Orthotown December 2020 - 30
Fig. 2
Case presentation
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
30
Fig. 8
Mariola (Fig. 2) is a 41-year-old woman
of Eastern European heritage. She was
missing multiple teeth and had undergone
extensive dental care that was not of the
highest quality. Her chief complaint was,
" I don't like my smile. It's very narrow and
uneven. " Her cephalometric radiograph
(Fig. 3) revealed a negative Wits appraisal,
indicating a Class 3 skeletal pattern, mostly
due to a deficient maxilla. Her panoramic
radiograph (Fig. 4) revealed missing teeth
#4, #7, #19 and #29, with a nonsalvageable
#3, which was slated for eventual extraction.
Step 1 in the Global Diagnostic Process is
to evaluate facial height and facial proportions
(Fig. 5), and in doing so find that the lower
third of her face is longer than the middle
third. As we look closer at the lower facial
height (Fig. 6), ideally we would like the
length of the upper lip to encompass onethird of that height, and the remainder of
the lower facial height, from the commissure
of the lips to soft-tissue menton, should
be two-thirds of the lower facial. In this
case, we find that her upper lip (18mm) is
slightly short and that the anterior portion
of her mandible (43mm) is relatively long. A
short upper lip is often the result of a mouth
breathing habit, and therefore a potential
sign of nasal obstruction.
Step 2 in the process is to verify upper
lip length and mobility. To achieve this,
we routinely remeasure the upper lip from
the frontal view (Fig. 7) with the patient in
repose, asking them to say the word Emma
and then keep their lips apart. We then look
at lip mobility (Fig. 8) and ask the patient to
give us their biggest laugh. The difference
between the lip length in repose and the
fully animated smile should be 6-8mm.
A measurement more than this is the result
of hyperactivity of the levator labii muscles,
and can contribute to a gummy smile.
However, in this case her measurement was
5mm, which we often see in patients who
have guarded smiles or who've had Botox or
other neurotoxin injections to their upper lip
for wrinkle control. This patient had both.
Step 3 is to determine whether the
gingival architecture is level with the horizon
DECEMBER 2020 // orthotown.com
OT1220_Norris_Case-Study_MM.indd 30
11/24/20 12:54 PM
http://www.orthotown.com
Orthotown December 2020
Table of Contents for the Digital Edition of Orthotown December 2020
Embrace Progress
Poll: Small Equipment and Supplies
Message Board: Class II Div 1 Deep Bite Teen Aligner Case
Message Board: Extraction Mx 6
Office Visit: Dr. Jason Battle
As Easy As 4, 5, 6
5 To Grow On
Ad Index
Continuing Education: Slop-py Work
Orthotown December 2020 - Cover1
Orthotown December 2020 - Cover2
Orthotown December 2020 - 1
Orthotown December 2020 - 2
Orthotown December 2020 - 3
Orthotown December 2020 - 4
Orthotown December 2020 - 5
Orthotown December 2020 - 6
Orthotown December 2020 - 7
Orthotown December 2020 - Embrace Progress
Orthotown December 2020 - 9
Orthotown December 2020 - 10
Orthotown December 2020 - 11
Orthotown December 2020 - Poll: Small Equipment and Supplies
Orthotown December 2020 - 13
Orthotown December 2020 - Message Board: Class II Div 1 Deep Bite Teen Aligner Case
Orthotown December 2020 - 15
Orthotown December 2020 - 16
Orthotown December 2020 - Message Board: Extraction Mx 6
Orthotown December 2020 - Office Visit: Dr. Jason Battle
Orthotown December 2020 - 19
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Orthotown December 2020 - As Easy As 4, 5, 6
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Orthotown December 2020 - 5 To Grow On
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Orthotown December 2020 - Ad Index
Orthotown December 2020 - Continuing Education: Slop-py Work
Orthotown December 2020 - 43
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