Alignment is everything
Let's talk about the beneficial impact that proper placement of teeth, especially the upper and lower six front teeth, may have on lessening the impact of some of these facial changes.
While functional treatment is well established in Orthodontics, patients want more than just straight teeth. Patients are looking for “Lifetime Esthetics” and well done orthodontics can certainly contribute to this goal. The concept of the “Esthetic Line”, which relates an individual’s nose, lips and chin to each other, can be an aid in determining the need or exclusion of extraction of teeth from patient treatment. If only the crowding or spacing of the teeth themselves are used to make this decision, there may certainly be a negative affect on the esthetic profile of the patient.
The front teeth are a factor in helpingprovide the necessary lip support to maintain proper balance in the profile. Ideally, the lower lip should be within a few millimeters of this “E-Plan” and the upper lip a few additional millimeters further back when viewed in the profile. There are normal variations for patients of different ethnic backgrounds. The further forward the teeth are the more prominent they will be in the face. The further back the teeth are the more prominent the nose and the chin will be. The less teeth there are in the mouth, the further back the mid-face will end up.
In light of facial changes due tothe aging process, perhaps less dental extraction should be contemplated in certain situations. In fact, even in patients with significant dental crowding, other options to create space may need to be considered, if extraction looks like it will harm the patient’s looks in either the short or the long term. Conversely, patients with spacing between their teeth could potentially require some dental extraction if their profile protrudes too far.
In general, there is a tendency towards less extraction of teeth, for orthodontic corrections, then in the past. Treatment can be managed in many ways that exclude extraction when appropriate. Let it suffice the say that orthodontic technology exists today to more fully utilize the soft tissue of the patient to help decide the most appropriate treatment choices. X-rays or radiographs are useful but they often do not tell the complete story. How a person looks and where the true discrepancy lies can dramatically affect treatment choices. This is considerably more than just teeth.
Dr. Joel Schacher