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 Table of Contents  
Year : 2017  |  Volume : 7  |  Issue : 3  |  Page : 135-144

Comparison between Still photography and videography for smile analysis

Department of Orthodontics and Dentofacial Orthopedics, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication29-May-2017

Correspondence Address:
Jyoti Chaudhary
Department of Orthodontics and Dentofacial Orthopedics, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/apos.apos_48_17

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Introduction: The aim of this systematic review was to compare still photography and videography for smile analysis. Materials and Methods: Based on the available data, two authors conducted an electronic database PubMed search from January 1, 2000, to December 31, 2015, and ten strategies were designed using five keywords along with their respective synonyms. Twelve articles were shortlisted for the systematic review. Results: The search yielded 91 articles, of which 12 were included based on the selection criteria. Of these 12, five concluded videography compared to be a better tool. Seven articles had variable conclusions based on the study setting and population evaluated. Conclusions: Digital video clips offer a tremendous amount of information for analyzing the dynamic character of the smile, but a standard digital photograph allows for immediate viewing.

Keywords: Digital photograph, smile, smile analysis, smile esthetics, video clip

How to cite this article:
Chaudhary J, Agarkar S, Manerikar R, Rahalkar J. Comparison between Still photography and videography for smile analysis. APOS Trends Orthod 2017;7:135-44

How to cite this URL:
Chaudhary J, Agarkar S, Manerikar R, Rahalkar J. Comparison between Still photography and videography for smile analysis. APOS Trends Orthod [serial online] 2017 [cited 2018 Oct 19];7:135-44. Available from: http://www.apospublications.com/text.asp?2017/7/3/135/207215

  Introduction Top

The smile plays an important part in orthodontic diagnosis and treatment planning. This has been recognized since the beginning of our specialty, and in the current esthetically oriented society, it seems to play a central part in self-perception and social image.[1]

Conventionally, photography is used for an orthodontic record, but new videographic and computer technologies have enabled other diagnostic assessments. As part of a facial esthetics evaluation, a clinician studies lip function and posture. During this evaluation, a patient is often asked to smile and a split-second image of that dynamic action is captured on a still photograph. This photograph, used as part of the diagnostic process to determine a course of treatment, remains as a permanent record in the patient's chart. If we want to depend on a still photograph to reflect the esthetics of patient's smile, it is necessary to capture a true representation of that smile. For instance, if the photograph was taken a few seconds earlier or later, would it show the same smile? If a different directive was used to elicit a smile, would it trigger the same response? Would videography rather than photography provide a more effective diagnostic impression? Studies in the psychology literature have found that people are better able to detect posed emotion from motion photography than from still photography.[2],[3],[4],[5],[6],[7],[8]

Analysis of orofacial esthetics during spontaneous smiling and speaking is now feasible because the optimal record can be selected from a video registration. The use of digital videography to capture an authentic, spontaneous smile combined with digital measurements has been tested lately, and it appeared to be reliable, reproducible, and valid for use in clinical practice.

  Materials and Methods Top

This study was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).

Study screening criteria

Before the study, a screening protocol was developed, and the following inclusion and exclusion criteria were established.


  1. Studies that provide information on comparison between still photography and videography
  2. Study published between January 1, 2000, and December 31, 2015
  3. Study written in English or should have a detailed summary in English.


  1. On-going studies
  2. Reviews, abstracts, letters to editors, editorials, and in vitro studies
  3. Studies that did not use any standardized method of photography and videography

    • Search strategy for the identification of studies
    • An electronic database (PubMed) search was performed for articles published in the dental literature using the following search strategy. Two reviewers have included the studies for this systematic review.

Study selection

Preliminary screening consisted of 91 articles, of which 25 articles were selected. The papers were screened independently by one reviewer (JC) and cross-checked by another reviewer (SA). At first, the papers were screened by title and abstract. As a second step, full-text papers were obtained when they fulfilled the criteria of the study aim. For full-text screening, the following criteria were taken into consideration: randomized controlled trials, controlled clinical trials, comparative studies, observational studies, case reports, and twin studies. The keywords and search strategy used are shown in [Table 1] and [Table 2]. Finally, a total of 12 articles were included after duplicate removal. Studies excluded were not answering the framed question in any form. All the articles selected in the electronic and manual searches were evaluated independently by the first and the second author in accordance with the established inclusion criteria. Any disagreement between the two reviewers was resolved after additional discussion [Figure 1].
Figure 1: Flow diagram of the article-selection process

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Table 1: Keywords

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Table 2: Search strategy

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  Results Top

The database search showed 91 articles listed in PubMed. Twelve articles were selected after duplicate removal. Using the PRISMA flow diagram, an overview of the article selection process is illustrated in the flowchart.

A standard pilot form in Excel Sheet was initially used, and then, all those headings which were not applicable for our review were removed. Data extraction was done for one article initially and this form was reviewed by an expert and finalized. This was followed by data extraction for all the articles.

A summary of the main findings and the data regarding participants, intervention, comparisons, outcomes study design (PICOS) in this systematic review is presented in [Table 3].
Table 3: Data extraction

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  • P-Participants: Individuals
  • I-Intervention: Videography
  • C-Comparison: Photography
  • O-Outcomes: Smile
  • S-Study designs: Comparative studies.

Description of various studies

As previously mentioned, there are twelve studies which were conducted mainly in the United States, United Kingdom, Netherland, Germany, Iran, and China and were published between 2002 and 2013. Their main objectives were to compare and evaluate smile esthetics using videography and photography. The age of the participants ranged from 12 to 55 years. Some studies showed significant differences among the spontaneous smile and posed smile using videography and photography. Some studies concluded that digital video clips offer a tremendous amount of information for analyzing the dynamic character of the smile, but a standard digital photograph allows for immediate viewing and is a valid tool for analysis of the post-treatment smile and some found the need to continue to investigate and standardize the methods of eliciting and recording a smile of diagnostic quality. The fast onset and fading out of a spontaneous smile makes it impossible to capture the right moment with a static photograph. Therefore, it is proposed to switch from static to dynamic video recording of the smile for diagnostic purposes.

  Discussion Top

This systematic review assessed the existing evidence on the esthetics of smile and the relationship between smiles captured by clinical photography and smile images obtained from digital video clips. Because esthetic concerns have become more critical in orthodontic diagnosis and treatment planning, a fundamental question arises: Are standard static records obtained routinely by orthodontists capable of capturing the smile accurately?

The literature has addressed many aspects of the smile, but only a few studies have been touched on the aspect of the reproducibility of the smile by videography and photography together.

Walder et al.[9] analyzed smiles of 22 individuals simultaneously by videography and photography on two separate occasions. Objective measurements showed that the posed smile prompted with a visual or a verbal clue, or taken on day 1 or 2 can be reliably reproduced, whether captured by videography or still photography. However, subjectively, the panel members detected differences between the posed smiles taken on different days 80% of the time.

Schabel et al.[10] used the Smile Mesh program in their study to quantify and compare 14 characteristics of smiles captured by clinical photography and digital videography. A significant difference was found between 7 of the 14 mean Smile Mesh measurements. These were maximum incisor exposure, upper lip drape, buccal corridor right, left, buccal corridor ratio, upper lip height, and lower lip height. Other than lower lip to maxillary incisor, all showed moderate to strong relation with each other (P values 0.47–0.82; P < 0.001). In other studies, Schabel et al.[11],[12] evaluated the reliability of and the relationship between the Q-sort and visual analog scale methods used to measure esthetic preferences. Kappa agreement and the McNemar test were used to evaluate the level of agreement between orthodontists and parents for “attractive” and “unattractive” images of smiles captured with clinical photography. A statistically significant result (P < 0.05) of the McNemar test indicated that the raters disagreed on the percentage of “attractive” images.

Sarver and Ackerman [13] and Ackerman and Ackerman [14] described the evolution of smile analysis and reviewed the dynamic records needed. They concluded that visualization and quantification of the dynamics of the smile is a two-stage process. The first crucial step is the clinical examination and second is record taking.

Van Der Geld et al.[15] used records of spontaneous smiling next to posed smiling; diagnostics can be improved so that they approach the daily perceptions of patients by their social analysis. They found that for four-grade scale estimation, kappa values were slightly lower. Posterior-tooth kappa values for spontaneous smiling varied between moderate and substantial. Significant correlation for rating errors of smile line height of spontaneous smiling (Central incisor: r = 0.20, P = 0.026; second premolar: r = −0.26, P = 0.007).

Oshagh et al.[16] addressed one of the numerous factors determining smile esthetics and showed that, generally, dental students, art students, and laypeople do not prefer smiles with minimal and excessive buccal corridors for both male and female individuals. They concluded that regarding the male individuals, art students rated 10% buccal corridor as most attractive and 28% least attractive, but dental students rated 15% buccal corridor the best and 28% buccal corridor the least attractive. Art and dental students rated 22% buccal corridor the best and 2% buccal corridor the least attractive in female individuals. Laypeople rated 10% buccal corridor the best in male and 15% in female individuals. They rated 28% buccal corridor the least attractive in both genders. The data provided no significant differences (P > 0.05) between the male and female judges or between male and female individuals for each of the images using Mann–Whitney test.

Batwa et al.[17] measured the occlusal plane angle to the true horizontal rather than to the sella-nasion line. The occlusal plane range that was investigated in this study was 0–20° to the true horizontal. 10° rated as most attractive by patients and 15° smile as most attractive by dentist.

Van Der Geld et al.,[18] Liang et al.,[19] and Hu et al.[20] used the videographic method to capture spontaneous smiling and posed smiling images reproducibly. The spontaneous smile is a more relevant emotion than a photographic posed smile and approaches the way patients are perceived by their social environment. For most patients, the outcome of orthodontic therapy is directly related to visible improved dentofacial attractiveness and not so much to the more invisible occlusal relationships according to scientific standards. The central question in these studies was whether the use of posed smile rather than spontaneous smile is sufficient as a diagnostic record for facial esthetics and, more specifically, lip-tooth relationships. They concluded that the fast onset and fading out of a spontaneous smile makes it impossible to capture the right moment with a static photograph. Therefore, it is proposed to switch from static to dynamic video-recording of the smile for diagnostic purposes. Experiences of plastic surgeons, oral and maxillofacial surgeons, and orthodontists show that (digital) video registration in clinical practice is feasible.


Overall, studies lacked a standardized technique to investigate the method of eliciting and recording a smile of diagnostic quality.

  Conclusions Top

Digital video clips offer a tremendous amount of information for analyzing the dynamic character of the smile, but a standard digital photograph allows for immediate viewing and is a valid tool for analysis of the post-treatment smile.

Posed smiles can be reliably reproduced as measured objectively, but, subjectively, differences were noted. Spontaneous smiles are preferred to posed smiles by professional diagnosticians.

Video images are preferred to still images by professional diagnosticians. Videography provides diagnostic information that cannot be obtained with still photography alone.

Future implications

In orthodontic treatment planning, certain treatment modalities (in particular, intrusion, extrusion, and expansion) are based on an analysis of the full spontaneous smile. Since the videographic method is better able to capture this smile, it may be a preferred method of obtaining pre- and post-treatment facial photographs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ackerman JL, Proffit WR, Sarver DM. The emerging soft tissue paradigm in orthodontic diagnosis and treatment planning. Clin Orthod Res 1999;2:49-52.  Back to cited text no. 1
Rigsbee OH 3rd, Sperry TP, BeGole EA. The influence of facial animation on smile characteristics. Int J Adult Orthodon Orthognath Surg 1988;3:233-9.  Back to cited text no. 2
Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod 1992;62:91-100.  Back to cited text no. 3
Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: The keystone of the smiling mechanism. Plast Reconstr Surg 1989;83:1-10.  Back to cited text no. 4
Rubin LR. The anatomy of a smile: Its importance in the treatment of facial paralysis. Plast Reconstr Surg 1974;53:384-7.  Back to cited text no. 5
Paletz JL, Manktelow RT, Chaban R. The shape of a normal smile: Implications for facial paralysis reconstruction. Plast Reconstr Surg 1994;93:784-9.  Back to cited text no. 6
Kozel NJ, Gitter AG. Perception of emotion: Differences in mode of presentation, sex of perceiver, and role of expressor. CRC Rep 1968;18:1-61.  Back to cited text no. 7
Dusenbury D, Knower FH. Experimental studies on the symbolism of action and voice: A study of the specificity of meaning in facial expression. Q J Speech 1938;24:424-35.  Back to cited text no. 8
Walder JF, Freeman K, Lipp MJ, Nicolay OF, Cisneros GJ. Photographic and videographic assessment of the smile: Objective and subjective evaluations of posed and spontaneous smiles. Am J Orthod Dentofacial Orthop 2013;144:793-801.  Back to cited text no. 9
Schabel BJ, Baccetti T, Franchi L, McNamara JA. Clinical photography vs. digital video clips for the assessment of smile esthetics. Angle Orthod 2010;80:490-6.  Back to cited text no. 10
Schabel BJ, McNamara JA Jr., Franchi L, Baccetti T. Q-sort assessment vs. visual analog scale in the evaluation of smile esthetics. Am J Orthod Dentofacial Orthop 2009;135 4 Suppl:S61-71.  Back to cited text no. 11
Schabel BJ, Franchi L, Baccetti T, McNamara JA Jr. Subjective vs. objective evaluations of smile esthetics. Am J Orthod Dentofacial Orthop 2009;135 4 Suppl:S72-9.  Back to cited text no. 12
Sarver DM, Ackerman MB. Dynamic smile visualization and quantification: Part 1. Evolution of the concept and dynamic records for smile capture. Am J Orthod Dentofacial Orthop 2003;124:4-12.  Back to cited text no. 13
Ackerman MB, Ackerman JL. Smile analysis and design in the digital era. J Clin Orthod 2002;36:221-36.  Back to cited text no. 14
Van der Geld P, Oosterveld P, Schols J, Kuijpers-Jagtman AM. Smile line assessment comparing quantitative measurement and visual estimation. Am J Orthod Dentofacial Orthop 2011;139:174-80.  Back to cited text no. 15
Oshagh M, Zarif NH, Bahramnia F. Evaluation of the effect of buccal corridor size on smile attractiveness. Eur J Esthet Dent 2010;5:370-80.  Back to cited text no. 16
Batwa W, Hunt NP, Petrie A, Gill D. Effect of occlusal plane on smile attractiveness. Angle Orthod 2012;82:218-23.  Back to cited text no. 17
Van Der Geld P, Oosterveld P, Berge SJ, Kuijpers-Jagtman AM. Tooth display and lip position during spontaneous and posed smiling in adults. Acta Odontol Scand 2008;66:207-13.  Back to cited text no. 18
Liang LZ, Hu WJ, Zhang YL, Chung KH. Analysis of dynamic smile and upper lip curvature in young Chinese. Int J Oral Sci 2013;5:49-53.  Back to cited text no. 19
Hu X, Lin Y, Heberer S, Nelson K. Analysis of soft tissue display in Chinese subjects during an enjoyment smile. Quintessence Int 2012;43:105-10.  Back to cited text no. 20


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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