A checklist for what is an aesthetic smile. What makes a smile pretty?
What is esthetic?
• Age considerations- tooth display of upper and lower front teeth in repose:
o As we age, we will show less tooth structure in a rest position. For a young patient, it would be normal to observe 3-4mm of maxillary tooth structure at rest; in an older patient, it would be normal to observe 1mm or less of maxillary tooth structure at rest.
• Smile line-
o How much gingival tissue is observed during a smile? A full smile? Is symmetry observed?
• If asymmetry or an excessive amount of tissue is observed (>2mm), we must determine the cause.
• What is the lip length and mobility? Is the lip short or hypermobile?
• Are the teeth short anatomically or is their eruption pattern irregular?
• Is the growth pattern of the maxilla normal?
• Have changes in tooth position occurred due to wear and compensatory eruption?
o How much of the front teeth are observed in smile? Where does the gingival tissue relate to the teeth and smile?
• The full extent of the clinical crown of the upper front teeth in smile is desirable, along with the gingival tissues and lip draping symmetrically around these teeth.
o Where is the lower lip in relation to the upper teeth during smile?
o It is favorable when the upper teeth are observed to be cradled by the lower lip in a smile. If space exists between the teeth and lip, this space should be symmetric.
• Tooth length and proportion:
o Ideally, the two front teeth should be mirror images of each other, both in proportion and position, with the tissue architecture also appearing symmetric around these teeth.
Which of these variables can be changed?
• Changes due to aging can be altered with coordinated dental treatment and/or facial rejuvenation procedures.
• Smile line compromises due to a hypermobile lip may be treated with Botox injections to decrease the amount of tissue display, lip repositioning procedures, and/or behavior modification; whereas excessive gingival display due to a short lip does not have a predictable treatment approach at this time.
• Smile line compromises due to an altered eruption pattern, maxillary growth abnormalities, tooth size/proportional discrepancies, and compensatory changes due to wear may be treated with surgery, orthodontics, and restorations or a combination thereof depending on the diagnosis and various treatment considerations/treatment goals related to the structural, functional, and biological considerations of the patient.
Insurance considerations:
If excessive tissue is observed in animation and the etiology is an altered pattern of eruption and/or askeletal abnormality, insurance benefits may be applicable.
When to get seek consultation from a dentist and/or dental specialist:
• 7% of men and 14% of women have excessive gingival display in full animation.
• Treatment for the patient presenting with excessive gingival display is often interdisciplinary in nature because the etiology of this condition is often multifactorial.
• Correct diagnosis is paramount to developing the most favorable treatment sequence and decision path.
Jim Janakievski DDS, MSD, and Ashley Hoders DMD, MSD