Review Article for Different Smile Variables in Different Skeletal Growth Patterns

AbstractBackground: Smile esthetics play a significant role in orthodontic diagnosis and treatment planning. Skeletal growth patterns i.e., horizontal, average, and vertical are associated with soft tissue balance, lip posture, dental and gingival display, and overall smile dynamics.Objective: This review aimed to systematically assess the influence of skeletal growth patterns on different smile variables, including lip length and thickness, incisor display, interlabial gap, intercommissural widths, buccal corridor, smile arc, lip line, red ratio, smile index, gummy smile, and commissural height.Methods: A comprehensive literature search was done in Google Scholar for studies published between January 2000 and June 2025. Keywords included "smile analysis," "smile variables," "skeletal growth pattern," "vertical growers," "horizontal growers," and "orthodontics." Eligible studies included original research with quantitative or qualitative assessment of smile variables, with subjects classified as horizontal, average, or vertical growers using cephalometric or photographic methods. Case reports, narrative reviews, and studies with incomplete skeletal classification were excluded. Data extraction included study design, sample size, classification method, and smile parameters assessed.Results: A total of 30 studies were included. Vertical skeletal patterns were consistently associated with increased maxillary incisor display, gummy smile prevalence, larger interlabial gap, and exaggerated smile arcs. Horizontal patterns showed reduced gingival display, flatter smile arcs, and limited vertical mobility. Average skeletal patterns generally demonstrated balanced smile esthetics and served as the reference group. Inconsistent findings were observed for lip thickness and buccal corridors.Conclusion: Smile variables demonstrate distinct associations with skeletal growth patterns. Vertical and horizontal growers often exhibit deviations from balanced esthetics that may necessitate customized orthodontic or surgical interventions. Comprehensive smile analysis, integrating static and dynamic imaging with skeletal evaluation, should be an essential component of orthodontic diagnosis and treatment planning.