Maxillary anterior papilla display during smiling: a clinical study of the interdental smile line

The purpose of this research was to quantify the visual display (presence) or lack of display (absence) of interdental papillae during maximum smiling in a patient population aged 10 to 89 years. Four hundred twenty digital single-lens reflex photographs of patients were taken and examined for the visual display of interdental papillae between the maxillary anterior teeth during maximum smiling. Three digital photographs were taken per patient from the frontal, right frontal-lateral, and left frontal-lateral views. The data set of photographs was examined by two examiners for the presence or absence of the visual display of papillae. The visual display of interdental papillae during maximum smiling occurred in 380 of the 420 patients examined in this study, equivalent to a 91% occurrence rate. Eighty-seven percent of all patients categorized as having a low gingival smile line (n = 303) were found to display the interdental papillae upon smiling. Differences were noted for individual age groups according to the decade of life as well as a trend toward decreasing papillary display with increasing age. The importance of interdental papillae display during dynamic smiling should not be left undiagnosed since it is visible in over 91% of older patients and in 87% of patients with a low gingival smile line, representing a common and important esthetic element that needs to be assessed during smile analysis of the patient.