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The smile arc – Are we looking for this?
i n d i a n j o u r n a l o f d e n t i s t r y 4 ( 2 0 1 3 ) 3 8 e4 0
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/ijd
Short Communication
The smile arc e Are we looking for this? Pooja Kapoor a,*, Harpreet Singh b, Daljit Kapoor c a
Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India b Reader, Department of Conservative Dentistry and Endodontics, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India c Prof and HOD, Dept of Periodontology, Gian Sagar Dental College & Hospital, Ram Nagar, Rajpura, India
article info Article history: Received 6 November 2012 Accepted 31 December 2012 Keywords: Smile arc Consonant Non-consonant
1.
Introduction
Even a glimpse of the patient’s smile gives the operator an idea that the smile he or she noticed is framed by what Lavater,1 more than 200 years ago, called the lip curtain and what is currently called the soft tissue drape. Smiles can be either posed or spontaneous. Peck and Peck2 classified smiles as stages I and II, and Ackerman et al3 designated the stage I smile as the posed smile (Fig. 1) and stage II as the unposed/spontaneous (Fig. 2) smile.
2.
consonant is used to describe this parallel relationship. A nonconsonant, or flat, smile arc is characterized by the maxillary incisal curvature being flatter than the curvature of the lower lip on smile4,5 as shown in Fig. 3. Some amount of gingival display is certainly acceptable, esthetic and youthful appearing, but a complete lack of gingival display is not as attractive.6,7 Males, show less of the maxillary incisors and more of the mandibular incisors at rest and on smile than do females.8 The transverse dimension of the smile was first introduced in the prosthodontic literature by Frush and Fisher9 referred to in terms of broadness to the smile/buccal corridors/negative space.
Definition
The smile arc can be 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 upon smile; the term
3.
Etiology
Bracket placement may unwittingly lead to superior repositioning of the incisal edges relative to the posterior buccal segment heights. With our emphasis on the goal of attaining
* Corresponding author. E-mail addresses: [email protected] (P. Kapoor), [email protected] (H. Singh), [email protected] (D. Kapoor). 0975-962X/$ e see front matter ª 2012 Indian Journal of Dentistry. All rights reserved. http://dx.doi.org/10.1016/j.ijd.2012.12.005
i n d i a n j o u r n a l o f d e n t i s t r y 4 ( 2 0 1 3 ) 3 8 e4 0
Fig. 1 e Posed smile.
canine guidance, it is possible that we are creating relative intrusion of the maxillary incisors while extruding the maxillary canines. In patients in whom excessive gingival display on smile is noted, maxillary intrusion arches could result in an unwanted flattening of the smile arc if the smile arc relationship has not been noted and evaluated.
39
Fig. 3 e Non-consonant smile.
It is also possible that growth in the brachyfacial pattern, patients might, theoretically, have a tendency for the anterior maxilla to lack the clockwise tilt needed for an ideal smile arc; in some cases it might even exhibit a counterclockwise tilt that results in a flat smile arc. Habits may also be an etiologic factor. For example, thumb sucking leading to reduction in anterior vertical dentoalveolar development.
4.
Orthodontic implications of the smile arc
The concept of the smile arc is not a new one, as the literature review has shown. Clearly, its impact on the final facial and smile appearance can be quite dramatic. In case evaluation, it is important to assess and visualize the incisor-smile arc relationships and place brackets so as to extrude the maxillary incisors in flat smiles and to maintain the smile arc where it is appropriate contrary to the set formula for bracket placement as is often taught in orthodontic programs with all patients routinely having their maxillary central incisors placed 0.5 mm below that of lateral incisors and 0.5 mm above that of canines. This demands that we rethink some of our orthodontic mechanics and concepts of treatment to consistently build this factor into our diagnostic, treatment planning, and treatment regimens.
Conflicts of interest Fig. 2 e Spontaneous smile.
All authors have none to declare.
40
i n d i a n j o u r n a l o f d e n t i s t r y 4 ( 2 0 1 3 ) 3 8 e4 0
references
1. Lavater JC. Essays on Physiognomy, vol. 1e3. London: J&J Robinson; 1789. 2. Peck S, Peck L. Selected aspects of the art and science of facial esthetics. Semin Orthod. 1995;1:105e126. 3. Ackerman J, Ackerman MB, Brensinger CM, Landis JR. A morphometric analysis of the posed smile. Clin Orthod Res. 1998;1:2e11. 4. Hulsey CM. An esthetic evaluation of toothelip relationships present in smile. Am J Orthod. 1970;57:132e144.
5. Rigsbee OH, Sperry TP, BeGole EA. The influence of facial animation in smile characteristics. Int J Adult Orthodon Orthognath Surg. 1988;3:233e239. 6. Sarver DM. Esthetic Orthodontics and Orthognathic Surgery. St Louis: Mosby; 1997. 7. Sarver DM, Proffit WR, Dickson S. The dynamics of the maxillary incisor and the upper lipda cross sectional study of resting and smile hard and soft tissue characteristics. World J Orthod; 2001. 8. Vig RG, Brundel GC. Kinetics of anterior tooth display. J Prosthet Dent. 1978;39:502e504. 9. Frush JO, Fisher RD. The dysesthetic interpretation of the dentogenic concept. J Prosthet Dent. 1958;8:558.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/ijd
Short Communication
The smile arc e Are we looking for this? Pooja Kapoor a,*, Harpreet Singh b, Daljit Kapoor c a
Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India b Reader, Department of Conservative Dentistry and Endodontics, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India c Prof and HOD, Dept of Periodontology, Gian Sagar Dental College & Hospital, Ram Nagar, Rajpura, India
article info Article history: Received 6 November 2012 Accepted 31 December 2012 Keywords: Smile arc Consonant Non-consonant
1.
Introduction
Even a glimpse of the patient’s smile gives the operator an idea that the smile he or she noticed is framed by what Lavater,1 more than 200 years ago, called the lip curtain and what is currently called the soft tissue drape. Smiles can be either posed or spontaneous. Peck and Peck2 classified smiles as stages I and II, and Ackerman et al3 designated the stage I smile as the posed smile (Fig. 1) and stage II as the unposed/spontaneous (Fig. 2) smile.
2.
consonant is used to describe this parallel relationship. A nonconsonant, or flat, smile arc is characterized by the maxillary incisal curvature being flatter than the curvature of the lower lip on smile4,5 as shown in Fig. 3. Some amount of gingival display is certainly acceptable, esthetic and youthful appearing, but a complete lack of gingival display is not as attractive.6,7 Males, show less of the maxillary incisors and more of the mandibular incisors at rest and on smile than do females.8 The transverse dimension of the smile was first introduced in the prosthodontic literature by Frush and Fisher9 referred to in terms of broadness to the smile/buccal corridors/negative space.
Definition
The smile arc can be 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 upon smile; the term
3.
Etiology
Bracket placement may unwittingly lead to superior repositioning of the incisal edges relative to the posterior buccal segment heights. With our emphasis on the goal of attaining
* Corresponding author. E-mail addresses: [email protected] (P. Kapoor), [email protected] (H. Singh), [email protected] (D. Kapoor). 0975-962X/$ e see front matter ª 2012 Indian Journal of Dentistry. All rights reserved. http://dx.doi.org/10.1016/j.ijd.2012.12.005
i n d i a n j o u r n a l o f d e n t i s t r y 4 ( 2 0 1 3 ) 3 8 e4 0
Fig. 1 e Posed smile.
canine guidance, it is possible that we are creating relative intrusion of the maxillary incisors while extruding the maxillary canines. In patients in whom excessive gingival display on smile is noted, maxillary intrusion arches could result in an unwanted flattening of the smile arc if the smile arc relationship has not been noted and evaluated.
39
Fig. 3 e Non-consonant smile.
It is also possible that growth in the brachyfacial pattern, patients might, theoretically, have a tendency for the anterior maxilla to lack the clockwise tilt needed for an ideal smile arc; in some cases it might even exhibit a counterclockwise tilt that results in a flat smile arc. Habits may also be an etiologic factor. For example, thumb sucking leading to reduction in anterior vertical dentoalveolar development.
4.
Orthodontic implications of the smile arc
The concept of the smile arc is not a new one, as the literature review has shown. Clearly, its impact on the final facial and smile appearance can be quite dramatic. In case evaluation, it is important to assess and visualize the incisor-smile arc relationships and place brackets so as to extrude the maxillary incisors in flat smiles and to maintain the smile arc where it is appropriate contrary to the set formula for bracket placement as is often taught in orthodontic programs with all patients routinely having their maxillary central incisors placed 0.5 mm below that of lateral incisors and 0.5 mm above that of canines. This demands that we rethink some of our orthodontic mechanics and concepts of treatment to consistently build this factor into our diagnostic, treatment planning, and treatment regimens.
Conflicts of interest Fig. 2 e Spontaneous smile.
All authors have none to declare.
40
i n d i a n j o u r n a l o f d e n t i s t r y 4 ( 2 0 1 3 ) 3 8 e4 0
references
1. Lavater JC. Essays on Physiognomy, vol. 1e3. London: J&J Robinson; 1789. 2. Peck S, Peck L. Selected aspects of the art and science of facial esthetics. Semin Orthod. 1995;1:105e126. 3. Ackerman J, Ackerman MB, Brensinger CM, Landis JR. A morphometric analysis of the posed smile. Clin Orthod Res. 1998;1:2e11. 4. Hulsey CM. An esthetic evaluation of toothelip relationships present in smile. Am J Orthod. 1970;57:132e144.
5. Rigsbee OH, Sperry TP, BeGole EA. The influence of facial animation in smile characteristics. Int J Adult Orthodon Orthognath Surg. 1988;3:233e239. 6. Sarver DM. Esthetic Orthodontics and Orthognathic Surgery. St Louis: Mosby; 1997. 7. Sarver DM, Proffit WR, Dickson S. The dynamics of the maxillary incisor and the upper lipda cross sectional study of resting and smile hard and soft tissue characteristics. World J Orthod; 2001. 8. Vig RG, Brundel GC. Kinetics of anterior tooth display. J Prosthet Dent. 1978;39:502e504. 9. Frush JO, Fisher RD. The dysesthetic interpretation of the dentogenic concept. J Prosthet Dent. 1958;8:558.