A comparison of gingival display with a requested smile, Duchenne smile, grimace of disgust, and funnel-shaped expression.

Statement Of Problem: A patient's smile may not elicit the maximum amount of maxillary gingiva.

Purpose: The purpose of this study was to measure the amount of gingival display with 4 different facial expressions.

Material And Methods: Video images of 91 randomly selected adults were evaluated to measure the height of gingival display at the maxillary anterior teeth and first premolars when participants were asked to give their biggest smile (requested smile), make a Duchenne smile, mimic an intense grimace of disgust (grimace), and produce a funnel-shaped expression (funnel). Measurements were compared with the Friedman Test with post hoc comparisons (α=.05 for all tests).

Results: The intraclass correlation coefficient was (95% CI)=0.913(0.623, 0.984). At the central and lateral incisors, the grimace and funnel expressions produced the greatest amounts of gingival display. At the canines and the first premolars, both smiles (requested and Duchenne) exhibited the largest amount of gingival display of the 4 facial expressions.

Conclusions: Neither smile type revealed a significantly greater amount of gingival display above the maxillary central or lateral incisors but the grimace and funnel facial expressions did (P ≤.001). Above the maxillary canines, both smiles displayed a significantly greater amount of gingiva than did the funnel expression (P<.001), but only the Duchenne smile displayed a greater amount than did the grimace expression (P=.05). Superiorly to the maxillary first premolars, both smile types revealed significantly greater amounts of soft tissue when compared with the other 2 facial expressions (P<.001).