1- Facial Esthetics & Soft Tissue Considerations (Dr. Salam)

Aisthesis

Facial esthetics originated from the Greek concept of "________" for "Perception" or "Sensation". It was formalized in the 18th century as a philosophical discipline.

Edward Angle

Who focused on the beauty inspired by Greek art and considered the profiles portrayed in their classical art as ideal standard for the orthodontic profession?

1. modern patient-centered approach

2. face-driven orthodontics

2 standards of beauty

Modern Patient-Centered Approach

What standard of beauty?

Facial esthetics emphasizes subjective beauty and cultural diversity

Face-Driven Orthodontics

What standard of beauty?

Current orthodontic treatment integrates facial harmony, function, growth, and patient satisfaction over strict cephalometric norms for better outcomes

1. Esthetics and Psychological Impact

2. Comprehensive Esthetic Evaluation (photos, angles - not just the correction of malocclusion)

3. Growth & Facial Esthetics

4. Parent Expectations (clear communication)

What are 4 reasons for why we need to evaluate soft tissue when considering orthodontic tx?

True

T/F: Growth and development impact facial esthetics, requiring anticipation of treatment effects on face and profile.

True

T/F: Successful outcomes depend on clear communication and aligning esthetic goals with parent/patient expectations.

nasolabial

what angle is this

102°

(Range: 90-120°)

What is the mean nasolabial angle?

0-3 mm

What is the interlabial gap when lips are relaxed?

Mentalis strain

What do you see on the chin with lip incompetence?

1. Lip incompetence

2. Mentalis strain

What are 2 common things to see in a profile analysis of a patient with bimaxillary dentoalveolar protrusion?

• convex: class II

• concave: class III

A convex vs. concave profile which skeletal class relationships

Deep bite

A deep sublabial fold is in indicative of what?

It guides diagnosis and influence decisions regarding the treatment modality either growth modification, camouflage, or orthognathic surgery

What is a clinical application of facial profile analysis?

3 approximately equal 1/3s

In a well-proportioned face, the face is divided vertically into what?

Trichion (hairline) to glabella

The upper facial 1/3 extends from what to what?

Glabella to subnasale

The middle facial 1/3 extends from what to what?

Subnasale to menton

The lower facial 1/3 extends from what to what?

- Upper lip = 1/3

- Lower lip and chin = 2/3

In an esthetically balanced face, the lower facial 1/3 is divided into what?

1. glabella

2. nasal tip

3. upper lip midpoint

4. chin along the midsagittal plane

When analyzing the midsagittal plane symmetry, ideal facial symmetry aligns which 4 key landmarks

zygomatic arches

facial width is usually greatest where

Vertical growth pattern/open bite tendency

An increased lower facial 1/3 is most commonly associated with what?

Deep bite

A decreased lower facial 1/3 may be indicative of what?

1. Upper stomion

2. Lower stomion

When the lips are incompetent at rest, the lower facial third is divided using which landmark?

Harmony, balance

Alignment of facial features, such as mouth edges with iris edges, guides esthetic judgment of _________ + _________

S-line (steiner line)

Define the following:

A line from soft tissue chin to the midpoint of the S-curve line

Evaluates...

- Lip support

- Underlying position of dentoalveolar complex

- Functional

What is the purpose of the Steiner S-line?

Retrusive (lips are behind the S-line)

What is the lip posture described as?

Protrusive (lips are in front of the S-line)

What is the lip posture described as?

B. Increased body mass index (BMI)

Which of the following factors increases the risk of sleep-disordered breathing (SDB)?

A. Decreased body mass index (BMI)

B. Increased body mass index (BMI)

C. Increased overbite

D. Class I molar relationship

Nasal tip to soft tissue chin

Where is the Ricketts E-line drawn from?

• upper lip: 2-4 mm behind the E-line

• lower lip: On the E-line (0 mm) or about 2 mm behind it

In a well-balanced female profile, the lips are typically positioned where?

Males

Who has a slightly less protrusive E-line, males or females?

Nasal tip

The E-line is dependent on the position of the __________

The E-line is affected by the position of the nasal tip

Why should clinicians be cautious when interpreting the E-line in a patient with a prominent nose?

Buccal corridor

Define the following:

The dark space visible between the corners of the mouth and the buccal surfaces of the posterior teeth during smiling

A broad smile with minimal buccal corridors

What type of buccal corridor is described as more esthetic and fuller?

75-100%, 2 mm

Upon smiling, ideal exposure is ___-___% of the crown height to ___ mm of gingival tissues

Females

Who shows more gingival tissues, males or females?

Touch or closely follow the contour of the lower lip during smiling

In a youthful smile, the maxillary incisal edges typically follow what?

True

T/F: Lateral incisors should be positioned slightly gingival to the central incisors and canines

False - gingival smile line diminishes with age

T/F: Gingival smile line improves with age

Lower

(Rather than the upper incisors - this is particularly true when the mandibular anterior teeth are above the functional occlusal plane at the start of treatment)

From an esthetic point of view, the best treatment strategy in the majority of deep overbite cases is to actively intrude which incisors?

Decreased

As patients age, a __________ maxillary incisor display is typically observed

Lengthening

Aging is commonly associated with __________ of the upper lip

Nasal tip ptosis

Which nasal change commonly occurs with aging and can affect facial esthetics?

- Lip lengthening

- Tooth wear

The decrease in maxillary incisor display seen with aging is primarily related to what?

Senile smiling

What type of smile has the following characteristics?

- Lip lengthening

- Nasal tip ptosis

- Tooth wear

- Decreased both upper incisal and gingival display

Early assessing smiles in static and dynamic states helps clinicians create treatment plans preserving esthetic appeal over time

Why should smile esthetics be evaluated early in orthodontic treatment planning?

Too short

Is this upper left central incisor too short or too wide?

80%

The width of a tooth should be ____% compared to the height

Incomplete incisor display

What is affecting the esthetics?

Upper lip

There is an intimate relationship between the inclination of the upper incisors and the _________ position

1. Consonant Smile Arc

2. Marginal vertical positions

3. Shape and position of the gingival margins

what are the 3 major components of an esthetic smile

Lateral incisors

In an esthetic smile, which teeth are typically positioned slightly shorter than the maxillary central incisors?

Gingival zeniths

Define the following:

Highest points of the gingival margins