Never Overlook the Essential Step Before Orthodontic Treatment: Facial Analysis

In addition to taking dental X-rays, there is another essential step that must be performed before orthodontic treatment: facial analysis.

Orthodontics is not just about straightening teeth; it also focuses on the aesthetic harmony of facial structure. By analyzing the face, the orthodontist can gain a comprehensive understanding of your facial condition and, in conjunction with your specific concerns, design a more effective treatment plan to achieve the desired orthodontic results and avoid potential risks. During facial analysis, three aspects are typically considered: the frontal view, the profile view, and the temporomandibular joints.

• Frontal View

The frontal view primarily assesses facial proportions and the coordination of soft and hard tissues.

a. Facial Proportions

The first aspect is the assessment of facial height and width, the golden ratio of which is three foreheads for the height and five eyes for the width. This serves as the fundamental guideline for orthodontic evaluation. A face that conforms to the golden ratio is less likely to encounter issues, even if individual features are not exceptionally prominent. Analyzing these proportions helps determine facial harmony, allowing for more suitable treatment planning. For example, in cases of an overbite leading to an elongated chin, moving the upper front teeth closer to the lips and retracting the lower front teeth can provide improvement. In the case of adolescents still in their growth phase, their natural growth potential can also be utilized for correction.

b. Facial Symmetry

The second aspect involves assessing facial symmetry and identifying issues like asymmetry, facial size disparities, or a skewed jawline. A critical reference line, known as the “midline”, is used for this purpose. It connects points on the face when viewed from the front, including the midpoint between the eyebrows, the tip of the nose, the center of the upper lip, and the chin. Facial asymmetry not only affects aesthetics but also can lead to health problems. Mild to moderate asymmetry in the early stages can typically be addressed through orthodontics, improving both appearance and bite alignment.

c. Smile Analysis

Lastly, smile analysis evaluates facial features during smiling. “Smile aesthetics” is a significant criterion in orthodontic assessments. Factors like gum exposure when smiling, the positioning of the smile line, and the coordination of cheek contours are examined. This analysis helps orthodontists determine whether bone anchors are needed to adjust gum exposure or if expansion is necessary to enhance cheek contour.

For adolescents still in their growth phase, aspects such as body posture, breathing patterns, and speech and chewing habits are also considered. Their facial structures are not static and may change with different stages of development. Evaluating these aspects aids in predicting their future growth trajectory and whether interventions like guiding the upper jaw forward will be needed.

• Profile View

The profile view primarily assesses the harmony of the lower third of the face.

a. Facial Type

First, the orthodontist examines whether the face is straight, convex, or concave. If abnormal protrusions or retractions result from tooth-related or skeletal factors, orthodontic treatment can often help. However, in cases of skeletal issues, especially in adults, orthodontics alone may not suffice, and combined orthodontic and orthognathic treatment may be necessary.

b. Nasolabial Angle

Aesthetically, the ideal nasolabial angle is around 95 degrees. A smaller angle may make the upper lip appear more prominent, while a larger angle may cause the upper lip to appear flattened. Orthodontic treatment can effectively address issues in the lower third of the face, such as protruding lips, through methods like extraction, expansion, or intrusion.

c. Mandibular Plane Angle

The mandibular plane angle reflects the vertical relationship between the upper and lower jaws, which can affect facial shape. When the angle is high (>32 degrees), the face appears elongated with less prominent lower jaw angles. When the angle is low (<22 degrees), the face may appear short, round, or wide due to pronounced lower jaw angles. For high-angle patients, orthodontists may consider tooth extraction to retract the teeth, rotate the mandible counterclockwise, reduce the mandibular plane angle, advance the chin, and improve retrusion issues. In contrast, low-angle patients can have their mandibular plane angle increased by simultaneously intruding the anterior teeth and extruding the posterior teeth through orthodontic methods.

• Temporomandibular Joints (TMJ)

Orthodontics always prioritizes health and function before aesthetics. Therefore, a thorough evaluation of the temporomandibular joints is crucial before orthodontic treatment. Joint issues can adversely affect the outcome of orthodontic treatment. Temporomandibular joint problems are relatively common and may manifest as clicking, pain, jaw deviation during opening, or limited mouth opening. It is essential to inform the orthodontist of any joint issues to ensure a detailed medical examination of the joints before proceeding with orthodontic treatment.

The exact causes of temporomandibular joint disorders are unclear and may be related to dental and skeletal abnormalities as well as factors such as neurological issues, trauma, and systemic conditions like high-stress levels. If the issue is related to bite alignment, orthodontics can often provide improvement. However, if neurological factors are involved, orthodontics may be insufficient.

Whenever orthodontic treatment is required, Clickalign will consistently serve as a reliable partner for both dentists and patients.

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