Smile and facial harmony
The Pitts philosophy: the smile arc, the position of the front teeth, the lips and the profile are planned together.
Does this sound familiar
Patients most often come for this with these words:
My teeth are straight, but something about my smile is not quite right
Dark spaces show at the sides when I smile
My front teeth look short or sit in a straight line
In profile my lips stick out too far or look sunken
My smile looks asymmetric
I avoid smiling in photos
When people talk about a beautiful smile, most think only of straight teeth. But there are other details that make a smile look natural and youthful: the smile arc, the position of the front teeth, the width of the dental arch, how much gum shows, the position of the lips and how all of this fits the face. In research, both orthodontists and laypeople sense these details without knowing their names.
What the Pitts philosophy is
The Pitts philosophy is a treatment method created by the American orthodontist Dr. Tom Pitts. Here the doctor thinks not only about straight teeth and a correct bite but also about how the patient will look at the end of treatment. Treatment is not built by moving teeth "roughly in the right direction" but along a precisely thought out path. In 2022-2024 I completed the Pitts Masters Continuum 9 programme in the USA. More: what is the Pitts philosophy.
The elements of a smile
| Element | What I look at |
|---|---|
| Smile arc | Do the edges of the upper teeth follow the lower lip |
| Height of the front teeth | How much they show at rest and when smiling |
| Arch width | Are there large dark spaces at the sides when smiling |
| Gums | How much gum shows when smiling |
| Midline | Does the middle of the teeth line up with the middle of the face |
| Profile | How the lips relate to the nose and chin |
I wrote about each element separately: the smile arc, buccal corridors and can orthodontics change your face.
Diagnosis starts from the face
- Facial photographs: front and profile, at rest, in a natural and a broad smile
- Close-up photographs and video of the smile
- Intraoral photographs and models
- A cephalometric X-ray and profile analysis
- Planning the final smile, then the movements that lead to it
What it means for the patient
- A more predictable result
- Attention to aesthetics as well as function
- A systematic plan from day one
- Taking the profile, lips and facial features into account
- Protecting the profile in extraction decisions
With the right diagnosis and plan, the changes are not limited to the smile. In some of our patients, the proportions, contour and symmetry of the face also became more harmonious after treatment. But orthodontics has limits too: in adults it does not change the size of the jawbone or the shape of the nose. I say this openly at the consultation.
Teamwork
Sometimes full harmony of the smile requires, after the orthodontic phase, restoring the shape of the teeth, correcting the gums or other aesthetic steps. In such cases we plan together with a general dentist, a prosthodontist and a periodontist. I recommend making decisions about lip aesthetics after the orthodontic result: can you have lip fillers before orthodontic treatment.
What the science says
- Clinical paper (2001): the position of the front teeth determines the smile arc and must be planned in advance in treatment.
- Study (2006): orthodontists and laypeople find a smile arc parallel to the lower lip and minimal buccal corridors more attractive.
- Systematic review (2016): laypeople are sensitive to several aesthetic details of the smile.
- Systematic review and meta-analysis (2018): in treatment with extractions the lips move back more, so the profile must be considered in the decision.
Sometimes a good result is straight teeth. An exceptional result is a smile you cannot take your eyes off.
How the consultation goes
With a patient who comes about this, I first listen to what bothers them. Then I take photographs and video and we look at the elements of the smile together on screen. Sometimes the patient sees the cause of their concern for the first time there: for example, the problem is not crooked teeth but a flat smile arc or dark spaces at the sides. Then I explain how much of this can change orthodontically and what needs another specialist.
Frequently asked questions
Is this a separate treatment or part of braces treatment?
It is a planning approach I apply in every orthodontic treatment. Treatment with braces or aligners is carried out on the basis of this plan.
Will orthodontics change my face?
The lip profile, the width of the smile and how the mouth closes can change. In adults the size of the jawbones does not change.
Can the smile arc be improved?
If the cause is the position of the teeth, yes. If the teeth are short or worn, aesthetic restoration may be needed afterwards.
Will the dark spaces at the sides of the smile be corrected?
If the cause is a narrow arch or side teeth tipped inwards, it can often be improved orthodontically.
Can I see the result in advance?
During planning I explain the goal on photographs and models. The exact result also depends on the biological response of the teeth.
Can smile harmony be achieved with aligners?
In many cases yes. But when the height of the front teeth needs fine control, braces are more precise.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Sarver, D. M. (2001). The importance of incisor positioning in the esthetic smile: the smile arc. American Journal of Orthodontics and Dentofacial Orthopedics, 120(2), 98-111. [PMID: 11500650] | [DOI: 10.1067/mod.2001.114301]
- Parekh, S. M., Fields, H. W., Beck, M., & Rosenstiel, S. (2006). Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and laymen. The Angle Orthodontist, 76(4), 557-563. [PMID: 16808559] | [DOI: 10.1043/0003-3219(2006)076[0557:AOVITS]2.0.CO;2]
- Parrini, S., Rossini, G., Castroflorio, T., Fortini, A., Deregibus, A., & Debernardi, C. (2016). Laypeople's perceptions of frontal smile esthetics: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics, 150(5), 740-750. [PMID: 27871700] | [DOI: 10.1016/j.ajodo.2016.06.022]
- Konstantonis, D., Vasileiou, D., Papageorgiou, S. N., & Eliades, T. (2018). Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis. European Journal of Oral Sciences, 126(3), 167-179. [PMID: 29480521] | [DOI: 10.1111/eos.12409]