Aesthetics in orhtododntics /certified fixed orthodontic courses by Indian dental academy

Aesthetics in orthodontics

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction
Jackson’s triad :
Aesthetic
Stability
Function

Riedel :
Beauty
Utility
Stability

The Enigma Of Beauty
“We Know it when we see it – or so some
think”
What is beautiful is good – Plato
Beauty is truth, truth is beauty – John
Keats
More profound than truth itself – Anatole
France

Plastic surgeons may define it in terms of
“high cheek bones and stronger jaw”.
Science pronounces beauty as a strategy
that says “ I’m healthy and fertile . I can
pass on your genes.
Beauty celebrates, it matters, and it resides
in the brain circuitry of the beholder and
less so in the eye – Don Symons (UCSB)


 It could be macabre
 It could be deadly
 And it is costly
– 6 billion on fragrance, 6 billon on make up, 8
billion and hair and skin, a billion on nails ,
20 billion on diet products – 1999 US alone.

 It is a fundamental evolutionary strategy –
Victor Perret (NMSU)


“It has been said that beauty is in the eye of the

beholder, but a thing is said not to be truly
beautiful until it arouses the senses to an
emotional level of pleasure. This level of
perception is not in the cognitive part of the brain
(neocortex) but is thought to be located within the
subconscious or primitive portion of the brain
referred to as the reptilian complex or the limbic
system. The limbic system is thought to contain the
instincts.” Robert M Ricketts


It is considered capable of conditioned reflex so
that, in the appreciation of beauty and art, a
factor of discipline and previous exposure exists.
However, with the capacity to select beauty by
instinct and with the natural laws favoring
economy of tissue and energy, there probably is a
natural connection with the sensation of beauty
and efficiency. Mankind's mind is attracted to
precision; hence, survival and improvement in the
species biologically. This probably occurred
together with the development of the large brain
in man and the ability to think and reason.
Robert M Ricketts

 Phillip etal (1993) assessed the profiles and noted
that lay persons judged Class I profiles as most
attractive compared to Class II (non surgical)
and Class II surgical were judged least attractive.
 Sociologists and psychologists have shown that
the perception of appearance , particularly the
face affects mental health and social behavior,
with significant implications for educational and
employment opportunities and mate selection.
 Kleck and Rubinstien found that attractive
individuals elicit more smiles and are looked at
longer than less attractive people.

 Rutzen (1973) studied 250 patients 5 years after
completion of orthodontic therapy and compared
then with 67 subject who had received no
treatment for diagnosed malocclusion. Those
treated scored significantly more positive for their
assessment and also achieved a higher level of
occupational status even though the groups did
not differ in social class or status.


The esthetic heritage
Man, subconciously, has been aware of
facial esthetics for a very long time
The cave paintings of southern France
(35000 yrs ago) provide ample evidence
of his esthetic awareness


 Art and esthetic awareness flourished during the
early days of the Egyptian civilization and it
reflected the idealized proportion of the face
dictated by the ruling class.
 They exhibited a round broad face with a sloping
forehead, weak brow ridge, prominent eyes,
evenly contoured nose , thickened lips and a mild
yet positive chin.
 Yet this showed ideal, archeologist have shown
that the general public showed a large amount of
bi maxillary prognathism, taking into
consideration that the Egyptians were primarily a
mix of African Negroid and Caucasoid Asians.

Towards the end of the middle kingdom and
the start of the new kingdom the idealized
facial features shifted to more narrower
face and high brows and elaborate make
ups.


 After Egyptians, the Greeks emerges as the first
to express sensitively the qualities of facial
expression.
 Often rules or Canons were set forth for ideal
bodily proportions and harmonious anatomic
relations in human representation
 The Greek face is oval and slightly tapering
towards the chin and the basic facial features
appear to be treated identically.

 The face shows an anteriorly prominent forehead. Also characteristic
is the straight sweep fro the forehead to the nose tip with a faint
concavity at the root of the nose
 The lower face is seen to be well proportioned and the mouth is
framed by an undulating upper lip (cupids bow) and a slightly lower
lip roll.
 Between the lower lip and the convex fleshy chin is the well defined
mentolabial sulcus

 This classic Greek features appealed to many
early orthodontists including Angle through his
association with the artist Wuerpel and
considered Apollo and Aphrodite as paragons of
facial beauty.
 Though they were acutely aware that one standard
ideal cannot be attributed to all individuals
 Also later Wilson totally dismissed the Greek
aesthetics saying that is showed a retrognathic
lower face.
 Also whether the statues represented the actual
facial form of the common people of those times is
questionable.

 After the Greeks the Romans entered the scene
and advancement in Greek and Roman
architecture were made though there wasn’t any
new concepts developing.
 The Romans were depicted faithfully in their true
form with variations in proportions and facial
features.
 At the end of the 4th century the Roman period had
come to an end and the Dark Age had begun,
when Europe was gripped in a religious zeal
 Almost all medieval descriptions of the lower face
valued a small inconspicious mouth with thin red
lips and even small teeth

 The Renaissance period heralded the return of the
realistic aesthetic values and the names of
Michelangelo, Raphael, Leonardo Da Vinci, and
other renaissance artists became noted.
 Books of beauty began to appear and writings on
esthetics exceeded the imagination of the rational
drawing conclusions like : the width of the mouth
indicated the breadth of the stomach; the mouth
was the coarsest part of the face being the farthest
form the face; abundant facial folds and dimples
labeled a temperamental attitude; lip drape and
lip protrusion were related to animalistic passion

 The more significant description of the facial
features were provided by Woolnorth who
classified the facial profile into straight, convex
and concave and the handsomest being the
straight profile. The convex profile was attributed
to a more youthful feature whereas the concave
face determined the aged.
 though the idealistic features of the face changed
over the years there was a denominator common
to all the aesthetic marvels, physical beauty as
well as constructed, that persisted consciously or
subconsciously.

Whenever an artist determines the visually pleasing position or
placement of the major parts of his work , he is consciously or perhaps,
unconsciously, using the denominator.
Euclid revealed a visually pleasing geometric proportion which has been
regarded as the formation of accepted beauty by many artists (and
mathematicians). It is a ratio between the two dimensions of a plane
figure or the two divisions of a line, such that the smaller element is to
the larger as the larger is to the whole: the Golden Proportion. This
proportional relationship asserts a natural balance, a dynamic symmetry.
The Golden Section is also called the Golden Ratio, Divine Proportion or
the Golden Rectangle.

Golden proportion

1.618 =
Phi
0.618 = phi


Leonardo Fibonacci was born in Pisa, Italy, around 1175. He was
the gratest European mathematician of the Middle Ages. He was the
first to introduce the Hindu - Arabic number system into Europe.
By charting the populations of rabbits Fibonacci discovered a
number series from which one can derive the Golden Section.
French mathematician Edouard Lucas named this series Fibonacci
numbers and found their numerous significant applications.
Leonardo Fibonacci died in Pisa soon after 1240 ...

The Fibonacci numbers appear as leaf arrangements because the Fibonacci
numbers form the best whole number approximations to the Golden Section.
Dividing each number in the Fibonacci series by the one which precedes, we
will find the following series of numbers :
1/1
2/1
3/2
5/3
8/5
13/8
21/13
34/21
55/34
89/55

=
=
=
=
=
=
=
=
=
=

1
2
1.5
1.666666666
1.6
1.625
1.615384615
1.619047619
1.617647059
1.618181818

In the 16th Century, Luca Pacioli (1445-1514), geometer and friend of the great Renaissance
painters, rediscovered the "golden secret".Luca Pacioli, however, was a great admirer of the
Golden Section, as evidenced by the name of his treatise, Divina proportione, which actually
comprises three independent works ( 1509 ). At the beginning Pacioli places the
Compendium de divina proportione, the book about the Golden Section, which Pacioli
dedicated to Duke Lodovico Sforza of Milan in December 1498.

The learned Franciscan Pacioli finds five attributes of God in this special
proportion, the first four of which are unity and uniqueness, trinity, the
impossibility of defining in terms of human ratio, and the immutability. In the
fifth, functional comparison Pacioli sets the "divine proportion"

The properties of Phi
 This is the only number in mathematics that
when substracted from unity results its own
reciprocal I.e
 1- 1.618 = 1/1.618
 Sqt 5 +1 / 2 = Phi
 Sqt 5 – 1 / 2 = phi

 measurement of the sound waves also
corresponds to the phi value in harmonic
chords picked up by the ear.

The golden rectangle


The Sacrament of the Last Supper by Salvador Dali (1904-1989) is painted
inside a golden rectangle. Golden proportions were used for positioning
the figures. Part of an enormous dodecahedron floats above the table.
The polyhedron consists of 12 regular pentagons and has fundamental
golden connections.


The Pentagon and the Golden Triangle


The Golden Divider


Human
Age

Development
Stage

Key Attributes

0

Gestation

Conception

1

Newborn

Birth

1

Infant

Walking, vocalizing

2

Toddler

Talking, expressing, imitating

3

Toddler

Self image and control, toilet training

5

Early child

Formal education begins

8

Mid child

Age of reason, knowing of right and wrong

13

Adolescent

Thinking, puberty, sexual maturation and drive

21

Young adult

Full physical growth, adult in society, education complete, beginning career, financial
responsibility, eligible for voting

34

Mid adult

Refinement of adult skills, parenting role

55

Elder adult

Fulfillment of adult skills, serving, retirement begins with eligibility for Medicare,
Social Security and AARP

89

Completion

Insight and wisdom into life


The DNA molecule, the program for all life, is based on the
Golden section. It measures 34 angstroms long by 21
angstroms wide for each full cycle of its double helix
spiral.34 and 21, of course, are numbers in the Fibonacci
series and their ratio, 1.6190476 closely approximates Phi,
1.6180339.

The top of the head to the chin relation (T-M) to the two cheeks
forms a golden rectangle. The height of this rectangle is quite
similar to the distance from the umbilicus to the public triangle
(UP). The umbilicus (U) is golden from the top of the head (T) to
thr toes (F). The shoulders (S) and outstretched arm (H) are golden
to the total height (TF). The shoulders to the umbilicus to the top of
the head also forms another golden rectangle.

 Clinical facial assessment for diagnosis and
treatment planning.
 Arnett and Bergman presents analyses of 19 key
facial traits as an adjunctive treatment planning
tool used to produce improved facial and dental
results.
 The facial examination has to be done with the
patient assuming the Natural Head position.
 All examination has to be done in the with he
mandible in centric relation


Centric relation can be established as follows:
 1. Patient in a 45° sitting position.
 2. Use a warmed, double-thickness piece of pink
base plate wax.
 3. Guide the opening and closing to first tooth
contact, nondeflected position.
 4. Trim the wax bite to the buccal surfaces of the
teeth.
 5. Repeat step three.
 6. Wash the wax bite in cold water.
 7. Repeat step 3.

The relaxed lip position is obtained while the
patient is in centric relation by the following
method7:
 1. Ask the patient to relax.
 2. Stroke the lips gently.
 3. Take multiple measurements on different
occasions.
 4. Use casual observation while the patient is
unaware of being observed.


 The patient should be in the relaxed lip position
because it demonstrates the soft tissue, relative to
hard tissue, without muscular compensation for
dentoskeletal abnormalities. Vertical disharmony
between lip lengths and skeletal height (vertical
maxillary excess, vertical maxillary deficiency,
mandibular protrusion, mandibular retrusion with
deep bite) can not be assessed without the relaxed
lip posture. Existing positions and needed changes
in upper incisor exposure, interlabial gap, lip
length, and proportion are lost in the closed lip
position.

 Closed lip position may be adequate for
normoskeletal cases but is totally inadequate for
skeletal disharmony assessment (Figs. 4 and 5).
When the lips contact (distortion), the bite should
be opened (Fig. 4, B) by placing a wax bite
between the teeth until the lips separate in the
repose posture. By using this open bite posturing,
lip length and position distortion is avoided. Soft
tissue cosmetic problems can then be assessed
relative to needed bite changes


Outline form and symmetry

Facial height: Hairline (H) to
soft tissue menton (Me').
Facial widths: Zygomatic arch
(ZA) to zygomatic arch (ZA),
Gonion (Gó) to gonion (Go').

The widest dimension of the
face is the zygomatic width
(Fig. 1). The bigonial width is
approximately 30% less than
the bizygomatic dimension.
Farkas has established normal
values for height and width.
The height to width proportion
is 1.3:1 for females and 1.35:1
for males.


Facial level
Pupil plane (PP) is horizontal line
drawn through pupils. This line is
usually parallel to the horizon and is
referred to as frontal postural
horizontal. Upper dental arch
(UDA) level is a line formed
through the left and right maxillary
canine tips. Lower dental arch
(LDA) level is a line formed
through the left and right
mandibular canine tips. Chin-jaw
line (CJL) is assessed by a line
drawn on the under surface of the
chin at maximum tissue contact. All
four lines
www.indiandentalacademy.com should be parallel to each
other.

Constructed horizontal
reference line is formed
by drawing line through
pupil area parallel to
floor. This line is used
when the pupil plane is
not parallel to the floor
(eyes are not level) when
the head is in frontal
postural horizontal.


When pupils are not level,
constructed horizontal reference
line is used. A perpendicular to
the constructed horizontal line
through filtrum is used to assess
other midline structures.


Facial 1/3rd evaluation
Face is divided into thirds by drawing
lines through hairline (H), midbrow (Mb),
subnasale (Sn), and soft tissue menton
(Me').
The equality of the middle and the lower
thirds should not be used as the
determining factor in facial height
changes. The appearance of the
landmarks (incisor exposure, interlabial
gap) within the lower third are more
important in assessing balance than are
the equality of the middle and the lower
thirds.

With lips relaxed, lower
third is subdivided by
drawing lines through
subnasale (Sn), upper lip
inferior (ULI), lower lip
superior (LLS), and soft
tissue menton (Me'). The
upper lip is half the
length of the lower.


 The lips are measured independently in a relaxed
position The normal length from subnasale to
upper lip inferior is 19 to 22 mm.1 If the upper lip
is anatomically short ( 18 mm or less), an
increased interlabial gap and incisor exposure is
seen with a normal lower face height. This should
not be confused with vertical maxillary excess
(increased interlabial gap, increased upper
incisor exposure, increased lower one-third facial
height).


 The lower lip is measured from lower lip superior
to soft tissue menton and normally measures in a
range of 38 to 44 mm. Anatomic short lower lip is
sometimes associated with Class II malocclusion
and is verified by cephalometric measurement of
the lower anterior dental height (lower incisor tip
to hard tissue menton; women, 40 mm ± 2 mm,
and men, 44 mm ± 2 mm). Anatomic short lower
lip should not be confused with a short lower lip
secondary to posture (upper incisor interferences)
seen in Class II deep bite cases with normal
anterior dental height. Anatomic short lower lip
can be lengthened with a lengthening genioplasty.

Anatomic long lower lip can be associated with
Class III malocclusions. This should be verified
with the cephalometric anterior dental height
measurement. A closed lip position will produce a
long lower lip in combination with increased
lower facial height (vertical maxillary excess and
Class III) as the lip elongates to close. The closed
lip length is misleading and should not be used for
treatment planning. The normal ratio of upper to
lower lip is 1:2.
Proportionate lips harmonize regardless of length;
disproportionate lips may need length modification to
appear in balance. Lip measurements identify normal or
abnormal soft tissue length that can be related to
dentoskeletal length normalcy, excess, or deficiency.

Incisor exposure is
measured with lips relaxed
from upper lip inferior
(ULI) to maxillary incisor
edge (MxlE). The upper
tooth to lip (UTTL) is the
vertical dimension of the
incisor exposed between
ULI and MxlE.
Range between 1 to 1.5mm


Interlabial gap is
measured in relaxed lip
position from upper lip
inferior (ULI) to lower lip
superior (LLS).


Profile angle is measured
by connecting points
glabella (G'), subnasale
(Sn), and soft tissue
pogonion (Pg'). The angle
is measured on the left
hand side with the patient
facing right.


Fig. 11. Nasolabial
angle is developed by
connecting columella
line (inferior nasal
septum) (C),
subnasale (Sn), and
upper lip anterior
point (ULA).


Maxillary sulcus
contour (MxSC) is
subjectively assessed.
The contour is described
as either accentuated,
gentle curve (normal) or
flat. Measurement of
this contour is
impractical.


Mandibular sulcus contour
(MdSC) is subjectively
assessed. The contour is
either accentuated, gentle
curve (normal) or flat.
Measurement of this
contour is impractical.


Orbital rim projection is
measured from the
anterior most globe (Gb)
to the orbital rim point
(OR). A subjective
orbital rim description is
also given: Normal, flat,
or protruded.


Cheekbone contour is anteriorly facing, curved line that starts just anterior to ear, extending forward through
cheekbone point (CP), then extending anterior-inferiorly ending at maxilla point (MxP) adjacent to alar base of
nose. For descriptive purposes the cheekbone contour is divided into three areas: (1) zygomatic arch, (2) middle
contour area, and (3) subpupil areas. These three areas, when taken together, constitute the cheekbone contour.
Reconstruction of cheekbone contour, when deficient, should analyze all three parts separately in terms of
correction. CP and MxP indicates osseous cheekbone and maxillary base positions, respectively. The nasal baselip contour (Nb-LC) extends inferiorly from the maxilla point (MxP) as a gentle, anteriorly facing curve, ending
just below and lateral to the mouth commissure. In normoskeletal patients the cheekbone-nasal base-lip contour
complex is a smooth continuation, anteriorly facing, curved line. This line, when viewed frontally or from the
side, is a definite flowing curve with no interruptions which are apparent with skeletal deformities.

Maxillary retrusion: Cheekbone-nasal base-lip
curve is interrupted at MxP.

Mandibular protrusion: Cheekbonenasal base-lip curve is interrupted in
upper lip area.


Nasal projection (NP) is measured
from subnasale (Sn) to nasal tip
(NT). The lines through Sn and NT
are perpendicular to the floor when
the head is in a natural postural
position.


Throat length (TL) is
assessed from neck-throat
point (NTP) to soft tissue
menton (Me'). This distance
is subjectively described as
either normal, long or short
length, and with or without
sag.


Sn-Pg' line is frequently
used to surgically assess
chin-lip-nasal base balance.
With the VTO occlusion in
Class I, the line is oriented
from Sn through ideal lip
position. If Pg' falls on the
chin, balance of chin-lipnasal base is ideal. If Pg'
falls behind the line, a chin
advancement is necessary
to obtain balance.


Subnasale-pogonion reference line is
generated through points subnasale
(Sn) and soft tissue pogonion (Pg'). Lip
projections are evaluated relative to
this line.
A, Normal lip relationship to
Sn-Pg' line. B, Premature
aging associated with
premolar extractions and
incisor retraction. The lips fall
on or behind the Sn-Pg' line
giving the "dished-in"
orthodontic appearance. The
nasolabial angle may also
open to unacceptable ranges.


The relationship of the lips to this line is affected by the
following factors:
1. Skeletal relationship: When anterior or posterior skeletal
disharmony exists, producing overjet abnormalities (positive or
negative), the Sn-Pg' has no validity.

2. Incisor inclinations: With a Class I skeletal pattern, the upper
and lower incisors must be at proper overjet and axial
inclination to produce proper protrusion of the lips relative to
the Sn-Pg' line.
3. Lip thickness: The lip relationship to the Sn-Pg' line is
dependent on lip thickness. The Burstone relationship is true
only if the lips are the same thickness, all other factors being
ideal. Class I incisors (upper incisor in front of lower incisor)
produce Class I lips (upper lip in front of lower lip) only if the
lips are of equal thickness.

Systematic nasal evaluation:
1. Alar base width
2. Columella
3. Nasal tip
4. Nasal dorsum


1. Leptorrhine: long and narrow noses
2. Mesorrhine: usually found among Asians, lack of
dorsal height and columellar support
3. Platyrrhine: found in blacks and characterized
by a flat, broad nose and wide nostrils.

 Radix (radix nasii):
 Its is discrete but important part of nasal esthetics and
preferably lie at the frontosubnasal line.
 Lack of the radix will make the nose appear to have a
dorsal hump.

 The nasal tip:
 The most anterior point of the nose and just cephalic
to the tip lies the supra tip
 The supra tip break is cephalic to this and formed
where the lobule meets the doral portion. Forms a
slight depression that is more pronounced in the
female.
 Double break refers to the angular formation of the
nasal tip created by the discreet definition of the tip
cartilages created by supratip, tip and infratip

 Columella is the portion
of the nose between the
nasal tip and the base of
the nose .
 It consists of two medial
crus, with intervening
alveolar or fibrous tissue
with covering skin.


 The alar base width
should be the
intercanthal distance.
 In females there is
little fluctuation in the
width after the age of
14but in males a spurt
is seen from 11 to 13.


Nasal tip:
1. Nares should be barely
visible in NHP.
2. Gull in flight contour to the
base of the nose.
3. The columella is slightly
lower and parallel to the laa
when viewed in any
direction.
4. The contour of the alar
cartilages should be well
defined to form a scroll


The SMILE
 Philtrum height: measured in millimeters
and its relation with the upper incisors and
the commissure of the mouth.
Commissure height is measured from the
alar bases to the commissure and is
normally 2 – 3mm shorter than the
philtrum height
Maxillary lip to upper incisor at rest

Vig and Brundel (1978):
In general males show less upper incisor and
more lower incisor at rest while female sshow
more upper incisor and less lower incisor at
rest.
Whites exhibit more upper incisor show at rest
than do blacks or Asians.
 as age advances the upper incisor show
decreases and lower incisor show increases.


Anatomical features of excessive incisor
show at rest:
Short upper lip philtrum height – could be
due to incomplete lip growth
Vertical maxillary excess
Excessive crown height
Detroqued maxillary incisors

Inadequate incisor show at rest:
Aging results in loss of elasticity
Vertical maxillary deficiency
Inadequate crown height


 The “gummy smile” :
 Is quantitated by measuring the amount of gingival
display on a posed smile and full smile.
 Excessive gingival display:
Short philtrum
Vertical maxillary excess
Excessive curtain on smile.
Short incisor clinical crown
Upright maxillary incisors


 Details of the lower face:
 Lip projection is function of the following:
Lip thickness define by age, gender and ethnicity,
Dental protrusion or retrusion
Maxillomandibular protrusion or retrusion.

 Labiomental sulcus is the fold of tissue between the
lower lip and the chin and may vary in form and
depth. Upright lower lip projection will tend to
produce a shallow sulcus. And proclined incisors will
deepen the sulcus.


 Lip – chin – throat angle should be
approximately 90 degrees, an obtuse angle often
reflects the following:
 Chin deficiency – resulting in salckiening of the
submental and platysmal musculature resulting on
obtuse angle.
 Lower lip procumbency
 Excessive submental fat
 Retropositioned mandible
 Low hyoid bone position.

 Cervico – mental angle: Vistnes and Souther
stressed that the normal angle is 90 degrees,
while other studies have suggested that it may
vary from 105 to 120.
 Submental or subplatysmal fat deposition,
 Vertical resting hyoid bone position
 Anterioposterior position of the chin
 Soft tissue aging.


 The success of orthodontic treatment is frequently
related to the improvement gained in the patient’s
facial appearance, particularly in relation to soft
tissue. - NM Bass 2003
 Experienced clinicians are generally aware of the
poor aesthetic results often obtained by “treating
to the numbers’ and the limitations of the
cephalometric analysis. Park and Burstone (1986).
 Applying statistical population means to parts of
the structure of an individual face does not always
produce ideal realtionships. Lundstrom (1991)

 Lundstrom and Lundstrom (1992) compared the
reproducibility of the NHP and variation in the
anatomic reference plane and found a variation
of 4.5 to 5.6 degrees where only 2 degrees for the
NHP.
 Also it was shown that the NHP would produce
true to life positioning of the head.
 Lundstrom and Lundstrom (1995) assesed the
reliability of FH plane with the NHP and NH
orientation in younger children. They found a
large amount of variability to make the FH plane
unreliable and found that NHP adjusted to NHO
formed the most reliable basis.

 The effects of ear posts, an external source of eye
reference (a wall mirror), sex and time were evaluated in
relation to the reproducibility of recording lateral
cephalometric radiographs in this natural head posture.
Boys looked up more when changing from the selfbalance position to the mirror eye reference position
(mean change 2°, P £ 0.001). No other significant maleversus-female differences were detected. NHP
reproducibility was better with a mirror (with mirror,
method error = 1.9°, without mirror, method error =
2.7°). No significant differences in reproducibility were
detected between NHP recordings taken with and without
ear posts. However, without ear posts the radiographs
tended to be of poor quality. The reproducibility of sameday repeat radiographs recorded with ear posts and with
a mirror (after 4 to 10 minutes and 1 to 2 hours) was
1.9°. NHP was only slightly less reproducible 3 to 6
months later (method error = 2.4°)
Cooke and Wie(1988)

 The success of orthodontic treatment is frequently related to the
improvement gained in the patient’s facial appearance, particularly in
relation to sift tissue

. - NM Bass 2003

 Experienced clinicians are generally aware of the poor aesthetic results
often obtained by “treating to the numbers’ and the limitations of the
cephalometric analysis. Park and Burstone (1986).
 Applying statistical population means to parts of the structure of an
individual face does not always produce ideal realtionships.
Lundstrom (1991)


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Aesthetics in orhtododntics /certified fixed orthodontic courses by Indian dental academy

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