International Journal of Applied Dental Sciences 2019; 5(4): 297-302 

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2019; 5(4): 297-302 Smile, its anatomy, types, components and cosmetics in
© 2019 IJADS
www.oraljournal.com
orthodontics: A review
Received: 19-08-2019
Accepted: 22-09-2019
Dr. Naveen Chandran, Dr. Nitin V Muralidhar, Dr. Suma S, Dr. Munaif
Dr. Naveen Chandran V and Dr. Aishwarya R
PG Student, Department of
Orthodontics, JSS Dental College
Abstract
and Hospital, JSSAHER,
Mysuru, Karnataka, India
An attractive smile is the centre of attraction of the face. The smile is the most dominant, bright, moving
part of the face and hence noticed first. Currently there has been a shift from traditional treatment goals,
Dr. Nitin V Muralidhar such as ideal occlusion and cephalometric standards, to include goals embodying principles of micro
Reader, Department of esthetics and soft tissue harmony. Orthodontists have an important role to play in smile designing which
Orthodontics, JSS Dental College involves the correction or modification of all the parts that comes in the smile frame, including the upper
and Hospital, JSSAHER, and lower lips, gingival exposure during smile, the size, color and shape of the teeth and the negative
Mysuru, Karnataka, India spaces between the tooth and the cheeks. Best esthetics in smile can only be designed by proper
understanding of the structures contributing to smile and establishing a good harmony and balance
Dr. Suma S between those structures.
Reader, Department of
Orthodontics, JSS Dental College Keywords: muscles of smile, smile esthetics, components of smile, types of smile, smile arc
and Hospital, JSSAHER,
Mysuru, Karnataka, India
Introduction
Dr. Munaif V A simple smile can bring out all the positive emotions in you. The mouth is the center of
PG Student, Department of communication in the face; the smile plays an important role in facial expression and
Orthodontics, JSS Dental College appearance. This has been demonstrated in studies with photographs, where higher intellectual
and Hospital, JSSAHER,
Mysuru, Karnataka, India
and social abilities were attributed to individuals with esthetic smiles. They were also judged
to be more attractive than the same individuals on photographs with modified lower-level
Dr. Aishwarya R esthetic smiles [1, 2].
PG Student, Department of Eyes are attracted first to a single location in the composition, most likely the most dominant,
Orthodontics, JSS Dental College or bright, or moving part. In a face, the smile contains contracts of bright teeth against red lips
and Hospital, JSSAHER,
Mysuru, Karnataka, India
and is active in speech and expression. Thus, it is dominant and attracts one’s attention first.
Dentists can plan these visual channels in his/her composition using line, contrast and size of
objects by attending to the many details of a smile, including tooth position and the
development of the smile to establish self. Currently there has been a shift from traditional
treatment goals, such as ideal occlusion and cephalometric standards, to include goals
embodying principles of micro esthetics and soft tissue harmony. This has caused the
orthodontic profession to place a greater emphasis on gingival esthetics, tooth form, and on
interdisciplinary care in general. Todays society not only endorses good looks and the
attendant impression of good health, but advocates it as a measure of self-respect.

Anatomy of Smile
The smile expresses itself mainly in the oral region and eyes. The oral region includes the
upper and lower lips, the corner of the mouth and anterior portions of the cheeks. The
nasolabial grooves, if present, pass through the oral region from the nose toward the angles of
the mouth and may extend inferiorly. The philtrum, usually present, is a vertical depression of
the upper lip extending from the septum of the nose to the red zone [4].
There are five groups that contribute to the anatomy of a smile (figure 1). These groups are as
Corresponding Author:
Dr. Naveen Chandran follows:
PG Student, Department of 1. The elevators of the upper lips- quadrants labii superioris and caninus. The most important
Orthodontics, JSS Dental College muscle in this group is the levator labii superioris.
and Hospital, JSSAHER, 2. The elevators of the corner of the mouth- zygomaticus major and portions of the
Mysuru, Karnataka, India
buccinators.
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3. The depressors of the corner of the mouth- triangularis The unposed smile is involuntary and is induced by joy or
risorius and portions of the buccinators. mirth. It is dynamic in the sense that it bursts forth but is not
4. The depressors of the lower lip quadrates labii inferioris sustained. An unposed smile is natural in that it expresses
and the mentalis. authentic human emotion. Lip elevation in the unposed smile
5. The orbicularis oris has anterior fibers which purse the is often more animated, as seen in the laughing smile.
lips, pull them tightly against the teeth in a “clench
smile” or roll the lower lips out into a “chimpanzee like
smile”
There are striking variations in the amount of movement that
exists in the normal smile from one person to another. A
maximum spontaneous smile results in movement of the
commissure from 7 to 22 mm. Likewise, the average direction
of movement of the commissure is 40 degree from the
horizontal, the direction of movement of most smiles is to
helix scalp junction. Fig 2: Social Smile and enjoyment smile

Fig 3: Posed and Unposed smile

The Eight Components of a Balanced Smile

Types of smile
There are five variations in which dental and/or periodontal
tissues are displayed in the smile zone [5]:
 Type 1: Maxillary only
 Type2: Maxillary and over 3mm gingival
 Type 3: Mandibular only
 Type 4: Maxillary and Mandibular
 Type 5: Neither Maxillary or Mandibular

Types of smiles were also classified as [6]:

1. Convex smile
2. Concave smile
3. Straight smile
 
The Social Smile and the Enjoyment Smile Fig 4: 8 components of balanced smile
The social smile is a voluntary smile a person uses in social
settings or when posing for a photograph. When you are 1. Lip line
introduced to someone, your smile indicates that you are The lip line is the amount of vertical tooth exposure in
friendly and “pleased to meet” that person. The enjoyment smiling i.e - the height of the upper lip relative to the
smile (or Duchenne smile) is an involuntary smile and maxillary central incisors.
represents the emotion you are experiencing at that moment [7] As a general guideline, the lip line is optimal when the upper
(Figure2). What differentiates the social smile from the lip reaches the gingival margin, displaying the total cervico
enjoyment smile is not the activity of the orbicularis oris incisal length of the maxillary central incisors, along with the
musculature, but instead the participation of the orbicularis interproximal gingivae.
oculi. In the enjoyment smile there is a crinkling around the With aging, there is a gradual decrease in exposure of the
eyes that cannot be duplicated with a social smile [6]. maxillary incisors at rest and, to a much lesser degree, in
.
Smiles can also be classified as either posed or spontaneous. smiling. This steady decline in maxillary tooth exposure at
Peck and Peck [7] classified smiles as stages I and II, and rest is accompanied by an increase in mandibular incisor
Ackerman et al. [8] designated the stage I smile as the posed display.
smile and stage II as the unposed (spontaneous) smile. The The amount of vertical exposure in smiling depends on the
posed smile is voluntary and need not be elicited or following six factors [9].
accompanied by emotion. A posed smile is static in the sense
that it can be sustained. The lip animation is fairly  Upper Lip Length. The average lip length at rest, as
reproducible, similar to the smile that may be rehearsed for measured from subnasale to the most inferior portion of
photographs or school pictures (Figure 3). the upper lip at the midline, is about 23mm in males and
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20mm in females [10]. Lip length should be roughly equal maxillary incisors, whether in a Class II division 1
to the commissure height, which is the vertical distance malocclusion or in a Class III compensation, tend to
between the commissure and a horizontal line from reduce the incisor display at rest and in smiling. On the
subnasale. other hand, uprighted or retroclined maxillary incisors, as
 Lip Elevation. According to Zachrisson et al [11] in seen in Class II, division 2 malocclusion or after
smiling, the upper lip is elevated by about 80% of its orthodontic retraction without torque control, tend to
original length, displaying 10mm of the maxillary increase the incisor display. According to Sarver et al.
[12]
incisors. Women have 3.5% more lip elevation than men. , maxillary incisor inclination can best be assessed on
Actually, there is considerable individual variability in profile and oblique smiling photographs, which should
upper lip elevation from rest position to the full smile, become standard orthodontic records.
ranging from 2-12mm, with an average of 7-8mm.If a
gingival smile is caused by a hypermobile lip, it would be 2. Smile Arc
a mistake to correct it with aggressive incisor intrusion or The smile arc is the relationship between a hypothetical curve
maxillary impaction surgery, because that would result in drawn along the edges of the maxillary anterior teeth and the
little or no incisor display at rest and thus make the inner contour of the lower lip in the posed smile. According to
patient look older. Miller [14] the curvature of the incisal edges appears to be
 Vertical Maxillary Height. The importance of the more pronounced for women than for men, and tends to
vertical position of the maxilla in tooth display has been flatten with age. Sarver et al. [13] stated that an optimal smile
demonstrated in both prosthetic dentistry and arc described as "consonant” the curvature of the maxillary
orthognathic surgery. When upper lip length and mobility incisal edges coincides with or parallels the border of the
are normal, a gingival smile with excessive incisor lower lip in smiling. The lower lip can either touch, not touch,
display at rest can be attributed to vertical maxillary or slightly cover the upper incisal edges. In a "nonconsonant"
excess. Zachrisson [11] states that the full smile does not smile arc, the maxillary incisal edges are either flat or
make a good reference, partly because of the individual reversed relative to the curvature of the lower lip. The smile
variation in lip mobility. A short upper lip should not be arc can be unintentionally flattened during orthodontic
treated by shortening the maxilla unless the facial outline treatment like over intrusion of Maxillary Incisors., Bracket
can accommodate such a change. According to Sarver et Positioning and canting of the Occlusal Plane. (Figure 5)
al [12] it should also be noted that in maxillary impaction,
the upper lip shortens by as much as 50% of the surgical
skeletal intrusion.
 Crown Height; The average vertical height of the
maxillary central incisor is 10.6mm in males and 9.8mm
in females [13]. 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 incisaly 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.
 Vertical Dental Height; The incisor exposure at rest,
rather than the overbite, determines the vertical position Fig 5: Patient with flat smile arc after orthodontic treatment
of the incisal edge, all other factors being equal.
Therefore, a deep bite should be corrected by maxillary 2. Upper Lip Curvature
incisor intrusion in a patient with excessive incisor The upper lip curvature is assessed from the central position
display at rest, but with posterior extrusion and/or lower to the corner of the mouth in smiling.
incisor intrusion in a patient with a normal lip line at rest. Upward -when the corner of the mouth is higher than the
The opposite applies to an open bite, which should be central position, Straight -when the corner of the mouth and
corrected by maxillary incisor extrusion if there is the central position are at the same level and Downward -
inadequate incisor display at rest, but with posterior when the corner of the mouth is lower than the central
intrusion and/or lower incisor extrusion if the lip line is position (figure 6).
normal at rest.
 Incisor Inclination; Peck et al [7] stated that proclined

Fig 6: Upper lip curvature A: Upward B: Straight C: Downward

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3. Lateral Negative Space dental elements it contains and their harmonious integration.
The transverse dimension of the smile is also referred to as According to Moskowitz [15] dental components of the smile
"transverse dental projection". Lateral negative space is the include- Size, shape, color, alignment of the teeth, Crown
buccal corridor between, the posterior teeth and the corner of angulations (tip) of the teeth, Midline, and Arch symmetry.
the mouth in smiling. Orthodontists refer to buccal corridors
as "negative" spaces to be eliminated by transverse maxillary 8. Gingival Components
expansion. A first- molar-to-first-molar smile is often The gingival components of the smile are the color, contour,
advocated in orthodontics, but is considered evidence of a texture, and height of the gingivae. Inflammation, blunted
poorly constructed denture in prosthodontics. papillae, open gingival embrasures, and uneven gingival
margins detract from the esthetic quality of the smile.
4. Smile Symmetry The space created by a missing papilla above the central
Smile symmetry, the relative positioning of the corners of the incisor contact point, referred to as a "black triangle", may be
mouth in the vertical plane, can be assessed by the parallelism caused by root divergence, triangular teeth, or advanced
of the commissural and pupillary lines. Although the periodontal disease. Orthodontic root paralleling and
commissures move up and laterally in smiling, there is a flattening of the mesial surfaces of the central incisors,
difference in the amount and direction of movement between followed by space closure, will lengthen this contact area and
the right and left sides. A large differential elevation of the move it apically toward the papilla.
upper lip in an asymmetrical smile may be due to a deficiency The gingival margins of the central incisors are normally at
of muscular tonus on one side of the face (figure 7) 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
tissue4. The gingival margins can be leveled by orthodontic
intrusion or extrusion or by periodontal surgery, depending on
the lip line, the crown heights, and the gingival levels of the
adjacent teeth [16].

Cosmetic Dentistry in Orthodontics

The literature on cosmetic dentistry contains excellent
Fig 7: Patient with asymmetrical smile due to deficiency of muscle definitions of desirable characteristics of tooth shape and
tonus on side of face proportions, gingival esthetic characteristics, and what
constitutes esthetic teeth and gingival relationships. These
Myofunctional exercises have been recommended to help characteristics include (1) tooth proportionality, (2) contacts,
overcome this deficiency and restore smile symmetry. An connectors, and embrasures, and (3) gingival characteristics.
oblique commissural line in an asymmetrical smile can give
the illusion of a transverse cant of the maxilla or a skeletal 1. Tooth proportionality- height and width
asymmetry. The ideal maxillary central incisor should be approximately
80% width compared with height, but it has been reported to
6. Frontal Occlusal Plane vary between 66% and 80%. A higher width/height ratio
The frontal occlusal plane is represented by a line running means a squarer tooth, and a lower ratio indicates a longer
from the tip of the right canine to the tip of the left canine. A appearance. The corresponding solutions to the tooth height
transverse cant can be caused by differential eruption of the problem are all different, including bonding or laminates to
maxillary anterior teeth or a skeletal asymmetry of the increase the length of the tooth, awaiting completion of
mandible. This relationship of the maxilla to the smile cannot passive eruption, or periodontal crown lengthening. The most
be seen on intraoral images or study casts, and smile commonly reported maxillary incisor height width
photographs can also be misleading. Therefore, clinical relationships are illustrated in (Figure 8). A higher
examination and digital video documentation are essential in width/height ratio means a squarer tooth, and a lower ratio
making a differential diagnosis between smile asymmetry, a indicates a longer appearance. Many smiles exhibit
canted occlusal plane, and facial asymmetry. disproportionality, so that these measurements should not be
taken as an absolute rule. The ranges of height and width are
important to note [17-20], because the disproportionality of a
tooth can then be evaluated with regard to what parameter is
at fault and in need of improvement. This concept is
illustrated in (Figure 9) which shows a tooth that is virtually
square

2. Contacts, connectors, and embrasures

Contacts (interdental contact points) are defined as the exact
Fig 8: Pre treatment and post treatment photograph of a patient place that the teeth touch (what makes floss snap). The
showing increased esthetics after correction of occlusal plane connector (also referred to as the interdental contact area) is
where the incisors and canines “appear” to touch [10]. (Figure
7. Dental Components 10).
A pleasant smile also depends on the quality and beauty of the The contact points progress apically as the teeth proceed from
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the midline to the posterior. The connector height is greatest

between the central incisors and diminishes from the central
to the posterior teeth. The embrasures ideally are larger as the
teeth progress posteriorly.
 Appropriate ratio for connector between central incisors
is 50% of tooth height;
 Ratio for central and lateral incisor connector is 40% of
central incisor height;
 Ratio for lateral incisor and canine connector is 30% of
central incisor height

3. Gingival esthetics
Gingival shape refers to curvature of the gingival margin of
the tooth, determined by the cementoenamel junction and the
osseous crest. According to the American Academy of Fig 9: In this incisor is too short. Crown width is 8.0 mm, within
Cosmetic Dentistry [21], The gingival shape of the mandibular normal range, but height is 8.5 mm, significantly shorter than
incisors and the maxillary laterals should exhibit a acceptable range
symmetrical half-oval or half-circular shape. The maxillary
centrals and canines should exhibit a gingival shape that is
more elliptical. Thus, the gingival zenith (the most apical
point of the gingival tissue) is located distal to the
longitudinal axis of the maxillary centrals and canines. The
gingival zenith of the maxillary laterals and mandibular
incisors should coincide with their longitudinal axis. (figure
12).
The gingival esthetic line [22] (GAL) is a line connecting the
apices of the gingival scallop. The most apical part of the
gingival scallop should reflect the angle of the long axis of the
tooth, and there should be an interdental papilla of 4.5 to 5.0
mm from tip of the papilla to the depth of the marginal scallop Fig 10: Contact between anterior teeth
[23]
.
The papillae will fill embrasure when the distance between
alveolar crest and contact are less than 5mm24. This decreases
to 56 % of the time when the distance is 6mm and 27% at
7mm. When the interradicular distance between central
incisors is greater than 2.4mm the distance from contact to
alveolar crest loses its influence [17].
Recently, the uses of soft tissue lasers in orthodontic practice
has become popular to enhance smile esthetics and improve
finishing of orthodontic patients, use of soft tissue lasers
broadly fall into the following categories: (1) improving
gingival shape and contour, (2) lengthening crowns, (3)
idealizing tooth proportionality, and (4) resolving Fig 11: Gingival zenith (most apical point of gingival tissue) is distal
crown/height asymmetries [25]. to longitudinal axis of maxillary central incisors and canines

Conclusion
A smile is a gesture unique to our race, that is unlike the
grimace of lower primates and adds the human touch. People
are concerned with their smile, the way they feel about it and
its effect on other people too. A pleasing smile enriches, not
only yourself but also the world around you.
Having a dentist actually craft a new smile for a patient is
very much becoming an art form and it should be since each
persons smile is a unique as its owner.
The orthodontist responsibility lies in preserving, creating and
enhancing an existing smile without impairing function. The
key to successful treatment lies in establishing harmony
within the orofacial complex. The joy of its blending into
engaging smile is shared by the patient, viewer and the
dentist.

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