Human fascination with beauty and esthetic trends is continuously evolving;
moreover, public awareness and desire to improve facial appearances are at the
highest level.
This trend of heightened public awareness and expectation is paving a new way of
dentistry toward a more comprehensive approach with esthetic principles at its
core. The oral health of the patient and his or her dentition are fundamental in
dental treatment. However, the final esthetic outcome should be among the first
steps in treatment planning. The ideal esthetic approach in dental treatment
planning often requires a multidisciplinary approach engaging various dental
professionals. This process requires thorough communication among dental
practitioners and a basic understanding of what each discipline can provide.
FACIAL ANALYSIS
Facial evaluation is an integral part of patient examination. It starts with
evaluating facial symmetry, as symmetric faces are considered more beautiful
than those that are not. The facial midline is the reference used to assess
facial symmetry . Facial examinations begin with symmetry evaluation and then
establish the interpupillary line and determine whether it’s normal
(perpendicular to the facial midline) or slanted. Both jaws should be assessed
in reference to the facial midline to determine any canting. The position of the
chin should also be marked for any deviation.
The lips receive special attention in facial evaluation; fuller lips are
considered more youthful, and the loss of lip volume is regarded as a sign of
aging. The position of the lips depends largely on the underlying dental
structures. Planning to move the teeth in order to improve the patient’s
appearance should be vigilantly studied. Excessive proclination of the maxillary
incisors results in a compromised look. On the other hand, excessive retraction
of the maxillary incisors compromises the projection of the lips and gives more
of an aged look. Next, the nasal–labial angle is examined to determine whether
the angle is normal, acute, or obtuse. This determination is also important when
planning the final position of the maxillary incisors. It is not recommended to
retract the maxillary incisors when the nasal–labial angle is obtuse as this
will increase the angle, while the maxillary incisors should not be brought more
anteriorly when the nasal–labial angle is acute. According to Rickets, the ideal
position of the upper lip should be about 4mm behind the E-plane. Lower lip
should be about 2mm behind the E-plane. After that, mentolabial sulcus is
examined to decide if it has normal depth, is flat, or is deep . If the
mentolabial sulcus is flat, the lips’ competence should be evaluated, while if
the mentolabial sulcus is deep with an everted lower lip, one should assess
whether an excessive overjet is associated with it. Finally, lip competency
should be evaluated to determine if they are competent, competent with muscle
strain, or incompetent
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