Orthotown October 2020 - 36
Case 2: 31-year-old woman
Fig. 6b
Fig. 6a
Fig. 6c
Macroaesthetic observations
From facial front and facial profile photos (Fig. 6a)
Similar to the first case presented, in regard to this patient's
lower-third facial height, I would grade her as short. She shows an
overall round appearance to her face and the appearance of welldeveloped masseters. The nasolabial angle is acute and her upper
lip is everted and forward relative to her lower lip.
vertical show of these teeth. Because of their angulation, they
appear shorter despite being very nicely proportioned, full teeth.
Contact lines between the maxillary anterior teeth are acceptable,
the teeth themselves have favorable shape, and she does not
show any dark embrasure spaces, but in my opinion, conservative
IPR would still provide a microaesthetic benefit here.
Considerations in treatment planning
Miniaesthetic observations
From facial front smiling photo (Fig. 6a)
The "smile window" is normal in width but seems short in
height, which negatively reduces the aesthetic display potential
for the teeth. I have noticed that this type of decrease in "smile
window" height can be more common in patients with a short
lower-third facial height due to the soft tissue (lip) redundancy
encroaching on it and thus reducing height. The upper incisor
show within the "smile window" is definitely less than ideal at
around 50%. The smile arc is flat. Her transverse tooth display
seems good, although there is some degree of lingual tapering of
her bicuspid area that is noticeable.
Microaesthetic observations
From intraoral photos (Fig. 6a)
Maxillary anterior proclination is obvious and it affects the full
36
I think the significant maxillary dental protrusion and the
severe mandibular crowding in this case justify consideration
of a four-bicuspid extraction pattern, and I think it could be well
treated that way. 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.
Macroaesthetic considerations in treatment planning
I know for sure as it relates to macroaesthetics,
miniaesthetics and microaesthetics, anything short of significant
retraction/uprighting of the upper incisors will be a failure. It is
absolutely a must in this case. Extraction of two bicuspids in the
upper arch would surely create enough midarch space to enable
this retraction. The extraction option is very predictable in this
regard.
OCTOBER 2020 // orthotown.com
OT1020_Foster_Choices_AG_V5.indd 36
9/24/20 3:50 PM
http://www.orthotown.com
Orthotown October 2020
Table of Contents for the Digital Edition of Orthotown October 2020
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Orthotown October 2020 - 1
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