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Smile, Its Anatomy, Types, Components and Cosmetics in Orthodontics: A Review
Smile, Its Anatomy, Types, Components and Cosmetics in Orthodontics: A Review
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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International Journal of Applied Dental Sciences http://www.oraljournal.com
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
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
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
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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].
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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