International Journal of Science and Research (IJSR)

ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583

Smile Esthetics in Orthodontics - Review of

Literature
Jibin Joy1, Anilkumar2
1
Post Graduate Student, Department of Orthodontics, AJ Institute of Dental sciences, Mangalore, Karnataka, India
Email id: jibinjoythayyil[at]gmail.com
2
Reader, Department of Orthodontics, AJ Institute of Dental sciences, Mangalore, Karnataka, India

Abstract: The goal of modern orthodontics is to establish the best possible occlusal relationship between the maxillary and
mandibular dentition while maintaining or enhancing facial esthetics. Patient interest in improving facial esthetics is, in part,
responsible for the increased growth of the orthodontic practice.One of the most important facial features in predicting attractiveness is
smile.As the field and available technologies have continued to evolve, a gradual shift towards an increased emphasis on dental
esthetics in treatment planning has occurred, and now an esthetically pleasing smile is a key desired outcome of orthodontic treatment.
This review article emphysis on components of macro, micro esthetics components in orthodontics.

Keywords: Smile, Macroesthetics, Microesthetics

1. Introduction This review article emphasis on components of macro,

micro esthetics components in orthodontics
Beauty is in the mind of the beholder, each mind perceives a
different beauty” famously said by writer Margeret Wolfe Macroesthetics2, 3
Hungerford1. A beautiful smile is a gateway to the world1. The first step in evaluating facial proportions is to take a
The search for improved dentofacial esthetics persists in good look at the patient, examining him or her for
modern society Webster defines the smile as “a change of developmental characteristics and a general impression.
facial expression involving a brightening of the eyes, an
upward curving of the corners of the mouth with no sound A. Facial Proportion
and less muscular distortion of the features than in a laugh
that may express amusement, pleasure, tender affection, 1) Vertical Division
approval, restrained mirth, irony, derision or any of various The face is ideally divided into equal thirds:
other emotions.”  Upper: tragion too pharic
 Middle: opharic to subnasion
The goal of modern orthodontics is to establish the best  Lower: subnasion to gonion
possible occlusal relationship between the maxillary and
mandibular dentition while maintaining or enhancing facial The lower third of the face is further divided into two
esthetics. Patient interest in improving facial esthetics is, in unequal parts:
part, responsible for the increased growth of the orthodontic a) Subnasion to commissures of the lips is equal to one-
practice. Physical attractiveness is important social resource third or 18 to 20 mm from the subnasion to the upper lip.
in our culture. One of the most important facial features in b) Commissures of the lips to the gonion is equal to two-
predicting attractiveness is smile.This review article thirds or 36 to 40 mm from the lower lip to thegonion.
emphasis on components of macro, micro esthetics
components in orthodontics.

1.1 Classification of Smile Esthetics

Smile esthetics can broadly be classified into

 Macroesthetics
 Miniesthetics
 Microesthetics

 Macro-esthetics: Here patient profile, vertical proportion,

lip fullness, chin-nasal projections, facial widths are
considered.
 Mini-esthetics: Here assessments of excessive incisor
display on smile, smile symmetry, smile arc etc are Vertical facial proportions in the frontal and lateral views
considered. are best evaluated in the context of the facial thirds. Changes
 Micro-esthetics: This includes assessment of tooth in lower third of the face
proportions in height and width, gingival shape and
contour, connectors and embrasures tooth shade etc.
Volume 9 Issue 10, October 2020
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Paper ID: SR201005223148 DOI: 10.21275/SR201005223148 367
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583
Facial proportions and symmetry in the fro
Increase lower one-third height
a) Vertical maxillary excess
b) Class III malocclusion

Decreased lower one-third height

a) Vertical maxillary deficiencies
b) Mandibular retrusion bite

2) Horizontal Division
An ideally proportional can be divided into central, medial,
and lateral equal fifths. The separation of the eyes and the
width of the eyes, which should be equal, determine the
central and medial fifths. The nose and chin should be
centered within the central fifth, with the width of the nose
the same as or slightly wider than the central fifth. C) Facial Profile
This step requires placing the patient in the physiologic
natural head position, the head position the individual adopts
in the absence of other cues. This can be done with the
patient either sitting upright or standing, but not reclining in
a dental chair, and looking at the horizon or a distant object.
With the head in this position, note the relationship between
two lines, one dropped from the bridge of the nose to the
base of the upper lip, and a second one extending from that
point downward to the chin. These line segments should
form a nearly straight line. An angle between them indicates
either profile convexity (upper jaw prominent relative to
chin) or profile concavity (upper jaw behind chin).

A convex profile therefore indicates skeletal Class II jaw

relationship,

A concave profile indicates a skeletal Class III jaw

relationship.

B) Balance and Symmetry If the profile is approximately straight, it does not matter
Facial symmetry is defined by the facial midline. The whether it slopes either anteriorly (anterior divergence) or
midline runs through the center of the face and a philtrum of posteriorly (posterior divergence). Divergence of the face
the lip (cupid’s bow), dividing it into right and left sides. (the term was coined by the eminent orthodontist-
The more symmetric and identical the sides, the closer they anthropologist Milo Hellman) is influenced by the patient's
come to bilateral duplication or mirror images, the more racial and ethnic background.
inherently harmonious and beautiful the face (horizontal
symmetry). This is the opposite of the dental midline, which
seeks beauty through diversity (radiating symmetry).

2 (B) Micro esthetics obtained.

Subtleties in the proportions and shape of the teeth and
associated gingival contours have been emphasized in the 1) Width and Height of Crowns7, 8
burgeoning literature on "cosmetic dentistry" in recent years. There is a variation on dental dimensions that canbe
A similar evaluation is necessary in the development of an considered as normal or desirable, specially when
orthodontic problem list if an optimal esthetic result is to be considering that there are individuals with different facial

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Paper ID: SR201005223148 DOI: 10.21275/SR201005223148 368
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583
patterns. Some works show that the dimensions of anterior Proportions11,12. It is an excellent guideline in day to day
teeth can be defined within a limited range. The height of the practice in finishing cases when lateral incisors are
central incisor varies from 10.4 to 11.2 mm while its width disproportionately small or are missing.
varies from 8.73 to9.3 mm, and, usually, these references are
used in prosthetic reconstructions, when no other parameters
are available.

The most important is the correlation of these dimensions,

i.e., the dental proportions. Two proportions must be
considered: the relation between height and width of each
tooth, and the relation of height and width among the teeth.
In these cases, we will always be referring to the real
dimension of the teeth, i.e., the clinical crown dimensions of
anterior teeth.

A classic study that investigated dental proportions was that

by Gillen et al who found the following proportions of width 2) Connector area and Embrasures
among the upper anterior teeth: a) lateral incisors have 78% Morley & Eubank recently introduced the term connector
of the width of the central incisor (lateral incisor = central area as a useful tool and a visual goal to optimize smile
incisor x 0.78); b) lateral incisor has 87% of the width of the esthetics in dental patients. Connector areas are larger,
canine (lateral incisor = canine x 0.87); c) canine has 90% of broader areas than the contact points between teeth and can
the width of the central incisor (canine = central incisor x be defined as the zone in which two adjacent teeth appear to
0.90). touch. The most aesthetic relationship of connector area
between the maxillary anterior teeth is referredtoasthe50-40-
30rule. This rule defines the ideal connector area between the
two maxillary central incisors as 50% of their clinical crown
length, the ideal connector area between central and lateral is
40% of central incisor clinical crown length and between
lateral and canine it is 30% of clinical crown length of
central incisor.

Most authors define the height/width ratio of 0.80 for the

upper central incisor (which represents the key tooth to
esthetical composition of the smile) as standard to be used in
Prosthesis, Periodontics and Orthodontics. Therefore, on
establishing ideal widths, based on intact teeth, it is
suggested to use the proportion of 80 ± 5% to define the
ideal height, relating it to the facial pattern and to the The most important connector area is the one between two
individual’s natural dental proportions maxillary central incisors and should be maintained in
orthodontically treated cases.
The relation of proportion between the crown heights of
anterior teeth proposed by Gillen et al. is widely used. It The embrasures (the triangular spaces incisal & gingival to
suggests that the height of the clinical crown of the upper the contact) ideally are larger in size than the connectors and
lateral incisor must be 82% of the height of the crowns of the gingival embrasures are filled by the inter dental papillae.
the central incisor and canine. Therefore, canines and upper
central incisors would have the same anatomical crown Short inter dental papillae leave an open gingival embrasure
height. This study was used to justify the bonding of above the connectors called “black triangles” which give an
orthodontic brackets at the same height for canines and unesthetic appearance of the teeth during smile.
upper central incisors, during placement of the orthodontic
appliance. In adults, they arise due to loss of gingival tissue but when
crowded and rotated maxillary incisors are corrected
In an attractive smile, the apparent width of the lateral orthodontically, the connectors move incisal and black
incisor is 62% of the width of Central incisor, width of triangles may appear.
canine is 62% of the width of lateral incisor and1stpremolar
is 62% of the width of canine. The apparent width of Reshaping of teeth by orthodontic root paralleling and
maxillary anterior teeth on smile and their actual mesio- flattening of the mesial surfaces of the central incisors,
distal width, differ because of the curvature of dental arch. followed by space closure, will lengthen this contact area
This recurring 62% proportion also appears in other and move it apically toward the papilla and correct the black
relationship in human anatomy and is known as Golden triangles.
Volume 9 Issue 10, October 2020
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Paper ID: SR201005223148 DOI: 10.21275/SR201005223148 369
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583
3) Tooth shade and colour planning. In order to correctly diagnose and treat problems
Aging brings about changes in the tooth colour and shade. In associated with the smile, meticulous clinical observation
Young age teeth appear lighter and brighter. As age advances and record taking in the form of photos and videos is
the teeth appear darker & duller. This is due to the formation warranted, in various dimensions.
of secondary dentin as pulp chambers decrease in size and
thinning of enamel leads to decrease in its transparency and a In achieving smile aesthetics, dental elements, facial
greater contribution to darker shade. elements, gums related factors and physical elements should
be evaluated collectively. Treatments should be applied in a
A normal progression of shade changes from midline unified frame.
posteriorly is an important contributor to an attractive &
natural appearing smiles. The maxillary central incisors tend These concepts of smile esthetics are not new, but are too
to be the brightest in a smile, lateral incisor less bright often overlooked in orthodontic treatment planning. The
&canines the least, 1st and 2nd premolar are lighter and ideal components of the smile should be considered not as
brighter than the canines and closely match lateral incisors. rigid boundaries, but as artistic guidelines to help
orthodontists treat individual patients who are today, more
4) Gingival height, shape & contours than ever, highly aware of smile esthetics.
Proportional gingival height is necessary to produce a normal
&attractive dental appearance. The central incisor has the Although there are many things to consider when planning
highest gingival level, lateral incisor is 1.5 mm incisal and an esthetic case, many principles and guidelines exist that
canine is at the same level as central incisor. A difference of can help direct treatment. It is important to have a good
more than 2 mm in the gingival height is obvious. This is understanding of the overriding ethical principles as well as
important in finishing all orthodontic cases and also when the elements of macro, mini and micro-esthetics prior to
tooth substitutions are planned. Gingival shape refers to performing esthetic dentistry.
curvature of gingiva at the margin of the tooth.
A simple rule of thumb is to start with the large features and
work toward the smaller features. Look at the face, lips and
gingiva before individual tooth assessments are performed.
In other words, look at the forest before you look at the
trees. A sound knowledge of orthodontic mechanics and
growth changes as well as the principles of cosmetic
dentistry should help the orthodontist to truly live uptothe
epithet of Smile Architect.

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Licensed Under Creative Commons Attribution CC BY
Paper ID: SR201005223148 DOI: 10.21275/SR201005223148 370
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ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583
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Licensed Under Creative Commons Attribution CC BY
Paper ID: SR201005223148 DOI: 10.21275/SR201005223148 371