Perfect symmetrical smile with radiant white canines

Unlocking Beautiful Smiles: A New Index for Assessing Canine Aesthetics

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"Discover how the Maxillary Canine Aesthetic Index (MCAI) is revolutionizing the evaluation of impacted canine treatment, ensuring a harmonious and confident smile."

A beautiful smile goes beyond just straight teeth; it's about the harmony and balance of each tooth with the surrounding tissues. When maxillary canines (the 'cornerstone' teeth) are impacted, meaning they don't erupt properly, treatment outcomes can vary widely, and aesthetic appraisal is important.

Traditionally, assessing the success of impacted canine treatment has been subjective and often overlooked the finer details of aesthetics. Existing indices, like the pink aesthetic score (PES), primarily focus on soft tissue around dental implants, leaving a gap in the comprehensive evaluation of natural canine teeth.

Now, a new tool is emerging to bridge this gap: the Maxillary Canine Aesthetic Index (MCAI). Developed and validated by researchers at the University Hospitals Leuven, Belgium, the MCAI offers a standardized, objective method for assessing the aesthetic outcomes of impacted maxillary canine treatment, considering both the tooth and its adjacent soft tissues.

What is the Maxillary Canine Aesthetic Index (MCAI) and How Does it Work?

Perfect symmetrical smile with radiant white canines

The MCAI is a scoring system designed to evaluate the aesthetic appearance of maxillary canines that have been previously impacted and subsequently treated. It considers twelve key variables, focusing on both the canine itself and the surrounding soft tissues. These variables are:

These variables are assessed based on comparisons with the adjacent and contralateral teeth, ensuring a natural and harmonious appearance. Rather than relying on generic rules, this approach allows for individual variations in facial shape, size, and sex.

Mesial and Distal Papilla: Evaluating the natural position of the interdental papillae.
Marginal Gingiva: Assessing the length and thickness of the marginal gingiva in harmony with the contralateral tooth.
Recession: Measuring the level of displacement of the marginal tissue relative to the cemento-enamel junction (CEJ).
Mesiodistal Crown Angulation: Ensuring proper alignment with adjacent and contralateral teeth.
Curvature of Marginal Gingiva: Comparing the curvature of the marginal gingiva with the contralateral tooth.
Soft Tissue Color and Texture: Evaluating redness and texture compared to the contralateral canine for a natural appearance.
Root Convexity: Assessing the projection of the root through the overlying mucosa.
Tooth Morphology: Comparing the shape and form of the treated canine with the contralateral tooth.
Vertical Tooth Position: Ensuring proper alignment with adjacent and contralateral canines.
Buccolingual Angulation: Ensuring proper alignment with neighboring teeth.

Each variable is rated on a scale, with points assigned based on the degree of deviation from the ideal aesthetic outcome. A score of 0 indicates the desired situation, 1 indicates a moderate result, and 2 or 5 indicate a gross deviation, depending on the variable's importance. The total MCAI score is then categorized as excellent, good, moderate, or poor aesthetic outcome.

The Future of Canine Aesthetics: Practical Applications of the MCAI

The Maxillary Canine Aesthetic Index offers a valuable tool for clinicians to objectively assess and compare the aesthetic outcomes of different treatment approaches for impacted maxillary canines. By standardizing the evaluation process, the MCAI can help to improve treatment planning, enhance communication with patients, and ultimately achieve more predictable and satisfying aesthetic results. While the MCAI focuses on aesthetics, remember that a beautiful smile is also a healthy smile! Further research and clinical studies are needed to validate its long-term effectiveness and refine its application in diverse patient populations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/cre2.133, Alternate LINK

Title: Development And Validation Of The Maxillary Canine Aesthetic Index

Subject: General Dentistry

Journal: Clinical and Experimental Dental Research

Publisher: Wiley

Authors: Koenraad Grisar, Gilles Claeys, Margot Raes, Emad Ali Albdour, Guy Willems, Constantinus Politis, Reinhilde Jacobs

Published: 2018-10-01

Everything You Need To Know

What is the Maxillary Canine Aesthetic Index (MCAI)?

The Maxillary Canine Aesthetic Index (MCAI) is a scoring system designed to objectively evaluate the aesthetic appearance of treated maxillary canines, especially those that were previously impacted (failed to erupt properly). It considers 12 key variables focusing on both the canine tooth itself and the surrounding soft tissues, offering a standardized method to assess treatment outcomes. It goes beyond subjective assessments to provide a reliable way to evaluate the aesthetic success of canine treatments.

How does the MCAI differ from other aesthetic indices like the pink aesthetic score (PES)?

The Maxillary Canine Aesthetic Index (MCAI) distinguishes itself from indices like the pink aesthetic score (PES) by its comprehensive focus. While the PES primarily evaluates the soft tissues around dental implants, the MCAI assesses both the tooth and its surrounding tissues specifically for maxillary canines. It considers the tooth's form, position, and the health of adjacent gingiva, providing a more detailed evaluation of the aesthetic outcomes following impacted canine treatment, resulting in a more natural and harmonious smile.

What are the key variables assessed by the MCAI?

The MCAI considers twelve key variables to assess the aesthetic outcome of treated maxillary canines. These include the Mesial and Distal Papilla, Marginal Gingiva, Recession, Mesiodistal Crown Angulation, Curvature of Marginal Gingiva, Soft Tissue Color and Texture, Root Convexity, Tooth Morphology, Vertical Tooth Position, and Buccolingual Angulation. Each variable is rated on a scale based on the degree of deviation from the ideal aesthetic outcome, ensuring a thorough evaluation. The evaluation of each variable is based on comparisons with the adjacent and contralateral teeth, ensuring a natural and harmonious appearance.

How is the MCAI score interpreted, and what do the different categories mean?

Each of the twelve variables assessed by the Maxillary Canine Aesthetic Index (MCAI) is rated on a scale based on its deviation from the ideal aesthetic outcome. A score of 0 indicates the desired situation, 1 indicates a moderate result, and 2 or 5 indicates a gross deviation, depending on the variable's importance. These scores are then compiled to determine the total MCAI score, which is categorized into one of four outcomes: excellent, good, moderate, or poor. This categorization helps clinicians and patients understand the overall aesthetic success of the treatment.

What is the significance of the MCAI for both clinicians and patients?

For clinicians, the Maxillary Canine Aesthetic Index (MCAI) provides an objective tool to evaluate and compare the aesthetic outcomes of different treatment approaches for impacted maxillary canines. This helps to improve treatment planning and allows for more informed decisions. For patients, the MCAI can enhance communication, providing a clear assessment of the expected results and contributing to more predictable and satisfying aesthetic outcomes. By standardizing the evaluation process, the MCAI strives to achieve more beautiful and natural-looking smiles, reflecting a harmony between the tooth and its surrounding tissues.