Orthotown November 2020 - 44

We can't just show finished beautiful smiles;
we must show a dramatic contrast between
a patient's beginning smile and the finished
aesthetic smile of other patients.
It's relatively easy to consistently create
high-quality photography or videography in
a simple, reproducible and efficient manner.
A dedicated DSLR extraoral camera and a
small but purposeful photographic studio
are not expensive undertakings, and provide
the opportunity for consistent and dramatic
photography and video.
Clinical auxiliaries often are excited to
embrace a role that celebrates the artistic
nature of orthodontics, and with practice
can deliver excellent-quality photographs and
videos in a few minutes. These images and
videos are the source of differentiation for
an aesthetic practice and provide a wealth of
marketing materials for internal and external
marketing efforts and branding support.

Extending orthodontics'
Golden Age
Broadening the aesthetic scope of
orthodontics requires also considering
"white and pink" tissue aesthetics, using
positive and negative coronoplasty, soft-tissue refinement and aesthetic recontouring.
Refinement of the drape and quality of the
soft tissue of the mid- and lower face with
fi llers and Botox is a very recent entrant
into the orthodontic aesthetic arena, and
it defi nitely has a role.
Orthodontics is an aesthetic art, and to
be effective, orthodontists must adopt the
communication strategies of visual artists.
Learn how to present aesthetics! Remember,
the patient buys the presentation, not the
treatment plan.
In his recent book A History of the
Business of Orthodontics, Dr. Norman Wahl
considers the time from World War II to 1970
as the Golden Age of orthodontics. Wahl
believes that the subsequent oversupply of
orthodontists, advent of bonded appliances,
explosion of PCD delivery of orthodontic
services and downsides of communization
are signs that we've gone beyond that Golden
Age, but we view the future of our specialty
in a different manner than he does.

44

CASE 1
Yadira had been treated by another orthodontist a few years before I met
her; she estimated that her previous treatment had taken more than two years.
I didn't have access to her original records, but she appeared to have started out
as a Class III patient. Her treatment plan with me revolved around an aesthetic
issue, not an occlusal one-I wanted to give her more incisal display and smile
arc and proper anterior inclination.
The beginning smiling photo (Fig. 1) reveals she showed only 40% of her
upper centrals upon smile, with no smile arc and flared upper incisors. She was
the treatment coordinator in my Oregon practice and, after seeing some of my
dramatic smile transformations, she couldn't wait to have me improve upon
her smile.
I used SAP++ bracket positioning with Pitts 21 and inverted the upper four
anterior brackets (Fig. 2). My first wires were Pitts broad .018-by-.018 supersoft
thermal-activated nickel titanium wires (Fig. 3). I placed my disarticulation on the
upper first bicuspids at the first appointment and then had her wear immediate
light short Class III elastics full time through the bite from lingual of upper second
bicuspids and down to the labial of the lower canines. The short elastics were
applied to make sure her occlusal plane did not tip in a counterclockwise direction
and to widen both arches. She also wore a part-time rainbow elastic from lower
canines up over her upper centrals to help widening.
I was able to maintain a beautiful occlusion, upright the inclination of the upper
anteriors, extrude upper anteriors slightly and tip the occlusal plane favorably
(Fig. 4). She wore very light short Class III elastics (3/16, 2.5-ounce) up until the
last month of treatment, which took 14 months total. I think her smile aesthetic
improvement was extraordinary.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

NOVEMBER 2020 // orthotown.com

OT1120_Pitts,Brown_Aesthetic_MM.indd 44

10/27/20 9:24 AM


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Orthotown November 2020

Table of Contents for the Digital Edition of Orthotown November 2020

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