ORIGINAL ARTICLE

Characterization of posed smile by using visual

analog scale, smile arc, buccal corridor
measures, and modified smile index
Vinod Krishnan,a Sunish T. Daniel,b Don Lazar,c and Abin Asokc
Tamilnadu, India

Introduction: Smile evaluation and designing are important; recent emphasis on the soft tissues has been
on par with that on the hard tissues in orthodontic diagnosis and treatment planning. This importance has not
yet gained proper attention, and smile analysis is often ignored in clinical examinations. We attempted a
comprehensive evaluation of smile characteristics with the following aims: (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). Methods: The sixty
subjects included in the study had an age range of 18 to 25 years (mean, 21 years) with equal numbers of
men and women. Frontal posed smile photographs were taken of all subjects. The study had 2 parts. 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. Results: There was no perception difference between the
specialists and the laypersons on overall smile evaluation. Women had more consonant smile arcs than men,
and there was high correlation between the right and left buccal corridor spaces in men and women. 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. Conclusions: Smile analysis should be an important aspect of orthodontic
diagnosis and treatment planning. Orthodontists should not disturb consonant smiles but create them with
proper bracket positioning. The MSI, with negative correlation with the mandibular width-facial height index,
warrants further evaluation with a larger sample to validate its clinical use and to develop a predictive
approach of its relationship. (Am J Orthod Dentofacial Orthop 2008;133:515-23)

and to convey compassion and understanding,8 should not

S
mile, defined as a facial expression characterized
by upward curving of the corners of the mouth, is
often used to indicate pleasure, amusement, or
derision.1 The smile also influences a person’s per-
ceived attractiveness and is the cornerstone of social
interaction. Research suggests that we trust smiling
people more than nonsmiling ones.2 There are 2 forms
of smiles—the enjoyment or Duchenne smile, and the
posed or social smile.3,4 Humans learned to pose a
smile during evolution.5 Posed smiles gained impor-
tance in dentistry and orthodontics mainly because they
are repeatable over time.6,7 The smile, which is essen-
tial to express friendliness, agreement, and appreciation,
From the Department of Orthodontics, Rajas Dental College, Tirunelveli
District, Tamilnadu, India.
a
Assistant professor.
b
Senior lecturer.
c
Intern.
Reprint requests to: Vinod Krishnan, Gourivilasam, Kudappanakunnu PO,
Trivandrum, Kerala State 695043, India; e-mail, vikrishnan@yahoo.com.
Submitted, January 2006; revised and accepted, April 2006.
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2006.04.046
be ignored in diagnosis and treatment planning.
Orthodontic diagnosis has come a long way and
now includes patient-driven esthetic diagnosis and
treatment planning along with its problem-oriented
approach. The reemergence of the soft-tissue paradigm
in clinical orthodontics9 has made smile analysis and
designing key elements in diagnosis and treatment
planning.10 Much attention is given in clinical exami-
nation to the display zone of smile, which is determined
by lip thickness, intercommissural width, interlabial
gap, smile index, and gingival architecture.10
Esthetics denotes concern about beauty or appreci-
ation of beauty. The perception of esthetics varies from
person to person and is influenced by personal experi-
ences and social environments.11 For the same reasons,
there can be differences of opinion regarding beauty
between laypersons and professionals.12 One study
reported that laypersons preferred more natural profile
drawings than did dental specialists.13 Another report
pointed out an opinion difference between orthodon-
tists and their patients when the same smiles were
515
516 Krishnan et al American Journal of Orthodontics and Dentofacial Orthopedics
April 2008

Table I. Results of VAS: median and range of ratings, Spearman rho correlation coefficients, and significance
at .01 level
Median Range

Specialist rating for men 6.00 4.50-7.38

Specialist rating for women 4.93 3.00-6.00
Layperson rating for men 5.83 4.25-8.42
Layperson rating for women 5.50 3.60-7.50
Spearman rho correlations

Groups Correlation coefficient Significance

Specialist rating: male vs female smiles 0.079 No significant correlation

Layperson rating: male vs female smiles 0.044 No significant correlation
Male smiles: specialists vs laypersons 0.624 Significant at 0.01 level (2 tailed)
Female smiles: specialists vs laypersons 0.781 Significant at 0.01 level (2 tailed)

evaluated.14 Recent studies also confirmed that there is

a difference in esthetic perceptions between orthodon-
tists, general dentists, and laypersons.14-16
The smile arc is defined as the relationship between
the curvature of the incisal edges of the maxillary
anterior teeth and the curvature of upper border of the
lower lip.4,17,18 Their ideal relationship on smiling is
considered to be parallel and is known as a consonant
smile. If the 2 are not parallel (with flatter maxillary
incisal curvature to the upper border of lower lip), it is
called a nonconsonant smile.4,16 Orthodontists’ lack of
consideration of the smile arc in treatment planning and
mechanics was reported recently, resulting in flattening
of the smile arc and less esthetic smiles. The main
reason cited for this was that more attention was placed
on tooth measurements while positioning brackets,
causing compromise in the curvature of the maxillary Fig 1. Consonant and nonconsonant smiles: A, conso-
incisal edges.19 Ackermann et al6 conducted a comput- nant smile with parallelism between the curvature of the
erized multimedia study to measure smile-arc charac- maxillary incisal edge and the upper border of lower lip;
teristics in treated and untreated subjects; they reported B, nonconsonant smile, with no parallelism between the
flattening of the smile arc in 37% of the treated ones, curves.
whereas only 5% of the untreated group had noncon-
sonant smiles. Other authors found similar results.8,20
These findings were contradicted by a recent study; the Johnson and Smith22 evaluated the effects of premolar
authors stated that, although orthodontic treatment extraction on the visibility of negative space and found
results in flattening of the incisal edges, it does not lead no relationship between extraction pattern and negative
to a nonconsonant smile.19 Those authors found good space.22 Recently, a study suggested that large buccal
correlation between the fitted curve of treated subjects corridor spaces should be included in the problem list for
and the lower-lip curve at the maximum angle of treatment planning, but minimal buccal corridors can be
elevation. left as they are.23 Most recent studies reported that buccal
Buccal corridors (negative or black spaces) are the corridors lave little impact on smile esthetics and will not
spaces between the facial surfaces of posterior teeth and influence the overall rating of a smile by orthodontists,
the corners of lips when a person is smiling.21 There general dentists, and laypersons.16,23,24
seems to be a difference of opinion among investigators A smile index was developed by Ackermann and
about the esthetic value of buccal corridors. Some Ackermann10 to describe the display zone of a smile.
concluded that they have no esthetic value; others This is determined by dividing intercommissural width
believe that visible buccal corridors are unattractive.16 by the interlabial gap during smiling. This ratio is
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 133, Number 4
Fig 2. Method to measure buccal corridor spaces: the
distance between the inner commissural and commis-
sural lines was the buccal corridor measurement.
Fig 3. Measurements for MSI values. The vertical mea-
surement was made between the upper and lower
vermilion borders at the midline. The transverse mea-
surement was made between the right and left lip
commissures.
useful for comparing smiles among patients. The lower
the smile index, the less youthful the smile appears.6,10
Even though the index is proposed, not much research
has been performed to validate it. With this back-
ground, our aims in this study were to (1) evaluate and
compare esthetic perceptions of frontal views of smiles
by dental specialists and laypersons, (2) compare smile
arcs for consonance and nonconsonance in men and
women, (3) evaluate and compare buccal corridor space
(right vs left; male vs female) in the whole sample, and
(4) calculate the modified smile index (MSI) value and
check its correlation with the facial index and the
mandibular width-facial height index.
MATERIAL AND METHODS
This was a cross-sectional study. The 60 subjects
(ages, 18-25 years; mean, 21 years), students at Rajas
Dental College, included equal numbers of men and
women. The following inclusion criteria were strictly
followed: (1) no previous orthodontic treatment or
maxillofacial surgery, (2) complete permanent denti-
tion except for third molars with no missing or super-
numerary teeth, (3) overjet and overbite of 2 to 5 mm,
Krishnan et al 517
Fig 4. Classification of smiles as very good, good,
average, and bad. The data from specialists and layper-
sons were pooled. Note the distribution of female smiles
between good and average. Four male smiles were
rated as bad, even after strict inclusion criteria were
followed in selecting subjects.
Fig 5. Consonant and nonconsonant smiles. Note that
most women have consonant smile arcs.
(4) no active periodontal disease and no periodontal
treatment except for routine scaling and polishing,
(5) normal upper lip length (in a balanced face, the
length of the upper lip [distance from subnasale to
stomion] is equal to one third of lower facial height
[subnasale to menton]), (6) no craniofacial anomalies
or other pathologies, (7) no severe malocclusion (es-
thetic component of index of orthodontic treatment
need was followed so that laypersons’ perspectives
were also considered; scores including and below 3
were included), and (8) no canting of the maxillary
occlusal plane.
Informed consent forms, approved by The Tamil-
nadu MGR Medical University (Tamilnadu, India)
ethical committee, were signed and obtained from each
subject before taking the frontal view photograph. The
518 Krishnan et al
Table II. Buccal corridor measurements
Male, right side
Male, left side
Female, right side
Female, left side
Pearson correlation coefficients
Right vs left sides Pearson correlation
Male smiles 0.865
Female smiles 0.835
Independent samples t test for equality of means
Male vs female t value df
Right side 0.057 58
Left side 0.355 58
Paired t test to assess difference between right and left sides
Female smiles 1.454 29
Male smiles 1.794 29
subjects were photographed with posed smiles (because
posed smiles are the most repeatable) after seating them
in a cephalostat with natural head position. Pictures
were taken in the same environment with the same
lighting conditions by using Yashica Dental Eye II
camera (Kyocera Co, Japan). The camera was fixed in
position with a tripod, and all the photographs were
taken in color. The photographs were then transferred
to computer software (Adobe Photoshop, version 7,
Adobe Systems, San Jose, Calif); they were cropped
with vertical (nose tip and soft-tissue pogonion) and
transverse (perpendicular drawn down from the zygo-
matic prominence) limits. All images were then ad-
justed to a standardized image size. Measurements
between 2 points (subnasale to soft-tissue menton) were
considered representative to check magnification error.
This was then compared with clinical measurements
and was found to have a statistically significant corre-
lation (0.92). The ruler in the same software was used
to obtain all measurements for this study. Averages of
the 2 measurements made by 2 investigators (V.K. and
S.T.D.) were used for the study. To verify the repeat-
ability of the measurements, 15 randomly selected
subjects were photographed again with the same set-
tings. The MSI parameters measured in these photo-
graphs were compared with the initial photographs of
the same patients to check for reproducibility of posed
smiles. We obtained statistically significant correlations
between the posed smile photographs taken at the 2
times (correlations of 0.84 [vertical parameter, interver-
American Journal of Orthodontics and Dentofacial Orthopedics
April 2008
Mean (mm) SD
6.97 1.61
7.43 1.73
6.95 1.30
7.27 1.75
Significance
Significant at 0.01 level (2 tailed)
Significant at 0.01 level (2 tailed)
P value Significance
.954 Not significant
.724 Not significant
.157 Not significant
.083 Not significant
milion distance in the midline) and 0.86 [horizontal
parameter, intercommisural distance]).
A panel of evaluators was selected: 20 persons, of
whom 10 were dental specialists (2 orthodontists, 2
prosthodontists, 2 endodontists, 2 periodontists, 1 oral
anatomist, and 1 oral surgeon) and 10 were laypersons
(family members of patients at our outpatient clinic on
the day of test). The standardized photographs were
projected with a projector (Philips multimedia projector
No. LC 3631/40; Philips, Amsterdam, the Nether-
lands). All 60 photographs were randomly projected
before the panel as a slide show to familiarize them
with the photographs, before asking the panel to eval-
uate each one. The panelists were given a chart with a
visual analog scale (VAS) ranging from 1 to 10 (1, very
good; 10, worst) to rate the overall appearance of the
smiles. The VAS was briefly explained to the panel
members, with illustrations. For the evaluation, each
smile was projected for 25 seconds, and the ratings
were tabulated. The average value for each smile was
calculated and rated from good to bad with the follow-
ing classification system: ⬍3, very good; 3-4.9, good;
5-6.9, average; ⬎7, bad.
Then the smiles were segregated and tabulated
(Table I) by sex. The Spearman rho correlation coeffi-
cient was calculated with SPSS software (version 12,
SPSS, Chicago, Ill) to find any correlation between
specialists’ and laypersons’ ratings, and between male
and female smiles.
The 60 standardized photographs were developed
American Journal of Orthodontics and Dentofacial Orthopedics Krishnan et al 519
Volume 133, Number 4

into 4 ⫻ 6-in prints and labeled according to sex. Two

lines were drawn on the photograph (1 connecting the
incisal edges of the maxillary incisors and the cusp tips
of the maxillary canines, and the other through the
upper border of the lower lip). Both lines were checked
for parallelism (Fig 1). The numbers of consonant
(parallel) and nonconsonant (nonparallel) smiles were
determined separately for men and women.
Each photograph was opened in the computer
software to draw the inner and outer commissural lines
on both sides as proposed by Ackerman and Acker-
man.10 The distances between these lines on both sides
were obtained as the right and left buccal corridor
spaces (Fig 2). The paired t test was used to determine
whether there was any significant difference between
the right and left sides in both sexes. Regression
analysis and Pearson correlation coefficients were cal-
culated between right and left buccal corridor spaces in
both sexes. To check for correlation in the right and left
sides between the male and female smiles (right sides in
men and women; left sides in men and women), the
independent samples t test was used.
The smile index proposed by Ackerman et al6 and
Ackermann and Ackermann10 is calculated by dividing
the intercommissural width by the interlabial gap
(width/height). We used a modified form of this smile
index, called the MSI. As part of the modification, to
include the lips, we measured intervermilion distance at
the midline for height (Fig 3). We reversed the calcu-
lation; we divided height by width and multiplied that
by 100 to obtain a percentage. This was done mainly to
make the calculated value comparable with other com-
Fig 6. Regression plots comparing right and left buccal
mon indexes such as the facial index (N-Gn/Zy-Zy X
corridor spaces: A, male smiles; B, female smiles. Note
100) and the mandibular width-facial height index the positive correlations between the right and left sides in
(Go-Go/N-Gn X 100). The formula for calculating the both plots, indicating predictability in relationships.
MSI is:

Intervermilion distance at midline
⫻ 100
Intercommissural distance
The facial index and the mandibular width-facial
height indexes were calculated directly from clinical
measurements with the methods proposed by Farkas
and Posnick25 and Proffit and Fields.26 All values
(MSI, facial index, and mandibular width-facial
height index) were tabulated without any sex differ-
ence. The female and male data were pooled after
subjecting the values to correlation and regression
analyses separately. We observed little difference
between these values, making pooling of data feasi-
ble for this study. (Correlations of 0.291 and – 0.287
were obtained for separate analyses by for the male
and female samples, respectively. Regression analy-
sis with male and female data provided ‘B’ values of
0.287 and 0.291, respectively.) Regression analysis
and Pearson correlation coefficients were calculated
to find any correlations between these parameters.
Individual vertical (intervermilion distance and
N-Gn distance) and transverse (mandibular width
[Go-Go] and intercommissural distance) measure-
ments were also compared for correlations with
Pearson correlation coefficient with the SPSS soft-
ware.
A retrospective power analysis with Power and Pre-
cision software (version 2.0, Power and Precision, 2000,
developed by Borenstein, www.powerandprecision.com)
was calculated to determine whether the correlations for
comparison between the MSI and the other indexes were
520 Krishnan et al
Table III.
Mean and standard deviations of all measurements for MSI, facial index, and mandibular width-facial height
index and results of the Pearson correlation coefficients
N-Gn distance
Bizygomatic width
Bigonial width
Intervermilion distance at midline
Intercommissural width
Facial index
Mandibular width-facial height index
MSI
Pearson correlation coefficients
Grouping
Intervermilion distance at midline and N-Gn distance
Intercommissural width and bigonial width
MSI and facial index
MSI and mandibular width-facial height index
valid. For this purpose, the P value (␣) was set at .01 (2
tailed).
RESULTS
The data from the VAS are summarized in Table I,
which also shows the Spearman rho correlation coeffi-
cient values and the significance levels at P ⬍.01. It is
clear that, when rated by both specialists and layper-
sons, there is no statistically significant correlation
between male and female smiles. A highly significant
correlation was observed between specialists’ and lay-
persons’ ratings when male and female smiles were
considered separately.
The classification system showed no smile in the
“very good” category; 14 female smiles were rated as
good, and 16 were rated as average. In the men, 4
smiles were rated as bad, and most (24) was rated as
average (Fig 4). When male and female smiles were
compared for consonance, we found a significant differ-
ence between the numbers of consonant and nonconso-
nant smiles, with more female consonant smiles (Fig 5).
The paired t test with buccal corridor measurements
showed no significant difference statistically between
the right and left sides for either sex, and there was high
correlation between the right and left sides. No statis-
tically significant difference was seen when indepen-
dent samples t tests for equality of means were calcu-
lated between male and female buccal corridor spaces.
Regression plots with the data showed a positive
relationship between the right and left sides in both
sexes (Table II, Fig 6).
Means, standard deviations, and Pearson correla-
American Journal of Orthodontics and Dentofacial Orthopedics
April 2008
Mean (mm) SD
107.45 6.03
115.02 11.89
123.95 2.28
30.95 4.05
67.42 4.69
92.51 6.33
115.65 7.13
46.04 6.16
Correlation coefficient Significance
0.381 Significant at 0.01 level (2 tailed)
0.442 Significant at 0.01 level (2 tailed)
0.194 Not significant
⫺0.363 Significant (negative correlation)
at 0.01 level (2 tailed)
tion coefficient values for the MSI, the facial index, and
the mandibular width-facial height index are given in
Table III. Comparisons between measurements for
correlating the vertical and transverse parameters dif-
ferently are also shown in Table III. Clearly, there is no
correlation between the facial index and the MSI
values. Comparison of vertical (intervermilion distance
and N-Gn distance) and transverse (mandibular width
and intercommissural distance) parameters with the
Pearson correlation showed a high correlation coeffi-
cient that was significant statistically (Fig 7). A nega-
tive correlation of 0.363 was observed between the
mandibular width-facial height index and the MSI that
was significant statistically. Regression plot analysis by
comparison of the mandibular width-facial height index
and the MSI confirmed this finding (Fig 8).
With the correlation obtained (0.363), the power
analysis showed a power of 0.628 with a sample size of
60 and the P value set at .01. This means that 63% of
studies would be expected to generate a significant
effect such as this. (With P at .05, the power test for this
sample size would be 84%, considered highly signifi-
cant for a scientific study.)
DISCUSSION
We evaluated characteristics of the smile with 2
methods. One was the subjective evaluation of overall
appearance of the smile with ratings by 10 specialists
and 10 laypersons on a VAS. The other was quantifi-
cation of smile characteristics by identifying consonant
and nonconsonant smiles, by measuring buccal corri-
dors, and by calculating the MSI and comparing it with
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 133, Number 4
Fig 7. Regression plots comparing the vertical and
transverse anthropometric measurements: A, correla-
tion between vertical parameters (facial height [N-Gn]
and intervermilion distance at midline); B, correlation
between transverse parameters (mandibular width [Go-
Go] and intercommisural distance). Note the positive
correlation in both plots, indicating predictability in
relationships.
the facial index and the mandibular width-facial height
index.
The high correlation between specialists and lay-
persons in rating the overall appearance of the smiles
goes against most research in this regard.12-16 Our
results agree with those of Flores-Mir et al,11 who
stated that the level of dental-related education has little
impact on dental and esthetic perceptions. We included
more panelists for evaluating the smiles and went 1 step
farther than other reports, with equal numbers of dental
Krishnan et al 521
Fig 8. Regression plot comparing MSI and the mandib-
ular width-facial height index. Note the negative corre-
lation between these indexes, indicating that an in-
crease in 1 will result in a decrease in the other.
specialists (from 6 backgrounds) and laypersons. The
only drawback or shortcoming of this study was not
considering male and female judges separately to de-
termine any differences in evaluating smiles by sex. It
has been reported that laypersons consider facial and
dental arrangements in evaluating overall smile appear-
ance.12-16 These and our results point to the need for
thorough discussion with a patient, to learn his or her
preference of the smile and the dental arrangement,
before determining a treatment plan.
In this study, we also evaluated consonance and
nonconsonance in the smile-arc relationship. It is well
known that a consonant smile arc is more attractive
than a nonconsonant one.4,17 We found more women
(67%) with consonant smiles than men (40%). To
determine whether this has any relationship to attrac-
tiveness, we categorized the ratings of the panelists for
a comparison with our MSI. To our surprise, no smile
was rated as “very good,” and the 14 female smiles
rated as “good” all had consonant smile arcs. Thus,
female smiles seem to be more attractive and consonant
than male smiles. This aspect has clinical implications.
The arc of the maxillary incisal edges can be altered by
therapeutic measures— either orthodontic or restorative
treatment. In orthodontics, the brackets can be carefully
positioned (not to disturb the existing consonance or to
create a consonant smile) to create a parallel smile-arc
relationship that is also attractive. It was proposed that
increasing the cant of the maxillary occlusal plane to
the Frankfort horizontal plane will increase maxillary
anterior tooth display and improve the consonance of
the smile.10 There also is a relationship between a
patient’s arch form and smile-arc curvature. We sug-
522 Krishnan et al
gest not altering the patient’s original arch form or, at
least, not creating a broader arch form that will cause
less curvature of the anterior segment resulting in a flat
smile arc, because this is often unesthetic. This finding
agrees with a recent report that flat smile arcs have
lower attractiveness ratings.27
The impact of buccal corridors on smile esthetics
has been studied in recent years. All reports show that
buccal corridors have no effect on the esthetic evalua-
tions of smiles.16,23,24,27 The results of our study, which
looked at differences between buccal corridor spaces of
the right and left sides in posed smiles, indicated no
statistically significant difference between the right and
left negative spaces in either sex. We also observed a
positive correlation between the right and left buccal
corridor spaces in both sexes. The regression plot
confirmed this finding and suggests predictability of 1
side from the other. The positive regression plot indi-
cates that, as the negative space on 1 side increases or
decreases, the same change will occur on the other side.
This finding was same in both sexes.
When male and female smiles were compared for
their buccal corridor measurements, we found a high
correlation. This finding disagreed with our VAS val-
ues, which showed a significant difference between
perceived male and female smiles. 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 architec-
ture, gingival display, lip thickness, and so on. The
drawback of this research was the controlled sample
selection with strict inclusion criteria, including attrac-
tive smiles with only minimal to moderate buccal
corridor spaces. These results should be viewed cau-
tiously, since a recent report stated that excessive
buccal corridor spaces are less attractive to both orth-
odontists and laypersons.24
In the last part of our research, we proposed and
calculated the MSI, enabling a smile to be compared
with time-tested indexes (facial index and mandibular
width-facial height index). This research is the first that
attempted a comparison of facial indexes to smile
characteristics. The anthropometric measurements made
in this study helped us to determine that no relationship
exists between facial types and smile characteristics.
The various facial types (euryprosopic, mesoprosopic,
and leptoprosopic) as proposed by Farkas and Posnick,25
had different MSI values that could not be correlated.
An interesting finding was the correlation between
vertical and transverse parameters when analyzed indi-
vidually. This finding agrees with a report that vertical
development of the face causes increases in all associ-
American Journal of Orthodontics and Dentofacial Orthopedics
April 2008
ated parameters and affects smile characteristics.7 We
also found correlation between transverse parameters.
The high correlations indicate predictive capability;
this means that a change in 1 parameter will have a
definite influence on the other and will be reflected as a
change in its measurement, with the ratio maintained.
When we combined both correlating variables in the
form of MSI and correlated with mandibular width-
facial height index, it showed a negative correlation.
This suggests that any change in the mandibular width-
facial height index value will have a negative impact on
the MSI value (as the mandibular width-facial height
index increases, there will be a corresponding decrease
in the MSI index value). Although the correlation
coefficient was low (0.363), this finding was significant
statistically. The clinical significance of these results is
still questionable and points to the need for thorough
research with larger samples and a well-planned re-
search strategy. We suggest that this report is prelimi-
nary in this regard, because more research should be
performed to confirm the finding and to elucidate its
predictive value.
CONCLUSIONS
1. There is no difference in evaluation of overall smile
characteristics between specialists and laypersons.
2. More women (67%) than men (40%) have conso-
nant smiles.
3. There is no significant difference between right and
left buccal corridor spaces in either sex; these
spaces have a high correlation.
4. The MSI values showed no correlation with facial
index values.
5. There are positive correlations between vertical
anthropometric (N-Gn) and vertical measurements
of the MSI (intervermilion distance at midline) and
transverse anthropometric (Go-Go) and transverse
measurements of the MSI (intercommissural dis-
tance).
6. The MSI has low negative correlation with the
mandibular width-facial height index that is signif-
icant statistically.
We thank the chairman and the management of
Rajas Dental College, staff members (Suresh Sathia-
sekar, Biju Sebastian, Babukuttan Pillai, and Dhivakar
Selvaraj) of the Department of Orthodontics, statisti-
cians Muralidharan Nair and Nisha Kurian, and the
panel members.
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