Editorial

Perspective of the Orthodontics diagnosis towards facial aging

Dailin Castiñeira López^{1  *} 
http://orcid.org/0000-0003-0589-9986

Lizandro Michel Pérez García² 
http://orcid.org/0000-0003-3111-0432

¹Clínica Estomatológica Orestes García Saroza, Fomento, Sancti Spíritus, Cuba.

²Clínica Estomatológica Provincial, Sancti Spíritus, Cuba.

In Cuba, orthodontic treatment begins, generally, at early ages with the aim of preventing dentomaxillofacial anomalies or preventing them from getting worse. Most patients finish their care after adolescence and sometimes require a new intervention in adulthood, together with the growing interest of receiving these treatments to recover the young appearance of the face, requires new considerations in the diagnosis. ¹

Science and technology have made progress, information is closer and more attainable than ever with globalization, paradigms change and health professionals are obliged to know and manage the tools, resulting from research, to apply appropriate therapies to each particular problem. ²

During the last decades the research in Orthodontics was directed to the development of new materials, designs and techniques, the accurate diagnosis and the essence of the treatment were underestimated to be stable over time. ²

The diagnosis and therapeutic planning are key elements for a successful treatment, on the contrary, if they are deficient, there is a probability that the professional will make wrong decisions that could cause irreparable damage to the dentomaxillofacial structures and decrease the possibilities of conservative treatments. ³ At present, the diagnosis is guided from the outside inwards, with an initial visualization of the patient's face to determine how his physiognomy is affected according to the concepts of aesthetics and facial beauty. ²

When considering the current aging of the population, people worry about improving their appearance with the achievement of an aesthetically acceptable and lasting smile, ^1,2,4) so the orthodontist must take into account during the diagnosis the changes that therapy can cause and not only those of the growth and development of the person, but also those of facial aging which makes this process an integrator.

After the development achieved by the clinical method, between the nineteenth century and the first half of the twentieth in the last decades there has been a crisis that manifests itself in the deterioration of the doctor-patient relationship, little value to interrogation and physical examination, overvaluation of the role of technology, which is no stranger to the specialty of orthodontics. ³

In the formulation stage of the problem and search for basic information, the clinical variables must be taken into account: upper lip length, interlabial space, position of the lip closure, volume of the lips, number of millimeters of exposure of the incisor at rest and in the smile , size of the incisor in the direction of the incisal edge of the neck and distal mesio diameter, presence of anterior diastemas, shape of the arch, amplitude of the buccal corridors, deviation of the midline, level of the smile line, absence of anterior teeth, depth of facial grooves, nasolabial angle which would facilitate provisional presumptive diagnosis. ¹

For the contrast and verification of the presumptive diagnosis and diagnosis of certainty or confirmatory, three categories of complementary examinations or registries are used: to assess teeth and oral structures: gypsum models, to assess occlusion: gypsum models mounted on articulators and to assess facial and oral structures: radiographs and photographs. ⁵

From the authors´ opinion about the cephalometric analysis, some variables related to facial aging should be taken into account such as: nasal projection, thickness and length of the lips, as well as the distance from both to Ricketts and “H” lines “E” from Holdaway. ¹

To consider the current concepts of aesthetics and dynamics of the smile from the diagnosis would be very useful in the planning of treatment, ^1,6,7,8,9,10 mainly, when dental extraction is necessary during the compensation of the bone-tooth discrepancy and the satisfaction of the aesthetic needs of the patients.

REFERENCIAS BIBLIOGRÁFICAS

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2. Quiros Álvarez O, Castiñeira López D. Hacia dónde va la Ortodoncia. Gac Méd Espirit [Internet]. 2017 [citado 2019 ene 27];19(2). Disponible en: Disponible en: http://scielo.sld.cu/pdf/gme/v19n2/GME01217.pdf

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9. Ward DH. Proportional smile design: Using the recurring esthetic dental proportion to correlate the widths and lengths of the maxillary anterior teeth with the size of the face. Dent Clin North Am [Internet]. 2015 [cited 2019 Jul 24]; 59(3):623-38. Available from: Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S001185321500018X.pdf?locale=es_ES&searchIndex

10. Hata K, Arai K. Dimensional analyses of frontal posed smile attractiveness in Japanese female patients. Angle Orthod [Internet]. 2016 [cited 2016 Jan 14];86(1):127-34. Available from: Available from: https://www.angle.org/doi/10.2319/091814-670.1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Received: January 29, 2019; Accepted: August 05, 2019