# The Influence of Anteroposterior Head Inclination on the Perceived Consonance of the Smile Arc and Lower Lip Curvature on Photographs: A Cross-Sectional Study

## TL;DR

This study shows that head tilt affects how the shape of a smile looks in photos, with forward tilt making smiles appear less harmonious.

## Contribution

The study empirically demonstrates that anteroposterior head inclination impacts perceived smile consonance in frontal photographs.

## Key findings

- A −20° head inclination produced the most consonant smile arc (score: 0.146).
- A +20° head inclination resulted in the least consonant smile arc (score: 1.326).
- Differences in consonance scores were statistically significant (p < 0.05).

## Abstract

Objectives: To determine the extent to which anteroposterior head inclination influences smile arc curvature assessment on frontal photographs. Materials and Methods: Sixty-three young adults participated in this study. Each had five standardized frontal-view photographs captured with posed smiles at five anteroposterior head inclinations (−20°, −10°, 0°, +10°, +20°) using a cervical range of motion device. Two curves were traced per photograph: one following the shape of the lower lip and the other the incisal edge of the maxillary anterior teeth from canine to canine (smile line). These curvatures were approximated by quadratic function and compared for concordance based on the maximum curvature of the obtained functions. A score was calculated, with 0 denoting a consonant smile (perfect concordance) and 2 a non-consonant smile. Results: Among the sixty-three participants, fifty-nine were included in the analysis after excluding those with insufficient tooth exposure in the photographs for the smile line assessment. The analysis revealed that the perceived smile line was more consonant (concordant with lower lip curvature) with a −20° head anteroposterior inclination (score: 0.146), and the least consonant with +20° anteroposterior inclination (score: 1.326), with statistically significant differences (p < 0.05). Conclusions: The smile arc curvature assessment on frontal photographs may be influenced by the anteroposterior inclination of the head on frontal photographs. However, due to the two-dimensional nature of this study, further investigations incorporating three-dimensional imaging are recommended.