We’ve established in our last several blog posts that the face and the smile are REALLY IMPORTANT! We are hard wired in our brains to notice faces, and react to them emotionally on a very deep level. In this blog post, we’d like to discuss the impact orthodontic treatment can have on faces, and how the decisions that are made can affect the appearance of our patients’ faces for the rest of their lives.
The profile is the view of the face or head when viewed from the side. Although orthodontic treatment does not alter the shape of the forehead or the nose, we should consider the shape of these structures when evaluating our patient’s profiles. Orthodontic treatment can have a dramatic effect on the shape of the lips and the chin, and we want to make sure that all the elements of the profile are well balanced, and in harmony. There is actually a lot of science about how to measure a “balanced profile”, and we are taught in our orthodontic residencies how to “measure” a profile to see if the nose, lips, and chin are balanced. We also know from research that the profile changes over time, with the nose and chin becoming more prominent as we age. We also learn how important it is that our patients be able to easily keep their lips closed when breathing, chewing food, or simply resting. If the mouth is held apart (because it is too difficult to close the lips, or because it is difficult to breathe through the nose), then the tongue is lowered inside of the mouth, and the muscle balance between the tongue and the lips/cheeks is disrupted. This can cause the teeth to shift over time and contribute to the long-term failure of orthodontic treatment.
So how can good orthodontic treatment affect the balance of the profile? Primarily by decisions that we make in regards to how we fix bite problem.
This patient’s profile is affected by the position of his upper and lower front teeth. Because the teeth are positioned too far forward, his lips cannot close easily. When he forces the lips together, the chin muscle contracts, thus flattening out the chin. This is not a balanced profile. When they are closed together, the lips push out in front of the chin, and are strained. Our goal is to help this patient to be able to easily and naturally keep his lips closed, without strain. This will allow the chin muscle to relax, thus helping establish a more normal chin contour.
So the goal of this patient’s treatment was to bring the upper and lower front teeth inwards, to allow the lips to close more easily, and allow the chin muscle to relax. How can the orthodontic treatment do this? We did this by having the patient have 4 premolar teeth removed before the placement of his braces (these are the teeth halfway back on the sides). The removal of these teeth created gaps that were closed with braces. When the gaps were closed, the front teeth were brought back (which was the original goal of treatment).
If you look closely at these pictures, you’ll notice that the front teeth are not angled outward as much, and that there are fewer teeth in the right hand photo. Orthodontic treatment was done in order to reduce the forward protrusion of the front teeth, and to bring the teeth further back so that the lips and profile could be affected in a positive manner. The patient wore braces for 20 months and currently wears his retainers at night only.
After orthodontic treatment, this patient was able to easily and naturally keep his lips together, without straining his chin muscle. This is the direct result of consciously directing his orthodontic treatment to resolve the specific problem of his front teeth being too far forward in his mouth. As a result, it almost appears as if his chin grew, but in fact, the chin was unchanged. The chin looks different because the muscles are no longer strained.
Naturally, nobody desires to have teeth removed as part of orthodontic treatment, but sometimes, it is the best thing to help the profile. The key here is that we keep the goals of treatment in mind when making up a treatment plan for each individual patient. Sometimes, patients have wonderfully balanced profiles with very crowded teeth. In these situations, we might recommend the removal of teeth like was recommended for this patient just to preserve the beautiful balance that is already present, while at the same time, straightening the crooked, crowded teeth.
The flip side of this story, of course, is that if the lips are flat and lacking support, good orthodontic treatment can help move the front teeth forward, thus giving the lips better support.
Here is a young patient who’s lips were lacking support because her front teeth were “pushed back”. Her mouth was very crowded, so the removal of premolar teeth as described above could have been considered. However, because her front teeth and her lips would benefit from moving forward, we chose NOT to have any premolar teeth removed so that we could use braces to move her front teeth forward as they were uncrowded.
After orthodontic treatment, her front teeth are no longer “pushed back”, and they give her lips better support. This is especially important as she ages, as her chin and nose will become more prominent with age. Helping our patients have a well balanced profile throughout life is our goal, and the decisions we make when they’re teenagers can have important effects long into the future.
Hopefully, you now have some understanding of how orthodontic treatment can be planned to improve the profile, and create beautiful, balanced faces in addition to beautifully straight teeth. We’ll talk more in future blog posts about other ways in which orthodontic treatment can affect facial attractiveness, and why it’s important to consider the WHOLE patient when planning orthodontic treatment.