Abstract

Aim: The aim oI the study was to analyze the vertical allocation oI maxillary and mandibular anterior teeth under the diIIerent
categories oI smile.
Material and methods: 160 subjects were selected Irom the students and patients reporting to the out patient department oI A.B.
Shetty Memorial Institute oI Dental Sciences, Mangalore, Karnataka, India. They were segregated into 2 age categories compr-
ising oI 80 subjects below35 years and 80 subjects above 50 years oI age with an equal distribution oI males and Iemales in each
group. The percentages oI tooth display in papilla, gingiva, tooth and mucosa smiles in relation to age and gender was analyzed.
Results: Teeth occupy nearly 99-100 oI the vertical smile space in tooth smile and papilla smile. In gingiva smile it occupies
85-90 and in mucosa smile it occupies 78-80 oI the vertical smile space.
Conclusion: The study reveals that the vertical allocation oI the maxillary and mandibular anterior teeth can be used as a charac-
teristic Ieature oI smile to help achieve optimum result in esthetic oral rehabilitation.
Keywords: Smile; tooth display; anterior teeth; vertical smile space; maxillary teeth; mandibular teeth.
Vertical Space Allocation of Maxillary and Mandibular Anterior Teeth in Different Types of Smile
1 2 2 2
Nitin Shetty B , Manoj Shetty , N. Sridhar Shetty , Krishna Prasad D
Introduction maxillary and mandibular anterior teeth under the diIIerent
Esthetics has been the primary concern and a subject oI categories oI smile in diIIerent age groups and to reveal
interest to many investigators in prosthodontics. Restorat- possible diIIerences that can be applied to the construction
ion oI the anterior teeth is one oI the challenging tasks in oI an aesthetic smile when Iabricating prosthesis, to repl-
dentistry, as the prosthesis within the oral cavity are surrou- ace edentulous areas in this region.
nded by oriIice oI the mouth which consists oI the vermill-
ion border oI the upper and lower lip. The smile is one oI Material and methods
the most important components oI Iacial expression and is For the purpose oI analyzing the percentages oI tooth disp-
essential in expressing Iriendliness, agreement, and appre- lay in papilla, gingiva, tooth and mucosa smiles in relation
ciation. An attractive and pleasing smile involves the har- to age and gender, the study was conducted on 160 subje-
monious relationship between 3 primary components: lip cts, both male and Iemale, selected Irom the patients and
posture, the teeth and the associated gingival architecture. students oI the A.B. Shetty Memorial Institute oI Dental
Failure to expose the upper teeth gives a disastrous look to Sciences, Mangalore, Karnataka, India. The study was
the smile. Exposure oI the teeth alone produces a mediocre approved by the ethical committee oI the institution. The
smile. When teeth and gingiva are exposed a pleasant, nat- investigation was carried out in the Iollowing manner: sel-
ural, attractive smile is produced. ection oI the subjects, grouping oI the subjects based on
Smiles have been broadly classiIied based on 2 compone- their smile types, age and gender, obtaining the photogra-
nts, namely lip component and tooth and soIt tissue comp- phic data and analysis oI the amounts oI tooth display.
1
Selection of the study sample: All subjects were to have a onent as Iollows:
Iull complement oI sound teeth, with the exception oI the I. Based on lip components: Straight, concave and convex.
third molars. Subjects with malocclusion were not select- II. Based on tooth and soIt tissue components, 4 types oI
ed. Subjects undergoing and/or history oI orthodontic trea- smile are identiIied namely: Tooth smile, papilla smile,
tment were also not considered in the study. Subjects with gingiva smile and mucosa smile.
moderate to severe gingivitis were not included in the stu- The present study incorporates the second component (too-
dy. The teeth were to be Iree oI prosthodontic restoration oI th and soIt tissue) Irom the above classiIication Ior determ-
any Iorm; crowns, Iixed partial dentures, etc, in the area oI ining the vertical tooth allocation oI the maxillary and
the study. The soIt tissues were to be Iree Irom any Iorm oI mandibular anterior teeth in the existing smile space in
congenital deIects and cosmetic deIects. In Iemale sampl- each oI the smile types. The vertical allocation oI the max-
es, lips were to be devoid oI the application oI lipstick. Sub- illary and mandibular teeth is useIul in improving the esth-
jects having excessive Iacial hair that would obstruct the etic value oI restorations, establishing the length oI the
interpretation oI the borders oI the lips and commissures oI maxillary teeth and the interincisal distances between the
the mouth were not considered. anterior teeth. Thus, the vertical allocation oI the maxillary
For the purpose oI standardization all observations were and mandibular anterior teeth is a useIul characteristic
made by one observer only. All photographs were obtained Ieature oI smile to help achieve optimum result in esthetic
with a digital camera with the Iollowing calibrations: cam- oral rehabilitation.
era resolution: eIIective 6.0 Megapixels; lens: Carl Zeiss This study was done to analyze the vertical allocation oI
1 2
Department oI Prosthodontics, D.Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, Department oI Prosthodontics, A.B. Shetty
Memorial Institute oI Dental Sciences, Mangalore, Karnataka, India. Correspondence: Dr. Nitin Shetty, email: drnitinshettyyahoo.co.in
Indian J Stomatol 2013;4(1):26-30
26
Vario-Tessar 2, 8-5, 2 with 3x optical zoom. All photogra- assessment oI the amount oI tooth display (P2).
phs were analyzed on a TFT monitor calibrated with the Analysis of the Photographic data: All analysis was
Iollowing settings: screen resolution: 1024x768 at 62dpi; made on digital photography soItware (Adobe Photoshop
reIresh rate: 60Hz; phosphors: HDTV (CCIR 709); gam- CS3, Adobe Systems Inc). The Irontal view oI the smile
ma: 2.20; hardware white point: 6500K (daylight). No was aligned along a common horizontal axis obtained usi-
analysis was made on printed photographs so as to mini- ng the soItware. All measurements were made in millimet-
mize distortion oI the data during the printing process. ers. All measurements were made digitally using the 'Mea-
The subjects were segregated into 2 age categories compr- sure Tool oI the digital photography soItware. For the Iro-
ising oI 80 subjects below 35 years and 80 subjects above ntal view photograph oI the smile, the Iollowing measure-
50 years oI age with an equal distribution oI males and Iem- ments were made:
ales in each group. The male and Iemale subjects were Iur- Measurement of Vertical Smile Space (Figure 5)
ther grouped based on the type oI smile: tooth smile (Figure Tooth Smile/Papilla Smile: The length along the perpend-
1), papilla smile (Figure 2), gingival smile (Figure 3), and icular line to the horizontal reIerence plane drawn through
mucosa smile (Figure 4). the mid point oI the mesio-distal width oI the central, lat-
Obtaining the Photographic Data: Clinical documenta- eral incisors and canine connecting both the vermilion bor-
tion oI the data was made with the Iollowing sets oI photo- der oI the upper and lower lips.
graphs Ior each subject: Gingiva Smile/Mucosa Smile: The length along the perp-
1. Frontal mid-Iace view with the subject smiling, Ior endicular line to the horizontal reIerence plane drawn Irom
classiIication oI the smile (P1). the vermillion border oI the upper lip to the vermillion bor-
2. A Irontal view with the subject smiling Ior the der oI the lower lip with the Iollowing reIerence points:
Indian J Stomatol 2013;4(1):26-30
Figure 1: Tooth smile
Figure 2: Papilla smile
Figure 3: Gingiva smile
Figure 4: Mucosa smile
Figure 5: Measurement oI Vertical Smile Space Figure 6: Measurement oI the vertical allocation oI tooth
27

Table 1: Mean percentage oI tooth display oI the anterior teeth in tooth, papilla, gingiva and mucosa smiles in the 2 age groups
1. At zenith oI 11 and 21 tral and lateral incisors oI the maxillary teeth to the zenith
2. At zenith oI 12 and 22 oI the same tooth. The distance Irom the cusp tip oI canines
3. At zenith oI 13 and 23 oI the maxillary teeth to the zenith oI the same tooth.
Measurements made in Tooth smile/Papilla smile: Mandibular: The distance Irom the incisal edges oI the
Maxillary: The distance Irom the incisal edges oI the cent- central and lateral incisors oI the maxillary teeth to the ver-
ral and lateral incisors oI the maxillary teeth to the vermill- million border oI the lower lip. The distance Irom the cusp
ion border oI the upper lip. The distance Irom the cusp tip tip oI canines oI the maxillary teeth to the vermillion border
oI canines oI the maxillary teeth to the vermillion border oI oI the lower lip.
the upper lip. The Iollowing parameters were considered Ior the mandi-
Mandibular: The distance Irom the incisal edges oI the bular teeth Ior the above mentioned smiles:
central and lateral incisors oI the maxillary teeth to the ver- 1. II the incisal edges oI the central and lateral incisors and
million border oI the lower lip. The distance Irom the cusp the cusp tip oI the canines oI the mandibular teeth are
tip oI canines oI the maxillary teeth to the vermillion border seen, the Iollowing recordings were made:
oI the lower lip. - The distance Irom the incisal edges oI the central and lat-
Measurements made in Gingiva smile/Mucosa smile: eral incisors oI the mandibular teeth to the vermillion
(Figure 6) border oI the lower lip.
Maxillary: The distance Irom the incisal edges oI the cen- - The distance Irom the cusp tip oI canines oI the mandi-
Indian J Stomatol 2013;4(1):26-30

Below 35 years
Maxillary Teeth Mandibular Teeth
Central
incisors
()
Lateral
incisors
()
Canine
()
Central
incisors
()
Lateral
incisors
()
Canine
()
Tooth
Smile
Males 86-87 89- 90 91 12 8 7
Females 99 98 99 0 0 0
Papilla
Smile
Males 96-97 95- 96 94-97 2- 3 1-3 1- 4
Females 86-89 86- 89 93 9-12 9-12 5
Gingiva
Smile
Males 78-79 73-74 75- 76 11 12-13 12-13
Females 83 78- 79 82- 83 0.8 0- 0.4 0
Mucosa
Smile
Males 77 73-74 77-79 3- 4 3- 4 1- 4
Females 72 69- 70 71- 72 3 3 1
Above 50 years
Tooth
Smile
Males 69 66- 67 72 29 31 26
Females 69 68 73 10 10- 11 9
Papilla
Smile
Males 66- 67 64 70 32 34 28
Females 73 71- 72 76 25- 26 26 22
Gingiva
Smile
Males 66 63 68- 69 23 24 20-21
Females 64-65 62-63 67- 68 25 26 23
Mucosa
Smile
Males 65-66 63 66-67 15 16 13-14
Females 65 62 66-65 14 16 14

28

bular teeth to the vermillion border oI the lower lip. buccal mucosa.
2. II the incisal edges oI the central and lateral incisors and Decrease in the exposure oI maxillary anterior teeth with
the cusp tip oI the canines and the zenith are seen, the age has been reported by many authors. While the maxill-
Iollowing recordings were made: ary anterior tooth display showed steady decrease with agi-
- The distance Irom the incisal edges oI the central and lat- ng, the mandibular teeth showed a corresponding incre-
2
eral incisors oI the mandibular teeth to the zenith oI the ase. The Iinding oI the present study is in agreement with
same tooth. the aIorementioned study. The increased visibility oI man-
- The distance Irom the cusp tip oI canines oI the mandi- dibular teeth with age is because the total muscle mass in
bular teeth to the zenith oI the same tooth. the body contains 50 oI body water. With aging the mus-
3. II the incisal edges oI the maxillary incisors and the cusp cle mass shrinks and the muscle becomes thin and stringy
tips oI the maxillary canine are covered by the vermill- due to water loss. Muscle strength diminishes and the Iacial
ion border oI the lower lip, then the measurement is contours collapse. This leads to sagging oI the lower lip
3
made Irom the vermillion border oI the lower lip to the and dropping oI the upper lip. In addition to the loss oI ela-
upper respective points Ior diIIerent smiles as mentio- sticity and tooth support oI the upper lip which accounts Ior
ned earlier. less maxillary and more mandibular incisor display, attrit-
The data obtained was then expressed as a percentage oI ion is another Iactor in the aged that contributes to a reduc-
4
the total amount oI space occupied in the smile.
ed tooth display.
The Iindings oI the present study inIerred that the mandi-
Results
bular anterior teeth play an important role in all types oI
The results are shown in Table 1. Teeth occupies nearly 99-
smile. This is in concurrence with another study which rep-
100 oI the vertical smile space in tooth smile and papilla
orted that the mandibular anterior teeth do play an import-
smile where as in gingiva smile it occupies 85-90 and in
ant role in patient appearance. These teeth are displayed in
mucosa smile it occupies 78-80 oI the vertical smile spa-
smile. It also stated that a positive relationship exists betw-
5
ce. In tooth, papilla and gingiva smiles among Iemales, the
een the exposure oI mandibular anterior teeth and age. The
percentage oI maxillary anterior teeth visibility was more
Iinding oI the present study is in agreement with the
and the mandibular tooth visibility was less in the age gro-
aIorementioned study that the mandibular teeth do play an
up below35 years when compared to above 50 years in the
important role in smile.
allocated vertical smile space. In mucosa smile among
Astudy inIerred that in tooth smile only the labial surIaces
1
Iemales, the percentage oI mandibular anterior tooth visib-
oI the maxillary anterior teeth are exposed. However, in
ility was more in the age group above 50 years when com-
the present study it was noted that in tooth smile among
pared to below35 years, but there was no signiIicant diIIer-
males, not only the labial surIaces oI the maxillary anterior
ence in the maxillary anterior tooth visibility between the 2
teeth but also the labial surIace oI the mandibular teeth is
age groups.
seen. The result oI the present study showed maximum
In tooth, papilla and mucosa smiles among males, the per-
exposure oI the maxillary canines in most oI the smiles. It
centage oI maxillary anterior teeth visibility was more and
can be related to the Iact that the centre oI the lip is oIten
the mandibular tooth visibility was less in the age group
inIerior to the lateral aspects during smile because oI the
below35 years when compared to above 50 years in the all-
thickness and the shape oI the philtrum, which is oIten
6
ocated vertical smile space. In gingiva smile among males,
reIerred to as having a Cupid's bow shape. Hence, the
there was signiIicant diIIerence in the visibility oI the max-
result oI this study is in accordance with the aIoremention-
illary and mandibular central incisors between the 2 gro-
ed study. The contour oI the gingival scallop is also impo-
ups.
rtant and is a Iunction oI the emergence proIile, the cemen-
toenamel junction, and the Iacial contour oI the tooth. The
Discussion
location oI the gingival margin has been discussed and can
Preplanning the esthetic design or tooth space allocation oI
be variable by design. Ensuring an optimal amount oI
the proposed prosthesis is one oI the most important steps
gingival display, a level gingival plane, and healthy comp-
in the procedure which is most commonly ignored. All dec-
lete papillae presents the teeth in their most Ilattering ma-
7
isions made with regard to tooth selection and placement
nner.
should be made on the basis oI the Ieatures oI smile space
Astudy concluded that individual perception oI smile esth-
and the evaluation oI the patient as a being. Regardless oI
etics is inIluenced by national/cultural background and lay
judgment and technical ability, dentists can place the artiI-
persons can reliably identiIy the ideal smile and the range
8 icial teeth more precisely iI clues are available as to Iormer
oI acceptability when using a lower Iace view oI models.
natural tooth position. The proposed classiIication oI smile
Smile rejuvenation can positively impact a patient's selI-
based on tooth and soIt tissue components is as Iollows:
esteem and emotional health through an improved appear-
1. Tooth smile displays the labial surIace oI the maxillary 9
ance. Some studies have been done to display the number
teeth only.
oI teeth in smile but there is no relevance on the extent oI
2. Papilla smile displays the labial surIace oI the teeth and 10-15
each tooth seen.
the interdental papilla.
The results oI this study would aid in smile designing, to
3. Gingiva smile displays the labial surIace oI the teeth,
determine the position oI the marginal gingiva during hard
interdental papilla and marginal gingiva.
and soIt tissue surgeries, where the tooth and the gingiva
4. Mucosa smile displays the labial surIace oI the teeth,
displayed plays a crucial role in obtaining an esthetic smile.
interdental papilla, marginal gingiva and the labial and
In edentulous patients, it would aid in determining the len-
Indian J Stomatol 2013;4(1):26-30
29
gth oI the anterior teeth depending upon the type oI smile to The vertical allocation oI the maxillary and mandibular
be designed Ior the patient. The results oI this should not be anterior teeth is useIul in improving the esthetic value oI
interpreted as rules, but should be considered as biologic restorations and in establishing the length oI maxillary
guidelines. It is impossible to Iormulate an overall rigid teeth and the mandibular anterior teeth.
rule Ior the visual characteristics oI an attractive smile.
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