JIOS

10.5005/jp-journals-10021-1052
ORIGINAL ARTICLE
Esthetic and Smile Characteristics at Rest and during Smiling

Esthetic and Smile Characteristics at

Rest and during Smiling
1
Kavita Sachdeva, 2Anil Singla, 3Vivek Mahajan, 4HS Jaj, 5Anurag Negi

ABSTRACT

Objective: This study was conducted to evaluate the role of smile in overall facial esthetics.
Materials and methods: The sample comprised of photographs taken in natural head position of 100 normal Himachali subjects (50 males,
50 females) and they were divided in 3 age groups: Group I consisiting of 39 subjects aged (15-20) years, Group II consisiting of 35 subjects
aged (21-24) years, Group III consisiting of 26 subjects aged (25-29) years. The various parameters were analyzed using the clever ruler
software: Upper lip length during rest and smiling, lower lip length during rest and smiling, smile index, buccal corridor, upper lip thickness,
lower lip thickness, interlabial gap, incisal display, widest visible maxillary display and intercommissural width. Student t-test and using one-
way analysis of variance (ANOVA) were used to compare the mean of different groups.
Results: The results showed changes in the maxillary incisal display, interlabial gap and smile index were highly significant from Group I to
Group III. There was a decrease of 2.2 mm in maxillary incisal display and 2.0 mm in interlabial gap whereas smile index showed an
increase of 0.7 mm with the increasing age.
Conclusion: It has been concluded from the study that with the increasing age, the smile gets wider transversely and narrow vertically.
Keywords: Smile, Esthetics, Facial profile, Gingival display, Buccal corridor.

How to cite this article: Sachdeva K, Singla A, Mahajan V, Jaj HS, Negi A. Esthetic and Smile Characteristics at Rest and during Smiling.
J Ind Orthod Soc 2012;46(1):17-25.

INTRODUCTION can be defined as a facial expression characterized by upward

Esthetics has become increasingly important in the practice of
modern dentistry and is synonymous with a natural harmonious
appearance.1 The primary objective of seeking orthodontic
treatment is to improve dental esthetics. Smile esthetics has
become a central concern for patients and orthodontists because
this is a primary reason that patients seek orthodontic treatment
and orthodontists are now using this as a focus for treatment
planning.2 Although ideal occlusion should certainly remain the
primary functional goal of orthodontics, the esthetic outcome is
also critical for patient satisfaction and therefore essential to the
overall treatment objectives.3 As the mouth is the center of
communication in the face, the esthetic appearance of the oral
region during smiling is a conspicuous part of facial
attractiveness.4 The esthetics or display zone is composed of the
size, shape, position and color of the displayed teeth, the gingival
contour, the buccal corridor and the framing of the lips.5,6
A pleasing smile involves a harmonious relationship among
the teeth, the gingival scaffold and the lip framework.7 Smile
1
PG Student, 2Professor and Head, 3Senior Lecturer, 4,5Reader
1-5
Department of Orthodontics and Dentofacial Orthopedics
Himachal Dental College, Sundernagar, Himachal Pradesh, India
Corresponding Author: Kavita Sachdeva, PG Student, Department
of Orthodontics, Himachal Dental College, Sundernagar-175002
Himachal Pradesh, India, e-mail: kavitasachdeva1985@gmail.com
Received on: 5/5/11
Accepted after Revision: 11/11/11
curving of the corners of the mouth, is often used to indicate
pleasure, amusement or derision.8 There are two forms of
smiles—the enjoyment or Duchenne smile and the posed or
social smile.9,10 Posed smile is used routinely when evaluating
facial esthetics and smile characteristics because the posed smile
is reproducible and can be generated on command.9,11 The
enjoyment or unposed smile however is involuntary, natural in
that it expresses authentic human emotion.12 Lip position and
the amount of tooth and gingival display during smiling and
speech are important diagnostic criteria in orthodontics,
dentofacial surgery and esthetic dentistry.4
When developing the appropriate diagnosis and treatment
plan for a patient, the hard and soft tissues are usually analyzed
in three-dimensions: Sagittal vertical and transverse.7 Recently,
time has been recognized as the fourth-dimension.10,13 With
time, people undergo many skeletal and soft-tissue cellular
changes that dramatically affect the overlying soft-tissue
envelope, the related muscles and their functions. Although
orthodontic retainers help the patient to maintain the post-
treatment occlusion and ensure long-lasting function and
esthetics, we believe that appropriate knowledge of smile
changes with age can help orthodontists to obtain healthy, long-
lasting and esthetically appealing treatment results.7
Orthodontic diagnosis has come a longway to include smile
aspects into treatment planning and therefore the smile esthetics
are a major goal of orthodontic mechanotherapy.
Therefore our study was done to evaluate the age-related
changes of the smile-related to upper lip length at rest and during

The Journal of Indian Orthodontic Society, January-March 2012;46(1):17-25 17

Kavita Sachdeva et al

smiling, lower lip length at rest and during smiling, upper lip 2. No previous orthodontic treatment or maxillofacial surgery
thickness, lower lip thickness, maxillary incisal display, 3. Complète permanent dentition
interlabial gap at smile, smile index, buccal corridors, widest 4. Voluntary involvement in the study
visible maxillary display and intercommissural width and sexual 5. No active periodontal disease
dimorphism with respect to smile. 6. No craniofacial anomalies or other pathologies
The aims and objectives of the study were:
1. To check the sexual dimorphism with respect to smile in
Himachali population.
2. To check the age-related changes with smile in Himachali
population.

MATERIALS AND METHODS

The present study was conducted in the Department of
Orthodontics, Himachal Dental College, Sundernagar. The
sample consisted of Himachali population who were examined
for three generations, i.e up to grandparents to confirm the
ethnicity. It was explained to potential subjects that this was a
study on posed smile capturing only a small part of the face
(chin to nose). Subjects were separated into three groups with
the following age ranges: Group I (15-20 years) (Figs 1A and B),
Group II (21-24 years) (Figs 2A and B), Group III (25-29 years)
(Figs 3A and B). The ages ranged from 15 to 29 years; 50.0%
were female and 50.0% were male (Table 1). All the
photographs were taken in natural head position in which the
patient head was in an upright posture with the eyes focused on
a point in the distance at eye level, which implies that the visual
axis is horizontal.14
The inclusion criteria for selection were:
1. Class I subjects with well balanced faces/orthognathic
profile. Figs 2A and B: Group II—21-24 years: (A) At rest, (B) During smiling

Figs 1A and B: Group I—15-20 years: (A) At rest, (B) During smiling Figs 3A and B: Group III—25-29 years: (A) At rest, (B) During smiling

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Esthetic and Smile Characteristics at Rest and during Smiling

Table 1: Description of study sample (age groups)

Groups Age (years) Total

Group I 15-20 years 39

Group II 21-24 years 36
Group III 25-29 years 25

Total 100

7. No severe malocclusion
8. No deleterious habit causing malocclusion (tongue thrusting,
thumb-sucking, etc.).
The exclusion criteria included:
1. Missing teeth that could have been visible on smile
2. Prosthodontic work on teeth visible in smile
3. Excessive dental attrition Fig. 4: (1) Upper lip length (rest)—from subnasale to stomion
superius; (2) Lower lip length (rest)—from stomion inferious to menton
4. Lip irregularities (incompetent, potentially incompetent,
short lips, etc.).
5. Inability to determine natural head position.
The subjects were photographed with posed smiles. The
photographs taken for each subject will follow the described
standardized parameters:
1. Nikon D-40 digital camera.
2. Distance between the camera and the subject was taken as
3.5 ft.
3. The camera was mounted on a tripod stand with the lens
positioned parallel to the true perpendicular of the face in
natural head position.
4. The camera was raised to the level of subject’s lower facial
third.
5. The same illumination was used for photography of each
individual.
Fig. 5: (1) Outer commissure width—distance from outer most corner
Each file was opened in Microsoft Office Picture Manager of the mouth from one side to the other, (2) Inner commissure width—
and adjusted by using the millimeter ruler in the frame. The distance from inner most corner of the mouth from one side to the
following procedure was used to adjust each picture. First, the other, (3) Upper lip length (smiling)—from subnasale to stomion
superius, (4) Visible maxillary widest display—teeth displayed from first
picture was magnified to 51% to get 1 inch = 97 pixels. Then, molar to first molar, (5) Upper lip thickness—vertical distance from the
the clever ruler function was chosen and adjusted, so as to get most superior point of the cupid's bow to the most inferior portion of the
1:1 ratio. To check the accuracy of these steps, the 10 mm area tubercle of the upper lip, (6) Interlabial gap—the position of the upper
and lower lips as measured from the midpoint of the lips when a patient
on the ruler was measured again. If done correctly, this
is relaxed and smiling, (7) Incisal display—stomion superius to maxillary
measurement would read 10 mm and thus direct measurements incisor edge (if the central incisors were not at the same levels, 2
could be recorded. The various parameters were studied using measurements were taken and the average used for that subject, (8)
clever ruler software are: (1) Upper lip length at rest and during Lower lip thickness—lower lip inside to vermilion—cutaneous junction,
(9) Lower lip length (smiling)—from stomion inferious to menton
smiling—subnasale to stomion superius; (2) lower lip length at
rest and during smiling—from stomion inferious to menton;
(3) upper lip thickness—vertical distance from the most superior (8) inner intercommissural width; (9) visible maxillary dental
point of the cupid’s bow to the most inferior portion of the width (Figs 4 and 5).
tubercle of the upper lip; (4) lower lip thickness—lower lip Smile index was developed by Ackermann and
inside to vermilion—cutaneous junction; (5) maxillary incisor Ackermann10 and determined by dividing the outer inter-
display—stomion superius to maxillary incisor edge (if the commissural width by the interlabial gap height during smile.
central incisors were not at the same levels, two measurements Vertical lip thickness was the vertical distance from the most
were taken and the average used for that subject; (6) interlabial superior point of the peak of the lip to the most inferior portion
gap at smile—the position of the upper and lower lips as of the tubercle of the upper lip.
measured from the midpoint of the lips when a patient is relaxed Frush and Fisher15 defined buccal corridors as the spaces
and smiling; (7) outer intercommissural width—distance from between the buccal surfaces of the posterior teeth and the corners
outer most corner of the mouth from one side to the other; of the mouth when smiling.

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Kavita Sachdeva et al

RESULTS
The mean, standard deviation and p-value were calculated for
each parameter. Overall means for the various perioral
measurements were calculated.
There were highly significant age-related differences in
lower lip length during smiling, interlabial gap, incisal display,
outer commissure width and smile index. Upper lip length during
smiling and widest visible maxillary display was also found to
be significant (Table 2, Graph 1).
Multiple comparisons among subgroups were done via the
HSD (Honestly significant difference test) (Table 3). The data
demonstrated a significant difference between Group I and
Group III in certain parameters: Lower lip length during smiling,
incisal display, smile index, interlabial gap.
Statistically significant sex-related differences were found
in upper lip length at rest and during smiling, lower lip length at
rest and during smiling, upper lip thickness and lower lip
thickness (Table 4, Graphs 2 and 3).
DISCUSSION
One of the primary aims of an orthodontic treatment is to attain
and preserve facial attractiveness.16 Facial attractiveness and
smile attractiveness appear strongly connected to each other.
Furthermore, attractiveness is suggested to influence personality
development and social interaction.4 The smile also influences
a person’s perceived attractiveness and is the cornerstone of
social interaction.17 In most arenas, attractiveness was found
to be equally important for men and women. The smile is
rightfully deemed a valuable means of nonverbal social
communication and sound criteria of facial attractiveness.18
Smile analysis and smile design have become key elements of
orthodontic diagnosis and treatment planning over the last

Table 2: Mean values of parameters according to age (one-way analysis of variance ANOVA)

Measurements (mm) Age groups Mean Standard deviation p-valve

Upper lip length at rest 15-20 19.0600 2.32716 0.135

21-24 17.9474 2.23881
25-29 18.6800 2.65016
Lower lip length at rest 15-20 38.0467 3.92198 0.075
21-24 39.9286 4.49329
25-29 40.1200 4.04316
Upper lip length during smiling 15-20 13.4267 2.71218 0.032*
21-24 12.5171 2.25267
25-29 14.3300 2.96110
Lower lip length during smiling 15-20 36.9667 3.39726 <0.001**
21-24 39.8023 3.78007
25-29 40.8100 3.89999
Upper lip thickness 15-20 7.6933 1.52983 0.744
21-24 8.0377 1.63270
25-29 8.7100 1.75029
Lower lip thickness 15-20 9.7933 1.52579 0.847
21-24 9.9097 1.22888
25-29 9.7000 1.50130
Interlabial gap 15-20 9.3067 2.12751 0.003**
21-24 8.5726 1.93077
25-29 7.3800 2.46447
Incisal display 15-20 8.6867 1.99596 <0.001**
21-24 7.6737 1.54639
25-29 6.4100 1.99905
Outer commissure width 15-20 58.7600 6.01648 0.009**
21-24 60.5726 4.55883
25-29 63.2800 6.54253
Inner commissure width 15-20 48.7800 4.62248 0.079
21-24 49.8309 3.53691
25-29 51.1800 4.17602
Widest visible maxillary display 15-20 45.2200 4.43943 0.041*
21-24 46.9263 3.31068
25-29 47.7800 4.65411
Smile index 15-20 1.7111 0.32486 <0.001**
21-24 1.9247 0.43982
25-29 2.4617 0.73689
Buccal corridor 15-20 7.2737 3.10370 0.102
21-24 5.7942 2.45113
25-29 6.7159 3.31072

*Significant; **Statistically significant

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Esthetic and Smile Characteristics at Rest and during Smiling

Graph 1: Mean values of parameters according to age

Table 3: Multiple comparisons among subgroups via HSD

Dependent variable (mm) Age group (I) Age group (J) Mean difference (I-J) p-value

Upper lip length at rest Tukey HSD 15-20 21-24 1.11257 0.117
25-29 0.38000 0.804
21-24 15-20 –1.11257 0.117
25-29 –0.73257 0.464
25-29 15-20 –0.38000 0.804
21-24 0.73257 0.464
Lower lip length at rest Tukey HSD 15-20 21-24 –1.88190 0.132
25-29 –2.07333 0.126
21-24 15-20 1.88190 0.132
25-29 –0.19143 0.983
25-29 15-20 2.07333 0.126
21-24 0.19143 0.983
Upper lip length during smiling Tukey HSD 15-20 21-24 0.90952 0.303
25-29 –0.90333 0.368
21-24 15-20 –0.90952 0.303
25-29 –1.81286* 0.024*
25-29 15-20 0.90333 0.368
21-24 1.81286* 0.024*
Lower lip length during smiling Tukey HSD 15-20 21-24 –2.83562* 0.004**
25-29 –3.84333* <0.001**
21-24 15-20 2.83562* 0.004**
25-29 –1.00771 0.540
25-29 15-20 3.84333* <0.001**
21-24 1.00771 0.540

Upper lip thickness Tukey HSD 15-20 21-24 0.25562 0.778

25-29 –0.01667 0.999
21-24 15-20 –0.25562 0.778
25-29 –0.27229 0.794
25-29 15-20 0.01667 0.999
21-24 0.27229 0.794
Lower lip thickness Tukey HSD 15-20 21-24 –0.11638 0.934
25-29 0.09333 0.964

Contd...

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Kavita Sachdeva et al

Contd...

Dependent variable (mm) Age group (I) Age group (J) Mean difference (I-J) p-value

21-24 15-20 0.11638 0.934

25-29 0.20971 0.837
25-29 15-20 –0.09333 0.964
21-24 –0.20971 0.837
Inter labial gap Tukey HSD 15-20 21-24 0.73410 0.313
25-29 1.92667* 0.002**
21-24 15-20 –0.73410 0.313
25-29 1.19257 0.088
25-29 15-20 –1.92667* 0.002**
21-24 –1.19257 0.088
Incisal display Tukey HSD 15-20 21-24 1.01295 0.054
25-29 2.27667* <0.001**
21-24 15-20 –1.01295 0.054
25-29 1.26371* 0.026*
25-29 15-20 –2.27667* <0.001**
21-24 –1.26371* 0.026*
Outer commissure width Tukey HSD 15-20 21-24 –1.81257 0.363
25-29 –4.52000* 0.006*8
21-24 15-20 1.81257 0.363
25-29 –2.70743 0.164
25-29 15-20 4.52000* 0.006**
21-24 2.70743 0.164
Inner commissure width Tukey HSD 15-20 21-24 –1.05086 0.525
25-29 –2.40000 0.063
21-24 15-20 1.05086 0.525
25-29 –1.34914 0.424
25-29 15-20 2.40000 0.063
21-24 1.34914 0.424
Widest visible maxillary display Tukey HSD 15-20 21-24 –1.70629 0.185
25-29 –2.56000* 0.043*
21-24 15-20 1.70629 0.185
25-29 –0.85371 0.706
25-29 15-20 2.56000* 0.043*
21-24 0.85371 0.706
Smile index Tukey HSD 15-20 21-24 –0.21360 0.163
25-29 –0.75063* <0.001**
21-24 15-20 0.21360 0.163
25-29 –0.53703* <0.001**
25-29 15-20 0.75063* <0.001**
21-24 0.53703* <0.001**
Buccal corridor Tukey HSD 15-20 21-24 1.47949 0.085
25-29 0.55787 0.736
21-24 15-20 –1.47949 0.085
25-29 –0.92162 0.452
25-29 15-20 –0.55787 0.736
21-24 0.92162 0.452

* The mean difference is significant at the 0.05 level; **Statistically significant

decade.19-21 Perception of facial attractiveness varies from
person to person and is influenced by their personal experience
and social environment. So the aim of our study was to evaluate
the various parameters of the smile. The significant parameters
of smile are as follows:
Upper Lip Length
Upper lip length at rest indicated a decrease of 19.0 mm
(Group I) to 18.6 mm (Group III) though it was statistically
nonsignificant. Upper lip length during smiling is increased from
13.4 mm (Group I) to 14.3 mm (Group III) indicating atrophy
of muscles as person ages which leads to the decrease in lip
volume, loss of lip architecture and lip lengthening. These
changes highlight the importance of having age-related norms
as references, so that more objective and specific treatment can
be rendered to older patients. This is in accordance with the
study conducted by Ravindra Nanda et al.7
The present study shows upper lip length at rest was
21.7 mm for males and 19.4 mm for females. Mean value was
statistically higher in males as compared to females. The values
for upper lip length from our study were in close proximity
with the study conducted by Farkas et al22 who found the upper
lip length in the range of 21.8 mm for males and 19.6 mm for

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Esthetic and Smile Characteristics at Rest and during Smiling

Table 4: Mean values of parameters according to sex distribution (t-test)

Measurements (mm) Sex N Mean Std. deviation p-valve

Upper lip length at rest Male 50 21.7392 2.01316 <0.001**

Female 50 19.4044 2.21392
Lower lip length at rest Male 50 40.6640 4.81570 0.001**
Female 50 37.8248 2.97618
Upper lip length during smile Male 50 14.7784 2.30547 <0.001**
Female 50 11.9080 2.27816
Lower lip length during smile Male 50 40.1388 4.37053 0.003**
Female 50 37.7780 3.18834
Upper lip thickness Male 50 14.1568 1.72260 0.001**
Female 50 12.6596 1.29544
Lower lip thickness Male 50 10.4312 1.36738 <0.001**
Female 50 9.1884 1.16585
Inter labial gap Male 50 8.8608 2.51303 0.170
Female 50 8.2368 1.96572
Incisal display Male 50 7.8728 2.17534 0.519
Female 50 7.6076 1.91695
Outer commissure width Male 50 60.9076 6.28995 0.571
Female 50 60.2316 5.57133
Inner commissure width Male 50 50.6064 4.47005 0.047*
Female 50 48.9372 3.81878
Widest visible maxillary display Male 50 47.1744 4.41583 0.103
Female 50 45.7912 3.97086
Smile index Male 50 1.9246 0.54149 0.332
Female 50 2.0374 0.61341
Buccal corridor Male 50 6.7838 2.82021 0.566
Female 50 6.4380 3.17000

*Significant; **Statistically significant

Graph 2: Mean values of parameters in male patients Graph 3: Mean values of parameters in female patients

females. Wolford et al23 also found the upper lip length in the
range of 22 mm for males and 20 mm for females which is also
similar to the results of our study.
Lower Lip Length
Lower lip length during smiling is increased from 36.9 mm (Group
I) to 40.8 mm (Group III). The present study shows lower lip
lengths at rest was 40.6 mm for males and 37.8 mm for females
and during smiling were 40.1 mm for males and 37.7 mm for
females. Mean value was statistically higher in males as compared
to females. This in accordance with the study conducted by the
Scheideman et al24 who reported increased lower face height in
male subjects. This is mainly because of increased lower lip
length. This significant difference in facial heights between men

The Journal of Indian Orthodontic Society, January-March 2012;46(1):17-25 23

Kavita Sachdeva et al
and women might be significant in treatment planning because
these differences can be indications to increase or decrease facial
height. Similar results were found by the study conducted by
Kalha et al25 and Arnett and Bergman.26
Upper Lip Thickness
Upper lip thickness indicated an increase of 7.6 mm (Group I)
to 8.7 mm (Group III) though it was statistically nonsignificant.
This is in accordance with the study conducted by Ravindra
Nanda et al7 who found an increase in upper lip thickness from
7.87 mm to 8.28 mm.
The present study shows upper lip thickness at rest was
14.1 mm for males and 12.6 mm for females. This is in
accordance with the study conducted by Kalha et al25 and Arnett
and Bergman.26
Lower Lip Thickness
Mean value of lower lip thickness was 9.79 mm (Group I) to
9.7 mm (Group III) though it was statistically nonsignificant.
The present study shows lower lip thickness was 10.4 for males
and 9.1 mm for females. This is in accordance with the study
conducted by Kalha et al25 and Arnett and Bergman26 who also
reported higher lower lip thickness for males than females.
Incisal Display
The data in Table 2 show that there is a decrease in the upper
incisal display from 8.6 mm (Group I) to 6.4 mm (Group III).
This is evidence that, as one ages, the upper lip displays less
maxillary incisors on smile. This is in accordance with the study
conducted by Husely27 and Tjan et al.1 Similar results were
obtained by Vig and Brundo28 who noted a decrease in maxillary
incisor exposure of about 3.41 mm from less than 29 years to
over 60 years of age. Dong et al29 examined both maxillary
incisor display at rest and smile. They described decreases in
maxillary incisor display of about 2.5 mm at rest and 2 mm at
smile between the 20 to 29 year and the 60 to 69 year age groups.
The present study shows no statistically significant
difference in upper incisal display 7.8 mm for males and
7.6 mm for females.
Interlabial Gap
Interlabial gap is decreased with age from 9.3 mm (Group I) to
7.3 mm (Group III) causing an increase in the smile index
between the same age groups as shown in Table 2. This data
provide the evidence as the person ages the smile gets wider
transversely and narrower vertically. This is in accordance with
study conducted by Shyam Desai and Ravindra Nanda7 who
also reported a decrease in the interlabial gap with age from
12.0 mm to 10.42 mm.
The present study shows no statistically significant
difference in interlabial gap 8.8 mm for males and 8.2 mm for
females.
Smile Index
Smile index is increased with age from 1.7 mm (Group I) to 2.4
mm (Group III). This is in accordance with the study conducted
24
by the Shyam Desai and Ravindra Nanda7 who found an increased
of smile index from 5.6 mm to 6.7 mm which indicates, that as
person ages smile gets narrow vertically and wider transversely.
Similar results were found by Ackermann et al.10 The present
study shows statistically nonsignificant difference in smile index
1.9 mm for males and 2.1 mm for females.
Buccal Corridor
Buccal corridor is decreased with age from 7.2 mm (Group I)
to 6.7 mm (Group III). The present study shows statistically
nonsignificant difference in bucca1 corridor 6.7 mm for males
and 6.4 mm for females. The impact of buccal corridors on
smile esthetics has no effect on the esthetic evaluations of smiles.
The results of our study, which looked at differences between
buccal corridor spaces, indicated no statistically significant
difference in either sex and age groups. This is in accordance
with the study conducted by Martin AJ et al.30 Thus, we can
assume that buccal corridor space plays only a minimal role in
esthetic evaluation of a smile and the perceived difference could
be due to other factors, such as smile arc, tooth arrangement,
tooth shade, gingival architecture, gingival display, lip thickness.
Our study indicates that incisal dispay decreases with time,
therefore treatment should be age-specific. It also helps to
broaden our knowledge and understanding of how the perioral
soft tissues change with age and helps clinicians to optimize
dentofacial esthetics while satisfying other treatment goals.
CONCLUSION
Standardized photographs were taken with posed smiles. Means,
standard deviations and statistical significances were calculated
for all values. These results show:
1. A significant decrease of 2.2 mm in maxillary incisal display
and 2.0 mm in interlabial gap was found at smile with
increasing age.
2. The smile index significantly increased, indicating that the
smile gets narrower vertically and wider transversely as a
person ages.
3. Outer commissure width and lower lip length during smiling
also increases with age.
4. It was found that Himachali males had larger upper lip length
and lower lip length both at rest and during smiling than
Himachali females. Upper lip and lower lip thickness was
also found to be more in Himachali males when compared
to Himachali females.
5. Longitudinal studies with larger samples should be carried
out in future as this type of study can give better applicable
values clinically.
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