Journal of Prosthetic Dentistry
Systematic Review| Volume 128, ISSUE 6, P1184-1189, December 2022

Download started.


Dentogingival display through lip border movements: Report of the Committee on Research in Fixed Prosthodontics of the American Academy of Fixed Prosthodontics


      Statement of problem

      Dentists strive to create natural looking teeth for their patients. However, much of the research on esthetic dentistry has used artificial and computer-generated images to establish esthetic norms. Altered images are helpful in determining personal preferences but may be misleading for natural norms.


      The purpose of this report from the Committee on Research in Fixed Prosthodontics of the American Academy of Fixed Prosthodontics was to establish an evidence base for clinical guidelines on lip mobility and the visibility of oral tissues.

      Material and methods

      A systematic search was conducted to collect data on the lip border movements and the visibility of teeth and gingiva of human participants.


      One thousand and ninety-six articles were processed, and, based on inclusion criteria, 48 articles were reviewed. The findings determined that the upper lip lengthens with age resulting, at rest, in less display of the maxillary teeth and more of the mandibular arch. When evaluating the maxillary incisal edge position at rest, the canines are the most reproducible. Women tend to display more gingiva in a social smile than men, but this may not be so for a true smile of joy. Both the middle and lower facial thirds should be evaluated to detect a maximal smile. Care must be taken not to classify a person incorrectly as having a low smile line because they could still have a potential to show gingiva.


      Evidence-based clinical guidelines are offered to reduce the risk of esthetic failures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Richetts R.M.
        Esthetic, environment, and the law of lip relation.
        Am J Orthod. 1968; 54: 272-289
        • Siddiqui N.
        • Tandon P.
        • Singh A.
        • Haryani J.
        Dynamic smile evaluation in different skeletal patterns.
        Angle Orthod. 2016; 86: 1019-1025
        • Toth E.K.
        • Oliver D.R.
        • Hudson J.M.
        • Kim K.B.
        Relationships between soft tissue in a posed smile and vertical cephalometric skeletal measurements.
        Am J Orthod Dentofacial Orthop. 2016; 150: 378-385
        • Grover N.
        • Kapoor D.N.
        • Verma S.
        • Bharadwaj
        Smile analysis in different facial patterns and its correlation with underlying hard tissues.
        Prog Orthod. 2015; 16: 28
        • Tjan A.H.
        • Miller G.D.
        • The J.G.
        Some esthetic factors in a smile.
        J Prosthet Dent. 1984; 51: 24-28
        • Goldstein R.E.
        • Esfandiari A.
        • Schultz A.K.
        • Ronald E.
        Goldstein’s esthetics in dentistry.
        3rd ed. John Wiley & Sons, Inc, 2018: 1236-1260
        • Walter R.D.
        • Goodacre B.J.
        • Goodacre C.J.
        • Naylor W.P.
        • Udochukwu O.
        A comparison of gingival display with a requested smile, Duchenne smile, grimace of disgust, and funnel-shaped expression.
        J Prosthet Dent. 2014; 112: 220-227
        • Vig R.G.
        • Brundo G.C.
        The kinetics of anterior tooth display.
        J Prosthet Dent. 1978; 39: 502-504
        • Al Wazzan K.A.
        The visible portion of anterior teeth at rest.
        J Contemp Dent Pract. 2004; 5: 53-62
        • Padmasree S.
        • Rekha B.
        • Rajesh S.
        • Ranukumari A.
        Incisal show-a decrease with an increase in lines of life.
        Int J Sci Study. 2016; 4: 215-219
        • Van der Geld P.
        • Oosterveld P.
        • Kuijpers-Jagtman A.M.
        Age-related changes of the dental aesthetic zone at rest and during spontaneous smiling and speech.
        Eur J Orthod. 2008; 30: 366-373
        • Al-habahbeh R.
        • Al-Shammout R.
        • Algananem M.
        • Al-Jabrah O.
        • Al Habahbeh N.
        Tooth and gingival display in the anterior region at rest and during smiling of different age groups: a comparative study.
        JRMS. 2013; 20: 32-39
        • da Motta A.F.
        • de Souza M.M.
        • Bolognese A.M.
        • Guerra C.J.
        • Mucha J.N.
        Display of the incisors as functions of age and gender.
        Aust Orthod J. 2010; 26: 27-32
        • Khan F.
        • Abbas M.
        The mean visible labial length of maxillary and mandibular anterior teeth at rest.
        J Coll Physicians Surg Pak. 2014; 24: 931-934
        • Kurian B.P.
        • Seethi F.
        • Charles I.L.
        Esthetic visibility of anterior teeth in operator perspective: a cross-sectional survey.
        Int J Oral Care Res. 2016; 4: 98-103
        • Dindaroğlu F.
        • Doğan S.
        • Erdinç Ertan
        Smile esthetics: age related changes, and objective differences between social and spontaneous smiles.
        J Clin Pediatr Dent. 2011; 36: 99-106
        • Jeelani W.
        • Fida M.
        • Shaikh A.
        The maxillary incisor display at rest: analysis of the underlying components.
        Dental Press J Orthod. 2018; 23: 48-55
        • Desai S.
        • Upadhyay M.
        • Nanda R.
        Dynamic smile analysis: Changes with age.
        Am J Orthod Dentofacial Orthop. 2009; 136: 310.e1-310.e10
        • Misch C.E.
        Guidelines for maxillary incisal edge position-a pilot study: the key is the canine.
        J Prosthdont. 2008; 17: 130-134
        • Patel J.R.
        • Prajapati P.
        • Sethuraman R.
        • Naveen Y.G.
        A comparative evaluation of effect of upper lip length, age and sex on amount of exposure of maxillary anterior teeth.
        J Contemp Dent Pract. 2011; 12: 24-29
        • Rashed R.
        • Heravi F.
        Lip-tooth relationships during smiling and speech: an evaluation of different malocclusion types.
        Aust Orthod J. 2010; 26: 159-165
        • Peck S.
        • Peck L.
        • Kataja M.
        Some vertical lineaments of lip position.
        Am J Orthod Dentofacial Orthop. 1992; 101: 519-524
        • Al-Jabrah O.
        • Al-Shammout R.
        • El-Naji W.
        • Al-Ajarmeh M.
        • Al-Quran A.H.
        Gender differences in the amount of gingival display during smiling using two intraoral dental biometric measurements.
        J Prosthodont. 2010; 19: 286-293
        • Owen E.G.
        • Goodacre C.J.
        • Loh P.L.
        • Hanke G.
        • Okamura M.
        • Jo K.H.
        • et al.
        A multicenter interracial study of facial appearance. Part 2: a comparison of intraoral parameters.
        Int J Prosthodont. 2002; 15: 283-288
        • Mahn E.
        • Sampaio C.S.
        • Pereira da Silva B.
        • Stanley K.
        • Valdés A.M.
        • Gutierrez J.
        • et al.
        Comparing the use of static versus dynamic images to evaluate a smile.
        J Prosthet Dent. 2020; 123: 739-746
        • Hochman M.N.
        • Chu S.J.
        • Tarnow D.P.
        Maxillary anterior papilla display during smiling: A clinical study of the interdental smile line.
        Int J Periodontics Restorative Dent. 2012; 32: 375-383
        • Liébart M.F.
        • Fouque-Deruelle C.
        • Santini A.
        • Dillier F.L.
        • Monnet-Corti V.
        • Glise J.M.
        • et al.
        Smile line and periodontium visibility.
        Perio. 2004; 1: 17-25
        • Hu X.
        • Nahles S.
        • Nelson C.A.
        • Lin Y.
        • Nelson K.
        Analysis of soft tissue display during enjoyment smiling: Part 1-caucasians.
        Int J Periodontics Restorative Dent. 2013; 33: e9-e15
        • Hu X.
        • Lin Y.
        • Heberer S.
        • Nelson K.
        Analysis of soft tissue display in Chinese subjects during an enjoyment smile.
        Quintessence Int. 2012; 43: 105-110
        • Nelson K.
        • Hu X.
        • Nack C.
        • Nahles G.
        • Mehrhof J.
        • Nahles S.
        Analysis of soft tissue display during enjoyment smile. Part II: elder Caucasians.
        Int J Periodontics Restorative Dent. 2014; 34: 573-578
        • Van der Geld P.
        • Oosterveld P.
        • Schols J.
        • Kuijpers-Jagtman A.M.
        Smile line assessment comparing quantitative measurement and visual estimation.
        Am J Orthod Dentofacial Orthop. 2011; 139: 174-180
        • van der Geld P.A.
        • Oosterveld P.
        • van Waas M.A.
        • Kuijpers-Jagtman A.M.
        Digital videographic measurement of tooth display and lip position in smiling and speech: reliability and clinical application.
        Am J Orthod Dentofacial Orthop. 2007; 131: 301.e1-301.e8
        • Van Der Geld P.
        • Oosterveld P.
        • Bergé S.J.
        • Kuijpers-Jagtman A.M.
        Tooth display and lip positions during spontaneous and posed smiling in adults.
        Acta Odontol Scand. 2008; 66: 207-213
        • Lin A.I.C.
        • Braun T.
        • McNamara J.A.
        • Gerstner G.E.
        Esthetic evaluation of dynamic smiles with attention to facial muscle activity.
        Am J Orthod Dentofacial Orthop. 2013; 143: 819-827
        • McNamara L.
        • McNamara J.A.
        • Ackerman M.B.
        • Baccette T.
        Hard- and soft-tissue contributions to the esthetics of the posed smile in growing patients seeking orthodontic treatment.
        Am J Orthod Dentofacial Orthop. 2008; 133: 491-499
        • Li H.
        • Cao T.
        • Zhou H.
        • Hou Y.
        Lip position analysis of young women with different skeletal patterns during posed smiling using 3-dimensional stereophotogrammetry.
        Am J Orthod Dentofacial Orthop. 2019; 155: 64-70
        • Peck S.
        • Peck L.
        • Kataja M.
        The gingival smile line.
        Angle Orthod. 1992; 62: 91-100
        • Khan F.
        • Abbas M.
        Frequency of gingival display during smiling and comparison of biometric measurements in subjects with and without gingival display.
        J Coll Physicians Surg Pak. 2014; 24: 503-507
        • Suh Y.-J.
        • Nahm D.-S.
        • Choi J.-Y.
        • Baek S.-H.
        Differential diagnosis for inappropriate upper incisal display during posed smile: contribution of soft tissue and underlying hard tissue.
        J Craniofac Surg. 2009; 20: 2006-2012
        • Arriola-Guillén L.E.
        • Flores-Mir C.
        Anterior maxillary dentoalveolar and skeletal cephalometric factors involved in upper incisor crown exposure in subjects with Class II and III skeletal open bites.
        Angle Orthod. 2015; 85: 72-79
        • Miron H.
        • Calderon S.
        • Allon D.
        Upper lip changes and gingival exposure on smiling: vertical dimension analysis.
        Am J Orthod Dentofacial Orthop. 2012; 141: 87-93
        • Chou J.-C.
        • Thompson G.A.
        • Aggarwal H.A.
        • Bosio J.A.
        • Irelan J.P.
        Effect of occlusal vertical dimension on lip positions at smile.
        J Prosthet Dent. 2014; 112: 533-539
        • Hulsey C.M.
        An esthetic evaluation of lip-teeth relationships present in the smile.
        Am J Orthod. 1970; 57: 132-144
        • Nold S.L.
        • Horvath S.D.
        • Blatz M.B.
        Analysis of select facial and dental esthetic parameters.
        Int J Periodontics Restorative Dent. 2014; 34: 623-629
        • Liang L.Z.
        • Hu W.J.
        • Zhang Y.L.
        • Chung K.H.
        Analysis of dynamic smile and upper lip curvature in young Chinese.
        Int J Oral Sci. 2013; 5: 49-53
        • Drummond S.
        • Capelli J.
        Incisor display during speech and smile: age and gender correlations.
        Angle Orthod. 2016; 86: 631-637
        • Al-Habahbeh R.
        • Al-Shammout R.
        • Al-Jabrah O.
        • Al-Omar F.
        The effect of gender on tooth and gingival display in the anterior region at rest and during smiling.
        Euro J Esthet Dent. 2009; 4: 382-395
        • Ackerman M.B.
        • Brensinger C.
        • Landis J.R.
        An evaluation of dynamic lip-tooth characteristics during speech and smile in adolescents.
        Angle Orthod. 2004; 74: 43-50
        • Sackstein M.
        Display of mandibular and maxillary anterior teeth during smiling and speech: age and sex correlations.
        Int J Prosthodont. 2008; 21: 149-151
        • Weeden J.C.
        • Trotman C.A.
        • Faraway J.J.
        Three dimensional analysis of facial movement in normal adults: influence of sex and facial shape.
        Angle Orthod. 2001; 71: 132-140