Concept of facial balance /certified fixed orthodontic courses by Indian dental academy

CONCEPT OF FACIAL BALANCE

INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Nasal growth

1. Age 10-13yrs
2. Age 13-16yrs


The Aging face
 Behrents
 113

 Soft

–Bolton brush growth study

untreated individual from ages 17-83yrs

tissues changes

 Profile

straightened
 Lips-more retrusive,lessfuller
 Nose size increased in all dimension
 Nasal tip moved more inferiorly
 Acute- nasolabial angle
 Thinning of the lips
 Droop at the commissures.

The Aging face
 Incisor

show at rest


Facial keys to orthodontic diagnosis & treatment
planning.part I .Am J Orthod Aprl 1993,Arnett & Bergman


Aim



To present an organized, comprehensive clinical facial
analysis



To discuss the soft tissue changes associated with
orthodontic & surgical treatment of malocclusion.



NHP,Centric relation, relaxed lip posture.


Natural head position


Centric relation


Relaxed lip


19 keys


1 key-outline form & symmetry
Bigonial width
Bizygomatic width
Ht – Width ratio-1.3:1


2key-facial level


3rd key-Midline alignment


4th key –Facial one-thirds


5th key –upper & lower lip length


6th key –incisor to relaxed u/lip
•Upper lip length
•Maxillary skeletal length
•Thickness of lips
•Angle of view


7th key –interlabial gap

•Increased
•Decreased


8th key –closed lip position
Reveals disharmony between skeletal & soft tissue lengths.
•In cases of vertical maxillary excess
•Increased mentalis contraction
•Lip strain
•Alar base narrowing.
•In cases of vertical maxillary deficiency
•Lip redundancy


9th key – Smile- lip level
 Ideal

exposure with smile is three-quarters of
the crown height to 2mm of gingiva.

 Variability

in gingival exposure is related to

 Lip

length
 Vertical maxillary length
 Maxillary anatomic crown length
 Magnitude of lip elevation with smile


10th key –profile angle
•Class I -165*-175*
•Class II-less than 165*
•Class III-more than 175*


11th key-Nasolabial angle
Avg – 85*-105*
females>males.
•Factors to be considered in Rx planning
•Existing angle
•Tipping/ Bodily movement
•Amount of lip tension
•Lip thickness
•Extraction/ Nonextaction


12th key –maxillary sulcus contour.

Upper lip tension.


13th key-mandibular sulcus contour


14th key-Orbital rim


15th key- Cheekbone contour


16th key-Nasal base to lip contour


17th key –nasal projection

Avg-16-20mm


18th key-throat length

Clinical significance:mand setback.


19th key-subnasale-pogonion line


Vertical maxillary excess
 Increased

lower one third
 Increased interlabial gap
 Increased incisor exposure
 Increased gingival smile
 Mentalis strain
 Increased mandibular sulcus contour
 Decreased chin throat length.


Vertical maxillary deficiency
 Decreased

lower one-third
 Decreased interlabial gap
 Decreased incisor exposure
 Lip redundancy
 Increased chin-throat length
 Decreased nasolabial angle


conclusion:


Facial examination can determine the best treatment
for achieving facial balance.



“when attention is directed only to bite correction, facial balance
may not improve & can deteriorate. The orthodontist’s job is to
balance occlusal correction, temporomandibular function,
periodontal health, stability,& facial balance while moving the
teeth to correct the bite.”


Facial analysis; the comprehensive systematic
assessment of the frontal view. D M Sarver.

..
 Frontal

vertical
relations
 Long face
 Short face


Long face& short face


Long face problems & Rx
 Maxillary

impaction
 Advancement
genioplasty with
vertical shortening


Short face Rx
 Adoloscents
 Anterior

bite plates

 Growth

modification
 Reverse curve of
spee

 Adults
 Maxillary

down

graft
 Augmentation
genioplasty

Transverse facial & dental
proportion
 “Rule

of fifths”

 Middle

fifth
 Medial two fifths
 Outer two fifths


Middle fifth


Medial two fifths


Outer two fifths


Eyes & the upper face
 Inter

pupillary-65mm
 Inter canthal-35mm
 Outer canthal-9.8cm


Transverse nasal proportion
 Nasal

anatomy

 Skeletal
 Cartilaginous


 Fomon

& Bell

 Leptorrhine
 Mesorrhine
 Platyrrhine


Systematic nasal evaluation.
 Alar

base width
 Columella
 Nasal tip
 Nasal dorsum


Alar base width


alar base width=intercanthal distance.

 Ideal

nasal width -70% of nasal height.

 Nasal

length in the mature face =stm-Me

 Clinical

significance:LeFort I
osteotomies.

columella
 Lower

nasal
cartilage
 Location
 Anterior
 Intermediate
 basal


Nasal tip
4

definining points

 Nares

should be barely visible
 Base of the nose- “gull in flight” contour
 Columella –lower than the ala
 Contour of the ala- “scroll”


Symmetry: facial & dental
 Definition;

“ The similar arrangement in form &
relationships of parts around a common axis
or on each side of a plane of the body”

 True

structural asymmetry

 Apparent

facial asymmetry/displacement


etiology
 Genetic/congenital

malformations
 Environmental factor
 Functional deviation
 Tumors
 Condylar hyperplasia/ hypoplasia
 Masseteric

hypertrophy.


Systematic evaluation of dental &
facial asymmetry.
 Nasal

tip to midsagital plane
 Maxillary dental midline to midsagital plane
 Maxillary dental midline to mandibular dental
midline
 Mandibular midline to midsymphysis
 Midsymphysis to midsagital plane.


Nasal tip –Midsagittal plane
 Deviation

of nasal tip

 Trauma
 DNS
 Congenital

nasal stenosis
 Iatrogenic deformity


Maxillary dental midline –
midsagittal plane.









Spacing
Crowding
Premature loss of primary canine.
Rotation
Missing teeth
Buccally / lingually placed teeth
Crowns / fillings which change tooth mass.
Congenital tooth mass difference.


Maxillary-Mandibular dental midline.





Maxillary dental midline shift
Mandibular dental midline shift
Mandibular asymmetry
Functional shift of the mandible


Facial asymmetry


Incisor to lip relations







Philtrum height
Commissure height
Maxillary lip to upper
incisor at rest
Lip incompetence
Crown length
Gingival display on smile


Profile view


Midface profile
 Radix

nassi
 Nasal dorsum
 Nasal tip
 Columella
 Nasolabial angle
 Soft tissue thickness
of maxillary lip


Lower face
 Lip

projection
 Labiomental sulcus
 Chin projection
 Vertical facial height
relations
 Lip chin throat angle
 Chin neck angle.


Smile elements
 Extent

of the smile is outlined by

 Curvature

of the upper & lower lip
 Position of the angle of mouth
 Degree of exposure of both anterior & posterior
teeth,gingiva,width of the buccal corridor.

 Smile

can be classified as

 Passive
 Active

(moderate)

 laugh


Smile element


Smile elements
 Lip

& lip lines

The length, curvature& shape-tooth
exposure.
Muscular atrophy
Ideal location of upper lip ht relative
to the upper incisor
Avg maxillary incisor display1.91,3.40


Smile elements
 Upper

lip line

 low,medium,high
 Gingival

zenith
 Toothy smile
,gummy smile


Smile elements
 Lower

lip line
 Smile line
 Negative space


References:
•

Graber TM & Vanarsdall RL;Orthodontics current
principles & techniques,Ed 3,Mosby Inc,St
Louis,USA;2000.

•

Proffit W R : contemporary orthodontics , 2nd edi ,
Mosby year book Inc , St Louis USA 1993

•

David M Sarver: Esthetic orthodontics and
orthognathic surgery , Mosby year book Inc , USA
1998


 Ratnadeep Patil : Esthetic dentistry an artist’s science
, 1st edi , 2002


A Jacobson : Radiographic cephalometry ,
Quintesscence publishing Co Inc , 1995



H Peck & S Peck – concept of facial esthetics 1970 .
The Angle Orthod :287-317


 P S Vig & A M Cohen – Vertical growth of the lips : A

serial cephalometric study 1979 Apr . Am J Orthod :
405 – 415


R S Nanda & S Kapila – Growth changes in soft
tissue profile 1989. The Angle Orthod : 177-192



G W Arnett & R T Bergman – Facial keys to
orthodontic diagnosis & treatment planning 1993 Apr.
Am J Orthod ; 103 : 229 - 307


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Concept of facial balance /certified fixed orthodontic courses by Indian dental academy

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