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.


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’.


I’ve been successfully engaged reading the first half of the book. And by a constant reiteration of several simple aspects of his approach Sarver has definitely challenged some of my beliefs. I am going to publish the second part in a week.


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