A morphometric analysis of the posed smile

A fundamental goal of orthodontics is to improve the smile, but no objective criteria exist to assess the lip-teeth relationship, establish objectives of treatment or measure treatment outcome. Here we propose a method to digitally measure the smile characteristics of orthodontic patients. Specifically, the ‘posed smile’ is measured. By definition the posed smile is voluntary and not elicited by an emotion. It can be a learned greeting or a signal of appeasement and can be sustained. The posed smile is reliably repeatable. The multimedia computer program for smile measurement we developed was based on studies of the utility of the smile photograph and the assessment of the lip-teeth characteristics of the posed smile in treated and untreated patients. On the computer screen a grid, or smile mesh, employs horizontal and vertical lines to measure eleven attributes of a smile. Not all orthodontically ‘well-treated’ patients with exemplary plaster casts exhibit desirable anterior tooth display while smiling. We suggest that the photographic analysis of an unstrained posed smile might be a standard orthodontic record.     

正畸治疗结束女性患者微笑像主观评价相关因素分析

目的通过对治疗结束女性患者微笑像的主观评价,了解影响微笑美学主观评价的相关因素;探讨专业正畸医生与普通人对微笑美学的评价的一致性。方法14-27岁正畸治疗结束女性80名,Ⅰ类骨型、牙齿排列整齐,覆合覆盖正常,磨牙和尖牙关系均为I类关系。拔牙42例,非拔牙38例。收集面下三分之一微笑像,将全部图片随机编号,按照恒定的顺序排列后分发到评价人员手中,分别由10名有经验正畸医生和10名普通人对微笑像做主观评价（VAS）。结果专业正畸医生和普通人对微笑像的评分差异有统计学意义（P〈0．001）;拔牙组和非拔牙组微笑像的美学得分差异不显著。正畸医生与普通人微笑主观评价（VAS评分）与微笑指数呈正相关,与微笑高度、牙龈暴露程度、尖牙宽度比例、可见牙列宽度比例呈负相关。结论拔牙与非拔牙矫治本身对微笑美学主观评分的影响无显著差异,牙龈暴露程度是影响微笑美学主观评分的主要因素。     

Smile attractiveness. Self-perception and influence on personality

OBJECTIVES: To investigate self-perception of smile attractiveness and to determine the role of smile line and other aspects correlated with smile attractiveness and their influence on personality traits. SUBJECTS AND METHODS: Participants judged their smile attractiveness with a patient-specific questionnaire. The questionnaire contained a spontaneous smiling photograph of the participant. Objective smile-line height was measured using a digital videographic method for smile analysis. Personality was assessed with the Dutch Personality Index. RESULTS: Cronbach's alpha for the smile judgment questionnaire was .77. The results showed that size of teeth, visibility of teeth, and upper lip position were critical factors in self-perception of smile attractiveness (social dimension). Color of teeth and gingival display were critical factors in satisfaction with smile appearance (individual dimension). Participants, smiling with teeth entirely displayed and some gingival display (two to four millimeters), perceived their smile line as most esthetic. Smiles with disproportional gingival display were judged negatively and correlated with the personality characteristics of neuroticism and self-esteem. Visibility and position of teeth correlated with dominance. CONCLUSION: The results of this research underpin the psychosocial importance and the dental significance of an attractive smile.     

Smile aesthetics

The aim of this article is to outline some of the factors practitioners should take into consideration when planning optimal smile aesthetics. The components of the smile that will be discussed include the smile arc, incisor/gingival display, smile width, gingival aesthetics, tooth proportionality/symmetry, contacts/connectors/embrasures and the dental midlines. CLINICAL RELEVANCE: A systematic evaluation of the components of the smile when planning treatment will help to improve smile aesthetics and produce greater patient and dentist satisfaction.     

140名山西籍青年人微笑美学定性指标初步分析

目的:分析山西籍青年人姿势微笑位美学定性指标,探讨性别对微笑特征的影响,为前牙美学区域修复治疗提供参考依据。方法:选取20~30岁个别正常140例受试者,男68例,女72例,平均年龄25.6岁。采用视频录像的方式记录姿势微笑位的整个过程,使用计算机软件获取姿势微笑位图像。对微笑线、微笑弧、上唇曲度、上颌前牙与下唇的关系、微笑宽度进行定性分析。使用Pearson chi-square检验分析性别组间微笑指标,微笑定性指标之间采用Spearman相关分析。结果:在总体样本中,中微笑线(59.3%)、平行微笑弧(71.4%)、笔直上唇曲线(51.4%)、上前牙与下唇不接触(72.9%)以及微笑宽度显示至第二前磨牙(54.3%)较为常见。除了微笑线(P=0.040)和上颌前牙与下唇的接触关系(P=0.039)以外,其它定性指标在性别间无统计学差异。微笑线和上前牙与下唇的接触关系相关、微笑宽度和上前牙与下唇的接触关系相关(P<0.05)。结论:中微笑线、平行微笑弧、笔直上唇曲度、上前牙与下唇不接触以及微笑宽度显示至第二前磨牙的微笑特征在受试者中占比较高。微笑线和上颌前牙与下唇的接触关系差异在性别组间有统计学意义,女性较男性显示更高的微笑线,易出现下唇覆盖上颌前牙的唇齿关系。笑线越高,上前牙与下唇的接触关系越易出现覆盖关系;笑线越低,上前牙与下唇的接触关系越易出现不接触关系。微笑时牙齿显露数量少,上前牙与下唇的接触关系越易出现覆盖关系;微笑时牙齿显露数量多,上前牙与下唇的接触关系越易出现不接触关系。     

Comparative study of smile analysis by subjective and computerized methods

PURPOSE: This study compared: 1) the subjective analyses of a smile done by specialists with advanced training and by general dentists; 2) the subjective analysis of a smile, or that associated with the face, by specialists with advanced training and general dentists; 3) subjective analysis using a computerized analysis of the smile by specialists with advanced training, verifying the midline, labial line, smile line, the line between commissures and the golden proportion. METHODS: The sample consisted of 100 adults with natural dentition; 200 photographs were taken (100 of the smile and 100 of the entire face). Computerized analysis using AutoCAD software was performed, together with the subjective analyses of 2 groups of professionals (3 general dentists and 3 specialists with advanced training), using the following assessment factors: the midline, labial line, smile line, line between the commissures and the golden proportion. The smile itself and the smile associated with the entire face were recorded as being agreeable or not agreeable by the professionals. RESULTS: The McNemar test showed a highly significant difference (p=0.0000) among the subjective analyses performed by specialists compared to general dentists. Between the 2 groups of dental professionals, there were highly significant differences (p=0.0000) found between the subjective analyses of the smile and that of the face. The McNemar test showed statistical differences in all factors assessed, with the exception of the midline (p=0.1951), when the computerized analysis and subjective analysis of the specialists were compared. In order to establish harmony of the smile, it was not possible to establish a greater or lesser relevance among the factors analyzed.     

The importance of incisor positioning in the esthetic smile: the smile arc.

The smile arc is defined as the relationship of the curvature of the incisal edges of the maxillary incisors and canines to the curvature of the lower lip in the posed smile. The ideal smile arc has the maxillary incisal edge curvature parallel to the curvature of the lower lip. Evaluation of anterior smile esthetics must include both static and dynamic evaluations of profile, frontal, and 45 degrees views to optimize both dental and facial appearance in orthodontic planning and treatment. This article presents the concept of the smile arc and how it relates to orthodontics-from the recognition of its importance, to its impact on orthodontic treatment planning, to how procedures and mechanics are adapted to optimize the appearance of the smile. Three cases are used to illustrate how treatment is directed, emphasizing how facial and smile goal setting go hand in hand.     

Self-reported smile satisfaction: smile parameters and ethnic origin among Israeli male young adults

This study was undertaken to evaluate smile satisfaction among Israeli young males, to develop norms for young Israeli adults' smile parameters, and to determine whether there is a relationship between these parameters and par-ticipants' ethnic origin. The study population consisted of 403 Israeli young male adults. Participants were asked to report their ethnic origin, past orthodontic treatment and to grade their overall satisfaction from their own smile on a numerical scale of from 1 to 5. Smile parameter measurements were taken and the data analyzed. We concluded that there may be a common Jewish/Israeli norm of smile parameters. Consideration of the criteria of a smile obtained from this study may be useful in improving the esthetic value of prosthetic, restorative and orthodontic treatments.     

黄金比例面具对种植体支抗压低上切牙改善露龈笑的美学评价初探

目的 利用黄金比例面具对露龈笑进行分类,并评价使用种植体支抗压低上切牙后患者露龈笑的改善程度,探讨种植体支抗压低上切牙治疗露龈笑过程中唇-齿-龈关系的变化趋势.方法 选择17例露龈笑患者,女性16例,男性1例,年龄16～40岁,平均26.2岁.于上颌侧切牙和尖牙间唇侧植入微螺钉种植体支抗压低上切牙,在Photoshop软件中将正面微笑黄金比例面具标准化模板与治疗前后的正面微笑像重叠,比较治疗前后正面微笑像唇、齿、龈在黄金比例面具相应区域内所占比例的变化,定性分析并评价露龈笑的改善程度.结果 17例患者的上切牙均被成功压低,露龈笑明显改善,疗程平均9.8个月.通过黄金比例面具分析发现,治疗前露龈笑形成原因不同,治疗后患者正面微笑像唇-齿-龈关系基本符合黄金比例面具的唇-齿-龈关系.结论 通过使用黄金比例面具对露龈笑患者的唇-齿-龈关系进行分析,可以对使用种植体支抗压低前牙改善露龈笑患者的矫治效果进行初步临床评价.     

L’estetica del sorriso e del volto: fattori determinanti, canoni di riferimento e cambiamenti con l’età

Objectives. To illustrate some of the fundamental orthodontic guidelines for maintaining the harmony of the dento-periodontal unit and the face, which includes a dynamic component: the smile. Materials and methods. This dossier examines the golden ratio of dental to gingival components in the smile; the relationships between teeth, gums, and lips in the dynamic smile; the effects on the smile of excessively large buccal corridors and their relation to the position of the teeth within the dental arches; and the role of the smile the overall facial esthetics. It also reviews the modifications that will be produced by aging in the soft and hard tissues of the face, for the orthodontist must always evaluate the patients face prospectively: not only as it appears at the time of treatment, but also as it will appear after the passage of time. Results and conclusions. Esthetics is a relative concept, and it is difficult to establish rigid guidelines for producing a beautiful smile and a beautiful face. However, orthodontics has introduced some general rules that can help maintain the harmony of the face through the dynamic component of the smile.     

Mechanics to Enhance Facial and Smile Esthetics

The parameters for achievement of treatment success sometimes differ between patients and orthodontists, while patients focus on esthetics, orthodontists usually emphasize occlusal criteria. Although smile esthetics is an extensive topic, clinicians must understand the main principles of an ideal smile in order to use the appropriate orthodontic mechanics to enhance facial and smile esthetics. The objectives of this paper are: 1) to review the two main principles of a beautiful and youthful smile to guide the clinician to visualize the main esthetic goals of orthodontic treatment, and 2) to present two clinical situations where appropriate orthodontic mechanics were used to obtain optimal facial and smile esthetics results.     

Smile aesthetics

The aim of this article is to outline some of the factors practitioners should take into consideration when planning optimal smile aesthetics. The components of the smile that will be discussed include the smile are, incisor/gingival display, smile width, gingival aesthetics, tooth proportionality/symmetry, contacts/connectors/embrasures and the dental midlines.     

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??Aesthetics has got increasingly attention in the practice of today′ s dentistry. The smile is one of the most important facial expressions. A number of characteristic features were described to formulate a standard smile??including smile type??gingival contour??buccal corridor??etc. These parameters vary from study to study and have changed a lot in the recent decades. The present review aims to address the factors associated in the smile aesthetics.     

正畸可控的笑容特征指标对微笑美的影响研究

目的 探讨各项正畸可控的笑容特征指标与微笑美的相关性。方法 选取男女微笑时面下1/3照片各1张,利用Photoshop依据各指标（切牙暴露量、露龈量、笑弧、颊廊、上颌牙合平面倾斜度及上切牙下唇间距）分别进行变动,选择200名大学生对其进行评价。数据输入Spss 19.0 统计软件包,将每项指标对应各图得分与该指标的变化进行等级资料Spearman相关分析。结果 男女笑容图的得分均与切牙暴露量、笑弧一致性成正相关（P<0.05）,与露龈量、颊廊面积、上颌牙合平面倾斜度、上切牙下唇间距成负相关（P<0.05）。结论 唇齿龈的相对位置对笑容的美观有显著影响,正畸过程中应注意调控。     

正畸微笑美学的影响因素及研究进展

一个完美自信的微笑可以大大提升个人的魅力。微笑美学已成为患者寻求正畸治疗的主要原因,而且是正畸医生的治疗目标。正畸医生有必要了解面部美学和当前社会对面部吸引力的偏好。正畸医生了解微笑美学的指标,可以用于指导临床操作,从而达到最佳的治疗效果。该文归纳了笑线、笑弧、颊廊、牙齿、牙龈等影响微笑美学的因素并从微笑的微观美学和迷你美学两方面作一综述。     

An evaluation of the functional lip posture

The purpose of this study was to evaluate the relationship of the functional lip posture to the anterior teeth and gingiva and at the same time establish an objective esthetic standard in the clinic. The functional lip posture referred here were the smiling lip line and the maximum opening lip line. From an esthetic and clinical point of view, the functional lip posture was described, classified and scored using the relationship of the border of the upper and lower lip to the labial surface of the anterior teeth and gingiva. A device for taking standardized oral photographs with a high degree of reproducibility was used. Tjan, et.al. studied the esthetic factors in a smile. Using their classification the result of this study were as follows: high smile, 32%; average smile, 42%; and low smile, 26%. The difference in the amount of maxillary and mandibular gingival exposure were also determined in this study. The measurement of the maxillary area was used in classifying the smile since the mandibular area showed interproximal gingiva only. In analyzing the maximum opening lip line, it was not possible to apply Tjan's classification since it referred only to the smile line. A scoring system (smile score) was devised, instead, to evaluate the functional lip posture. By this scoring system, the smiling lip line was classified using the maxillary teeth and gingiva only. The classification were as follows: high smile, score was over 4; average smile, from 3-4; and low smile, under 3. Note that the maxilla was used as reference in analyzing the smiling lip line and the mandible for the maximum opening lip line.     

Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and laymen

OBJECTIVE: To evaluate changes in attractiveness on the basis of computerized variations of smile arcs and buccal corridors for male and female smiles judged by orthodontists and laypersons. MATERIALS AND METHODS: Using a visual analog scale in a Web-based survey, orthodontists and laypersons rated the attractiveness of nine digitally altered smile arc and buccal corridor variations of male and female smiles. The variations were accomplished in a clinically relevant manner and based on standards set by experienced orthodontists in a pilot web-based survey. RESULTS: The results indicate that both laypersons and orthodontists prefer smiles in which the smile arc parallels the lower lip and buccal corridors are minimal. Significantly lower attractiveness ratings were found for smiles with flat smile arcs and excessive buccal corridors. Flattening of the smile arc overwhelms the deleterious effects of excessive buccal corridors on attractiveness ratings. CONCLUSIONS: On the basis of the results of this study, care should be taken not to produce an excessively flat smile arc during orthodontic treatment.     

The periodontal factor in esthetic smile design--altering gingival display

The periodontal soft and hard tissues are an important determinant of restorative smile esthetics. Management of the periodontal tissues that "frame" each tooth is crucial to esthetic smile design. This article describes a four-step technique that makes it possible to sculpt the position of the labial gingival margin to provide additional crown height or length, a process the author describes as smile sculpting. This periodontal smile sculpting can aid in determining the pre-restorative treatment profile for teeth and create a blueprint for the restorative dentist to enhance a patient's final esthetic treatment results. Crucial to understanding this process is an appreciation of the periodontal principles that govern smile design, especially the periodontal biologic width and the influence of the underlying hard tissue bony architecture in defining the periodontal envelope from which the teeth emerge.