Review Article

MACROESTHETIC ELEMENTS OF SMILE; A REVIEW ARTICLE

Sapana Singh1, Gaurav Jasoria2, Ashish Kushwah3, Shashank Soni4
Post Graduate 1,4,3, Professor2
1,2,4- Department of Orthodontics, M.P.C.D & R.C. Gwalior, Madhya Pradesh, India
3- Department of orthodontics, Teerthankar Mahaveer University, Moradabaad, Uttar Pradesh, India

Abstract
Smile esthetics is a subjective phenomena which has individual variations. However there are certain dental
characteristics that are considered to have influence over one’s smile esthetics. The role of an orthodontist is to
incorporate these elements to achieve a balanced smile for the patient. Smile designing is an elaborate subject which
includes facial esthetics, gingival esthetics, microesthetics and macroesthetics. This article reviews the various
elements of macroesthetics which should be considered while treating the patient.
Key Words: Esthetics, Macroesthetic, Microesthetic, Smile.

INTRODUCTION ELEMENTS OF SMILE DESIGN

The word ‘esthetics’ is derived from Greek, which The smile designing elements includes face
translates as ‘perception’. Esthetics or beauty has two characteristics, gingiva, microesthetics and
main dimensions to it: objective and subjective1. macroesthetics. The aim is to understand all the factors
Objective esthetics is based on the intrinsic that contribute to an individual’s esthetics and to apply
characteristics of the object being perceived that makes it them clinically to an achievable limit.
praiseworthy. Subjective esthetics on the other hand is
based on the others who are contemplating it.1,2 Facial esthetics
Subjective esthetics has a varied with individual Facial and muscular characteristics are important criteria
perception and cannot have a single definition to it, so it for smile evaluation and vary from patients to patients.
is based on several studies on group of people and by Photographic analysis can be utilized for determination
different group of people. Esthetics varies with ethnicity, of various features of smile during smiling as well as
race and gender. during speaking. Various norms of symmetry of face are
Smile is considered to be an essential facial expression intricately examined and included in the problem list.
that plays an important role in social interactions. The
aim of orthodontic treatment is not merely the correction Gingival esthetics
of dentition but to achieve a favourable esthetics of face. Healthy gingiva is essential for esthetic smile that
Esthetically pleasing smile enhances attractiveness thus involves various aspects of gingiva including its color
contributes in boosting one’s confidence. For the same and texture. Amount of gingival show also affects the
reason, smile analysis and designing have become main esthetics. Little gingival exposure contributes to youthful
elements orthodontic treatment planning in recent times.3 smile while too much exposure is not acceptable and is
not esthetically pleasing.
THE SMILE
A smile is a complex gesture formed in two stages, by Microesthetics
raising the lip to the nasolabial fold followed by further Microesthetics involves the individual tooth
elevating the lip by three muscle groups.4 characteristics like tooth anatomy, location, translucency
patterns, lobe development and incisal haloing. For better
ANATOMY OF THE SMILE esthetics microesthetic elements must not be overlooked
The soft-tissue characteristic of the smile consists of lip while treating the patient orthodontically.
dimensions, distance between the commissures, gap
between the lips, smile index, and the gingival Macroesthetics
features(FIG 1). When individual teeth are considered as a single unit and
Artists use the eye unit theory suggested that the distance contribute to esthetics as a group then it is regarded as
between the base of the nose and the lower border of the macroesthetics.6 Macroesthetics attempt to evaluate the
lower lip is same as one eye (length of the individual’s relationships of anterior teeth to each other as well as
eye), which remain constant whether at rest or during a with their surrounding soft tissues. Orthodontists bring
smile.5 about major changes in the macroesthetics of the patients.

The following macroesthetics elements are considered

during smile designing:

Midline
Midline is an important aspect of an esthetic treatment
plan which is regarded to be the focal spot of smile easily
Figure 1: Anatomy of the smile recognizable by the patient if off centered. Midline is

TMU J Dent. Vol. 5 Issue 4. October - December 27

viewed in reference to the facial midline which is decided M-position: By asking the patient to utter letter “M” the
by two soft tissue landmarks; nasion and base of the minimum teeth reveal is assessed. The maxillary incisor
philtrum. display decreases as the patient ages.
The goal of treatment is to achieve coincident upper and
lower dental midlines which are in coincidence with Upper lip position: An average smile involves 75 % to
facial midline for better esthetics as well as functional 100 % of maxillary teeth display. A high smile shows
purpose.7-11 total length of upper anterior as opposed to low smile
The midline between centrals should not be angulated to display which involves less than 75% of teeth display.
the facial midline. Axial midline angulations of 10° or More tooth display is perceived as more youthful while
greater require orthodontic intervention for esthetic less tooth display makes the face look old.
correction.
Upper lip curvature: Upward lip curvature means that
Incisal embrasures the corner of the mouth is higher than the midpoint of the
The gaps between the edges of the teeth are called as lower margin of the upper lip. Straight lip curvature
incisal embrasures and holds important role in smile means that the corner of the mouth and the midpoint of
esthetics. The dimensions of these spaces which includes the lower margin of the upper lip are on a straight line.
volume and size is least in the midline and tends to Downward lip curvature means that the corner of the
increase on going away from the midline.12 mouth is lower than the midpoint of the lower margin of
the upper lip. Upward and straight smiles are more
Connectors esthetic than the downward smile.
It is a large, broad area where two adjacent teeth seem to
touch. For better esthetics, connecting area between Lower lip position: The relationship between upper
anterior should follow the rule of 50-40-30.13 anterior teeth and lower lip is of three types. The
maxillary incisors can be slightly enveloped by lower
Symmetry lip.(Fig.2) The upper anterior just contacting the lower
Symmetry is considered to be an essential component of lip(Fig.3) and the third situation where there is no contact
dental esthetics.14 There are two types of symmetry: between upper anterior and lower lip.(Fig4). The latter
horizontal and radiating. Dentition follows radiating two are more esthetically pleasing than slightly covered
symmetry where the design starts from the centre point smiles.
and both the sides are mirror images.15

Axial Inclination of Teeth

The long axis of the tooth inclines towards the midline
and this tipping towards the midline increases as the
distance from the centre point increases.

Shade Progression Figure 2: Straight Smile Arch

The shade and color patterns of upper teeth follow a
progressive pattern with maxillary centrals being the
lightest and canines having the greater saturation than
other anteriors.16

Tooth shape and harmony

The tooth form of maxillary central incisor should be
identical to the individuals facial outline upside down as
Figure 3: Concave Smile Arch
stated by Williams.17

Teeth shown in a smile

The teeth display during smile consists of anterior six
teeth along with first and second premolars.

Teeth reveal
It refers to the amount of tooth material that’s shown in
different views and lip position. It is discussed under Figure 4: Convex Smile Arch
various parameters as follows-
Smile line or smile arc
Smile lines are of three types, straight, parallel and
reverse.. In straight smile line edges of upper anterior are
in straight line. In parallel smile line the edges of upper

TMU J Dent. Vol. 5 Issue 4. October - December 28

anterior follow the upper border of the lower lip In embrasures? Madison, Wis : American Academy of
reverse smile line edges of upper anterior are in curved Cosmetic Dentistry; 1999.
relationship with upper border of lower lip.18,19,20 13.Morley JA. A multidisciplinary approach to complex
Intercommissure line, Maxillary incisors display and esthetics restoration with diagnostic planning. Prac Perio
lower lip framing Aesth Dent 2000; 12:575-7.
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There is no “ideal” smile that can be applied to all so the relationships present in the smile. AM J Orthod 1970;57:
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macroesthetics must be applied. The mechanotherapy to Orthop 2001;120: 98-111.
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