What are today’s patients looking for? - What can I provide that will stand out from the crowd? - Factors Affecting
the Perception of Esthetics - Esthetics in Orthodontics

1. Nasir Al-Hamlan BDS, MPH, MSc, FDS RCSEd, FDS RCSEd, MOrth RCSEd, FICD
Consultant and Assistant Professor, Orthodontics
King Saud bin Abdulaziz University for Health Sciences
Riyadh, Saudi Arabia
@nhalhamlan
@saudibraces
nasiralhamlan
@nasiralhamlan
LIFETIME ORTHODONTIC ESTHETICS

2. Appearance Driven Treatment Planning
One thing is clear in today’s rapidly changing orthodontic
environment: patients in the information age are far more
aware of their options and are more empowered to get
what they want when they want it.

3. -What are today’s patients looking for?
-What can I provide that will stand out from the crowd?
The simple answer to both questions is LIFETIME ESTHETICS.

4. While functional treatment is well established in
orthodontics, patients want more than just straight teeth.
The emerging paradigm in our field is a global esthetic
approach with emphasis on patient- centered interaction
that enhances a good occlusion. Striving for esthetic
excellence and involving patients in their treatment are
critical to case acceptance and create the “raving fan”
experience that drives practice growth.

5. At Future Visions, you will learn to develop and
implement a rock-solid process to achieve outcomes
every time.
The globally renowned Soft Tissue Paradigm provides a
framework for the systematic evaluation, treatment
planning, and interdisciplinary clinical execution to
deliver the individual esthetic needs of each patient.
How can you efficiently achieve
these demanding goals?

6. One of the primary goals of orthodontics is to
Attain & Preserve optimal facial attractiveness,
To achieve this orthodontist needs to carry out a
thorough facial examination so that orthodontic
correction of the malocclusion doesn’t adversely affect
facial traits,
Bite correction doesn’t always lead to maintenance of
facial harmony (contrary to Angle’s beliefs)

7. Factors Affecting
the Perception of Esthetics

8. • The perception of esthetics varies from person to
person
Factors Affecting
the Perception of Esthetics
• Nationality and ethnicity play a major role in formation
of esthetic preferences
• Other factors such as gender, age, education,
socioeconomic status, and geographic location also
affect esthetic preferences

9. • Relying on cephalometric analyses can lead to
problems in terms of overall aesthetics
Factors Affecting
the Perception of Esthetics
• Measurements are often made around the cranial base.
Since the position of Nasion is variable these
measurements should be taken as a rough guide
• Soft tissue appearance is only partly dependent on
underlying hard tissue. To predict soft tissue response to
hard tissue changes is difficult.

10. • Professional opinions regarding evaluation of esthetics
may not coincide with the perceptions and demands
of patients or laypeople
o Less tolerant
o More tolerant
Factors Affecting
the Perception of Esthetics

11. • “We orthodontists tend to forget that esthetics is a subject
that interests all people everywhere, and the ultimate
source of esthetic values should be the people and not just
ourselves.”
(Peck and Peck, 1970)

12. What is attractiveness?

13. • Keating (1985) constructed ‘Identi-kit’ composite portraits of male
and female faces, altering sizes of each component, eyes, lips etc.
- Female raters selected men faces that had ‘dominant’, ‘mature’
features such as large jaws, small eyes, thin lips.
What is attractiveness?

14. What is attractiveness?
- The combination of mature with neonate features may signal that
the female is at an optimum age for mating.
- Most attractive females had additionally some ‘mature’ features
such as prominent cheekbones.
- Males preferred ‘non- dominant’ or neo-natal type, large
foreheads, large wide set eyes, small nose & chin & full lips.
Simulate nurturing or caring instinct.

15. • Normal values are used to define acceptable facial
traits and to establish a range of values within which
lies acceptability
• Norms should only be used as a guide. They vary
according to ethnicity of the patient.
• Love of averageness. We tend to plan patients so
that they become ‘average’.
What is attractiveness?

16. Esthetics in Orthodontics
Presented by Sarver and Ackerman:
Components of the Classification of Appearance and Esthetic Analysis
1. Macroesthetic analysis encompasses the face in all three planes of
space. Examples of macroesthetic appearance issues include a long face,
a short face, lack of chin prominence, and other facial features.
2. Miniesthetic analysis focuses primarily on the smile framework and
includes such assessments as gingival display on smile, inappropriate
gingival heights and buccal corridors.
3. Microesthetic analysis includes assessment of tooth proportion in
height and width, gingival shape and contour, black triangular holes and
other dental attributes.

17. Soft-tissue based diagnostics and
treatment planning. (Sarver , Clinical
Impressions, Vol 14, 2005)

18. He discussed skeletal aging citing Rolf Behrent's
study and informed the audience of the
characteristics of soft tissue aging through each
decade.
Dr. Sarver compared the appearance of youthful
and aging lips and mentioned how the orthodontist
makes a lifetime decision regarding continued
youthfulness (whenever the intervention).

19. The aging face shows macro and miniesthetic changes:
• Decreased lower facial height, lower nasal tip,
• Decreased vermillion,
• Less lip projection,
• Deepened nasolabial fold
• Decreased incisor display at rest and on smiling,
• Change in tooth shade, and decreased lip turgor.

20. Treatment strategies should therefore involve soft
tissue support, increased lower facial height, and
increased tooth display.

21. Conclusion

22. Beauty is altogether in the eye of the beholder
(Margaret Hungerford 1878)
Listen to patient’s concerns
It is a great error to try and put everyone in the
same aesthetic framework and an even greater
error to do this from hard tissue relationships
alone
Conclusion