The lower bow-shaped curve as a novel reference frame to determine the lateral limit of the maxillary anterior arch for smile esthetics.

ABSTRACT

INTRODUCTION: Smile analysis in horizontally angled views is indispensable for esthetic assessment and could reveal teeth-to-lip disharmony, which might escape discovery in the frontal and profile views. However, evidence is lacking on where the anterior teeth should be positioned for esthetics in angled smiles. METHODS: Based on 3-dimensional facial image processing and geometric analysis, the lip edges were projected to the horizontal plane, and the horizontal teeth-to-lip relation was simplified and represented by the distances from dental landmarks to lower bow-shaped curves (LBSC), with the distance from facial-axis (FA) point of the canine to LBSC (FA-tangent line [TL] distance) identified as the key parameter. Using photographic modification and esthetic assessment, the effect of FA-TL distances on the attractiveness of 45° angled smiles was tested, with esthetic ranges identified. A simplified method was developed to obtain the estimative LBSC and FA-TL distances using 2-dimensional photographs and geometric analysis to facilitate clinical application. RESULTS: The FA-TL distance remarkably affected the esthetics of 45° angled smiles. Smiles were attractive when the FA-TL distance ranged from -1.0 to 1.5 mm perceived by orthodontists and from -1.5 to 1.5 mm perceived by laypersons. The 2-dimensional photograph-derived estimative FA-TL distance was not significantly different from that obtained in a 3-dimensional image, validating the simplified method. CONCLUSIONS: The LBSC could serve as a reference frame to determine the lateral limit of the maxillary anterior arch for the esthetics of 45° angled smiles. The FA-TL distance, which represented the spatial relation of the maxillary canine with the lower lip, was an esthetically essential parameter. For females aged 20-30 years, the FA point of the maxillary canines should be positioned no more than 1.5 mm labial or lingual to the LBSC.