Abstract
Background
Determining the lip smile line is a key component of esthetic and prosthetic evaluation in dentate, partially, and fully edentulous patients, as it quantifies dentogingival exposure and informs necessary surgical or prosthetic interventions, especially in high smile line cases.
Purpose
To present a simple technique for capturing accurate maximum smile records to enhance prosthodontic planning and smile design.
Methods
The technique involves photographing patients smiling with their eyes closed over multiple appointments, helping them reproduce a natural, uninhibited maximum smile in a clinical setting.
Results
This method improves the accuracy of smile records, aiding in the determination of finish lines for fixed dental prostheses (FDP) and transition lines for implant-supported FDPs (ISFDP/ICFDP), thus reducing the risk of esthetic compromise.
Conclusion
A multi-appointment, eyes-closed photography approach offers a practical and effective strategy to capture reliable maximum smile records for esthetic dental treatment planning.
Clinicians have habitually utilized patients’ maximum smile as a diagnostic aid to identify smile line, smile width, and dentogingival display.1–4 In fact, some classifications have been developed to provide recommendations for risk assessment and managing complex cases according to the maxillary lip dynamics.5–11 Conversely, inaccurate maximum smile records could primarily lead to establishing deficient finish lines in a conventional fixed dental prosthesis (FDP) case or transition line for an implant-supported fixed partial or complete dental prosthesis (ISFDP or IFCDP) and result in a compromised esthetic outcome. Hence, using videography and, more recently, asking patients to close their eyes have been suggested to capture the true maximum maxillary display better while smiling.12, 13 Moreover, certain diagnostic questions remain to be answered. For instance, could existing recommendations for capturing a maximum smile be enhanced—either by modification or in combination with other techniques—to improve the reliability of smile records? Alternatively, are the current protocols sufficient to obtain an accurate and reproducible maximum smile required for esthetic analysis during treatment planning?
The time factor was not considered in the previous recommendations. It is notable that having the patients at ease and comfortable in the clinical setting could be challenging. This could have patients resist properly contracting the expression muscles to provide a true maxillary dentogingival display closer to a natural, spontaneous hyper smile. It has been reported that a clinician–patient trusting rapport, maintaining regular appointments, and perhaps becoming familiar with the new clinical setup may ameliorate these challenges.14–18
The need to provide more reliable results led the authors to modify a technique capturing the definitive maximum smile display with videography or static images with closed eyes at an appointment other than the initial one. By factoring time to the technique, the problem of misdiagnosing patients that are anxious at the initial appointment may be considerably decreased. Thus, the purpose of this technique is to reduce the faulty records that could be initially obtained.
Technique
Proceed with obtaining all the patient’s diagnostic records at the initial appointment, including the extraoral static and dynamic pictures and videos with closed eyes. The maximum smile record at this visit becomes a control.
At a subsequent appointment, repeat the maximum smile display with closed eyes, preferably in the same room or operatory and by the same clinician or allied dental profession staff member. The maximum smile record obtained at this visit will be used to verify the record from the previous visit (control).
Compare the dentogingival exposure obtained at the pictures and videos obtained at the initial and subsequent visits.
The maxillary lip smile line is determined based on the maximum smile exposure and is used as the definitive record for the esthetic analysis. If there is suspicion that the maximum smile was not obtained, repeat the record at a further visit.
Design the digital or conventional prototype based on the maximum smile exposure and obtain esthetic approval and consent whether a physical trial is planned.
Discussion
An alternative to the proposed technique is to obtain the maximum smile record traditionally, during the first appointment or in a single session.1, 2 However, in the modified approach, the initial smile record obtained during the first visit serves only a pre-diagnostic purpose, as it is not used as definitive record. Subsequent appointments allow for additional smile records, which are then used for final evaluation. This progression helps patients become more comfortable across visits, improving the reliability and predictability of this technique. Thus, the definitive evaluation would be obtained after the first appointment, where rapport and a sense of adaptability from the patient’s perception are expected. The additional time spent in the described modified technique, which could be perceived as a potential disadvantage, might be, in fact, a benefit for securing a more predictable outcome. It is important to note that the time for proper diagnosis should be communicated to the patient and factored by the clinician in terms of the number of appointments and length of treatment.
In other words, the first appointment smile photography or videography with closed eyes can remain as control. However, the following appointments will provide a more reliable maximum display as rapport between the dentist and patient is established. This leads to a less tense environment for the patient since the “white coat” syndrome is well documented and visits to a dental office may trigger anxiety. Consequently, using the first appointment picture might not be considered the best image or video to assess the true smile display in every case. Since the proposed technique can be easily adopted, dental educators, postgraduate students, and researchers are encouraged to implement it in their practice.
Conclusion
This article presents a practical and straightforward method for recording the dynamic maximum dentogingival display by obtaining pictures or video of the patient smiling with the eyes closed and repeating in two or more visits to verify the initial record. This technique intends to promote accurate treatment planning and diminish the risk of an unexpected esthetic outcome compromise.
Footnotes
Acknowledgments
The authors thank Dr. A. Bidra, a clinical professor at the Department of Reconstructive Sciences in the University of Connecticut Health Center, for his comments on this technique.
Authors’ Contributions
Conceptualization: KIA; Methodology: KIA; Investigation: KIA and MA; Validation: MA; Resources: KIA and MA; Writing – Original draft preparation: KIA; Writing – Review & editing: KIA and MA; Supervision: KIA; Project administration: KIA. Both authors have read and approved the final version of the manuscript.
Data Availability Statement
Data sharing is not applicable to this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
