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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??The gingival aesthetics is an important part of the smile aesthetics??as well as a great factor influencing the beauty of the lower 1/3 face. Such problems as the gingivitis??periodontitis??gingival hypertrophy and lack of gingival papilla will change the color??morphology??texture and quantity of gingiva. They also hurt the harmonious relationship between gingiva and the tissue around it. Consequently??those problems exert negative impacts on the gingival aesthetics and damage the beauty of smile. As for the treatment plan??different problems and individuals require personalized treatment plans. In this paper??the authors will make an introduction to the common problems affecting the gingival aesthetics and their treatment principles.     

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提要：上颌前牙区美学修复是口腔医学的重要组成部分。多数学者一直致力于牙体排列、大小、颜色等方面的研究,而对于牙龈美学的研究相对较少。牙龈美学作为微笑美学不可或缺的部分,也越来越受到医生和患者的重视。如何构建更为协调、美观的微笑,这使得学者们不得不共同关注牙齿、牙龈、口唇三者之间的美学参数。本文就上颌前牙区牙龈美学相关参数做一综述。     

Morphological features of smile attractiveness and related factors influence perception and gingival aesthetic parameters

IntroductionIn addition to understanding the basic standards of a smile and patient's opinion, dentists should take into account smile aesthetics, an essential factor for optimal outcomes. This study aimed to evaluate the factors that affect the perception of an aesthetic smile and determine its morphological characteristics and measure the gingival aesthetic parameters.MethodsIn all, 200 Vietnamese aged 18-35 years were recruited to have their spontaneous smiles captured. These smile images were assessed by 50 laypersons and 50 dentists using a visual analogue scale measurement. The images were analysed to evaluate perceptions of evaluators, determine smile attractiveness, and measure gingival aesthetics.ResultsThe difference in the judgements of laypersons and dentists, males and females, and laypersons aged 18-25 and 26-35 years were nonsignificant. High or average anterior smile line, parallel smile arc, upward upper lip curvature, second premolars as the posterior-most teeth displayed, smile index of 5.23-5.63, and dynamic smile symmetry of 1 were scored highly on smile attractiveness. The following maxillary gingival aesthetic parameters were preferred: gingival zenith (GZ) of the canine 0.72-0.75 mm apical to the GZ of the central incisor; GZ of the lateral incisor 0.66 mm coronal to the gingival line; gingival line angle of ～87°; for the central incisor, lateral incisor, and canines, distance from the GZ to the long axis of 1, 0.4, and 0 mm, respectively; interdental papilla height of 4.25, 3.60, and 3.85 mm, respectively; ratio of the distance from the GZ and the interdental papilla tip to the incisal edge of ～1.74-1.77 mm.ConclusionsFactors including profession, gender, and age of evaluators had almost no impact on their perception of aesthetics. Smile attractiveness characteristics and gingival aesthetic parameters have clinical applicability for patient care.     

牙列中线偏斜的审美研究进展

面部对称是容貌美观的重要影响因素。在微笑美学的研究中,牙列中线与面中线的一致性与微笑审美评价结果密切相关,直接影响患者微笑的美观程度。由于牙列中线偏斜在普通人群中发生率较高,因此,牙列中线与面中线不一致常作为患者就诊的主诉,同时也是正畸医生在制定治疗计划时需要特殊考虑的一个临床诊断指标和矫治目标。本文将对牙列中线偏斜的流行病学情况、病因学分类、诊断与治疗方法及其对微笑审美的影响作一综述,以期指导临床操作。     

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正畸治疗要为患者塑造美丽的笑容,对于微笑的评估和设计是很重要的,但是在临床检查中正畸医生经常忽略了微笑分析。本文综述了影响微笑美的主要因素,探讨了其在正畸诊断、矫治设计及治疗中的重要性。     

The unique contribution of elements of smile aesthetics to psychosocial well‐being

Pleasant smile aesthetics is an important contributory factor to psychosocial well‐being. The aim of this study was to determine the psychosocial influence of smile aesthetics. The study was cross‐sectional on a convenient sample that included patients, pupils, students and faculty staff. A total of 155 subjects (36% male) aged 12–39 (mean age 21, interquartile range 19–23) were included. Occlusal characteristics were recorded by the Index of Complexity, Outcome and Need, and smiling frontal view photographs were obtained. Fourteen variables were measured using photogrammetric analysis: smile width, visibility of buccal corridors, maximum teeth exposure, total gingival display, lip thickness, degree of occlusal cant and deviation from golden proportion of the teeth in maxillary intercanine sector. Psychometric instruments included the Psychosocial Impact of Dental Aesthetics Questionnaire and the Rosenberg Self‐Esteem Scale. Statistical analysis comprised multiple linear regressions. Malocclusion severity is the most important predictor of psychosocial influence of smile aesthetics and self‐esteem, the unique contribution of which accounts for a total of 4–27% of variability. Female gender is associated with higher psychological influence of dental aesthetics while male gender and older age with self‐esteem. Malocclusions have higher psychosocial impact than parameters of mini‐ and micro‐aesthetics of smile related to visibility of buccal corridors, amount of teeth exposure, gingival display, lip thickness, presence of occlusal cant and deviation from golden proportion of the teeth. It appears that people are not as focused on details of their smile as they are on distinctive malposition of teeth.     

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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.     

Perceptions of Jordanian laypersons and dental professionals to altered smile aesthetics

The purposes of this study were to rate the attractiveness of different smile variables, to compare the perception of Jordanian laypeople, general practitioners, and orthodontists to altered smile aesthetics, and to identify the threshold where different variables begin to impair smile aesthetics. A smiling photograph of a female dental student was selected and digitally manipulated to create changes in buccal corridor space (BCS), the amount of gingival display, and the midline diastema. These altered images were rated by three groups of Jordanians: 200 laypeople (100 females and 100 males), 200 general practitioners (100 females and 100 males), and 160 orthodontists (40 females and 120 males). Smile aesthetics scores were calculated and comparisons between groups were performed using the univariate general linear model. The results showed that profession and gender affected BCS and midline diastema attractiveness ratings (P<0.001). Wide BCSs, a gingival display of more than 2 mm, and the presence of a midline diastema of any size were rated as unattractive by all groups.     

Effect of extraction of first four premolars on smile aesthetics

The objective of the present study was to assess smile aesthetics after orthodontic treatment in subjects with and without the extraction of four first premolars. Post-treatment coloured frontal photographs (4 × 6 inches) of 60 Pakistani subjects, 21 males and 39 females, aged between 15 and 30 years were assessed by one examiner. For 50 per cent (n = 30) of the patients, treatment included the extraction of four first premolars, whereas the other half were treated without extractions. Smile aesthetics were evaluated by a panel of 10 laypersons, five males and five females, aged between 20 and 30 years. Smile aesthetic parameters were measured using seven variables, and the ratios were calculated. An independent sample t-test was used to assess smile aesthetics. All seven variables namely smile width, smile height, visible dentition width, maxillary intercanine width, visible maxillary first molars, visible mandibular teeth, visible maxillary gingival margin, and the ratios between the above mentioned variables showed no detrimental effects following extraction of four first premolars on smile aesthetics.     

Smile aesthetics as perceived by dental students: a cross-sectional study

Background

An aesthetic smile has a number of components, and people generally equate a good dental appearance with success in many areas of life. The features that determine smile aesthetics could provide significant insights into post-treatment satisfaction and may predict a patient’s objectives when undergoing treatment. The purpose of this study was to evaluate how smile characteristics are perceived by dental students.

Methods

The study was performed in 431 local and international dental students at the Lithuanian University of Health Sciences. The study data were collected using a three-part questionnaire. The first part of the questionnaire included sociodemographic items, i.e., student gender, age, nationality, and years of study; the second consisted of questions about facial aesthetic features; and the third elicited responses to photographs of 17 different smiles retrieved from the Lithuanian University of Health Sciences Clinic of Orthodontics database. The smile aesthetics were evaluated according to their dentolabial, dentogingival, dental, and dental arch characteristics using a 5-point numeric rating scale (1, best; 5, worst). The data were analysed using the Pearson’s chi-square and Mann-Whitney U tests.

Results

The study included 336 local and 95 international dental students (132 men [30.6%], 299 women [69.4%]). Significantly more women than men focused on a person’s teeth when communicating (41.5% vs.32.6%, p?<?0.005). Women were more critical than men when evaluating gingival smile, the ‘golden proportion’, occlusal cant, and dental crowding. The most unfavourable smile characteristics were identified in the dental analysis category, with hypodontia ranked as the worst smile feature (mean numeric rating scale score 4.71).

Conclusion

Among dental students, the most distracting characteristics of a smile when determining its attractiveness were hypodontia, gingival smile, a reversed curvature of the occlusal plane, and dental crowding.

     

Multidisciplinary management of anterior diastemata: clinical procedures.

Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance the aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology and treatment planning.     

Functional and esthetic rehabilitation with in-ceram alumina and zirconia system: a multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In- Ceram single crowns. CLINICAL SIGNIFICANCE: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.     

Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination

This study was designed to determine the esthetic perception of men and women to variations in upper and lower gingival display at smile and speech and to incisal plane tilting. Composed photographs of smile and speech with varying amounts of gingival exposure of the upper and lower teeth and gingiva at smile and at speech and with varying degrees of incisal plane tilting were rated for attractiveness by two groups of lay people. The images were presented as male or female images. A total of 300 questionnaires, including 7500 images, were evaluated by 100 subjects. The results showed that images were scored as less attractive as the amount of upper and lower gingival display was increased during smile and speech. The amount of gingival exposure graded in the esthetic range was up to one mm for the upper incisors and zero mm for the lower incisors. Incisal plane tilting was graded as unesthetic when above two degrees of deviation from the horizontal. Male and female evaluators scored images differently with upper gingival exposure. Female evaluators gave statistically significant higher scores than male evaluators to upper gingival exposure images at smile and speech of both males and females, suggesting that females are more tolerant of upper gingival exposure. Images were scored differently when presented as male or female images. Female images were scored lower by both male and female evaluators, suggesting that additional efforts should be taken in female patients to achieve an esthetic result.     

Smile design

Many scientific and artistic principles considered collectively are useful in creating a beautiful smile. The evaluation and analysis of the face, lips, gingival tissues and teeth are all considered in this process. Recognizing the ideal as a goal provides a direction for diagnosis and treatment planning for smile rejuvenation. This article focuses on the dental and dental-facial composition involved in smile design. Basic facial esthetics are reviewed as a guideline for facial analysis.     

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.     

Lasers in aesthetic dentistry

This article focuses on lasers and aesthetic dentistry and their unique parallel in history from their early development to their present day usage and application. The demand for aesthetic dentistry has had a major impact not only on treatment planning but also on the choice of materials, techniques, and equipment. It is this demand that has married the use of lasers with aesthetic dentistry. A short literature review on the five basic laser types precedes the basic premise of smile design and its critical importance in attaining the desirable aesthetic end result. A short review on biologic width and biologic zone reinforces their importance when manipulating gingival tissue. Four case reports highlight the use of diode, erbium, and carbon dioxide lasers. The end results show the power of proper treatment planning and the use of a smile design guide when using these instruments and confirm a conservative, aesthetic treatment without compromising the health and function of the patients.     

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。     

正畸患者对露龈微笑的审美认知

目的：调查成人正畸患者对露龈微笑的审美认知，并探讨医师的专业知识对正畸患者审美认知的影响。方法建立露龈微笑模型，采用电子调查问卷对正畸患者进行问卷调查。结果调查样本共计99例，露龈微笑的审美理想值-1.0 mm，可接受程度为2.0 mm。经医师对患者进行审美干预后可接受程度为2.5 mm。结论露龈微笑的理想值和可接受度可以为临床治疗提供一定的量化标准，正畸患者接受正畸专业知识干预后，对微笑显露牙龈的可接受程度增大。     

青少年姿势位微笑与头影测量指标的相关分析

目的对比普通人与正畸医生对姿势位微笑的审美观异同，研究面部软硬组织与姿势位微笑的关系。方法用Canon EOS 50D数码照相机拍摄60名（男30名，女30名）个别正常胎的青少年面部正面照片数张，由正畸医生和普通人用视觉模拟尺度（VAS）评判美的微笑，并测量头颅侧位片的相关数据，最后经SPSS13．0统计软件进行统计学分析。结果1）正畸医生与普通人的微笑主观评分差异有统计学意义；2）正畸医生对姿势位微笑的主观评分高低与SNA角和SNB角呈负相关，与U1-L1角呈正相关；普通人对姿势位微笑的主观评分高低与MP角、PP—MP角和颏唇沟角呈正相关。结论1）正畸医生与普通人对姿势位微笑的审美观有差异，在正畸临床诊治患者的过程中，医患双方需加强沟通；2）正畸医生在诊治患者的过程中应关注患者面部侧貌的凸度及其面下1／3的协调美观。