Orthodontics for Esthetic Dental Treatment: Symbiotic Efforts for Optimal Results

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