Why Do Orthodontists Prefer Flat Faces?

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Research suggests that the public prefer forward growing faces with good cheek bones, but surprisingly Orthodontists appear to prefer flatter faces and retruded cheek bones. Peck and Peck (1970) studded the X-rays of good looking film stars and found that “The general public admires a fuller, more protrusive dento-facial pattern than customary standards” (of Orthodontics).

This finding was later supported by others (Tedesco 1983) who found that “Lay judges seem to be more sensitive, than judges with orthodontic training, to dental-facial esthetic impairment”. This is not just a Western concept because Soh (2005) using a sample of Chinese subjects concluded that “Orthodontists considered a flatter male profile to be most attractive, but Oral Surgeons (who aim to improve the face) preferred a fuller normal Chinese profile”.

Why should Orthodontists think so differently from the rest of us? Part of the reason might be that most of them are taught that it is not possible to increase the forward growth of the face by more than 2 millimetres which hardly shows (Looi and Mills 1986). However Zettergren-Wijk et al (2006) found that if children learnt to close their mouths, their face grew forward by about 10mm, but if the mouth was left open, the jaws became flatter and less attractive.

This finding was later supported by Trotman et al in 1997, who also found the reason why Orthodontic X-rays failed to show this”. Other research (Mew 2015) showed that patients who were trained to keep their mouths closed became very much better looking than patients who had not, but this still does not explain why Orthodontists think flat faces look better. I can only assume that they learn to like the flat faces they create.



Orthodontists placed this case 12th most successful out of a series of 32 cases but members of the public placed it last.









This case was considered most successful by both the lay public and the orthodontists.


0.9 The long term consequences of treatment

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see YouTube video here

I have already mentioned some of the consequences of orthodontic treatment such as facial damage and root resorption but there are other longer-term risks such as re-crowding and some such as gum damage which have only recently been recognised. Because patients prefer to avoid extractions Orthodontists currently go to great effort to avoid extracting teeth where possible. Some orthodontists and many general dentists use a screw appliance or an ‘ALF’ to expand the upper jaw to provide enough space for all the teeth. However this does not usually provide room for the wisdoms which they may say are unnecessary.

These are a simple way of avoiding extractions but the teeth usually re-crowd a few years later. This is avoided by many clinicians who give the patient a retaining appliance or attach fixed wires to their teeth either permanently or until they brake or are removed. Other clinicians avoid extractions for a while by pushing the side teeth back to make room for the front teeth but this tends to result in a flat looking face, it is then more likely that the wisdom teeth will become impacted and have to be extracted which can involve complex surgery.

Few if any orthodontists seem to use the Orthotropic method of lengthening the jaw as well as widening it. This makes much more room for the teeth and provided it is done by the age of 8 or 9 should always provide room for the permanent teeth including the wisdoms. This of course also takes the whole upper jaw forward improving the appearance of the cheek bones, sometimes dramatically. See the picture below.

Another long-term problem is gum damage which has more recently become recognised as a matter of concern. As we explained earlier the teeth and their supporting bone are normally supported by the tongue, lips and opposing teeth. But if the teeth are moved and held in a different position for a long time, such as with a retainer, the bone around them remains unstable and tends to resorb. The blood supply to the gums is carried through the bone and if it resorbs the gum often recedes or dies leaving what are called ‘fenestrations’ or holes which can severely shorten the life of the teeth.