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Original Article

Esthetic factors of smile in vertical dimensions: A comparative

evaluation
Divyaroop Rai1, P Janardhanam2, Anuroop Rai3

Abstract
Introduction: The variations in aesthetic perception among the professionals and the laypersons were compared, to understand the
association of various skeletal and dental factors in vertical dimension, which alter the soft‑tissue characteristics during posed/social smile,
among young adults. Methods: Images of the posed smile were captured with a digital camera from the 60 nonorthodontic treated young
adults (30 girls, 30 boys). Determinants of the “pleasing smile” were identified from the results of a Visual Analog Scale. Quantitative
measurements of the soft‑ and hard‑tissue were made by using the smile images and cephalometric radiographs. The esthetics of the smile
was correlated with specific skeletal, dental, and soft‑tissue structures in the anteroposterior and vertical dimensions. Results: Three factors
formed significant components of a pleasant smile, for orthodontists (incisogingival display, upper lip, and buccal corridor) and three
for laypersons (upper lip, lower lip, and smile arc). A strong positive correlation was seen among skeletal and dental vertical dimensions
and incisor show. The vertical thickness of the upper lip had a significant positive correlation with the position of the maxillary incisor.
Conclusion: Incisogingival display, upper lip, lower lip and buccal corridor proved to be the most influential variables in smile esthetics.
The significant relationship of incisor protrusion with the vertical thickness of the vermilion border of the upper lip shows that skeletal
and dental vertical dimensions for incisal display must be considered when planning orthodontic treatment.

Key words: Aesthetics, incisogingival display, posed smile, smile, smile analysis, smile arc, upper lip, Visual Analog Scale, vermilion
border, vertical dimension

Introduction Specific hard‑ and soft‑tissue features of the smile have been
studied extensively in the literature,[5‑8] but without examination
The pleasant dental esthetics has been rated as an important
of the relationship between their etiology and smile esthetics.
factor for psychosocial well‑being. Ideal occlusion should
certainly remain the primary functional goal of orthodontics, For the present study, quantitative measurements of vertical
but the esthetic outcome is critical for patient satisfaction.[1] lip thickness and incisogingival display were made by using
images of the posed smile, along with the cephalometric
The posed smile has been described to be sustained, and the
analysis of the subjects with attractive smile factors. In
lip animations are fairly reproducible. Therefore it should
addition, the judgments of both laypersons and orthodontists
be considered the most desirable for treatment planning and
on these same images provided subjective indications of what
research.[2‑4]
constitutes a pleasing smile. This subjective analysis was an
Access this article online
effort to verify and expand on previous investigations of smile
Quick Response Code attractiveness and provide esthetic values for this sample of
Website:
orthodontic patients before treatment.
www.jios.in

DOI:
10.4103/0301-5742.158630
Material and Methods
The samples included in the study were selected from the
PMID:
students of Meenakshi Ammal Dental College, Chennai,
xxxxx
after getting approval from ethical committee. The samples

Assistant Professor, 2Professor, 3Reader

1

Department of Orthodontics and Dentofacial Orthopedics, Rajasthan Dental College and Hospital, Jaipur, Rajasthan, 2Department of Orthodontics and Dentofacial
1

Orthopedics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, 3Department of Oral and Maxillofacial Surgery, Ahmedabad Dental College and
Hospital, Ahmedabad, Gujarat, India
Address of correspondence: Dr. Divyaroop Rai, Rai Smile Central Dental Hospital, D‑135, 1st Floor, Opposite Lazeez Hotel, Janpath Corner, Shyam Nagar,
Jaipur ‑ 302 019, Rajasthan, India. E‑mail: dr.divyaroop@gmail.com

Received: 07-08-2014, Accepted with Revisions: 17-04-2015

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Rai, et al.: A comparative evaluation

were required to meet the following criteria; Young adults

between the age group of 18–25 years, Indian, had no history
of any orthodontic treatment, no clinically evident skeletal
asymmetry, anterior or posterior cross‑bite was not present, no
missing or malformed teeth causing a tooth size discrepancy
and subjects should have a clinically acceptable smile (no
reduced lip length, reverse smile line or gummy smile >3 mm
gingival show) and a good profile. Sixty subjects (30 boys and
30 girls) fulfilling the criteria mentioned above were selected
and their posed smile photographs were taken.
A digital camera (Nikon–D70S) with a EX Sigma F28 DG
macro lens, focused at 1:1 ratio was used to record anterior
tooth display while the subjects were smiling. To standardize
the technique, a fixed patient camera distance, a cephalometric
head holder, and natural head position were used [Figure 1].
Figure 1: Fixed patient camera distance and natural head position using
The patient was asked to relax and give a social/posed smile. a cephalometric head holder
Ten frames per patient were captured of the dynamic oral
aperture, adjacent tissues (including parts of the nose and the
chin) and the two metallic scales placed at right angle to each
other were fixed to the cephalometric head holder. The frame
that best represented the patient’s natural unstrained social
smile, that is, the most reproducible smile in all the frames,
was selected and was cropped to eliminate most of the nose,
cheeks and chin to minimize the influence of background
facial attractiveness. By eliminating most of the background,
Figure 2: Image was cropped to eliminate most of the nose, cheeks and
parameters not under orthodontic control are less likely to
chin to minimize the influence of background facial attractiveness (male
become a factor in the rating of the smile [Figure 2]. and female)
Visual examination of the images
The frames were standardized in width, at 4 inches. Each
frame was identified by patient number and was pasted in
a power‑point presentation with their identification number
on each slide (males: 30, females: 30), and were given for
evaluation to 10 orthodontists and 10 laypersons (not related
to dentistry), all of Indian origin.
Each evaluator was given a Performa [Figure 3] to complete,
which contained a Visual Analogue Scale (VAS). Evaluators
used their own esthetic values to rank the patients’ smiles from
“unpleasant” to “pleasant.”
The smile was determined by four factors which affects the
pleasantness or unpleasantness of the smile; incisogingival
display: Amount of visibility of the incisor crown height and
the gingival show, upper vertical lip thickness: The vertical
distance from the most superior peak of the lip to the most
inferior portion of the tubercle of the upper lip, lower vertical
lip thickness: The vertical distance from the deepest midline
point on the superior margin of the lower lip to the most
inferior portion of the lower lip, and smile arc (consonant,
flat, reverse): The curvature of the maxillary incisal edges
and canines relative to the curvature of the lower lip on smile.
For the ease of statistical analysis these factors were given a Figure 3: Performa – with a Visual Analogue Scale
coding individually (F1 to F4), and were evaluated with the
help of a 5 point Likert scale (from 1 being very unattractive The laypersons were given a brief explanation about the
to 5 being very attractive) [Figure 3]. four factors taken for smile esthetics, before the evaluation

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Rai, et al.: A comparative evaluation

was done. Each judge received all 60 images simultaneously • Upper vermillion lip thickness: The vertical distance
and rated the smiles from least pleasing to most pleasing. from the most superior peak of the lip to the most inferior
All the data acquired were stored in a Microsoft Excel Spread portion of the tubercle of the upper lip
Sheet. Average values were taken out for VAS score and Likert • Lower vermillion lip thickness: The vertical distance from
scale score of five factors thereby having 2 values (orthodontist the deepest midline point on the superior margin of the
and layperson) of each parameter for a single photograph. lower lip to the most inferior portion of the lower lip.
Unpleasant smiles were defined as those with mean numerical
scores of 0–50. Pleasant smiles were defined as those with The incisogingival display was determined by two
mean numerical scores of 51–100. Attractive smile factors factors (maxillary incisor display and upper lip drape), as
were given mean numerical scores of 3–5 and the unattractive measured in the posed smile image. Positive value was
smiles factors were scored from 0 to 2.99. assigned for upper lip drape in individuals with lack of gingival
exposure, and was calculated as a difference between the
After determining which all factors were affecting the smile
height of maxillary central incisor (as measured on the cast)
esthetics, quantitative measurements were made from the
and the maxillary incisor show (as measured on the image).
images of the posed smile of all 60 individuals.
For individuals with gingival exposure, direct measurement
Smile analysis was performed on the images and a negative value was
Digimizer Image Analysis (version 3.7.0.0) by MedCalc assigned [Figure 5 – Performa 2].
Software bvba, Acacialaan 22 8400 Ostend, Belgium software
For the correlation of the cephalometric analysis
was used to analyze the smile [Figure 4]. Using the tool
with the smile analysis, 7 angular measurements and
named “unit line” and the metallic scale in the photograph,
6 linear measurements were measured on the lateral
the actual life size measurements could be calibrated by the
computer. The following attributes of the smile were measured
in millimeters [Figure 5 – Performa 2]:
• Maximum incisor exposure: The amount of vertical
display of the maxillary right central incisor
• Upper lip drape: The amount of vertical coverage of the
maxillary right central incisor by the upper lip (or amount
of gingival display if the value is negative)

Figure 4: Digimizer Image Analysis (version 3.7.0.0) software was used Figure 5: Case Performa for smile analysis and lateral cephalogram
to analyse the Smile (female and male) readings

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Rai, et al.: A comparative evaluation
cephalogram [Figure 5 – Performa 3], which were hand traced
with no attempt to standardize the magnification, because all
cephalograms were taken on the same machine.
Statistical analysis was performed with a software program
(SPSS version 12.0, for Windows by IBM Corporation, 1 New
Orchard Road, Armonk, New York, United States). Pearson’s
Chi‑square test was performed to determine number of pleasant
and unpleasant smiles and to correlate the aesthetic scores
between orthodontists and laypersons. The subjects were
divided into following eight groups for evaluation:
• Males – Unpleasant smiles (rated by orthodontists)
• Males – Pleasant smiles (rated by orthodontists)
• Females – Unpleasant smiles (rated by orthodontists)
• Females – Pleasant smiles (rated by orthodontists)
• Males – Unpleasant smiles (rated by laypersons)
• Males – Pleasant smiles (rated by laypersons)
• Females – Unpleasant smiles (rated by laypersons)
• Females – Pleasant smiles (rated by laypersons).
After determining the factors significantly contributing
to the pleasantness of the smile, further groups were
made based on Likert scale score. The subjects with
attractive smile factors were listed separately and the
smile measurement was undertaken in these along with the
cephalomeric analysis.
Descriptive statistics for cephalometric and smile measurements
were calculated. A Pearson correlation study (for parametric
correlations) and Kendall’s Tau‑b study (for nonparametric
correlations) were performed between all cephalometric and
objective smile analysis parameters.
Results
A highly significant difference was seen between the
perception of smiles by the orthodontist and layperson
(P = 0.002) [Table 1]. For the pleasantness of the smiles,
orthodontists rated incisor show highly significant (P = 0.000),
in both males and females, but, the laypersons did not in
either male or female group. In the present study, for both
Table 1: VAS* - orthodontist versus layperson
VAS ‑ layperson
Unpleasant Pleasant
VAS*‑ortho
Unpleasant
Count 7 13
Percentage of total 11.7 21.7
Pleasant
Count 2 38
Percentage of total 3.3 63.3
Total
Count 9 51
Percentage of total 15.0 85.0
*VAS: Visual Analog Scale
28
male (P = 0.001) and female (P = 0.000) groups, laypersons
rated smile arc as a highly significant factor, contributing
in the pleasantness of the smile. For both male and female
groups, laypersons (males – P = 0.000, females – P = 0.012)
and orthodontists (male and female – P = 0.000) used
the thickness of the upper lip as a factor determining the
pleasantness of a smile. While, the thickness of the lower lip,
in both males (P = 0.000) and females (P = 0.000) was rated
significantly pleasant only by laypersons [Table 2].
There was a highly significant positive correlation of maxillary
incisor exposure with the skeletal vertical dimension, as
measured from nasion to menton (N‑Me), (r = 0.754, P = 0.000)
and from anterior nasal spine to menton (ANS‑Me), (r = 0.685,
P = 0.00) in female group only. The amount of upper lip drape
showed significant negative correlation with the skeletal
vertical dimension in males (ANS‑Me [r = −0.684, P = 0.002])
and in females (N‑Me [r = −0.541, P = 0.009]). A positive
correlation was seen between maxillary incisor exposure and
U1‑PP (r = 0.553, P = 0.01) in female group, but not in the
male group [Table 3].
The vertical thickness of the upper lip showed a
significant correlation with SNA (r = 0.640, P = 0.001)
in female group and U1‑SN (r = 0.545, P = 0.008) and
U1‑Pt.A (horizontal) (r = 0.530, P = 0.009) in male
group [Table 4].
Discussion
Panel assessment to evaluate facial esthetics before and after
orthodontic treatment has been widely used. Although high
correlations have been reported between professionals and
laymen,[9,10] some investigators have shown that professionals
are more critical than laymen[5] while, others found the
opposite.[11,12]
The present study showed a statistically high significant
difference (P = 0.002) between the perception of the smile
by the orthodontist and layperson. This may be the result of
the subconscious critical evaluation of smile esthetics by
orthodontic specialists, considering their past experiences in
treating various malocclusions. While, the smiles were judged
as an aesthetic whole and minor discrepancies in specific smile
features were less of a decisive factor, according to laypersons.
Total
According to Peck et al.[13,14] lip coverage of the maxillary
incisors increases with age. Therefore, a high smile with
100% of the maxillary incisor exposure and a contiguous
band of gingiva is characteristic of a younger population.[15]
20
While, McNamara et al.[7] stated that there was no correlation
33.3
between the less pleasing smile esthetics with less incisor
40 display. Therefore, considering the age of the subjects taken
66.7 in the present study, it was hypothesized that, less incisor
display would be correlated with unpleasant smile, while more
60 incisor display would be correlated with more pleasing smile
100.0 esthetics. For the pleasantness of the smiles, orthodontists
rated incisor show as a contributing factor to the pleasantness
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Rai, et al.: A comparative evaluation

Table 2: Factors in pleasant smiles by orthodontist and layperson ‑ for males and females
Males Females
Factors Orthodontist (n=18) Attractive Unattractive P Factors Orthodontist (n=18) Attractive Unattractive P
Layperson (n=25) Layperson (n=25)
F1 Orthodontist 18 0 0.000** F1 Orthodontist 18 0 0.000**
Layperson 17 8 0.072 Layperson 17 8 0.072
F2 Orthodontist 16 2 0.001* F2 Orthodontist 16 2 0.001*
Layperson 22 3 0.000** Layperson 22 3 0.000**
F3 Orthodontist 10 8 0.637 F3 Orthodontist 10 8 0.637
Layperson 25 0 0.000** Layperson 25 0 0.000**
F4 Orthodontist 17 1 0.000** F4 Orthodontist 17 1 0.000**
Layperson 16 9 0.162 Layperson 16 9 0.162
F5 Orthodontist 13 5 0.059 F5 Orthodontist 13 5 0.059
Layperson 21 4 0.001* Layperson 21 4 0.001*
*P=0.001, **P=0.0001. F1: Incisogingival display, F2:Upper vertical lip thickness, F3: Lower vertical lip thickness, F4: Buccal corridor, F5: Smile arc

Table 3: Incisogingival display for females and males by orthodontists

Females (n=22) Mean±SD Maximum Upper lip Mean±SD Maximum Upper lip
Males (n=18) incisor exposure drape incisor exposure drape
r P r P r P r P
SNA 81.6±3.7 0.117 0.604 0.070 0.758 83.0±4.08 0.499 0.035 −0.379 0.120
U1‑SN 110.3±5.4 0.153 0.496 0.053 0.814 110.9±5.4 0.394 0.106 −0.186 0.461
SN‑MP 30.7±4.3 0.168 0.454 −0.138 0.539 29.2±5.0 −0.272 0.275 0.274 0.271
SN‑PP 8.7±2.5 −0.282 0.203 0.133 0.556 6.9±4.4 −0.433 0.072 0.444 0.065
Pt A – N perpendicular −0.8±3.3 0.269 0.088 0.279 0.278 −2.25±3.8 0.277 0.118 0.000 1.000
U1‑Pt.A (horizontal) 6.3±1.7 0.478 0.024 −0.275 0.216 6.6±1.9 0.481 0.043 −0.125 0.620
U1‑Pt.A (vertical) 20.5±6.8 0.491 0.020 −0.195 0.386 22.8±5.2 0.391 0.109 −0.529 0.024
U1‑PP (vertical) 28.7±10.5 0.553 0.008 −0.301 0.174 31.4±9.2 0.213 0.397 −0.492 0.038
N‑Me 105.4±8.2 0.754 0.000 −0.541 0.009 116.7±5.03 0.381 0.118 −0.536 0.022
ANS‑Me 59.1±6.1 0.685 0.000 −0.444 0.039 68.1±5.8 0.477 0.045 −0.684 0.002
Measurement of incisogingival display with smile analysis using maximum incisor exposure and upper lip drape compared with cephalometric SD: Standard deviation

Table 4: Upper lip thickness by orthodontist and layperson

Cephalometric Orthodontist Layperson
values
Upper lip thickness (male) Upper lip thickness (female) Upper lip thickness (male) Upper lip thickness (female)
Mean±SD r P Mean±SD r P Mean±SD r P Mean±SD r P
SNA 83.1±3.7 −0.055 0.809 81.6±3.6 0.640 0.001 82.9±3.6 −0.032 0.885 80.8±3.4 0.398 0.074
SNB 80.4±3.6 0.161 0.474 78.4±3.4 0.367 0.064 80.3±3.7 0.129 0.558 77.6±3.5 0.522 0.015
U1‑SN 110.3±5.3 0.288 0.193 110.3±5.2 0.147 0.494 112.9±7.3 0.545 0.008 109.2±5.0 0.127 0.583
SN‑MP 29.1±4.7 −0.220 0.324 30.3±4.3 −0.495 0.660 28.5±5.7 −0.421 0.051 31.2±4.6 0.199 0.387
SN‑PP 6.6±2.6 −0.109 0.630 8.4±2.6 −0.349 0.095 6.7±4.3 −0.186 0.396 8.9±2.4 −0.066 0.776
Pt A – N perpendicular −1.7±3.7 −0.068 0.669 −0.9±3.1 −0.139 0.355 −2.2±3.7 −0.067 0.669 −0.4±3.4 0.108 0.503
Pog – N perpendicular −4.6±6.4 0.166 0.293 −4.1±5.0 −0.015 0.920 −5.9±7.0 0.066 0.670 −3.0±5.6 0.305 0.062
U1‑Pt.A (horizontal) 6.3±1.8 0.223 0.319 6.2±1.7 0.046 0.830 6.4±1.8 0.530 0.009 6.3±1.9 0.245 0.284
N‑Me 114.8±5.3 0.072 0.749 105.4±7.9 0.165 0.442 113.6±8.1 −0.074 0.736 106.8±8.5 0.150 0.516
ANS‑Me 66.4±4.7 −0.265 0.232 59.1±5.8 0.283 0.181 65.0±4.7 −0.201 0.359 59.7±6.3 0.270 0.237
Measurement of upper lip thickness with smile analysis using upper lip thickness compared with cephalometric. SD: Standard deviation

of smile highly significant (P = 0.000), but, the laypersons The ideal smile arc has the maxillary incisal edge curvature
did not. While, for the unpleasantness of the smile the incisor parallel to the curvature of the lower lip upon smile; the term
show was not considered as a very significant factor by both consonant is used to describe this parallel relationship.[16]
orthodontists and laypersons. Hulsey[4] and Zachrisson[15] stated that the harmony between

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Rai, et al.: A comparative evaluation
the arcs of curvature of the incisal edges of the upper incisor
teeth and the upper border of the lower lip was an important
feature of an attractive smile however it can be influenced
by the orthodontist during the treatment, making the smile
arc flat rating it as less attractive. Parekh et al.[8] studied the
attractiveness of smile arc and found that flat smile arcs in both
male and female smiles were rated as less attractive by both
orthodontists and laypersons.
In the present study, for both male (P = 0.001) and
female (P = 0.000) groups, laypersons rated smile arc as a
highly significant factor, contributing in the pleasantness
of the smile. In agreement to the previous studies done
by Hulsey et al.[4] and Zachrisson[15] the present study also
showed that orthodontists did not give much importance to
the aesthetic value of smile arc.
Vertical lip thickness was important in the determination of
the attractiveness of the smile. Hall et al.[3] stated that more
prominent lips were preferred in American black patients
than in white. Later, McNamara et al.[7] stated that both
laypersons and orthodontists used the thickness of the upper
lip, and laypersons used the thickness of the lower lip, as
variables in determining the pleasantness of a smile. Much
commercialism today on television, radio, and the internet is
aimed at self‑improvement, specifically society’s interest in
fuller lips. Yet little information about lip esthetics is found in
the orthodontic literature, most of which concerns cleft repair
and norms for the lips at rest.
The present study showed that for both male and female
groups, laypersons (males – P = 0.000, females – P = 0.012)
and orthodontists (male and female – P = 0.000) used
the thickness of the upper lip as a factor determining the
pleasantness of a smile. While, the thickness of the lower lip,
in both males (P = 0.000) and females (P = 0.000) was rated
significantly pleasant only by laypersons.
Structural correlations
Quantitative measurements were made by using images of the
posed smile, focusing on features that previous investigations
deemed important to esthetics.[13,14,17,18] These measurements
included incisogingival display, the vertical thickness of upper
and lower lip. The results of this objective smile analysis were
correlated with the hard‑tissue dimensions derived from the
lateral cephalograms.
In a recent study done by Suh et al.[19] the amount of upper
incisor display during posed smile was significantly increased
in individuals with longer anterior maxillary height. For the
present study, maxillary incisor exposure in smile esthetics was
measured as the vertical distance from the inferior border of the
upper lip to the incisal edge of the maxillary central incisors, and
was found to have positive correlation with the skeletal vertical
dimension, as measured from N‑Me (r = 0.754, P = 0.000)
and from ANS‑Me (r = 0.685, P = 0.00) in female group only.
The amount of upper lip drape showed significant
negative correlation with the skeletal vertical dimension
30 Journal of Indian Orthodontic Society
in males (ANS‑Me [r = −0.684, P = 0.002]) and in
females (N‑Me [r = −0.541, P = 0.009]).
These results are in agreement with the study by Peck et al.[14]
showing that the mandibular plane angle and palatal plane
angle does not have any correlation with incisogingival
display.
In the current study, maxillary incisor exposure and upper lip
drape were also correlated with the linear measurement of
anterior maxillary height: A perpendicular was constructed
from the palatal plane to the incisal edge of maxillary central
incisor[14] and second linear measurement was taken from the
line parallel to F‑H on point A to the incisal edge of maxillary
incisor.[7] A positive correlation was seen between maxillary
incisor exposure and U1‑PP (r = 0.553, P = 0.01) in female
group only.
Since, the vertical lip thickness has been considered to be an
important part of the attractiveness of the smile, the present
study showed significant correlation of the vertical thickness of
the upper lip with SNA (r = 0.640, P = 0.001) in female group,
as rated by orthodontists and U1‑SN (r = 0.545, P = 0.008) and
U1‑Pt.A (horizontal) (r = 0.530, P = 0.009) in male group, as
rated by laypersons. These findings were in accordance with the
previous study done on similar subject by McNamara et al.[7]
where, the maxillary incisor protrusion relative to the maxilla
and arch depth were seen in positive correlation with the upper
lip thickness, showing a tendency to roll the upper lip up and
out, exposing more of the mucocutaneous lip and increasing
the vertical height of the exposed vermilion border of the lip.
The upper lip thickness was also positively correlated to the
skeletal vertical dimensions (N‑Me and ANS‑Me), but the
present study did not show any such correlation.
In maxillary antero‑posterior excess cases, the upper lip is
usually short and curled up, while in deficient maxillary
cases, less vermillion of upper lip is visible,[20] this provides
an agreement to the positive correlation of SNA (r = 0.640,
P = 0.001) with upper lip thickness seen in the present study.
The positions and angulations of the incisors play far more
influential roles in determining the position and curvature of
the lower lip than of the upper lip.[6] The present study showed
no correlation of any of the skeletal factors with the lower lip
thickness.
Conclusion
There was a strong disagreement between the orthodontists and
laypersons in smile evaluation. The present study confirmed
the hypothesis that more incisor display correlated with more
pleasing smile esthetics and vice versa and was rated as an
important factor by orthodontists.
The vertical thickness of the upper lip was an esthetic
determinant for both the orthodontists and the laypersons,
whereas the vertical thickness of the lower lip was an important
determinant for laypersons alone: Fuller lips were associated
with better smiles, in both male and female groups.
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Rai, et al.: A comparative evaluation

In addition to these subjective aesthetic findings, maxillary
incisor exposure was positively correlated with the skeletal
vertical dimension (N‑Me, ANS‑Me) and the anterior maxillary
height (U1‑PP): Greater the vertical dimension more the
incisor show. The upper lip drape was found to have a negative
correlation with the above‑mentioned factors.
Vertical lip thickness was the most influential variable in smile
esthetics and was correlated positively with the position of the
maxillary incisor and SNA: The more protrusive the incisor,
the fuller the upper lip. Although this soft‑tissue variable is not
completely under an orthodontist’s control, the relationship of
incisor protrusion with upper lip thickness must be considered
when planning orthodontic treatment.
Hitherto, very little is known about the effect of hard tissue
factors on smile esthetics. However, further verifiable and
multi‑centric investigations are required to study completely
the effect of multiple factors on smile esthetics. This study,
therefore, could be a step towards identifying additional
dimensions in enhancing the smile of an individual.
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How to cite this article: Rai D, Janardhanam P, Rai A. Esthetic factors of
smile in vertical dimensions: A comparative evaluation. J Indian Orthod
Soc 2015;49:25-31.
Source of Support: Nil. Conflict of Interest: None declared.

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Journal of Indian Orthodontic Society | Vol 49 | Issue 1 | Jan-Mar 2015 31