a relaxed smile. These negative spaces provide
cohesiveness to the dento-facial composition.(Fig 1)
Fig 1
Fig 2
To summarize, there is no such thing as a perfect
smile, however for the sake of defining guidelines for
prosthodontics, the constituents of an ideal smile are,
when: The upper anterior teeth coincide with the
curvature of the mandibular lip during a relaxed
smile.( Fig 2)
• The corners of the lips are elevated to the same
height on both sides (termed smile symmetry) (Fig 3)

*Senior Lecturer, ****Senior Lecturer, Department of Conservative Dentistry and Endodontics**Senior Lecturer, Department of Prosthodontics,
***Professor & Head, Department of Oral and maxillofacial surgery, TMDCRC, Moradabad- 244001 Uttar Pradesh
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IJDSR Volume 29 (3) July 2011

The smile is expressed by muscular action around the

lips in the inferior third of the face and by a
brightening of the eyes .The pleasing smile is one of
our special forms of non verbal communication, and
it expresses joy.9 (fig 5a,b,c)

Fig 3

Bilateral negative spaces are evident, separating the

teeth from the corners of the lips. (Fig4)

Fig5 a Normal smile Fig 5b Gummy smile

Fig 4
Additionally, the contact points of the anterior dental
Fig 5c Toothy smile
segment should also coincide with the incisal edges
and with the curvature of the lower lip, thus Yoon et al studied the attractiveness of the smile by
enhancing the cohesiveness of the dentofacial investigating the esthetic criteria of the smile.
composition4 Frush and Fisher5 have directed Five elements of the smile were analyzed:
attention toward the “smile line” the harmony 1. Upper lip Position
between the curvature of the incisal edges of the A high smile reveals the total cervico incisal length of
maxillary anterior teeth and the upper border of the the maxillary anterior teeth and a contiguous band of
lower lip. Hulsey6 found that the smile line ratio the gingiva. An average smile reveals 75% to 100% of
congruency of the arc of curvature of the upper border the maxillary anterior teeth and the interproximal
of the lower lip and the arc of curvature of the incisal gingiva only. A low smile displays less than 75% of
edges of the maxillary anterior teeth appeared to be the anterior teeth.
important in an attractive smile and the most 2. Upper lip Curvature
attractive smile displayed a smile line ratio of Upper lip curvature was divided into 3 categories.
1.00:1.25. Tjan et al7 reported that an average smile Upward - the corner of the mouth is higher than the
exhibits the full length of the maxillary anterior teeth, center of the lower border of the upper lip. (Fig 6)
displays an incisal curve of the maxillary teeth that is
parallel to the inner curvature of the lower lip, and
displays the 6 maxillary anterior teeth and the
premolars. There has been considerable recent
research on the esthetics of the smile and they have
reviewed work on 5 aspects of the esthetics; 8
1. The attractiveness of the smile
2. The effect of aging on the smile
3. Oral conditions and the smile
4. Personality and the smile Fig 6
5. Smile exercises
I. Attractiveness of the smile Straight - the corner of the mouth and the center of

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IJDSR Volume 29 (3) July 2011
the lower border of the upper lip are on a straight line.
(Fig 7)
Fig 7
Downward - the corner of the mouth is lower than the
center of the lower border of the upper lip. (Fig 8)
Fig 8
An upward smile was rare (12%), Straight (45%) and
downward (43%) smiles were relatively numerous.
Respondents ranked upward and straight smiles as
more esthetic than the downward smile (P < 0.05).
Parallelism of the Maxillary Anterior incisal curve
with the lower lip.
The parallelism of the maxillary anterior incisal curve
with the lower lip was divided into 3 categories.
Parallel means that the incisal edges of the maxillary
anterior teeth are parallel to the upper border of the
lower lip. Straight means that the incisal edges of the
maxillary anterior teeth are in a straight line. Reverse
means that the incisal edges of the maxillary anterior
teeth curved in reverse to the upper border of the
lower lip. Parallel and straight smiles received higher
esthetic ranks than reverse smiles (P < 0.05).
4. Relationship between maxillary anterior teeth
and lower lip
The relationship between maxillary anterior teeth and
lower lip was divided into 3 categories.
Slightly covered - the incisal edge of the maxillary
anterior teeth was slightly covered by the lower lip.
Touching - the incisal edge of the maxillary anterior
teeth just touched the lower lip.
Not touching - the incisal edge of the maxillary
anterior teeth did not touch the lower lip.
Touching and not touching smiles were reported more
esthetic than slightly covered smiles (P < 0.05)
5. The teeth displayed in a smile
Most subjects (57%) displayed to the second
premolar. Few subjects displayed only to the
canines.8
I. The Effect of Aging on the smile.
They reported that the amount of maxillary incisal
exposure gradually decreased with age; this was
accompanied by a gradual increase in mandibular
incisal exposure in the smiling position. The mean
amount of incisal exposure was 5.92 mm in the
maxilla and 2.78 mm in the mandible8
II. Oral condition and Smile
Ko et al investigated the effect of missing teeth,
prosthesis, and malalignment, such as crowding and
spacing, on the smile. This study took photographs of
a full smile and examined subject's oral conditions.
Of 145 subjects, 42 had a normal condition, 13 had
missing teeth, 21 had prostheses, and 69 had
malaligned teeth. The normal group had the highest
mean smile score and the missing teeth group had the
lowest.
III. Personality and Smile
Duchenne noted that the emotion of frank joy is
expressed on the face by the combined contraction of
the zygomaticus major muscle and the inferior
portion of the orbicularis oculi muscle. The first
muscle obeys the will, but the second is put into play
only by the appropriate emotions. Fake joy or a
deceitful laugh cannot provoke the contraction of the
latter muscle8.
IV. Smile Exercise
Gibson10 developed the smile exercise program in
1989 as a teaching program to develop and control
facial muscles to improve a smile. In Gibson's first
smile exercise,(Fig 9) the patient stands or sits before
a mirror and goes through a process of smiling. The
patient progresses from a small smile to larger ones
and then reverses the process. Each position is held
for 10 seconds and repeated several times.
Dr.Gibson's first smile exercise. Patient progresses from a small smile
to larger ones and then reverses the process. (Fig 9)
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 IJDSR Volume 29 (3) July 2011
The second exercise is an isometric exercise that
involves closing the smile against the resistance of the
fingers, which increases the tone and strength of the
muscles around the mouth. The patient makes a big,
full smile and holds the corners of the mouth firmly
with the fingers. Then he slowly closes the lips back
to no smile, against the resistance of the fingers.
(Fig 10)
Dr.Gibson's second smile exercise. Patient makes a big, full smile
and holds the corners of the mouth firmly with the fingers.
Then patient slowly closes the lips back to no smile, against
resistance of the fingers. (Fig 10)
Dong & Kim found that while Gibson's smile
exercises are effective in improving the attractiveness
of the smile, the effects are durable only as long as the
smile exercises are continued. Persistent motivation
and follow up are important for successful smile
exercises8
HOW TO AVOID AN AGING SMILE3
1. Watch for unnatural wear. It ages the smile.
2. Avoid bone and gum loss. Spaces between the teeth
can give an older look to the smile. Take proper oral
hygiene seriously and request frequent periodontal
evaluation from your dentist.
3. Replace fillings when necessary.
4. Don't let your crowns or bridges age you. If they are
worn down, replace them.
5. Have any discolored teeth corrected. Staining
makes you look older.
6. Replace any missing teeth as soon as possible.
Missing teeth can cause your bite to collapse and
tissues to sag.
7. Correct your bad bite. As you age, the bad bite tends
to become more pronounced. It's never too late to
have it corrected!
CONCLUSION
"Smile architecture" is used to describe the process
that guides the patient and dentist from initial
complaint through to final case acceptance. Basically
the smile is dependent on the musculature and the
presence of the teeth. But every person is not
fortunate enough to have a beautiful smile. The
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answer to the above problem is the esthetic dentistry
which has developed leaps and bounds with the latest
technologies and materials. Successful cosmetic
dental treatment is both functional and aesthetic. It
requires evaluation of a patient's expectations,
diagnosis of pre-existing problems and careful
planning of treatment to eliminate or control the
causes of existing conditions.
REFERENCES
1. Ratnadeep Patil R: Esthetic Dentistry An Artist's
science.2002, PR Publication.
2. Lombardi R: Visual perception and denture
esthetics. J. Prosthet Dent. 1973; 29:352-382.
3. Barry G. Dale, Kenneth W. Aschelim: Esthetic
Dentistry A clinical approach to techniques and
materials. Lea and Febiger, 1993; Philadelphia,
London.
4. Ahmad. I: Anterior dental aesthetics: Dentofacial
perspective. British Dental Journal 2005;
199:81-88.
5. Frush JP, Fisher RD: The dynasthetic
interpretation of the dentogenic concept. J.
Prosthet Dent. 1958; 8: 558-581.
6. Hulsey CM. An esthetic evaluation of lip teeth
relationship present in the smile. Am J Orthod.
1970; 57:132-144
7. Tjan AHL, Miller GD. Some esthetic factors in a
smile. J. Prosthet Dent. 1984; 51:24-28.
8. Jin-Keun Dang, Tai-Ho Jin: The esthetics of the
smile. A review of some recent studies. Int.
J.Prosthodont 1999; 12:9-19.
9. Mathews TG: The anatomy of a smile. J.
Prosthet. Dent. 1978; 39:128-134.
10. Gibson RM: Smiling and facial exercise DCNA
1989; 33: 137-144.
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