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Abstract

Background

The smile is one of the most fundamental facial expressions, used to convey friendship, agreement, and admiration. There are various smile analysis method available.

Objective

The aim of this scoping review to find most reliable smile analysis method. Which smile analysis method is most reliable and accurate while assessing the smile of patients undergoing orthodontic treatment?

Design

Results

A preliminary search of databases and grey literature yielded 525 articles. Following the application of the eligibility criteria, 16 articles were included.

Conclusion

With the use of latest technologies and knowledge in literature, a clinician can correctly identify the problem, assess the treatment need and give a satisfactory outcome to the patient.

Keywords

Smile analysis smile design balanced smile digital smile design smile aesthetic

Introduction

The smile is one of the most fundamental facial expressions, used to convey friendship, agreement, and admiration. When a smile is pleasing and appealing to observers, it benefits not only the person who smiles but also others who see it. An appealing or pleasurable smile obviously increases an individual’s acceptance in society by boosting the first impression in interpersonal connections.¹ The smile is a difficult trait to examine. Because it is not a fixed notion, aesthetic prediction of dynamic facial features after treatment completion can be much more difficult to appraise than any other physical process. However, professionals need reliable measurements and guidelines to fully evaluate the outcome of orthodontic therapy, which frequently begins with aesthetic concerns.

Janzen underlined that the ultimate treatment goal is a well-balanced smile. It must be acknowledged that there is no such thing as a universal “ideal” smile. The dentist must deal with two opposing forces. The first is soft tissue repose and animation, which is measured during the patient’s examination and includes how the lips animate on smile, gingival display, crown length, and other smiling features. The second is the impact of skeletal and soft tissue maturational and ageing characteristics on face change across a patient’s lifespan. Clinical success in smile design is decided by an understanding of the patient’s soft tissue, ‘reatment restrictions, and the extent to which orthodontics or interdisciplinary treatment may satisfy the patient’s and orthodontist’s aesthetic goals.² The clinician should prioritize these smiling characteristics in order of relevance in establishing a balanced smile. The final problem list will assist the orthodontist in determining the viability of various treatment options and selecting the best mechanotherapy for optimal smile design.³ More patients are demanding extremely attractive treatment outcomes in modern dentistry. To increase smile attractiveness, physicians must perform a full facial and dental examination that analyses the smile and face objectively and standardized, addressing the patient’s sources of discontent and worry.

Facial, dentogingival, and dental aesthetics should be the primary criteria for aesthetic examination. Several computer software applications for digital smile design (DSD) have been introduced to clinical practise and research in recent years. They are multi-purpose conceptual tools that help improve diagnostic vision, communication, and treatment predictability by allowing careful study of the patient’s face and oral traits that clinical, photographic, or diagnostic cast-based evaluation techniques may have overlooked.⁴ The aim of this scoping review to find most reliable smile analysis method. Research question: Which smile analysis method is most reliable and accurate while assessing the smile of patients undergoing orthodontic treatment?

Materials and Methods

This review was carried out in accordance with the Joana Briggs Institute’s scoping review criteria.⁵ No ethical clearance is required for scoping review. The results are reported in accordance with the PRISMA statement extension for scoping reviews.⁶

Inclusion Criteria

The articles in this review were chosen based on the participants, concept, and context (PCC) criteria.⁵ This study attempts to help clinicians for choosing a smile analysis approach based on its reliability. Thus, the criteria were:

Participants

Individuals undergoing orthodontic treatment or approach orthodontist for the treatment.

Concept

Use of Smile analysis method for diagnosing, assessments and treatment purpose.

Context

Reliability of the smile analysis method.

Type of the Studies

Conference papers, experimental studies, quasi-experimental studies, exploratory research, randomized/non-randomized controlled trials, cross-sectional and qualitative studies would be included.

Search Strategy

An electronic search was executed on PUBMED, Cochrane, SCOPUS, hand search was made on google scholar and references of the articles selected. Keyword used while searching the databases as “((smile analysis) AND methods) AND comparison.” There were no time constraints attached to any database searches having last search till August 2022. Only English-language articles were included.

To discover potentially relevant papers, search results were evaluated based on their titles and abstracts, and duplicates were deleted by first and second reviewer. The papers were then assessed based on their abstracts, and those that were deemed to be relevant to the search topic were evaluated by all the authors using the inclusion criteria, only methods of assessment and comparative studies were included. A third reviewer and consensus-based discussion was used to settle disagreements. Based on the data gathered, responses to the targeted questions were developed, and suggestions were developed through consensus-based discussion.

Results

A preliminary search of databases and grey literature yielded 525 articles (513 through databases and 12 hand searched). In the Pubmed database, 191 articles were found using filters, a specific date range, and just English. The titles and abstracts of these were used to screen them. After screening and removing duplicates, 38 articles were read in their entirety. Figure 1 shows the PRISMA workflow diagram, which highlights each stage. Following the application of the eligibility criteria, 16 articles were included.

Figure 1.

PRISMA flow diagram.

All studies were conducted at a single location using data from the local population. The most studies were using photographs to analyze smile. The majority of the research was conducted in India, describing every aspect of smile analysis. The characteristics of the studies are described in Table 1 including the level of evidence.⁷

Table 1.

Characteristics of the Studies.

S. no	Author	Year of Publication	Country	Aim	Sample Size	Mode of Smile Analysis	Outcome	Key Findings	Method of Smile Analysis	Level of Evidence
1.	Basting RT et al⁸	2006	Brazil	1) the subjective analyses of a smile done by specialists with advanced training and general dentists; 2) the subjective analysis of a smile alone or, in conjunction with the face, by specialists with advanced training and general dentists; 3) subjective analysis with a computerized analysis by specialists with advanced training, verifying the midline, labial line, smile line, line between commissures and the golden proportion.	100 adults (65 female, 35 male)	200 photographs were taken, 100 with smile, 100 of entire face. Six examiners were selected for analysis of photographs.Smile Analysis by Subjective and Computerized Methods	More esthetical agreeable smiles were observed by general dentists when observing the “smile” with the entire face. There is difference between the computerized assessment and that performed by specialists.	Other facial components influence analysis of the smile	Subjective	Level 3
2.	Van der Geld PA et al⁹	2007	Netherlands	The aims of this study were to develop a dynamic registration method for assessment of spontaneous smile and speech and to subject this method to an extensive reliability test with regard to differences between raters (intrarater and interrater reliability), between records of the same subject, between types of teeth (anterior teeth, premolars, and molars), and between spontaneous smiling, posed smiling, and speech.	20 subjects	Four digital video recordings were made of each subject: spontaneous smile of joy, posed social smile, speech, and full dentition with the aid of cheek retractors. The full dentition was measured to obtain the actual lengths of tooth crowns. All recordings of a subject were taken during 1 day.	Generalizability coefficients ranged from .99 for anterior teeth to .80 for posterior teeth, show that the digital videographic method is a reliable way for smile line measurement	A reliable assessment of the smile line and tooth and gingival display during smiling and speech can be obtained with this digital videographic method. Moreover, this method is suitable for clinical practices.	Subjective	Level 2
3.	Maulik et al.¹⁰	2007	USA	To provide averages for various components of the smile and to compare some of these in orthodontically treated and untreated groups.	230 subjects and was divided into 3 groups: non orthodontically treated (n 73), orthodontically treated with RME (n 70), and orthodontically treated without RME (n 87)	A mini DV video camera (GL-2, Canon, Tokyo, Japan) was used for recording. Re- cording began approximately 1 second before each subject began speaking and ended after the smile. The smile frame was converted into a JPEG file by Scenalyzer.	The majority of subjects showed on smile flat smile arc, back to the second maxillary premolar, and an 11% buccal corridor. The orthodontically treated group showed a statistically significant more parallel smile arc compared with the untreated group.	The RME group had statistically significant less buccal corridor compared with the nonexpanded subjects.	Objective	Level 3
4.	Krishnan et al.¹¹	2008	India	(1) evaluation of perception differences, if any, between dental specialists and laypersons; and (2) quantification of smile characteristics with the smile arc, buccal corridor measurements, and a modified smile index (MSI).	60 subjects (male-30, female-30)	Analysis of perception differences between dental specialists and laypersons was performed with a visual analog scale. Quantification of smile characteristics was done with smile-arc evaluation for consonance or nonconsonance, buccal corridor measurements, the MSI, and comparisons of the MSI with the facial index and the mandibular width-facial height index.	There was no perception difference between the specialists and the laypersons on overall smile evaluation.	The MSI showed no correlation to the facial index, but there was a negative correlation of the MSI with the mandibular width-facial height index.	Subjective	Level 3
5.	Camara CA et al.¹²	2010	Brazil	To present six horizontal smile lines and their importance in obtaining the desired results in orthodontic treatments.	NA	The Diagram of Facial Aesthetic References (DFAR) is an auxiliary diagnostic tool. The diagram consists of six frames that surround the maxillary incisors and canines; their limits are specific to each aesthetic reference.	Observing the six lines is not enough to evaluate a smile. Several other factors also need to be taken in consideration. Buccal corridor, number of exposed teeth during smiling, frontal, oblique and profile facial analyses, relationship between resting and speech.	Analysis of these lines facilitates the understanding of the intrinsic characteristics of the smile and gives each professional a better look into their chances for success.	Objective	Level 5
6.	Singh VP et al.¹³	2011	Nepal	This article reviews concepts and principles of smile esthetics in orthodontic treatment that should lend esthetics to the entire orofacial complex involving unity, form, color, function and display of dentition.	NA	Smile recordsPhotographsDynamic recording is accomplished with digital videographyDirect measurement as a biometric tool	to correctly diagnose and treat problems associated with the smile, meticulous clinical observation and record taking in the form of photos and videos is warranted, in various dimensions.	well occluding casts and pleasing profiles can no longer be considered to be adequate treatment goals for the orthodontist.	Objective	Level 5
7.	Mclaren EA et al.¹⁴	2013	United states of America	Techniques for incorporating digital technology into smile design process	NA	Photoshop CS5 software using photoshop smile design technique	The smile analysis process begins at the macro level, examining the patient first, progressing to an evaluation of the individual teeth, and finally moving to the material selection considerations.	Knowledge of smile design, coupled with new and innovative dental technologies, allows dentists to diagnose, plan, create, and deliver aesthetically pleasing new smile.	Objective	Level 5
8.	Akyalcin et al.¹⁵	2014	United states of America	To investigate the common denominators of an esthetically pleasing smile in patients who were considered to be successfully treated upon the submission to American Board Orthodontics (ABO) clinical examination.	90 subjects	Eleven characteristics were evaluated digitally on frontal smile photographs. Image Tool for Windows version 3.00 (UTHSCSA, San Antonio, TX) was used for the measurements.The evaluation panels consisted of 10 parents, 10 general dentists, and 10 orthodontists with equal gender distribution in the groups.	difficulty of identifying objective parameters to evaluate the esthetics of a dynamic facial trait—the smile using two-dimensional photographs of actual patients.	A harmonious smile arc relationship and less gingival display during a smile are significantly associated with smile attractiveness in patients considered successfully treated according to ABO standards.	Subjective	Level 2
9.	Machado AW et al.¹⁶	2014	Brazil	Aim of this article is to present a protocol to assess patient’s smile: The 10 Commandments of smile esthetics.	NA	Smile arc : Maxillary incisors in vertical positionRatio and symmetry of maxillary central incisorsProportion between anterosuperior teethPresence of anterosuperior spacesGingival designGingival exposureBuccal corridorMidline and tooth angulationTooth color and anatomical shapeLip volume	The 10 Commandments of smile esthetics may be considered a starting point for clinicians who aim at achieving maximum esthetic in dental treatment. Special attention should be given to the first four commandments associated with dominance of central incisors at smiling.	Treatment should be discussed with patients so as to individualize treatment planning and, as a result, fulfil their desires.	Objective	Level 5
10.	Tarvade SM et al.³	2015	India	This article deals with all the different process of smile designing and lays norms for a beautiful smile.	NA	Diagram of facial aesthetic references (DFAR)Using Visual Analog ScaleDigital VideographySmile analysis using digital video and computer technologySmile analysis by questionnaireDirect measurement as a biometric tool	In order to diagnose and treat problems associated with the smile, clinical observation, photos, and video records in various dimensions are required. But, smile design depends on multiple factors and can vary among different races.	Developing a “standard of normalcy” for smiles is important as it would give guidelines for orthodontist and clinicians to have better treatment results.	Objective	Level 5
11.	Grover N et al.¹⁷	2015	India	To compare smile in various growth patterns, to determine sexual dimorphism, if any; as well as to correlate smile with underlying hard tissues.	150 patients	Cephalometric and photographic measurements were recorded and subjected to statistical analysis.	The mean incisal display, interlabial gap, lower lip to incisal edge distance, upper vertical lip length, and occlusal plane angle was highest in both males and females of vertical facial growth pattern group; whereas, the smile index, posterior corridor (left and right) were less in vertical facial growth pattern group in both males and females.	The facial growth pattern has significant influence on the parameters of smile along with definite sexual dimorphism.	Objective	Level 3
12.	Omar et al.¹⁸	2017	United Arab Emirates	This article aims to compare some of the most commonly used DSD programs in their ability to assess and digitally modify facial, dentogingival and dental smile esthetic parameters.	Seventeen articles were chosen using the following inclusion criteria: articles published from 2007 to 2017, studies that directly addressed parameters for dentofacial esthetics, human studies, and articles written in English language.	The programs included in this observation are Photoshop CS6 (Adobe Systems Incorporated), Keynote (Apple Inc.), Smile Designer Pro (SDP) (Tasty Tech Ltd), Aesthetic Digital Smile Design (ADSD - Dr. Valerio Bini), Cerec SW 4.2 (Sirona Dental Systems Inc.), Planmeca Romexis Smile Design (PRSD) (Planmeca Romexis!), Vis- agiSMile (Web Motion LTD) and DSD App by Coachman (DSDApp LLC).	Photoshop CS6 scored 20/20 in its ability to fulfil the analysis of facial, dentogingival, and dental esthetic parameters followed by keynote with 19/20	The ease of use of the programs and immediate applicability to a specific clinical setup.	Subjective	Level 2
13.	Wang et al.¹⁹	2018	China	This study was performed to validate the autonomous maximal smile (AMS) as a new reference for evaluating dental and gingival exposure.	100 subjects (34 men and 66 women)	Digital video clips of 100 volunteers showing posed smiles and AMS at different verbal directives were recorded for evaluation a total of three times at 1-week intervals. Lip-teeth relationship width (LTRW) and buccal corridor width (BCW) were measured.	AMS shows significantly larger LTRW and BCW, with significantly higher reproducibility.	The AMS might serve as an adjunctive reference, in addition to the posed smile, in orthodontic and other dentomaxillofacial treatments.	Objective	Level 3
14.	Khan M et al.²⁰	2020	Pakistan	To evaluate the components of smile among students of a dental institution.	157 dental students	Frontal view digital photographs with posed smile were assessed using Adobe Photoshop7.0. Smile characteristics evaluated included; smile line, smile arc, smile design, upper lip curvature, labiodental relationship and number of teeth displayed.	There was a significant relationship between lip curvature and smile pattern and lip curvature and smile arc revealing that upward lip curvature was associated with commissure type smiles and consonant smile arcs.	The smile characteristics should be considered before beginning the aesthetic treatment of the patient to obtain adequate results in oral rehabilitation.	Objective	Level 3
15.	Janu A et al.²¹	2020	India	To evaluate the differences in aesthetically pleasing smiles and compare the smile arc parameters in males and females by dental specialists using photographs.	The study was conducted on 500 North Indian subjects (Indo-Aryan race; 212 males and 288 females) aged 17-25 years (mean age, males=21.1 years; females=23.4 years).	The facial photographs of 500 subjects were taken using a Nikon SLR 3200D digital camera.Modified Smile Index=Inter-commissural width/Inter-labial gap X 100	Most females had VAS scores in the fair to attractive category whereas most males had VAS scores in the average to fair category. The buccal vestibular width (left side) was established to be more including those with a fair to charismatic smile as compared with those with an average smile. Most females with a parallel smile arc had an attractive smile.	An overall significant association between the left buccal corridor width and attractiveness was observed, favoring the proposed relationship that the larger buccal corridor was related to an attractive appearance.	Objective	Level 3
16.	Rao et al.²²	2021	India	To capture, analyse and measure the parameters through videos clips for studying the dynamics of posed and unposed smile and to measure the parameters through video clips for studying the dy- namics of speech.	100 subjects seeking orthodontic treatment with Angle’s Class I malocclusion were enrolled in the study consisting of 75 females and 25 males.	Frames after videography were used for measurements. Parameters like Maximum incisor exposure, Lower lip to upper incisor, Gingival exposure, Inter- labial gap etc were measured in “mm” for posed and unposed smile frames.	The median of maximum upper incisal exposure, lower lip to upper incisor, inter-labial gap, smile width and smile index were significant. There was a significant change from not exposed to exposed gingival exposure over posed smile to unposed smile.	Information obtained from the video graphic study can be used as a guideline for the diagnosis and as a part of comprehensive treatment planning.	Subjective	Level 3

A total of 11 studies has focussed on static records like photograph are Basting et al.⁸, Krishnan et al.¹¹, Singh et al.¹³, Mcleran et al. (photoshop CS6),¹⁴ Akyalcin et al. (Image Tool for Windows version 3.00 (UTHSCSA, San Antonio, TX),¹⁵ Machado et al.,¹⁶ Tarvade et al.,³ Grover et al.,¹⁷ Omar et al (DSD),¹⁸ Janu et al.,²¹ Khan et al. (Adobe Photoshop7.0).²⁰ These studies used software to analyze the facial photograph as well as examined by selected specialists or dentist and results are compared showing a significant difference.⁸

Six studies, Van der Geld et al.,⁹ Maulik et al.,¹⁰ Singh et al.¹³ Tarvade et al.,³ Wang et al.,¹⁹ Rao et al.²² have recorded videos of the patient as a dynamic records. They have recorded the patient while smiling, speaking, forceful smile, etc., each aspect of the facial feature to be analyzed later.

Three studies, Camara et al.,¹² Singh et al.,¹³ Tarvade et al.³ have done the direct measurement as a biometric tool of resting and dynamic tooth lip relationship, time related changes, philtrum and commissure height, interlabial gap, incisor show at rest and smile, crown height, gingival display, smile arc. But Grover et al.¹⁷ measured cephalograms to understand the effect of hard tissue profile on soft tissue.

Discussion

Clinical success in smile design is decided by an understanding of the patient’s soft tissue, treatment restrictions, and the extent to which orthodontics or interdisciplinary treatment may satisfy the patient’s and orthodontist’s aesthetic aim. Basic knowledge of the aesthetic elements of natural dentition can help to reduce difficulties in the dentist-patient interaction regarding the patient’s smile, aesthetic appearance, and psychosocial integration in a simple yet effective way. Aesthetics, on the other hand, is very subjective. According to Tjan and others, beauty is mostly determined by ethnic and cultural characteristics, as well as individual choice.^{1, 23} Whereas Cvaillon argues that each dentist has his or her own canons for defining a patient’s aesthetic appearance.²³ There are numerous methods for analyzing smiles, making it difficult to determine which is more reliable. A consistent smile analysis method is required to meet the patient’s expectations.

Carlos Alexandre Câmara gave six frames surround the maxillary incisors and canines in the diagram. The goal of this method was to provide an accurate representation of the positioning and ratios of teeth in the frontal plane, as well as their interaction with the gums and lips. They concluded that observing the six lines is insufficient for evaluating a smile. A number of additional things must also be considered. Buccal corridor, number of exposed teeth while smiling, frontal, oblique, and profile facial assessments, link between resting and speech positions, and the smile are all aspects to consider when diagnosing mouth aesthetics.¹²

Akyalcina et al. used a quantitative version of the visual analogue scale to score digital smile images of subjects taken in a standardized manner. Unattractive, average, and attractive smiles were divided into three categories. On the photograph, 11 smile features were digitally assessed. Smile arc (consonant, non-consonant) smile arc discrepancy/smile frame (%), gummy smile (present, not present), gingival display/visible dentition display (%), gingival display (right)/visible dentition display (%), gingival display (left)/visible dentition display (%), visible dentition width/inter-commissure width (%), dentition while smiling/distance from left to right cheilion during smiling visible dentition display/smile frame (%) right buccal space/visible dentition display (%).¹⁵ This study indicates that in any group of participants, even those with the best occlusal relationships, there is individual variability—tooth shape, lip curl, and mouth expression—that influences whether a smile is viewed as aesthetically attractive or not.²⁴. These findings also highlight the difficulties in developing objective measures to assess the aesthetics of a dynamic facial trait—the smile—using two-dimensional images of actual patients.

Khan et al. in their cross-sectional study took standardized photographs and analyze smile line or lip line, smile arc, smile design, upper lip curvature, labiodental relationship of the lower lip and maxillary anterior teeth, and number of teeth displayed. They concluded that the existence of an average smile line, consonant smile arcs, a cuspid-type grin, an upward lip curve, and a non-touching relationship between maxillary anterior teeth and lower lip, with teeth exhibited up to first premolars. Limitation of study was that findings can be used into smile analysis of only South Asian folks.²⁰

Machado et al. introduced 10 Commandments of smile esthetics which were Smile arc: Maxillary incisors in vertical position, ratio and symmetry of maxillary central incisors, proportion between anterosuperior teeth, presence of anterosuperior spaces, gingival design, gingival exposure, buccal corridor, midline and tooth angulation, tooth color and anatomical shape and lip volume. They concluded that the 10 Commandments of smile esthetics are a good place to start for practitioners who want to achieve maximal aesthetic in dental treatment. Special attention should be paid to the first four commands linked with central incisor dominance when smiling.¹⁶

Van der Geld et al. proposed the following smile analysis approach. The dynamic smile was recorded, and the selected video frames were measured using the digora application. The measuring program was calibrated with the filmed reference standard for each record. They concluded that with this digital videographic approach, an accurate assessment of the smile line and tooth and gingival presentation while smiling and speech can be acquired. Furthermore, this approach is appropriate for clinical applications.⁹

Rao et al. in their study included 100 patients seeking orthodontic treatment for Angle’s Class I malocclusion. The frames for speech were chosen by the primary investigator, while the suitable frames for posed and unposed smiles were chosen by a panel of five members. After-videography, frames were used for measurements. Maximum incisor exposure, lower lip to upper incisor, gingival exposure, inter-labial gap, and other parameters were measured in “mm” for posed and unposed smile frames. McNemar’s test was used to compare categorical data. p < 0.05 was considered significant.²²

Basting RT et al. selected six examiners chosen (three specialists with advanced training and three general dentists) and used AutoCAD software for computer analysis. Each specialist rated 100 images of smiles as aesthetically pleasing or unappealing. A week later, the same specialists rated photographs to see if they were aesthetically pleasing. This phase tested the impact of various facial features on smile aesthetics. Criteria adopted were midline, labial line, smile line, line between the commissures, golden proportion. Results found to be highly significant The McNemar test showed statistical differences in all factors assessed, with the exception of the midline (p = 0.1951), when the computerized analysis and subjective analysis of the specialists were compared.⁸

Omar D et al., in their study analyzed eight digital smile design software and concluded that DSD systems include digital technology into the smile design process and can be utilized as diagnostic tools, treatment plan visualization tools, and communication tools with the patient and technician to improve treatment outcome prediction. However, not all DSD programs on the market today offer the same level of capability for full analysis of dentofacial aesthetic characteristics. Although Photoshop and Keynote were not designed specifically for digital smile design, they define, measure, and adjust the greatest number of dentofacial aesthetic criteria addressed.¹⁸

The clinician can assess the dynamic anterior tooth display and smile analysis of the patient using computer and digital video technology. Esthetic smile design is influenced by a variety of factors and enables clinicians to treat patients using a personalized, interdisciplinary approach.²⁵ Based on the pioneering research of Kokich et al.,²⁶ some authors turned to digital imaging technologies to find more scientific and consistent references. Since then, the following smile variables have been studied: Smile arc^{11, 22, 27, 10}; buccal corridor^{10, 11, 19, 22, 28}; amount of gingival exposure when smiling asymmetry ^{22, 28–30}; presence of gingival and incisal ^{22, 22, 31-33} presence of anterosuperior diastema ^{29, 31} presence of midline shift and alterations in axial proclination^{26, 33} maxillary incisors ratio, size and symmetry.^{27, 34} Our scoping review also supports the use of digital video technology, DSD systems with use of 10 commandments of smile esthetics.^{8-10, 16, 18, 19, 22}

With the use of latest technologies and knowledge in literature, a clinician can correctly identify the problem, assess the treatment need and give a satisfactory outcome to the patient. To have a better knowledge of the most reliable smile analysis method, a systematic review and meta-analysis should be performed.

Conclusion

To correctly identify and treat problems related to the smile, rigorous clinical observation and record taking in the form of images and videos in various dimensions is required. Treatment should be discussed with patients in order to personalize treatment plans and, as a result, fulfil their desires. Use of DSD system are more beneficial but not all DSD programs on the market today provide the same level of capabilities for comprehensive dentofacial aesthetic examination. Finally, interdisciplinary treatment, or cooperation, is essential for achieving optimal aesthetic results.

Footnotes

Declaration of Conflicting Interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical Approval

Not applicable

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Informed Consent

Not applicable

ORCID iD

Akhter Husain

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A Scoping Review to Find Reliable Smile Analysis Method

Abstract

Background

Objective

Design

Results

Conclusion

Keywords

Introduction

Materials and Methods

Inclusion Criteria

Participants

Concept

Context

Type of the Studies

Search Strategy

Results

PRISMA flow diagram.

Characteristics of the Studies.

Discussion

Conclusion

Footnotes

Declaration of Conflicting Interest

Ethical Approval

Funding

Informed Consent

ORCID iD

References