The facial flow concept: An organic orofacial analysis

Authors: Bruno Pereira Silva, DDS, PhD,a Eduardo Mahn, DDS, PhD,b Kyle Stanley, DDS,c and Cristhian Coachman, DDS, CDT.

This article was cited by The Jornal of Prosthetic of Dentistry

Dental care includes not only treating oral health but also improving the appearance of the patient’s smile. The smile is probably the most remarkable and contagious social expression experienced by humans and has a considerable impact on facial beauty.

Facial symmetry has been suggested is important even in choosing partners.3 A positive relationship between facial symmetry and beauty has been reported,1,4 and smile symmetry has been applied in esthetic dentistry and has been assumed as an esthetic goal.

The purpose of this clinical report was to present the concept of facial flow (FF). The FF concept is divided into 2 components; vertical and horizontal. The vertical component guides the evaluation of the relationships among the facial midline (FM), dental midline (DM), and tooth axis to understand the DM shift and tooth axis cant with the face and help determine a better position for both in designing new smiles. The horizontal component guides evaluation of the relationships among facial anatomic features that create horizontal lines such as the interpupillary line, the commissural line, the mandibular angle, and the ramus and their relationships to the occlusal plane and incisal edges of the maxillary teeth.

The importance of symmetry among facial structures increases with proximity to the midline.5 The first step in a facially driven smile design usually is determining the horizontal and vertical position of the maxillary central incisors. The horizontal position of the FM is an important reference line for both restorative dentists and orthodontists.1 Authors have discussed which facial landmarks are best to define the FM and consequently the DM.

The relative position of the DM according to the FM has been controversial,9-13 although most agree that having the DM coincident with the FM transmits a sense of symmetry, balance, and harmony.9-13 It is also true that a certain tolerance of discrepancy is acceptable.1

Bidra and Cols6 stated that “the hierarchy of anatomic landmarks closest to the midline of the face in the smile was as follows: the midline of the oral commissures, natural dental midline, tip of philtrum, nasion, and tip of the nose.” They defined the FM as a line bisecting the distance between exocanthions. However, Owens et al,7 in a multicenter study, defined the FM as the line bisecting the interpupillary distance and found that 70% of all participants had a DM coincident with the FM.

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