Smile Enhancement Therapy
After 37 years of personally treating thousands of orthodontic patients, I have found that the majority of my patients present with diverse mixtures of "dentofacial traits". A dentofacial trait is a hard or soft-tissue characteristic, or combination of characteristics, that distinguish an individual’s facial appearance, and determines their level of oral and social function. Some traits are directly inherited from biological parents, while other traits come from previous generations. My staff and I always attempt to treat every case to the current “standard of care”, or to current philosophies mandated by universities, dental literature, clinical studies, textbooks, dental boards, as well as communications with my orthodontic and cosmetic dentist colleagues. Current orthodontic philosophy has evolved from concepts related to Prosthetic Dentistry (replacement and modification of missing or damaged teeth) and to Victorian era concepts proposed by Edward Angle (Angle 1899). The concept of what is normal occlusion (a normal bite relationship) as proposed by Doctor Angle has been the mantra of my profession for over 100 years. Previously accepted foundations of orthodontics are rapidly changing as more and more of my dental colleagues become aware of evidence-based studies and evolution of contemporary concepts.
In the 2007 book, Enhancement Orthodontics Theory & Practice, Doctor Marc Bernard Ackerman presents a radical departure from the conventional approach to orthodontics and smile rehabilitation through a direct and punctual analysis. Doctor Ackerman asserts, “In practice, most of our patients are simply seeking improvement of a recognizable variation in a dentofacial trait or mixture of traits, and are not necessarily seeking a complete remake of their entire occlusion.” Orthodontists, including myself, have been taught to diagnose and treat through means of Victorian concepts that were proposed by Doctor Edward Angle. In his writings Doctor Angle, the “father of modern orthodontics”, organized dental occlusion (bite relationships) into three categories:
n the illustration above A represents a Normal Bite Relationship, B is a Class I Malocclusion with irregular alignment and protruded teeth, C is a Class II Malocclusion with the upper teeth protruding beyond the lower teeth, D represents a Class III Malocclusion with the lower teeth protruding beyond the upper teeth.
In reality, 20% or less of the population has a Class I normal bite relationship free of irregular dentofacial traits. With further critique it is evident that there are several other dentofacial traits such as crowding, spacing, crossbites, openbites, skeletal deficiencies, tooth size problems, anatomical variations and more. All of the above traits contribute to the conditions orthodontists see everyday. Ackerman further claims that “Nature imposes a series of limitations on the orthodontist’s ability to modify any given dentofacial trait.” In the real world it is impossible to create ideal Class I smiles for every patient. Ackerman also states, “The Achilles heel of Angle’s orthodontic model was its total disregard for the ubiquity and normality of human variation.” The orthodontist should “act as the change agent for enhancement of dentofacial traits.”
You as the patient play a primary role in determining your smile enhancement, as any treatment rendered by our practice will be based on patient-directed objectives. Of course, my staff and I will inform you of the dentofacial traits you possess and the degree of modification that is attainable.
When you come to our office during the first and second visits we will perform a comprehensive examination that includes, but may not be limited to, medical and dental histories, direct oral examination, pre-treatment digital radiographs, facial and intraoral photography, digital study models (plaster models in the past) and other diagnostic tests as required. My staff and I will review the above diagnostic records and with your direct input determine the best and most affordable way to enhance your smile. We all look forward to meeting you!!
Paul L. Ouellette, DDS, MSDiplomate American Board of Orthodontics
Clinical Director of ClearSmiles Atlanta
Check out the following links:
Biology of The Human DentitionAngle's Classification of Malocclusion
HOME / SMILE ENHANCEMENT / OUR DOCTOR / LOCATIONS / SCHEDULE ME ASAP / CONTACT INFO