Evaluating and Establishing Ideal Smile Esthetics : Beauty is More than Skin Deep
Assessment of Smile Esthetics

Assessment of smile esthetics begins with an understanding of what defines an esthetic smile. While Margaret Wolfe Hungerford first stated that “beauty is in eye of the beholder”, as dental healthcare professionals, we also need to identify standards of optimal esthetics so that we can aim to create the best results for our patients. During the assessment process, dental healthcare providers must critically assess individual smile components and their relationships to each other and the overall facial structure. Both static and dynamic evaluations should be utilized to allow for capturing all aspects of ideal smile esthetics. Full facial photographs at rest, in a social or posed smile, and in full smile in a 1:1 image ratio can allow for measurements of dental midline alignment, lip length, lip mobility, gingival display, buccal corridor fill, smile cant, and consonant/non-consonant smile arc. Intraoral measurements of tooth length and width:length ratios can be made with a periodontal probe and/or a Chu esthetic gauge (Hu-Friedy, Cary, NC). Further, gingival position (gingival recession/overgrowth), gingival color/contour, clinical signs/symptoms of inflammation, and Jemt classification of papillary fill should also be recorded during a comprehensive intraoral examination. Lastly, utilization of videography to assess lip movements during smiling and speech may be helpful in patients with high esthetic concerns.

Emerging technologies to improve esthetic assessment, including machine learning and three-dimensional stereophotogrammetry, have been proposed to improve esthetic assessment and eliminate perception bias.^59-61 While these technologies are not widely used currently, their incorporation into future research may be critical to develop these novel tools.