Dentofacial Esthetics. Part 1: Engagement and Repetition

About a month ago, I started reading a wonderful new book by David Sarver titled Dentofacial Esthetics: From Macro to Micro. I am still in the middle of it because I can’t break a habit of reading multiple books simultaneously. Nevertheless, I decided to write the first part of a review now and do two more in a few weeks.

David Sarver is an adjunct professor of orthodontics in both the University of North Carolina and the University of Alabama. He runs a private practice in Vestavia Hills, Alabama. He is very well-known throughout orthodontic community as a prolific writer, demanded speaker and the guy who coauthored the most popular orthodontic textbook ever, Contemporary Orthodontics.


Truth to be told, I knew the new book was a masterpiece from the very first moment I received it. The book has a really nice design and the quality of printing is exceptional; the text, which is an outcome of four decades of clinical experience, truly deserves to be garnished this way.

In this part of my review, I will focus on the first three (out of eight) chapters of the book.


In the first chapter, Sarver states that effective teaching takes engagement and repetition. He also points out that ‘the style of the book is to ask a lot of questions and encourage a reader to think along as the series of questions lead to an answer’. This approach resembles how Robert Ricketts would describe the teaching style of Allan G. Brodie. All in all, I find this approach very reasonable.

Sarver hooks a reader from the very first case, which is a young adult patient with a massive trauma of the upper dentition. After a brainstorming session to find a solution for this relatively unusual patient, Sarver leads us through a plethora of his other cases.

He suggests to evaluate every case on three levels “from outside-in”:

Macro-esthetics: The profile and vertical dimensions

Mini-esthetics: The smile’s attributes

Micro-esthetics: The teeth and their attributes

I think it is a very good suggestion. I feel that the latter level is often overlooked by orthodontists.


The key recurring topic of the first chapters is the soft tissue paradigm. In other words, the notion that we should care more about the soft tissues of an actual patient rather than the cephalometric values of his or her skull.

Sarver dedicated the whole second chapter to describe his way to adopt this paradigm and then frequently refers to some of its aspects in the further text. For example, he defies the conventional IMPA value of 90 to 95 degrees saying: ‘my feeling that proclined mandibular incisors are a result of normal compensation for a retrognathic mandible and not necessarily an indication of a problem in need of treatment’. He also recommends to take an oblique facial photograph as a part of normal patient’s records. He states: ‘I refer to this as “social view” because this is the way that most of us are seen by other people’.

Sarver pays special attention to age-related changes. Here I find interesting his comment against reliance on Ricketts’ E-line: “it’s just a line between two changing points on a dynamically growing face”.

Another important issue, in my view, is Sarver’s concerns about CBCT. He analyses this recent study and then concludes the following: ‘Only take a CBCT when there is a clear, specific, and clinical justification’.


This is just the tip of an iceberg from what you’ll get from the book. I’ve been successfully engaged reading its first half. And by a constant reiteration of several simple aspects of his approach Sarver has definitely challenged some of my beliefs and made me see things in a new light.

Interestingly, in the beginning of the book Sarver describes how he once found on the Internet a TED talk of one successful American “self-help” guru which let him question why he does what he does and what makes his private practice different from others?

Personally, I have mixed feelings about the entire “self-help” industry. I can’t help thinking that it is just a bunch of eloquent parasites who take advantage over people’s day-to-day fatigue and ignorance of the Greek and Roman philosophy.

I think nowadays we reached a certain point in orthodontics that just by reiterating simple truths and doing our clinical work diligently we already stand out from many “options” on the market.

I think David Sarver is a great clinician who took a lot of effort to document and analyse his professional path. I think we all shall be never tired of reiterating simple truths. This way we help each other and protect our specialty.

I am going to publish the second part in a week.


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