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Understanding Aging Makes Beauty Timeless

How orthodontics, cosmetic and oral surgery enhance beauty

By Dr. David M. Sarver


Figure 3.
Figure 3: At age 11, note the position of Susan's lower jaw. The jaw position appears retrusive or “pushed back.”
Figure 4.
Figure 4: At age 14, orthodontic treatment has taken advantage of lower jaw growth by guiding the jaw and teeth into a stable bite. Note the improvement in her facial profile.
Figure 5.
Figure 5: At age 34, Susan's beautiful facial profile has been maintained due to a stable bite and proper jaw relationships.
Photos provided by Dr. David Sarver

From Theory Into Practice — Getting Better All The Time

The great implication of this information is that we can use the knowledge gained by these observations to “slingshot” change in the right direction via orthodontic treatment.

Let's start by looking at “Susan,” who as an 11 year-old adolescent had severely crowded teeth and a retrusive lower jaw — meaning her lower jaw was positioned behind the line of a normal lower jaw thus giving her the appearance that it had been pushed back slightly into her face and neck.

Susan's case illustrates the point for three reasons:

  • The long-term changes that her face will undergo are an important factor in evolving an orthodontic plan of action.
  • An excellent illustration of how knowledge of both skeletal and facial changes that will occur during growth and maturation can in fact guide the treatment.
  • Her case demonstrates how the principles of facial growth can be used to maximum advantage.

Using a multi-layered approach, the timing of Susan's treatment was more than important — it was critical. We asked ourselves the question, “Could we shoot for an outcome that would improve facial aesthetics as well as offer her face protection from the relentless effects of aging?” The answer was a resounding, “yes,” and evolved into a dramatic treatment approach to address both her teeth (bite) and facial aesthetic requirements.

  • The first part of the plan was to take advantage of the growth spurt that occurs pre-puberty. Growth guidance therapy started at age 11 to open her deep bite and increase the height of her lower face, along with orthodontic repositioning of her back teeth [Figure 3].
  • In comparing her problems with the treatment options, extraction therapy (pulling teeth) would solve the crowding problem with her bite; however, it would not improve her lip fullness and support. Given that her profile and lips would flatten with no treatment at all, moving the front teeth forward would have the definite advantage of addressing the crowding problem, while offering potential improvement in the shape of her lips.
  • After approximately nine months of lower jaw growth guidance, a dramatic improvement was noted. This approach provided sufficient space to “un-crowd” her teeth.
  • Susan's treatment was completed over the next 14 months resulting in the development of an exceptionally good, stable bite and dramatic improvement in her profile [Figure 4].

The Take Home Message From Susan's Case

The first message is simple, start from the outside and work your way in. By this we mean that in today's contemporary approach to orthodontics, treatment is timed to coincide with the skeletal growth spurt, and is not dictated by whether or not all permanent or adult teeth have erupted (surfaced). As it turned out in Susan's case, the transitional time between losing her baby teeth and getting her adult teeth provided a sufficient timeline to treat her without permanent tooth extraction.

The second message is to take the proactive approach and treat the face in concert with the teeth. Again, we turn to Susan's case and the opportunity that was seized to improve her facial aesthetics while correcting her crowded teeth problem.

The third message is that time stops for no man, or in Susan's case, no woman. If she had had a traditional approach, removal of four back teeth, she would have received the traditional standards of care. However, we might have never known just how attractive this young person could grow up to be. Twenty years later, her face [Figure 5] confirms the fortunate good decisions made in light of understanding the expected soft tissue changes, which occur regardless of treatment.