Facial keys to orthodontic diagnosis and treatment planning. Part I.

The purpose of this article is twofold (1) to present an organized, comprehensive clinical facial analysis and (2) to discuss the soft tissue changes associated with orthodontic and surgical treatments of malocclusion. Facial examination leads to avoidance of potential orthodontic and surgical facial balance decline and enhances diagnosis, treatment planning, treatment, and quality of results. Patients are examined in natural head position, centric relation, and relaxed lip posture. Nineteen key facial traits are analyzed. By examining the patient in this format, reliable facial-skeletal traits can be recorded that enhance all aspects of care. Orthodontics and surgery used to correct the bite alter facial traits; alteration should reverse negative traits and maintain positive traits. This cannot be achieved without a complete understanding of the face before treatment. Tooth movement (orthodontic or surgical) used to correct the bite can negatively impact facial esthetics, especially if pretreatment esthetics are not defined before treatment. Treating the bite based on model analysis or on osseous cephalometric standards without examination of the face is not adequate. Three questions are asked regarding the 19 facial traits before treatment: (1) What is the quality of the existing facial traits? (2) How will orthodontic tooth movement to correct the bite affect the existing traits (positively or negatively)? (3) How will surgical bone movement to correct the bite affect the existing traits (positively or negatively)? This article is for orthodontists, and yet, much surgical information is included. This is intentional. We only treat what we are educated to see. The more we see, the better the treatment we render our patients.