TITLE OF THE ARTICLE - COMPONENTS OF A BALANCED SMILE

DR. KHAVYA. C DR. KANNAN MS

TYPE OF ARTICLE - REVIEW

AUTHOR DETAILS-

Dr. KHAVYA. C,
Post Graduate,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital,
BIHER.

Dr. THULASIRAM,
Senior lecturer,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital,
BIHER.

Dr.MS KANNAN
Head of the department,
Department of orthodontics and dentofacial orthopedics,
Sree Balaji dental college and hospital,
BIHER.

CORRESPONDING AUTHOR-
Dr. KHAVYA. C,
Post Graduate,
Department of Orthodontics and Dentofacial Orthopedics,
Sree Balaji Dental College and Hospital, BIHER.
Contact No: 9840848985
Mail ID: khavi0703@gmail.com
 
 COMPONENTS OF A BALANCED SMILE
ABSTRACT
Patient’s expectation from orthodontic treatment has evolved over the years to include
smile esthetics as an important compound. It is important to make every effort to
develop a harmonious balance that will produce the most attractive smile possible for
each patient treated. The smile is a crucial aspect of oral health, and its appearance is
influenced by various factors such as lip length, lip elevation, vertical maxillary height,
crown height, vertical dental height, incisor inclination, smile arc, cant of the occlusal
plane, upper lip curvature, lateral negative space, and dental components.
INTRODUCTION
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, without considering the frontal view. The
orthodontic literature contains more studies on skeletal structure than on soft-tissue
structure, and the smile still receives relatively little attention. This article throws a light
on the major components of the smile and their impact on orthodontic diagnosis and
treatment planning.
DISCUSSION
1. Lip Line
The lip line refers to the vertical tooth exposure in smiling, with optimal results when the
upper lip reaches the gingival margin. 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. 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. "Gummy
smile" is considered undesirable, but some gingival display is certainly acceptable, and
is a sign of youthful appearance. In gummy smile caused by overactive muscle,
botulinum toxin can be indicated along with gingival surgery. A spontaneous smile is
involuntary, natural, and driven by emotions, with more lip elevation than a posed smile.
The amount of vertical exposure in smiling depends on the following six factors.
Upper lip length
The average lip length at rest is 23mm in males and 20mm in females. It is important to
consider the relationship between the upper lip to the maxillary incisors and to the
mouth commissures (figure A). A short lip length relative to commissure height results in
an unesthetic, reverse-resting upper lip line (figure B) . Lip lengthening can be achieved
with lip surgery or a Le Fort I osteotomy. In adolescents, a short upper lip may be
normal due to continuous lip lengthening even after vertical skeletal growth.
Lip elevation
The upper lip in smiling is elevated by 80% of its original length, with women having
3.5% more lip elevation than men. Individual variability varies from 2-12mm, with an
average of 7-8mm. Correcting a gingival smile due to hypermobile lips is incorrect, as
aggressive incisor intrusion or maxillary impaction surgery may result in an aging
appearance.
Vertical maxillary height
The vertical position of the maxilla is crucial in tooth display in prosthetic dentistry and
orthognathic surgery. A gingival smile with excessive incisor display at rest is associated
with excessive lower facial height, while a low lip line with no incisor display is "skeletal"
when it's due to a vertically deficient maxilla. The best reference for impacting or
lengthening the maxilla is the incisor display at rest, considering upper lip length and
attrition.

Crown height
The average vertical height of the maxillary central incisor is 10.6mm in males and
9.8mm in females. A short crown may be caused by attrition or excessive gingival
encroachment. Cosmetic dentistry can increase crown height, and a gingivectomy or
crown-lengthening procedure with crestal bone removal is recommended.
Vertical dental height
Incisor exposure at rest determines the vertical position of the incisal edge. Deep bites
require maxillary intrusion for excessive incisor display, while open bites require
maxillary extrusion for inadequate display. Correcting a deep bite requires posterior
extrusion and/or lower incisor intrusion for normal lip line.
Incisor inclination
Proclined maxillary incisors reduce incisor display at rest and smiling, while up righted
or retroclined ones increase it. Maxillary incisor inclination can be assessed using profile
and oblique smiling photographs, which should be standard orthodontic records.
2. Smile Arc
The smile arc is the relationship between the maxillary anterior teeth's edges and the
lower lip's inner contour in a posed smile. The curvature of the incisal edges is more
pronounced for women and flattens with age. In an optimal smile arc- described as
“consonant”- the maxillary incisal edges coincide with or parallel the lower lip's border.
The lower lip can either touch or slightly cover the upper incisal edges, with patients
with touch or not touch having higher esthetic scores. Orthodontically treated patients
have flatter smile arcs, resulting in a "denture mouth" appearance. Unintentional
flattening of the smile arc can occur during orthodontic treatment using any or all the
following techniques.
Over-intrusion of Maxillary Incisors
Maxillary incisors over-intruded for overbite or gingival smile without proper monitoring
can flatten the smile arc, causing low lip line and aging the patient.
Bracket Positioning
Maximize smile arc esthetics by considering incisal edges and lower lip curvature for
individual patients. Position brackets higher on maxillary central incisors and lower on
lateral incisors and canines for reverse smile arcs.
Cant of the Occlusal Plane
Extraoral forces, intermaxillary elastics, and orthognathic surgery can affect the cant of
the occlusal plane. An upward canted occlusal plane results in a non-consonant smile
arc, while an excessive clockwise tilt covers the upper incisal edges. Factors like
attrition, thumb sucking, posterior vertical growth, and lower lip musculature also affect
the smile arc. Maxillary incisor inclination affects the lip line and smile arc, with
excessive proclined incisors causing an everted lower lip.
3. Upper Lip Curvature
Upper lip curvature is assessed from the central position to the mouth corner in smiling.
Upward and straight lip curvatures are considered more esthetic. In non-orthodontic
populations with normal occlusions, upward lip curvatures are rare (12%), while straight
and downward lip curvatures are almost equally prevalent (43%). Upper lip curvature is
muscle-driven and cannot be altered by orthodontic therapy.
4. Lateral Negative Space
The transverse dimension of the smile, also known as "transverse dental projection,"
refers to the buccal corridor between the posterior teeth and the mouth corner.
Orthodontists consider 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. Research
shows that non-extraction treatment with maxillary expansion does not necessarily
improve the smile's attractiveness. Arch form also affects the transverse dimension of
the smile, with a broad arch filling the buccal corridors more effectively than a narrow
and constricted arch. The anteroposterior position of the maxilla and the width of the
mouth in smiling may influence the negative space. Further research is needed to
confirm this hypothesis.
5. Smile Symmetry
Smile symmetry is assessed by the parallelism of commissural and pupillary lines.
Asymmetrical smiles may result from a deficiency of muscular tonus on one side of the
face, requiring myofunctional exercises to restore symmetry. An oblique commissural
line can create a transverse cant or skeletal asymmetry.
6. Frontal Occlusal Plane
The frontal occlusal plane, a line connecting the right and left canines, can cause
transverse cants due to maxillary anterior teeth eruption or mandible skeletal
asymmetry. Clinical examination and digital video documentation are crucial for
distinguishing between smile asymmetry, canted occlusal plane, and facial asymmetry.
To detect an asymmetrical cant of the maxillary frontal occlusal plane, the patient can be
made to bite on a tongue blade or a mouth mirror in the premolar area during the clinical
examination.
7. Dental Components
A pleasant smile depends on the quality and beauty of dental elements, including the
relationship between teeth and lips, the way lips and soft tissue frame the smile, and the
harmonious integration of dental elements. Dental components include size, shape,
color, alignment, crown angulation, midline, and arch symmetry.
Dental midline is an important focal point in an esthetic smile and locating the facial
midline using anatomical landmarks like nasion and the base of the philtrum known as
"cupid's bow", determines its direction. Parallelism between the maxillary central incisor
midline and the facial midline is more important than coincidence. A mild midline
discrepancy is acceptable if the interproximal contact area (connector space) between
the maxillary central incisors is vertical. Arch symmetry is crucial for a balanced smile,
especially for cases with peg-shaped or missing lateral incisors.

8. Gingival Components
The gingival components of a smile include color, contour, texture, and height.
Inflammation, blunted papillae, open embrasures, and uneven margins can detract from
the smile's esthetic quality. A "black triangle" space may be caused by root divergence,
triangular teeth, or advanced periodontal disease. Orthodontic root paralleling and
flattening can lengthen the contact area. Gingival margin discrepancies can be caused
by attrition, ankylosis, crowding, or delayed migration. Leveling the margins can be
achieved through orthodontic intrusion, extrusion, or periodontal surgery.
CONCLUSION
According to the Jackson’s Triad, esthetic harmony is one of the key elements of
orthodontic treatment planning. A pleasing smile can create greater impact on the
esthetic component of the treatment. The concepts of smile esthetics are not new but
are too often overlooked in orthodontic treatment planning. These 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.
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