THE EDITOR'S CORNER
Esthetics--dental, dentofacial and facial--should be the dominant goals of present day orthodontics.
Dental esthetics is the appearance of the teeth. Dentofacial esthetics is the appearance of the teeth within the face. Facial esthetics is the appearance of the face as it may be influenced by the position of the teeth.
Not many parents come to us to improve the appearance of the faces of their children, even when there is a marked facial deformity. It probably is a psychological phenomenon that parents are uncritical of their childrens' faces and prefer to concentrate on the appearance of their teeth. Yet, the two are closely related and the orthodontist can frequently influence the appearance of the face. For some patients this may be the most important benefit of orthodontic treatment.
On the other hand, not many parents come to us because they want their children to chew better and rarely because they want them to speak or swallow better. They usually come because they want their teeth to look better. There is a social premium in our society placed on a good-looking set of teeth. This is sheer dental esthetics, the satisfying appearance of two well-formed, well-occluded dental arches.
While a perfect Class I occlusion looks better than a perfect Class II or Class III occlusion and far better than an irregular, imperfect Class I, Class II or Class III occlusion, a perfect Class I occlusion is not automatically attractive if the teeth protrude too far. That this is a variable is demonstrated by a seeming popular preference for a somewhat protrusive dental appearance. This protrusiveness is not admired by a large number of orthodontists who have a personal preference for a flatter appearance of teeth and face. They also may ascribe improved periodontal health, function and stability to the more retruded position. Whether this is supported by the evidence is open to question. Until orthodontists can show that the more retruded position of the dentition contributes to its health, comfort, function, stability and longevity, our opinion has only the potential virtue of being impartial if we can make it so.
In addition to being impartial, the orthodontists' opinion should be oriented toward esthetics and freed from an accumulation of questionable diagnostic memorabilia. Whatever else we may do, we are going to have to pick our heads up from our cephalometric tracings and look at the patient's face more often and more analytically than most of us are accustomed to doing.
The greatest influence on all three categories of esthetics lies in the positions and angulations of the upper anterior teeth. If this is so, it suggests that more attention should be given in our diagnostic analyses to the positions and angulations of the upper anterior teeth in order to permit these teeth to be in their most esthetic positions. Most orthodontists will agree that, in any individual, there is a range of position and angulation for upper anterior teeth that would be esthetically acceptable, although they might not agree on exactly what that range may be. Nevertheless, this concept regarding upper anterior teeth calls attention to the fact that dominance of lower anterior teeth in diagnosis and treatment planning may often cause one to over-retract upper anterior teeth to relate them to retruded lower anterior teeth. Esthetics should not be sacrificed without the most careful consideration, because the changes that may be detracting from the esthetic position of the upper anterior teeth may not be contributing in a significant way to improved function, health, stability or longevity of the dentition.
Of all the potential benefits of orthodontic treatment, esthetics--dental, dentofacial and facial--is, thus far, the most substantial. Until research can establish additional benefits, I feel that these three aspects of esthetics are ample to justify our existence. Beauty is one of the greatest gifts that one person can be empowered to bestow upon another.
