1) The document discusses various factors related to smile esthetics including smile arc, incisal edge contours, midlines, crown torque, and smile line. It emphasizes the importance of the smile arc and monitoring it during orthodontic treatment. 2) Guidelines are provided for analyzing esthetic factors by viewing the patient from the front and evaluating the smile, including factors like crown length and axial inclinations. 3) Variations in smile lines between males and females are discussed, with low smile lines being more common in males and high smile lines in females.

1. Presented by:-
Dr. Maulik patel

2. GOOD MORNING!!!!

3. Macro Esthetics
Mini Esthetics
Micro Esthetics

4.  Symmetry dental Midline And skeletal Midline
 Vertical Tooth lip relation:-
 Cant Of Occlusal Plane:-

5.  Social smile/posed
smile/Reproducible(orthodontic diagnosis)
 Enjoyment Smile/Duchenne smile in research
lit.

6.  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.

7.  Consonant
 NonConsonant
Reversed Flattened
Classified As:-

8.  The most important factor in smile Esthetic
is smile arc and only one that can change the
rating of smile from acceptable to
unesthetic.
 It should be monitored during the treatment.
Ker AJ,Chan R,Field HW,et al:- Esthetics and smile charecteristics
from the layperson’s perspective: a computer –based survey study.
J Am Dent Assoc 139:1318-1327,2008

9.  The purpose of this article is to discuss some
new concepts of the desirable characteristics
of tooth display during normal conversation
and smiling, and to provide guidance on how
to analyze esthetic factors by viewing the
patient from the front.
 It will emphasize the need for age-related
goals in orthodontics.

10.  Evaluating esthetics from the front in conversation
,facial expressions, and smilling.
 Factors analyzed by sitting or standing in front of
the patient.
 Crown length of incisors
 Incisal edge contours
 Axial inclinations
 Midlines
 crown torque
 Smile line
Lombardi, R.E:- The pinciples of visual perception and their clinical
implications in denture prosthesis,J Prosth. Dent. 1973

12.  Each pt should be coached and asked to achieve
the same lip position at least twice in
succession before photograph is taken.
 A short video sequence will be helpfull in
demostrating rest position, Normal
conversation, and smilling.
 In Rest position the teeth should be slightly
apart and the perioral soft tissue and
mandibular posture both must be unstrained. At
full smile the teeth should be lightly closed.

14.  The smile is apparently formed in two
stages, the first raising the lip to the
nasolabial fold, and the second involving
further superior raising of the lip and the
fold by three muscle groups.
 Nearly everyone, irrespective of age, will
display the maxillary incisors nicely on
maximum smiling, even if only the
mandibular incisors are visible during
conversation.

16.  Tjan, miller performed a semi quantitative
study of smile-line variations;their data
suggest evidence of sexual dimorphism of
smile lines in the vertical dimention.
 Full face photographs of smilling men and
women were analysed with the intention of
identifying features of lip position for help in
designing esthetic dental restorations.

17.  Low smile line were predominant in Male
 High smile line were predominant in Females

18.  “Low smile” less than 75% of clinical crown
height of maxillary anterior teeth.
 “Aveage Smile” 75-100% of maxillary anterior
crown height.
 “High smile” Exposing continuous band of
gingiva.

19.  The correction of deep overbite can be
accomplished by various combinations of
intrusion of the anterior teeth and extrusion
of the posterior teeth.
 A serious mistake commonly made is
orthodontic practice is "overintrusion" of the
maxillary incisors.

20. Unesthetic result
after overintrusion of
maxillary
incisors, and straight
incisal curvature in
relation to lower lip

21.  The best treatment strategy
in the majority of deep
overbite cases is to actively
intrude the mandibular
incisors, using double tubes
on the mandibular first molars
and continuous or segmented
base arches or utility arches.
 In a young patient with a
short lower face, extrusion of
the posterior teeth might
correct a deep overbite, but

22.  Another common mistake in
orthodontic finishing is to create a
straight (or even reverse) maxillary
incisal curve relative to the smile
line ( Fig.B,D). Parallelism of the
incisal curve and the inner contour
of the lower lip in smiling may
seem difficult to produce.
 In practice, however, this
appearance can readily be
achieved if the maxillary central
incisors are symmetrically
positioned 0.5mm longer than the
lateral incisors.

23.  If the lower lip shows a marked
curvature in smiling, the
distoincisal edges of the
maxillary central incisors can be
ground slightly without affecting
functional occlusion.
 It is particularly undesirable to
combine maxillary incisor
overintrusion with a straight
arrangement of these teeth.

24.  Etiology for “gummy smile”
 Biologic mechanism underlying the gingival smile
line
 Anterior maxillary excess(2-3 mm) excess
 Greater muscular capacity to raise the upper lip on
smilling
 Supplemental associated factors including
 Excessive overjet ,excessive interlabial gap at rest and
excessive overbite.
 Variables not associated
 Uppere lip length
 Incisor crown height
 Mandibular plane angle
 Palatal palne angle

25. 1) Upper Lip Length
 What is significant, however, is the
relationship of the upper lip to the maxillary
incisors and to the commissures of the
mouth.

26.  The average lip length at rest, as measured
from subnasale to the most inferior portion
of the upper lip at the midline, is about
 23mm in males and
 20mm in females (Table 1).

27.  It is not easy to alter commissure height, but
lip lengthening is possible with lip
surgery, either as a single procedure or in
combination with a Le Fort I osteotomy.
 A short upper lip is not always associated
with a high lip line; on the contrary, the
upper lip was found to be longer in a
gingival-display group than in a non-
displaying sample.
 Peck, S.; Peck, L.; and Kataja, M.: The gingival smile
line, Angle Orthod. 62:91-100, 1992.

28. 2) Lip elevation:
 In smiling, the upper lip is elevated by about 80% of
its original length, displaying 10mm of the maxillary
incisors.
 Women have 3.5% more lip elevation than Men.
 There is considerable individual variability in upper
lip elevation from rest position to the full
smile, ranging from 2-12mm, with an average of 7-
8mm.

29. Hypermobile Hypomobile
More elevation of lip and gingival
display on smile
Aggressive Intrusion of incisors- less
or no incisal display at rest./ older
look
Low lip line on smile
Extensive incisor extrusion
-an overbite with excessive
incisor display at rest.

30.  3)Vertical maxillary excess
 When upper lip length and mobility are
normal, a gingival smile with excessive
incisor display at rest can be attributed to
vertical maxillary excess.
 Treatment is disimpacting the maxilla
vertically up, the best reference is the
incisor display at rest, taking upper lip
length and any incisor attrition into account.

31.  Short upper lip should not be treated by
lefort I.
 It should also be noted that in maxillary
impaction, the upper lip shortens by as much
as 50% of the surgical skeletal intrusion.

32.  4) Crown height
 The average vertical height of the maxillary
central incisor is 10.6mm in males and
9.8mm in females.
 A short crown can be due to
 Attrition or
 Excessive gingival encroachment.

33.  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.

35.  5) Vertical dental height:-
 Deep bite:
 Openbite :- if incisor exposure is proper
correction done by posterior teeth intrusion
and if incisor display at rest is not proper it is
corrected by extrusion of incisors.

36.  Gingival contours and clinical crown length
descrepancies their diagnosis and treatment
options are described in this article.
 Also how to Enhence Restorative, Esthetic
, and Periodontal results with orthodontic
therapy.

40. (Am J Orthod Dentofacial Orthop 2003;124:116-27)

41.  In a direct measurement study of more than
3500 subjects, Dickens et al; The effects of
maturation and aging on the soft tissues can be
summarized as :-
 (1) Lengthening of the resting philtrum and
commissure heights,
 (2) Decrease in turgor (or tissue
“fleshiness”),
 (3) Decrease in incisor display at rest, And
during smile,
 (4) Decrease in gingival display during
smile.

42.  Smile changes with increase in age and
differs between males and females.
 As age advances, the loss of resting muscle
tone and increased flaccidity and redundancy
contribute more in lowering of the smile
height than the decreased muscle’s ability to
create a smile.
 Males have more vertical movements
whereas females have more horizontal
movements during smile.
Angle Orthod. 2013;83:90–96.
Patil Chetana; Pradeep Tandonb; Gulshan K. Singhc; Amit Nagard; Veerendra Prasade; Vinay
K.Chughf

43.  There should be studies which are done on
indian local population.
 Which include laypersons opinion and
orthodontist perception so that the esthetic
goals can be achieved which are socially and
scientifically acceptable.
 The studies should be done on longitudnal
basis most sudies are on cross sectional.