Orthotown April 2022 - 8
a voice in the arena
Aesthetic Importance of Upper
Incisor Vertical Position
by Chad Foster, DDS, MS, editorial director
Fig. 1
T
Fig. 2
Fig. 3
he position of the upper incisors within the lip frame is
arguably the most dominant feature in the world of smile
aesthetics. This topic has been thoroughly expounded upon
by two of my personal orthodontic heroes, Drs. David Sarver and
Tom Pitts. In this month's column, I'd like to share a case where
that feature became of singular importance during treatment.
To provide some background, I fi nd that Class 3 patients
will often show some degree of limited vertical upper incisor display,
which negatively affects smile aesthetics. On cephalometric
X-rays, you will often see upper incisors stepped up relative to the
occlusal plane; their active eruption was insuffi cient because of the
relatively more forward-positioned lower incisors (which led to
earlier, and thus incomplete, eruptive contact of the later-erupting
upper incisors). Interestingly, I fi nd the opposite is true for Class 2
patients or patients missing a lower incisor-they can often show
mild overeruption of the upper incisors that when extreme shows a
gummy smile, but when mild often places upper incisors in a more
ideal vertical position aesthetically.
Also, from a mechanics standpoint, it can be challenging to
improve defi cient vertical incisor display for Class 3 patients in particular.
In these cases, Class 3 elastics have a tendency to produce
unfavorable tipping of the occlusal plane-up in the anterior and
down in the posterior. This is exactly opposite of how you'd want
to affect the occlusal plane to benefi t incisor display when it is defi
cient. On the other hand, the mechanics involved in occlusal correction
of Class 2 patients and open-bite patients are much more
favorable for increasing vertical incisor display.
Patient case
For this patient (Fig. 1), in addition to occlusal correction, aesShare
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thetic upper incisor vertical position was highly prioritized in treatment
planning. At the bonding appointment, I tried to position
my bracket heights to facilitate altering the occlusal plane in favor
of upper anterior extrusion and lower anterior intrusion. I bonded
upper incisors more gingival and upper posteriors more occlusal
with a graded divergence. Lowers were bonded with the opposite
divergence-more incisal in the anterior and gradually more gingival
in the posterior.
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Orthotown April 2022
Table of Contents for the Digital Edition of Orthotown April 2022
Orthotown April 2022 - Intro
Orthotown April 2022 - Cover1
Orthotown April 2022 - Cover2
Orthotown April 2022 - 1
Orthotown April 2022 - 2
Orthotown April 2022 - 3
Orthotown April 2022 - 4
Orthotown April 2022 - 5
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Orthotown April 2022 - 49
Orthotown April 2022 - 50
Orthotown April 2022 - 51
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Orthotown April 2022 - 53
Orthotown April 2022 - 54
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Orthotown April 2022 - Cover3
Orthotown April 2022 - Cover4
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