title: Hard- and soft-tissue contributions to the esthetics of the posed smile in growing patients seeking orthodontic treatment.
abstract: BACKGROUND
  The purpose of this investigation was to broaden the understanding of how various skeletal, dental, and soft-tissue relationships are related to the esthetics of the smile in patients with malocclusions before orthodontic treatment.
  
  
  METHODS
  Images of the posed smile were captured from digital video clips of 60 growing patients (33 girls, 27 boys) seeking orthodontic treatment; they were judged by panels of laypersons and orthodontists. Discriminant analysis identified determinants of the "pleasing smile" from the results of a visual analog scale. Quantitative measurements of the soft and hard tissues were made by using the smile images, cephalometric radiographs, and study models. The esthetics of the smile were correlated with specific skeletal, dental, and soft-tissue structures in the anteroposterior, vertical, and transverse dimensions (Pearson test on non-topographic correlations).
  
  
  RESULTS
  The esthetic smile judgments of orthodontists agreed with those of laypersons (r >0.93). The vertical thicknesses of the lips were the most significant component of a pleasant smile, for both the orthodontists (upper lip) and laypersons (lower lip) (discriminant power: 75%). The vertical thickness of the upper lip had a significant positive correlation with the position of the maxillary incisor.
  
  
  CONCLUSIONS
  Vertical lip thickness proved to be the most influential variable in smile esthetics. The significant relationship of incisor protrusion with the vertical thickness of the vermilion border of the upper lip must be considered when planning orthodontic treatment.
authors.affiliation: Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA. lmcnam@umich.edu
authors.forename: Laurie
authors.initials: L
authors.lastname: McNamara
authors.forename: James A
authors.initials: JA
authors.lastname: McNamara
authors.forename: Marc B
authors.initials: MB
authors.lastname: Ackerman
authors.forename: Tiziano
authors.initials: T
authors.lastname: Baccetti
mesh_terms: D000293:Adolescent; D002508:Cephalometry; D002610:Cheek / Q000502:physiology; D002648:Child; D003481:Cuspid / Q000033:anatomy & histology / Q000502:physiology; D016002:Discriminant Analysis; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007180:Incisor / Q000033:anatomy & histology / Q000502:physiology; D008046:Lip / Q000502:physiology; D008297:Male; D008310:Malocclusion / Q000503:physiopathology*; D012904:Smiling / Q000502:physiology*; D018709:Statistics, Nonparametric; D014716:Vertical Dimension; D014741:Video Recording