Orthotown October 2020 - 32
Case #1: 20-year-old woman
Fig. 1b
Fig. 1a
Fig. 1c
Macroaesthetic (facial) observations
From facial front and facial profile photos (Fig. 1a)
or the size of her "smile window." The posterior teeth seem to
disappear behind the canines, lacking proper aesthetic gradation.
Upper central incisors show about 80% of their height. We know
that with normal aging, loss of elasticity in the upper lip will tend
to decrease this vertical incisor show over time. A more ideal
vertical show of these beautiful maxillary anterior teeth would be
closer to 100%. Lastly, her smile arc appears a bit on the flat side.
The facial front photo shows nice lips-full, with a good
vermilion display and cupid's bow. Mild excessive nasal dorsum
and the nose seems to project forward just slightly more than
ideal. However, in the facial profile photo, the lips strike me as
a little less full in the A-P dimension. While I wouldn't grade the
nasolabial angle as truly obtuse, it is more obtuse than I would
have expected from my initial impression of the lips on the facial
front photo. Relative to the nose and chin, if the lips were to be
even slightly retracted from where they currently are, it would
be unfavorable aesthetically. In my opinion, there is not much
forgiveness there. As far as my impression of facial thirds, I
would grade her as having a short lower-third facial height and
she shows an overall round appearance of her face with welldeveloped masseters.
Generalized large teeth-particularly upper incisors, which
seem disproportionately large. Upper incisors are barrel-shaped
and lower incisors triangular, both lending themselves to lessthan-ideal embrasures when properly aligned. Archforms are a bit
narrow and tapered, secondary to generalized lingual inclination of
posterior teeth.
Miniaesthetic (smile) observations
Considerations in treatment planning
From facial front smiling photo (Fig. 1a)
The significant crowding here justifies consideration of a
four-premolar extraction pattern. I also think that a non-extraction
treatment, properly executed, has the potential for a great
outcome as well. In my opinion, these opposing plans come with
their own set of compromises.
When evaluating the facial front smiling photo, her "smile
window" really stands out-large in both height and width. Her
teeth are beautifully large and the centrals show "barrel shape"
with convex lateral contours. The transverse tooth display seems
deficient and definitely not in harmony with the size of her teeth
32
Microaesthetic (teeth) observations
From intraoral photos (Fig. 1a)
OCTOBER 2020 // orthotown.com
OT1020_Foster_Choices_AG_V5.indd 32
9/24/20 3:50 PM
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Orthotown October 2020
Table of Contents for the Digital Edition of Orthotown October 2020
Orthotown October 2020 - Cover1
Orthotown October 2020 - Cover2
Orthotown October 2020 - 1
Orthotown October 2020 - 2
Orthotown October 2020 - 3
Orthotown October 2020 - 4
Orthotown October 2020 - 5
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