The 10 commandments of smiling

Modern society with an increasing concern for aesthetic dentistry, leads patients to look for the perfect smile for them by being inspired by beautiful faces and smiles. They seek treatments in the field of dental aesthetics with the aim of a dentofacial improvement and make their smile beautiful and unforgettable, they become more attractive and young with positive changes in psychological terms.

In order to find the ideal aesthetic results, we have to take into account certain aesthetic reference parameters. However, these clinical parameters are questionable since aesthetics is a subjective notion and tends to vary between individuals and cultures.

When constructing a smile, several parameters must be taken into account, such as: the arch of the smile, oral corridor, the amount of gingival exposure in the social smile, the presence of gingival and incisal asymmetry, the presence of anterosuperior diastemas, the presence of midline misalignment, changes in the axial inclination of the teeth, proportion, size and sometry of the maxillary incisors.

The purpose of this blog article is to make known “The 10 aesthetic commandments of the smile” which we must pay attention to in order to build a beautiful and harmonious smile. The aesthetic parameter that people talk about the most is the “color” parameter, that is, if a smile is white it is beautiful but if it is yellow then it is ugly. However, the parameter “color” is only one of them and so we often see white smiles but they are not pretty.

There are three levels of smile or patterns that we should evaluate:

The commissure smile, or so-called Mona Lisa smile, is commonly performed when people greet each other in unusual social contexts or places. In this smile the lip commissures are pulled upwards, showing or not the teeth.

– The second smile called the social smile that is often used in social media photos. In this smile pattern, the upper lip is pulled evenly upwards showing the upper teeth. It often helps patients with negative smile features (such as a gummy smile) to disguise these changes, thus limiting a correct smile analysis.

– The third smile pattern is known as the complex smile characterized by the movement of the lower lip and the wide movement of the upper lip. It is also known for the spontaneous (usually involuntary) smile that portrays the smile.

The third smile pattern is known as a complex smile21 characterized by lower lip movement and wide upper lip movement. It is also known as spontaneous (usually involuntary) smiling, which realistically portrays the patient’s real smile.

The ten commandments of an aesthetic smile here are as follows:

1. Smile arch – Incisors of the upper jaw in a vertical position;
2. Relationship and symmetry of the central incisors of the upper jaw;
3. Relationship of anterosuperior teeth;
4. Presence of the anterosuperior space;
5. Gingival drawing;
6. Levels of gingival exposure;
7. Oral Corridor;
8. Midline and tooth angulation;
9. Details – Tooth color and anatomical shape;
10. Lip volume.

Smile arch – Upper jaw incisors in an upright position

The aesthetic planning of the smile should start with the noblest area of it, that is, the upper central incisors. The first commandment states that the maxillary incisors should have a vertical position in the smile.

In the ideal smile arc, the edges of the upper incisors should follow the contour of the lower lip. This type of arch is the most aesthetic because it allows an arched contour of the incisal edges of the teeth in the aesthetic area, considered as the most important factor in dental aesthetics. Secondly, in terms of joviality. The more arched the incisal contour of the antero-superior teeth, the younger the smile becomes. While the flatter it is, the older it looks. In addition, the older the patients, the lower the exposure of the maxillary incisors and the greater the exposure of the mandibular incisors.

2nd Relationship and symmetry of the central incisors of the upper
jaw After the vertical positioning of the upper incisors, we will focus our attention on the relationship and symmetry of the central incisors of the upper jaw. The ideal ratio between width/height (H/W) and symmetry should be achieved.
The ratio between A/L should be between 75 and 85%, which are considered the most aesthetic. If the values tend to values of 75%, the central incisors will have a longer pattern, more accepted by the female sex, while the proportions of 85% are related to a pattern more accepted by the male sex. Depending on the patient, its length should vary between 9.5 mm and 11 mm.
3º The proportion between the anterior teeth (between maxillary canines)
This rule is based on the golden ratio initially proposed by Levin in 1978. According to this author, in frontal view, there is a proportion of tooth width seen and perspective, that is, the visible width of the lateral incisors should represent 62% of the width of the central incisors, while the width of the canines represents 62% of the width of the lateral incisors. However, the value of 62% is only an average value as it can be higher or lower depending on the type of patient and smile we are working with.
4th Presence of diastemas in the front teeth (spaces between the teeth)
Although the parameters of aesthetics are subjective from person to person, the presence of diastemas (spaces between the front teeth) should be closed with orthodontic treatment or using ceramics. The presence of these spaces makes the smile unaesthetic and not very credible as it is associated with children’s teeth.
5th Gingival
Design The architecture of the gingival tissue is a factor that must be taken into account in the aesthetic treatment. The canine gingival margin should coincide with the gingival margin of the central incisors, while the gingival margin of the lateral incisors should be slightly below this line.”
After determining the optimal gingival design, the clinician should focus on correcting gingival asymmetries, as long as they are evident in the patient’s smile. A gummy smile shows greater asymmetry and, for this reason, must be corrected. However, a small gum exposure when smiling does not require correction. Asymmetries that are visible when smiling and are close to the midline need greater correction, as they are more evident and make the smile asymmetrical.
6th Gingival
Exposure The evaluation of gingival and dental exposure in the aesthetic area is a preponderant factor to achieve an aesthetic smile. A greater exposure of the central incisors and little gingival exposure when smiling is an important aesthetic characteristic and associated with youthfulness.
The use of Botulinum Toxin (Botox®) is increasingly being applied to correct gummy smiles in order to reduce the lip strength of patients.
7th Oral
Corridor The oral corridor is the space between the tooth surfaces of the back teeth and the commissure of the lip. There are 3 types of oral corridors:
1 – wide, usually followed by a narrow maxillary arch;
2 – intermediate, where the maxillary arch has an intermediate
cross-sectional dimension 2 – narrow or non-existent, associated with a wide
dental arch There is no aesthetic consensus regarding oral corridors, as it varies from patient to patient, however there is a consensus that intermediate and non-existent oral corridors are the most aesthetic.
8th Midline and tooth
angulation Midline deviations of no more than 3-4 mm are not identified by ordinary people. This is explained because some famous artists and models exhibit deviations from the midline and are considered beauty models.
Although midline deviations are rarely detected, changes in the angulation of the teeth in the aesthetic zone are quite harmful to the harmony of the smile.
What is recommended by dentists dedicated to dental aesthetics is that deviations from the midline equal to or greater than 2.0 mm and any degree of change in the angulation of the teeth should be corrected.
9º Tooth color and anatomical
shape The principles that govern this commandment are usually carried out in the final phase of orthodontic treatment. The 9th commandment basically determines three procedures to assist aesthetic refinement: A) Teeth Whitening, B) Adjustment of contact points; C) adjustment of the incisal edges in the aesthetic zone.
10th Lip
Volume The last commandment is related to the frame of the smile, which is the lips. The current standard of a beautiful smile comprises not only a beautiful smile, but also voluminous lips and increased exposure to the incisor of the upper jaw, at rest or when speaking.
What commands the positioning of the lip is the positioning of the upper teeth, which plays a fundamental role in lip volume.
Dermatological procedures such as filling with hyaluronic acid produce satisfactory results with a more pleasant smile and greater lip volume