Pacific Coast Society of Orthodontists Bulletin Fall 2020 - 52

Let's Talk About That

PT: I'd like to pivot now to facial appearance.
What factors do you consider important?
WA: We think the characteristics of an attractive
face can actually be objectively described and measured, elevating that portion of diagnosis from art
to science. To do so, an important distinction must
be drawn between " harmony, " which is measurable, and " beauty " or " handsomeness, " which may
not be. Harmony implies that the positions of the
anatomic structures that we as orthodontists are
responsible for (teeth, jaws, and chin) contribute
maximally to the health, function, and appearance
of the individual. A person with harmony looks
as good as they are capable of looking because
the teeth, jaws, and chin are in positions that
most complement their appearance, but they still
might not be beautiful or handsome. Beauty and
handsomeness are influenced by features outside
the domain of orthodontics such as eyes, ears,
hair, and skin or are linked to intangibles such as
personality traits. The best we can hope for as
orthodontists is to create harmony.
The Six Elements of Orofacial Harmony™ outline
specific positional goals for the teeth, jaws, and
chin that best complement health, function,
and appearance by virtue of the positions of the
teeth within the jaws (Element I), the AP positions
of the jaws (Element II), the widths of the jaws
(Element III), the heights of the jaws (Element IV),
the prominence of the chin (Element V), and the
relationships of the teeth to the occlusal plane and
to each other (Element VI). Symmetry of the arches
and jaws is also important and can be accounted
for within the context of the Six Elements. A great
deal of emphasis is placed on the locations of the
maxillary anterior teeth, both within the maxillary
alveolus and within the larger context of the face.
We do not rely on traditional cephalometrics or
soft-tissue analysis for assessing this critical aspect
of facial harmony. In the context of the facial profile, the primary landmark for AP incisor positions
is the forehead. This was discussed in Part I of this
interview and all available scientific references are
listed there. Basically, there is an esthetic zone for

Figure 18. The esthetic zone for the AP position of
the maxillary incisors
the AP positions of the maxillary incisors that is related to the lower third of the forehead (Figure 18).
PT: So far, we've talked about function and
appearance, what about the last component of
harmony: health?
WA: When it comes to orofacial health, we have to
consider the long term. Is malocclusion unhealthy?
Is it a problem if the roots are moved out of the
alveolar bone but remain covered by gingiva?
How debilitating is root resorption? Is it psychologically detrimental to adversely affect facial or
smile attractiveness? The consequences of poor or
incomplete treatment could affect the dentition,
periodontal tissues, digestion/nutrition, temporomandibular joint dysfunction, airway, and/or
psychosocial well-being. Such sequela might not
be detected clinically until years or even decades
later, making it very difficult to ever link them back
to orthodontic treatment. Until we have reliable
data about the effects of our treatment on longterm health, we are forced to rely upon existing
lower-level evidence, logic, and common sense.
PT: Do you give attention to airway integrity?

PCSO Bulletin Fall 2020

Pacific Coast Society of Orthodontists Bulletin Fall 2020

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2020