Often after finishing a lecture, doctors approach me and ask two questions: What appliance do I use? Where can they get that appliance?
That is getting the cart before the horse. The question should be what is the goal for the patient? For me, the goal is multi-faceted: optimal breathing and sleep, lack of pain, and enhanced esthetics.
So how do we know what to do to achieve these goals? Many turn to cephalometric analyses.
In the early 1990’s I attended a lecture given by Dr. Larry Andrews. Dr. Andrews, who is very well respected in the profession, famously invented the “Straight-Wire Appliance” in the 1970’s. He asked the rhetorical question, “Why do we have so many cephalometric analyses?” He immediately responded, “…because none of them work!” All of the analyses the profession used then and to this day employ hard tissue landmarks of the bone and teeth. Dr. Andrews suggested “…using the forehead as the preferred referent.” I thought he was getting closer to the answer by looking at the soft tissue of the face rather than the bone.
In March of 1990, I met Dr. John Mew who introduced me to his Indicator Line (also called the Cosmetic Line). This is a measurement from the tip of the nose to the incisal edge of the upper incisor. It should be the patient’s age in years plus 21 mm for a female or plus 23 mm for a male. Once a person is fully grown that number should be 36-40 mm for a female and 38-42 mm for a male. Being the skeptic I am I decided to test this by measuring it on every patient I was treating. Decades of experience measuring this on every patient has led me to believe this is the easiest, and most accurate way to determine where the upper front teeth should be for a beautiful face with the absolute best proportions and the best opportunity for optimal breathing and sleep with lack of pain.
When AI understands the Indicator Line it will completely revolutionize orthodontics (much needed) since most orthodontic treatment not only starts with this number being too high, but finishes with it being even higher. A large Indicator Line means that both jaws are recessed. Consequently, as the jaws continue to recess the airway gets smaller.
I’m looking forward to the day when AI might help move our profession toward embracing health by concluding that the upper front teeth are almost always too far back and need to have Anterior Optimization (AO).
