Symmetry of oral structures in both static and dynamic smile analysis has been associated with increased perceived facial attractiveness.80,81 It is important in cases where patients are concerned about asymmetry and/or when esthetic concerns are related to a lack of symmetry that dental healthcare providers understand the chief complaint so that therapy can be targeted to meet patient needs. Asymmetry associated with tooth shape may be addressed restoratively but could also potentially require orthodontic tooth movement to establish space and proper tooth positioning to then allow for ideal restoration of teeth. Asymmetry associated with midline, smile arch, or smile cant may require treatment with orthodontic and/or orthognathic means.82 Gingival contour asymmetry may be due to gingival recession or gingival overgrowth. Comprehensive periodontal examination, including accurate recording of the gingival margin position in relation to the cementoenamel junction, and documentation of patient complains as well as clinical findings is necessary to best address concerns of asymmetry. For individuals whose gingival contour asymmetry is associated with gingival recession, periodontal plastic surgery procedures to achieve root coverage, either alone or in combination with restorative therapies can be used to reestablish appropriate gingival contours.82 Conversely, in the case of individuals who demonstrate gingival contour asymmetry associated with gingival overgrowth, assessment to determine if resective procedures involving gingival tissues only or gingival tissues and underlying alveolar bone should be performed. Lip asymmetry may be associated with volume and/or mobility. Asymmetry associated with lip volume may be addressed with dermal fillers83,84 and myofascial exercises may be helpful to strengthen weakened muscles leading to asymmetrical lip movement.85
Figure 11: Symmetrical smiles and facial contours are considered to be more esthetic than asymmetry. Identification of the underlying causes of perceived asymmetry allows the dental healthcare provider to address a patient’s esthetic concerns more fully.