Transverse Dimension and Smile Harmonies
The Essentials from the Front and Beyond
This informative and vigorous lecture will emphasize the transverse dimension and differential treatments utilizing essential and significant BioProgressive approaches for orthodontics. The long-neglected transverse dimension via the PA cephalogram will be addressed. Dr. Grummons teamed with the immortal Ricketts, to write and publish two landmark articles concerning frontal cephalometrics and its practical applications. For too long we have concentrated on the anteroposterior and vertical skeletal dimension via myriad measurements of lateral cephalometric tracings. Rapid palatal expansion is a very popular clinical procedure, too often based on the photographs and plaster study cast only.
Dental asymmetries and functional deviations can be treated with orthodontic and facial orthopedic correction during the growth period based upon the fundamentals of biologic science and clinical sensibility: surgical management becomes indicated later. Asymmetry problems challenge the understanding and clinical expertise with therapy based upon the fundamentals of basic science and clinical sensibility. Permanent occlusal therapies should not be attempted until structural integrity is returned to equilibrium without disease. In all that we do, let us copy nature in her fundamental majesty.
Trauma, distress, parafunction and malocclusion have interrelationships whenever these exceed the adaptive capability of the individual. Cumulative strain and eccentric TMJ overloading affect the orthodontic process, post-treatment maintenance and patient status. The maxillary width should be sufficiently wide to be in harmony with the individual patient facial type and morphology.
Facial harmony and smile beauty are optimal when facial and dental midlines are aligned. The chin should be centered, or nearly so. Stunning smiles have harmony, symmetry, and a broadness consistent with the individual’s facial form, morphology, and balance. Facial types demonstrate anatomic and TMD differences. Utilizing frontal facial information, therapeutic approaches are more specific and effective, while directed toward specific etiology. Occlusal plane, midline, chin location, and smile esthetics will be specified.
Early orthopedic intervention and nonextraction approaches provide for best functional occlusion, proportional structural components, with an esthetic smile and TMJ support. The younger the age when a patient receives orthopedic maxillary or mandibular growth modification, the more the face responds and the more stable is the result. As the patient nears maturity, less orthopedic change can be achieved. The patient should triumph after treatment with optimized self-esteem and a radiant smile. Knowledge is knowing facts; wisdom is knowing what to do with them.
Dr. Grummons will present up-to-date Class II and III clinical aspects, which affect facial harmonies, mandibular function, TMD perspectives, and esthetic treatment outcomes. The patient should triumph after treatment with optimized self-confidence and radiant smile.
Aims: Many clinicians have not employed the frontal perspective. Therefore, the purposes of this lecture are to: (1) update the findings in the morphology and growth in the transverse dimension; (2) simplify evaluation of facial asymmetry using the Ricketts and Grummons frontal analyses; (3) describe practical clinical applications of anteroposterior images and analysis; and (4) demonstrate the needs and benefits of three-dimensional diagnostic and treatment applications.
Methods: Maxillary width variations, frontal (anteroposterior) anatomic landmark locations, and frontal and related image analysis and tracing methods are detailed. Asymmetry conditions are differentially treated. Frontal analysis methods and applications are specified and integrated into facial, smile, jaw, and occlusal therapies.
Results: Utilizing frontal facial information, therapeutic approaches are more specific and effective, while directed toward particular etiology. Occlusal plane, midline, chin location, and smile esthetics are primarily addressed. Beautiful facial proportions and smile harmony can be developed despite initial facial dysmorphosis and disproportions. Asymmetry of the facial parts is the rule, rather than the exception.
Conclusion: Patients view themselves from the frontal perspective, so this carries priority in assessing problems and treatment outcomes. It is important to know the etiology of asymmetry to assist others with genetic counseling. In orthodontics, we are essentially a generation of profiles, looking at the lateral cephalometric image. Facial harmony and smile beauty are optimal when facial and dental midlines are aligned. The occlusal plane should be level, or nearly so. The chin should be centered, or nearly so. The maxillary width should be sufficiently wide to be in harmony with the individual patient facial type and morphology. Best facial development and proportionality exist when the transverse skeletal and dental components are optimized transversely and are symmetric.