Facial soft tissue harmony and growth in orthodontic treatment

The introduction of cephalometric radiography in orthodontic diagnosis inadvertently shifted the specialty's attention from the facial soft tissues to the skeletal structures. It has been shown that rigid adherence to the hard tissue norms results in neither facial balance and harmony nor long-term retention. The purpose of this article is to refocus the attention of the orthodontist on the consideration of harmonized facial structures as a primary goal of treatment. Balancing the position of the lips in relation to the nose and chin has a direct relationship with esthetic preference. Growth studies have clearly shown that dynamic changes in dental, skeletal, and facial integument occur over the entire period of active growth and even into the decades past the age of 20 years. Esthetic standards, therefore, must be different for children and for adults. Treatment results should be projected to when the patient is well into adulthood. Facial types also need to be considered because long-face and short-face individuals have different growth and maturational patterns. The compensatory nature of soft-tissue growth in these individuals should be noted. Caution must be exercised in using mean data from growth studies and applying them to all individuals at all ages, because of the wide variation among individuals in all races and both sexes.