I like to think I do a pretty good job at developing the esthetics of a smile. For years I have done my orthodontic set-up with indirect bracket placement. I have the photos and the Panorex right there to aid me in constructing the most ideal position for tooth and root alignment. I work to develop a smile line that follows the smiling curve of the lower lip. I note the gingival levels and display in the full smile. In some cases I might even have a diagnostic set-up to guide me to the proper orthodontic finish.

I like to think this careful planning will bring the patient to the finish line, “fait accompli” and a timely removal of the braces. I have also known the pain of hearing from my beloved referring dentists after I have removed the braces that the result is not quite what they expected. Try telling a newly de-banded patient we need to put braces back on. It is uncomfortable enough for me not to want that to happen again, ever. 

I have learned from Frank Spear's seminars that we don't know (treat) what we don't see. And if we don't look, important details can slip by us.

I realized that I spend a great deal of time diagnosing and developing my treatment plan and mechanics strategy to be as close to "right" as I could be. In the planning phase, I frequently seek out the help of my interdisciplinary team who are members of my Spear Study Club. So I asked myself, why would I not evaluate the same esthetics plan before I removed the braces? Why would I not seek the help of my interdisciplinary team at this important step? It is like testing the cake before removing it from the oven. It is a simple step to add finishing photos to my orthodontic treatment progress procedures.

Using the pupils as my horizontal line (barring any significant existing asymmetry) my team takes a center teeth together, “teeth apart “and full smile photos six months before we anticipate removing the braces. It is usually added to the same appointment we take the Panorex for evaluating final root position.

And oh, what a world of things you can see! When enlarged on a screen with a horizontal reference line added, you will notice changes that are needed while you still have time to make adjustments. It might be noting differences in wear right-to-left that may need to be addressed by the restorative dentist. Erupting an incisor with a chipped edge so it can be polished to match its partner. It might be canting with the right not level with the left side. You could find a tooth-size discrepancy or an extended gingival margin from altered passive eruption.

The value of the interdisciplinary team blooms when I send the photos to my referring dentists and ask them if I am on the right track. Each practitioner has a new set of eyes to see nuances that the other may not see. In an implant case, for example, the site development is critical for both the surgeon and the restorative dentist.

Let their eyes coach you so the best finish for the patient can be achieved. Close to home in the orthodontic practice, photos also give you an opportunity to "show off" the amazing changes you and the patient have accomplished, to an admiring parent who sees the value of choosing you for the care of their child. It may even help the parent think about their own smile and how it could be improved. It might be their turn next. Pictures truly speak a thousand words. Go ahead and look. Start the conversation.


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