American Journal of Orthodontics and Dentofacial Orthopedics
Centennial special articleInteractions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning
Section snippets
Systematic evaluation and treatment goal setting
Soft tissue changes occur over time, and it is usually the orthodontist who best understands the comprehensive principles of dental and skeletal development, maturation, and aging in addition to the many other facets of dental practice.
The 12-year-old girl in Fig 2, Fig 3 came with a chief complaint of “the dentist said I needed braces” because of her Class II deepbite malocclusion. Although correction of her malocclusion was the reason for seeking treatment, she obviously exhibited an
Treatment plan
In addition to correction of the functional issues of the Class II deepbite, the esthetic treatment plan is determined by esthetic issues (primarily the excessive gingival display on smiling) coordinated with the protection strategy (maintain the consonant smile arc).
Let's revisit the etiologies of the gummy smile in comparison with this patient's clinical examination. This problem-oriented and goal-oriented approach to the esthetic problems results in the clinical examination and a biometric
Treatment summary
Our treatment consisted of fixed appliance therapy combined with growth modification (high-pull headgear) to correct the Class II malocclusion. The deep overbite was approached with reverse-curve mandibular archwires to extrude the posterior teeth, thus lengthening the lower facial height. The improvement in gingival display on smiling was a result of lip growth, increased crown height supplemented with periodontal crown lengthening, and axial uprighting of the maxillary incisors (Fig 10, Fig 11
Conclusions
There are really 2 major points to be made here. First is the importance of looking at the patient clinically at the beginning of developing our diagnosis and treatment plan. In fact, this assessment has been practiced for quite a long time; clinicians have drifted back to it in practice, and it has just slowly formalized. As a resident, I remember that many of my teachers referred to the “window-shade diagnosis,” the act of holding an actual cephalometric head film (not digital), untraced, up
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