ORIGINAL ARTICLE

Esthetic evaluation of dynamic smiles with

attention to facial muscle activity
Angela I-Chun Lin,a Thomas Braun,b James A. McNamara Jr,c and Geoffrey E. Gerstnerd
Ann Arbor, Mich

Introduction: Numerous studies of smile esthetics have used still photos. Photos, however, do not capture the
dynamics of a smile, an element that can contribute to overall smile esthetics. In this study, we assessed the
esthetics of dynamic smiles. Methods: Four facially balanced female dental students were trained to produce
8 distinct smiles using the facial action coding system. Videos of the models’ whole faces were presented to
2 panels of raters: dental students and nondental undergraduate students. Smile attractiveness was rated using
a Web-based survey. Results: The smile that used 4 labial muscles was rated significantly better than the smile
involving only the risorius muscle (P \0.05). The orbicularis oculi improved smile attractiveness (P \0.04), es-
pecially among smiles rated less favorably (P \0.05). Visibility of the models’ eyes, however, did not influence
the ratings (P .0.05), perhaps because orbicularis oculi activation altered activations in other muscles in such
a way that smile attractiveness was increased in the lower face. Conclusions: Smile esthetics increased with
increased recruitment of muscles involved in smile production. The results were robust across the models, sug-
gesting that objective rating methods of smile-dynamic esthetics could become an important clinical tool. (Am J
Orthod Dentofacial Orthop 2013;143:819-27)

S
miles play a critical role in esthetics and social
behavior.1 With the reemergence of the esthetic
paradigm in patient-centered care, smile
enhancement has become increasingly important.2
However, a consensus on the criteria for smile esthetics
does not yet exist. In this study, we quantified the
esthetics of smiles and tested the reliability and repeat-
ability of these measures.
Most investigations of smile esthetics did not
examine the facial movements involved in smiling. The
results were based on still images cropped to show
only the subject’s lips and dentition.3,4 A smile,
however, consists of dynamic movements that cannot
From the University of Michigan, Ann Arbor.
a
Postgraduate student, Graduate Orthodontic Program, Department of
Orthodontics and Pediatric Dentistry; private practice, Chelsea, Mass.
b
c
Assistant professor, Department of Biostatistics, School of Public Health.
Thomas M. and Doris Graber Endowed Professor of Dentistry, Department of
Orthodontics and Pediatric Dentistry, School of Dentistry; research professor,
Center for Human Growth and Development; private practice, Ann Arbor, Mich.
d
Associate professor, Department of Biologic and Materials Sciences, School of
Dentistry.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Supported in part by the Delta Dental Foundation of Michigan.
Reprint requests to: Geoffrey E. Gerstner, Department of Biological and Material
Sciences, School of Dentistry, University of Michigan, 1011 N University Ave, Ann
Arbor, MI 48109-1078; e-mail, geger@umich.edu.
Submitted, September 2012; revised and accepted, January 2013.
0889-5406/$36.00
Copyright Ó 2013 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2013.01.017
be captured by still images. For instance, Tarantili
et al5 identified 3 phases in the motion of a spontaneous
smile: an initial attack phase, a sustaining phase, and
a fade-out phase. Smiles transition between these
phases through time; therefore, it is impossible to render
a complete smile in a single photograph.
Studies of smile dynamics suggest that facial
movements are critical in esthetic assessments of a smile.
Rubenstein6 showed low correspondence between the
attractiveness ratings of a face presented in the static vs
the dynamic format. Static images probably relay
structural facial information, whereas the dynamic
format introduces nonstructural features such as
emotions. These observations suggest a critical need to
develop objective methods to quantify and assess
dynamic smile esthetics. The facial action coding system
is a standardized method of describing facial muscular
activity during facial expressions.7,8 The system
identifies 46 distinct facial movements described as
action units. Most smiles involve contraction of the
zygomaticus major muscle, action unit 12, and
constriction of the eyes through contraction of the
orbicularis oculi, action unit 6. Action unit 6, also called
“Duchenne’s marker,” has been associated with
spontaneous smiles or true enjoyment.9,10 Subjects
asked to use action unit 6 during smiling report feeling
more positive emotions, and they display concomitant
changes in central nervous system activity.11
819
820 I-Chun Lin et al

Fig 1. Left: examples of smiles 1-4, with and without use of eyes (action unit 6). Right: depiction of the
main muscles involved in the study smiles. AU, Action unit.

The facial action coding system relies on subjective
interpretations by observers. Ekman and Friesen8
attempted to overcome this subjectivity by calibrating
and certifying facial action coding system observers.
This calibration improved intrarater reliability; however,
interrater reliability remained less than ideal.
Gracely et al12-14 developed a box scale to differentiate
between sensory and affective components of pain. The
scale has demonstrated high correlations between
sessions, groups, and experiments, and it has high
internal and external validity. Because of its power and
validity as a rating method, the scale was modified to
provide esthetic ratings in our study.
The aims of this study were to examine (1) whether spe-
cific attributes of dynamic smiles were involved in esthetic
ratings, (2) the role of the eyes in esthetic measurements,
and (3) the agreement between dental professionals and
laypeople on perceptions of dynamic smile esthetics.
MATERIAL AND METHODS
The study was approved by the University of
Michigan's institutional review board. Smile models
were recruited from the predoctoral dental classes at
the University of Michigan School of Dentistry. Inclusion
criteria were (1) women, ages 20 to 30 years; (2) good
facial and skeletal balance based on extraoral examina-
tions; (3) good general health; and (4) good dental
health with functional dentitions. The models were
within 15% of the ideal body mass index for their age,
and they had no history of organic disease, congenital
disease, orofacial pain, dysfunction, arthritis, joint noises
or restrictions, and medications known to interfere with
affective or motor parameters. The models were required
to follow the instructions to learn to perform specific
smiles on command. Only female models were selected
for this initial study to simplify interpretation of the
results by controlling for sex effects.
The exclusion criteria were based on the study of
Kokich et al15 of altered dental esthetics: maxillary
incisor angulation $2 mm from ideal, maxillary midline
$4 mm from the facial midline, open gingival embrasure
between the maxillary central incisors $2 mm (space
between the tip of the interdental papilla and the inter-
proximal contact point), maxillary incisal plane deviation

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I-Chun Lin et al 821

Fig 2. Instruction page for the box-scale rating, part 3 of the survey. The actual survey Web page was
similar to the instruction page, except that the phrases in the top left corner were removed from the
survey pages. Shown is a snapshot of a video with the subject's eyes blocked and the vertical Gracely
box scale with numbered boxes, 0-20, along with descriptors placed adjacent to the scale in a manner
similar to that used in pain studies (see text). The raters could play the video repeatedly by pressing
a button at the bottom left of the video; however, as soon as a numbered box was clicked, the survey
proceeded automatically to the next page.

$1 mm, and gingiva-to-lip distance $2 mm at the
maximum smile. The final 4 models were selected by
an orthodontic expert (A.L.) from the original sample
of 8 candidates, all of whom met the inclusion and
exclusion criteria described above.
The 4 models were trained to produce 8 different
smiles (Fig 1). The study smiles were carefully
constructed using the facial action coding system to
control for variations in smiles. The activity in action
units was monitored visually to reduce unwanted
variations in smile dynamics.
The action units used included (1) action unit
6, “cheek raise,” contraction of the orbicularis oculi;
(2) action unit 10, “upper lip raiser,” contraction of
the zygomaticus minor and levator labii superioris;
(3) action unit 12, “lip corner puller,” contraction of
the zygomaticus major; (4) action unit 20, “lip stretch,”
contraction of the risorius; and (5) action unit 25, “lips
part,” used by the facial action coding system to indicate
parting of the lips, thus showing the dentition (Fig 1).
All smiles were controlled for absence of nostril flare,
chin and forehead muscle movements, eye movements,
movements at the glabella, blinking, and unwanted
muscle movements involving the lips.
The models were trained by 1 investigator (A.L.) to
produce all 8 smiles naturally from the rest position.
The models practiced as many times as necessary to
achieve the desired movements, timing, and spontane-
ity. The smiles were videotaped with a camcorder aligned
with the model’s midsagittal plane to provide a full
frontal view of the face. The camera was located near
the level of the subject’s Frankfort horizontal plane
and 2 m from the subject’s face.
Upon command, the subjects produced each smile
starting from the neutral position, held the maximum
position for 2 seconds, and then returned to the neutral
position. Hence, the total smile episode, from neutral
back to neutral, lasted about 3 seconds, which is the
duration of many human motor events and their
perceptions.16 Training typically lasted 15 to 30 minutes
for each model and involved having them watch
themselves in a mirror while performing each smile on
verbal commands. After training, 2 or 3 trials were
necessary to obtain a video clip in which a satisfactory
smile was performed. The videos then were screened
by the same investigator to identify the best clip to
represent each smile for each model.
Videos were edited in i-Movie (Apple Inc, Cupertino,
Calif) and converted into individual 3-second clips in
MPEG 4 format. Each clip was 7 3 6.2 cm (2.8 3 2.44
in) on the computer monitor and showed the entire
head and neck region of the model plus the top of the

American Journal of Orthodontics and Dentofacial Orthopedics June 2013  Vol 143  Issue 6
822 I-Chun Lin et al

Fig 3. Instruction page of the forced comparison, part 4 of the survey. The actual survey Web pages
looked similar to that shown except for the phrasing in the top left corner. The raters could play the
videos repeatedly if desired by pressing the appropriate button in the bottom left corner of the videos;
however, the computer algorithm accepted the first click on the box below the video as the rater’s
response. The raters then clicked on the “next” box, bottom of the screen, to proceed with the survey.

In part 1, rater participant data, the raters’

Table I. Demographic data on the raters by panel
demographic information including sex, age, ethnicity,
Age (y) occupation, and sexual orientation were collected. The
Sex Ethnicity
Panel (F:M) \21 21-25 .25 (W:As:Af:H:I:U)
participants also indicated whether they knew any of
Dental 31:21 0 42 10 32:14:5:0:1:0 the models before this study. It was determined that
Lay 15:16 25 6 0 25:2:0:2:0:2 the raters gave higher scores to models whom they
Total 46:37 25 48 10 57:16:5:2:1:2 knew than to those they did not know (P \0.001).
Therefore, data representing models whom raters knew
F, Female; M, male; W, white; As, Asian or Asian American;
Af, African or African American; H, Hispanic; I, Indian; U, unknown. were removed from analyses.
In part 2, overall facial attractiveness of the models,
shoulders. The clips were duplicated, and the copy was photographs of the 4 models were presented on 1 Web
edited to include a rectangular block (7 3 1.9 cm, or 2.8 page. The pictures showed only the models’ heads, and
3 0.75 in) that covered the model’s eyes and nose (Figs all models were performing smile 4 in the photos. The
2 and 3). This approach resulted in 16 video clips (8 smiles participants were asked to rate each model’s overall
with and without the rectangular block) for each model. facial attractiveness on a scale of 1 to 10, with 1 the least
Two rater panels were recruited from the University attractive and 10 the most attractive.
of Michigan and signed informed consent forms to Based on the ratings in the preliminary pilot study,
participate. The dental panel consisted of dental the attractiveness ratings of models C and H were similar
students in their first to fourth years. The lay panel to each other, whereas the ratings of models K and S were
consisted of students from the Department of Psychol- similar to each other. As a result, only one of models C
ogy research subject pool. Anyone over 18 years old and H and only one of models K and S were assigned ran-
was invited to participate. The dental panel consisted domly to each rater for parts 3 and 4 of the survey.
of 52 raters (31 women, 21 men), and the lay panel In part 3, box scale, all 32 videos (16 per model 3 2
included 31 subjects (15 women, 16 men; Table I). models) were presented to a rater 3 times in random
A Web-based survey was created containing 5 parts. order, requiring 96 total responses (3 3 32). The raters se-
Each part had detailed instructions and examples of the lected the number in the box scale corresponding to their
tasks to be completed. The raters were allowed to watch impression of the attractiveness of each smile (Fig 2).
the smile videos as many times as needed to make their In part 4, forced comparison, 2 videos were presented
decisions. They were not allowed to skip responses or simultaneously, and the raters were forced to choose
change their responses once answered. which of the 2 smiles was more esthetic (Fig 3). The paired

June 2013  Vol 143  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
I-Chun Lin et al
videos were selected randomly using the following rules:
(1) the pair represented the same model; and (2) the pair
differed from each other in only one of 3 ways—type of
smile (smile 1, 2, 3, or 4), use of the eyes (action unit 6
used or not used), or blocking of the eyes (eyes blocked
or eyes visible). This protocol resulted in 40 paired video
presentations for each model: ie, 2 eye-use conditions
times 2 eye-blocking conditions times 10 smile pairs—
smiles 1 and 1, 1 and 2, 1 and 3, 1 and 4, 2 and 2, 2
and 3, 2 and 4, 3 and 3, 3 and 4, and 4 and 4.
To control for spatial order effects, each of the
40 video pairs was presented twice using an algorithm
that changed the left-to-right ordering randomly on
the screen. This resulted in the raters viewing a total of
80 (40 3 2) pairs of smile videos for each model. Since
each rater viewed the smiles from 2 models, 160 total
presentations were rated.
In part 5, overall facial attractiveness of models, at
the end of the survey, the raters were asked once again
to rate each model’s overall facial attractiveness on a
scale of 1 to 10. The presentation of this part was
identical to part 2.
The raters took the survey at the walk-in computer
center in the University of Michigan School of Dentistry
with the Mozilla Firefox web-browser software (Mozilla
Foundation, Mountain View, Calif) on personal com-
puter desktops linked to a high-speed Internet cable.
Statistical analysis
Descriptive statistics were calculated for the raters
including sex, age, ethnicity, and sexual orientation.
Parametric tests were used to analyze the box-scale
data (part 3, above). The mean box score for each smile
was plotted to identify rating trends that might have
existed across the 3 presentations of each video. Data
from the second video presentation were chosen for
analysis using a univariate analysis of variance (SPSS
version 17.0.1; SPSS, Chicago, Ill) to study effects from
smile type, use of action unit 6, blocking of eyes, rater
panel, rater age, and rater sex.
Data from the forced comparison (part 4) were
analyzed using multinomial logistic regression. Logistic
regression is used to predict the probability of the occur-
rence of an event based on a set of dependent and inde-
pendent variables.
For this study, 3 forced-comparison analyses were
performed using multinomial logistic regression:
(1) comparing the 4 smile types while holding “use of
action unit 6” and “blocking of eyes” constant; (2) com-
paring “use of action unit 6” while holding smile type
and “blocking of eyes” constant; and (3) comparing
“blocking of eyes” while holding smile type and “use
of action unit 6” constant.
American Journal of Orthodontics and Dentofacial Orthopedics
823
As an example, to compare smile types while holding
“use of action unit 6” and “blocking of eyes” constant,
we first determined for each rater the number of times
each smile type was selected in the forced comparison
with every combination of eye use and eye block. The
frequencies of the 4 smile types then were modeled
with multinomial logistic regression as a function of
the participant’s sex, age, panel, smile, use of action
unit 6, and blocking of eyes. Because each rater
evaluated a given smile many times during the survey,
all P values were computed using bootstrap methods
to adjust for this repeated-measure dependency.
RESULTS
For part 1, rater participant data, 83 raters took the
survey: 52 in the dental panel and 31 in the lay panel
(Table I). Although the lay panel was younger than the
dental panel (P \0.001), the age range (18-26 years)
was young adult in both panels; therefore, age was
not deemed a relevant factor for investigation in our
study. All but 1 rater indicated “heterosexual” for sexual
orientation. Only raters on the dental panel were
acquainted with the models (Table I).
For part 3, box scale, a quantile-quantile plot showed
a normal distribution for the box-scale scores for each of
the 4 smiles, pooled across models and eye-related fac-
tors. Therefore, parametric statistics were used to ana-
lyze the box-scale data.
Each smile was presented 3 times in the box-scale
portion of the survey. An analysis of order effects
showed no significant differences in presentation order
for any of the 4 smiles; therefore, scores from the second
presentation were used in analyses.
Also, for model S, the difference between all 4 smiles
was insignificant; therefore, the data for model S were
excluded from further analysis.
For all raters, smile 4 was rated the best, followed by
smiles 3, 1, and 2 (Fig 4). For both rater groups, the
difference between smiles 4 and 2 was significant
for models H (P 5 0.045) and K (P 5 0.005), but
insignificant for model C (Fig 4).
Among lay and dental raters, contracting the orbicu-
laris oris caused a significant increase in the scores for
models H (P 5 0.038) and K (P 5 0.004) for the less
attractive smiles (Fig 5). Use of the eyes also improved
the scores for model C, but the effect was statistically
insignificant.
Blocking the eyes (Fig 2) had no significant effect on
the scores involving any of the models or either rater group.
The dental panel gave significantly higher scores to
all 3 models than did the lay panel (P \0.001).
Among all raters, women gave significantly
higher scores to models C and K than did the men
June 2013  Vol 143  Issue 6
824
Fig 4. Box-scale ratings for the 4 types of smiles for
models K, H, and C. Smile numbers 1-4 correspond to
those represented in Figure 1. *P \0.05; ***P \0.005.
(P \0.001). No significant sex differences were found
involving model H.
Table II shows the raw forced comparison data from
1 rater. The numbers in the 4 smile columns indicate the
number of times each smile type and eye condition were
selected by this rater; eg, the smiles in the first row all
have eyes blocked with no use of eyes. The
frequencies of the 4 smile types were modeled as
a function of the participant’s sex, panel, smile type,
June 2013  Vol 143  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
I-Chun Lin et al
Fig 5. Effect of eye use on box ratings for the 4 types of
smiles for models K (top), H (middle), and C (bottom).
Smile numbers 1-4 correspond to those in Figure 1. No,
No eyes; yes, eyes used.
use of eyes, and blocking of eyes. Since each rater
made many forced comparisons, repeated measures
were modeled as well.
The results for the multinomial logistic regression
appear in Table III, which represents the combined
data from all 83 raters and shows the probabilities for
selection of a given smile type. Table III shows that smile
4 was preferred the most (probability of selection, 35%
I-Chun Lin et al
Table II. Results from 1 rater
Sex Age (y) Panel Use of eyes
Male 21-25 Dental No
Yes
No
Yes
Table III. Forced comparison results: fitted probability
for the 4 smile types while controlling for “use of eyes”
and “blocking of eyes”
Probability that each smile type was selected
Use of eyes 1 2 3 4
No 0.22 0.10 0.32 0.35
Yes 0.25 0.16 0.28 0.31
without eyes and 31% with eyes), followed by smile 3,
then smile 1, and finally smile 2.
Table III demonstrates that the probability of select-
ing smile 1 increased by 3% (0.25 0.22 5 0.03) with
eye use. Similarly, the probability that smile 2 would
be selected increased by 6% with inclusion of eyes
(0.16 0.10 5 0.06). On the other hand, the probability
of selecting smile 3 or smile 4 decreased by 4% when the
eyes were used. The changes in probabilities with eye use
over all 4 smiles was significant (P 5 0.001). However,
whether eyes were included did not affect the smile
preference order (4 .3 .1 .2). Blocking of the eyes
had no impact on the probabilities (P .0.05).
Model attractiveness ratings varied significantly
depending on the rater’s sex. Female raters gave
significantly higher ratings than did the men for models
C and H (P \0.001) but only marginally significantly
higher ratings for model K (P 5 0.067). On the other
hand, the rater’s panel affiliation did not significantly
impact model rating.
DISCUSSION
Smile esthetics are influenced by the subjective
preferences of a viewer and by objective measures of
a smile. In this study, we aimed to separate the objective
model factors from the subjective rater factors to
establish objective criteria of dynamic smile esthetics
that can be used in orthodontic diagnosis and treatment
planning.
The results of this study identified the type of smile,
the use of eyes, and the blocking of eyes as model
factors. These factors were intrinsic to the smiles and
common across all models and all raters, regardless of
the raters’ sex, panel, or knowledge of the models.
American Journal of Orthodontics and Dentofacial Orthopedics
825
Number of times smile selected
Blocking of eyes Smile 1 Smile 2 Smile 3 Smile 4
Yes 6 2 8 8
Yes 4 3 8 9
No 6 2 8 8
No 5 3 9 7
A consistent pattern of differential preference
emerged from the box scores and the forced comparison
data; smile 4 was most liked, followed by smiles 3, 1, and
2. How do these results compare with established criteria
for ideal smile esthetics? The smile index (ratio between
intercommissure width and interlabial gap) is one of the
Total
1.00
few measurements that focus on the overall shape of the
1.00 lips as dictated by the movement of facial musculatures.
According to Ackerman et al17 and Ackerman and
Ackerman,18 an ideal smile has an index between
5 and 6. Smile index values for the 4 smile types in all
3 models were measured and calculated.19 No presenta-
tions of the most-preferred smile, smile 4, had the
“ideal” smile index. By contrast, 2 presentations of smile
2, the least-preferred smile, had the “ideal” index of 6.
These results clearly contradict the established
orthodontic ideal of the smile index, suggesting the
inadequacy of examining esthetics using static and
cropped images of smiles.
The use of the orbicularis oculi during smiling had
a positive effect on all smiles. As shown by the forced
comparison data, the positive effect was even more
significant for smiles 1 and 2, the 2 least-preferred
smiles. This change in preferential distribution suggests
that people already with attractive smiles might benefit
some but not greatly from the use of eyes. On the other
hand, those with less attractive smiles can improve their
esthetics with some help from the orbicularis oculi.
This finding of the positive eye effect complemented
the results of another study, where the use of the orbicu-
laris oculi was identified as intensifying the emotional
valence.20 In our study, the participants not only picked
up on the use of the orbicularis oculi, but also related
this muscle activity to better smile esthetics. This finding
suggests an important relationship between smile
attractiveness and positive emotional valence.
Our method of blocking the eyes involved covering
most of the midface. It was, therefore, surprising that
blocking the eyes had little effect on the ratings. This
finding suggested that actions of the orbicularis oculi
showed through the smile regardless of whether a rater
could directly see the model’s eyes and midface. During
the training sessions, the models had difficulty producing
consistent smiles when activation of the orbicularis oculi
June 2013  Vol 143  Issue 6
826
was added; the use of the orbicularis oculi tended to make
each smile larger. Despite efforts to control this variation,
perhaps the raters still picked up on subtle differences
produced when the orbicularis oculi were used.
Sex, panel, and knowledge effects were the rater
factors in this study. These factors represent rater-
dependent preferences or tastes in beauty. Even though
the 2 rater groups were unequal in size—51 dental raters
vs 31 lay raters—we do not believe that these inequalities
impacted the results reported below.
In this study, female raters gave higher esthetic scores
than did the men in almost all cases. Two speculations
can be made with regard to this sex difference:
(1) women might be less critical of facial attractiveness
of other women than are men, or (2) the sex difference
observed might be more a reflection of the differential
sex preference in various facial attributes: ie, the models
might have had certain facial features that appealed
more to the female than to the male participants. The
latter conclusion is supported by the study of Meerdink
et al,21 who stated that men and women focus on
different features when assessing the attractiveness of
faces. Furthermore, Flores-Mir et al22 demonstrated
that men are less critical than women in rating facial
attractiveness when presented with still images of smiles,
suggesting that the first speculation, above, is not
a general finding.
The dental panel liked all 3 models more than the lay
panel did. Recent studies indicate cultural differences in
the perceptions of smile esthetics among various lay
populations.23 If dental and nondental raters interpret
esthetics differently, it will be important to identify
what are the specific differences that patients and
practitioners can agree on for treatment outcomes.
The box scales and forced comparisons hold great
promise to objectify and quantify esthetic measures.
Because we used specifically defined rater groups—lay
and dental students—its external validity is limited; there-
fore, future studies should be conducted to further test the
external and ecologic validity and psychometrics of these
methods in orthodontics. Also, since esthetics and their in-
terpretations can vary depending on demographic factors,
future studies with models and raters representing
broader demographic attributes will be required to deter-
mine how the findings generalize.21-25
CONCLUSIONS
This study was one of the first investigations to use
video clips of smiles to look for objective criteria in smile
esthetics. Smile esthetics increased with increased
recruitment of muscles involved in smile production:
smile 4 was more attractive than smiles 3, 2, and 1.
The ratings were higher when the eyes (orbicularis oris)
June 2013  Vol 143  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
I-Chun Lin et al
were used, regardless of whether the eyes were visible
to the raters, suggesting that eye use influenced the
actions of other facial muscles. The results were robust
across the models, suggesting that objective rating
methods of smile-dynamic esthetics could become an
important clinical tool. The discrepancy between the
traditional ideal smile index and the smile index of the
preferred smile (smile 4) in this study suggested that
static smile images are perceived differently from
dynamic smile videos. Therefore, it is important to
reexamine the criteria for evaluating smile esthetics us-
ing smile videos.
We thank Richard Gracely for extensive contributions
to the assessment tool designs, Clayton Gerstner for
creating the survey and algorithms necessary to conduct
the survey online, Beth Crane for help with facial action
coding, and Colleen Cunningham for reconstructing the
figures for reproduction.
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