Abstract

Esthetics in the Vertical Dimension: The Outside-In Approach

by Foster Chad

The vertical dimension is one of the most important—and sometimes underappreciated—components of dentofacial esthetics. Patients may present with vertical deficiencies dentally, skeletally, or as a combination of both. A decreased lower facial third, inadequate maxillary incisor display, and a vertically compressed smile can significantly influence facial balance and smile esthetics even when the occlusion itself is acceptable. Using an Outside-In diagnostic approach, this lecture will examine vertical problems beginning with the face, progressing to the smile, and finally evaluating the teeth and occlusion. Particular attention will be given to lower-third facial height, maxillary incisor display, smile arc, occlusal plane, and the relationship between dental and skeletal vertical deficiencies. Clinical cases will demonstrate how traditional orthodontic mechanics can be used to target vertical improvement and when skeletal anchorage with miniscrews can expand the orthodontist's ability to alter the vertical dimension. Nonsurgical treatment strategies for selected patients with vertical maxillary deficiency and short-face characteristics will also be discussed. The objective is to move beyond viewing the vertical dimension primarily through overbite and cephalometric measurements and instead evaluate how vertical treatment decisions affect the patient's face and smile. When treatment is planned from the outside-in, vertical mechanics can become a powerful tool for improving overall dentofacial esthetics.