Excessive tooth display due to long face heightOr short upper lip
It is important to differentiate between the posed smile and the spontaneous smile. A posed smile is the voluntary expression made when introduced to someone, or when taking a passport photograph or orthodontic records A spontaneous smile, by contrast, is involuntary, natural, and driven by emotions. With all the muscles of facial expression involved, a spontaneous smile always has more lip elevation than a posed smile.16 Most studies refer to the posed smile because it is reproducible and can therefore be used as a reference position.
The full smile will not provide thesame information, partly because of high individual variability in upper lip movement from rest position to full smile.
1. Fig. 7 Young male patient with severe anterior crowding before (A,C) and after (B,D) orthodontic treatment. Noteundesirable esthetic result after overintrusion of maxillary incisors, and straight incisal curvature in relation to lower lip.2 Fig. 8 A. Esthetically undesirable long-term result in 30-year-old male 15 years after orthodontic treatment. Too much ofmandibular incisors and too little of maxillary incisors are displayed. B. Pre- and post-treatment records from 1981 and 1983,respectively, show maxillary incisors were intruded.
Fig. 9 Young male patient with deep overbite. A. Rest position and smile photographs indicate that maxillary incisors shouldnot be intruded. B. Mandibular incisor intrusion. C. Continuous base arch from double tubes on mandibular first molars.2 ) the stability of such correction is uncertain, especially with less-than-adequate growth during and after treatment.
Fig. 4 Importance of vertical dimension in beautiful smile. A. Adult female with uncompensated attrition. B. After restorativetreatment by Dr. M.R. Mack of Fort Lauderdale, FL. Note physiologic positioning with improved lip form, smile, and facialproportions (reprinted by permission [Ref. 8]). C. Female patient with little maxillary incisor display. D. Dramatic estheticimprovement after surgical inferior repositioning of maxilla and treatment by Dr. P.K. Turley of Los Angeles (reprinted bypermission [Ref. 13])
Fig. 3 A,B. Improvement in parallelism between maxillary incisor curve and lower lip contour with orthodontic treatment ofadult female. C,D. Similar improvement in another adult female with Class II, division 2 malocclusion and abraded incisors.Orthodontic treatment was supplemented with four porcelain laminate veneers (courtesy of Dr. S. Toreskog, Sweden).
Lip length should be roughly equal to the commissure height, which is the vertical distance between the commissure and a horizontal line from subnasale (Fig. 2A). A short lip length relative to commissure height results in an unesthetic, reverse-resting upper lip line23 (Fig. 2B).
It is interesting to note that
Excessive lip elevationshould therefore be recognized as a limiting factor(Fig. 3).
The full smile does not make good reference, partly because of the individua variation in lip mobility.30
42 yrsol female pt dislikes her ireggular teeth
Vertical crown lengthOrtho for mandibular incisor retraction
studied the changes in philtrumheight and commissure height in patients from age6 years to their 40s and the relationship to the smile.with the rate of philtrum lengtheninggreater than that of the commissures This wouldexplain the flattening of the “M” characteristics of thevermilion border of the upper lip in the youthful lip.
Smile analysis in vertical dimention:- factors to be considered when observed by orthodontist
The most important factor in smile Esthetic
is smile arc and only one that can change the
rating of smile from acceptable to
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
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.
Evaluating esthetics from the front in conversation
,facial expressions, and smilling.
Factors analyzed by sitting or standing in front of
Crown length of incisors
Incisal edge contours
Lombardi, R.E:- The pinciples of visual perception and their clinical
implications in denture prosthesis,J Prosth. Dent. 1973
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.
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
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.
Low smile line were predominant in Male
High smile line were predominant in Females
“Low smile” less than 75% of clinical crown
height of maxillary anterior teeth.
“Aveage Smile” 75-100% of maxillary anterior
“High smile” Exposing continuous band of
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
after overintrusion of
incisors, and straight
incisal curvature in
relation to lower lip
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
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
If the lower lip shows a marked
curvature in smiling, the
distoincisal edges of the
maxillary central incisors can be
ground slightly without affecting
It is particularly undesirable to
combine maxillary incisor
overintrusion with a straight
arrangement of these teeth.
Etiology for “gummy smile”
Biologic mechanism underlying the gingival smile
Anterior maxillary excess(2-3 mm) excess
Greater muscular capacity to raise the upper lip on
Supplemental associated factors including
Excessive overjet ,excessive interlabial gap at rest and
Variables not associated
Uppere lip length
Incisor crown height
Mandibular plane angle
Palatal palne angle
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
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).
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-
Peck, S.; Peck, L.; and Kataja, M.: The gingival smile
line, Angle Orthod. 62:91-100, 1992.
2) Lip elevation:
In smiling, the upper lip is elevated by about 80% of
its original length, displaying 10mm of the maxillary
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-
More elevation of lip and gingival
display on smile
Aggressive Intrusion of incisors- less
or no incisal display at rest./ older
Low lip line on smile
Extensive incisor extrusion
-an overbite with excessive
incisor display at rest.
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.
Short upper lip should not be treated by
It should also be noted that in maxillary
impaction, the upper lip shortens by as much
as 50% of the surgical skeletal intrusion.
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
Excessive gingival encroachment.
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.
5) Vertical dental height:-
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.
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
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
(2) Decrease in turgor (or tissue
(3) Decrease in incisor display at rest, And
(4) Decrease in gingival display during
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
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
The studies should be done on longitudnal
basis most sudies are on cross sectional.