Dentofacial Esthetics. Part 2: Aquire a system!

About two weeks ago, I published the first part of my review on a wonderful new book by David Sarver titled Dentofacial Esthetics: From Macro to Micro. I was then reviewing the first three chapters of the book. Now I am going to look at the following two.

In the beginning of the fourth chapter Dr Sarver points out his adherence to checklists and suggests a reader to take a look at a book by Dr Gawande The Checklist Manifesto. ‘No matter how expert you may be, well-designed checklists can improve outcomes’, states Sarver.

During these two chapters we go through cases in which Sarver shows how he applies checklists to evaluate and then improve smile characteristics of his patients. Very reasonably he points out: ‘The profession of orthodontics has hundreds of cephalometric analyses, but to this point, I know of no orthodontic smile analysis’…DSC04271.jpg

The main smile parameters Sarver analyses are the following:

  • The smile arc
  • Maxillary incisor height-width ration
  • Maxillary incisor display at rest and on smile
  • Gingival display on smile
  • Buccal corridors
  • Torque

The main point of Sarver’s diagnostic approach can be summed up by this simple line: ‘how it looks clinically overrides the cephalometric measurements’.

Sarver also encourages a reader to pay attention to the changes in the philtrum hight and incisor display, which happen during a lifetime. He quotes Wayne Gretzky here: ‘I skate to where the puck is going to be, not where it has been’.

It was very interesting to look at many cases where Sarver addressed an inadequate maxillary incisors’ height by a diode laser crown lengthening. The results look very good and I think I should consider the procedure in some of my own patients.

I’m also thinking about adding Sarver’s smile analysis to a patient card that I composed for my personal needs a year ago. I think having a system in orthodontic diagnostic and treatment planning is of critical importance.

Of course, my brief retelling of Sarver’s approach could not replace the actual book with its detailedly documented cases and an authentic author’s narration, but nevertheless I’m going to write a third part in a very short time…

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