Control of the Vertical

Every orthodontist should be concerned with the vertical.

Vertical is detail. Vertical is precision. Vertical is why there is no speech impediment, why it’s easy to tear the cheese off a slice of pizza, and thankfully, why we don’t spit on those close by when we chat.

Vertical is also the type of extreme height you’d get off of skateboarding the BMX pipe Dr. Allen built.

Orthodontic schools don’t dwell on the detail “vertical” and the ability to manipulate the smile’s position relative to the nose, lips, and chin. Instead, that skill and knowledge comes from years of experience. It’s that kind of experience that sets Dr. Allen apart.

Several factors including the teeth’s positions along with the rotation of the lower jaw, its shape and dimension, as well as its relationship to the cranial base (i.e. the head) all affect where the teeth could end up in the face. It’s an Orthodontist’s control of the vertical that helps envision how to set teeth in a way that will look and function best. This skill can take a decade to master.

In a perfect world, the upper front tooth will end up right on top of the lower lip in a smile. Sometimes, however, this isn’t achievable due to the magnitude of bone between the bottom of the nose and where the front tooth exits the bone. Natural factors such as lip function (the way the lip often pulls asymmetrically naturally) and synthetic factors, like Botox and fillers, affect the decision for the placement of a top front tooth’s final position.

The top tooth’s final position can be moved up or down in a smile revealing more or less gum tissue in the smile. Orthodontists can mistakenly turn a smile upside down (natural frown to the teeth with a grin) or they can perpetuate an initial upside down smile often seen in those that have lost lower back teeth much earlier in life.

It is very easy to line teeth up in a face. It is extremely hard to end up exactly where I think it ought to be relative to the functioning scheme of the face.

I get it, I know it, and I deliver it!

Check out one of last month’s beautiful finishes regarding the vertical above.

Despite everything naturally fighting my efforts, her smile finished PERFECTLY. The finish is a beautiful fully functional occlusion that maximizes the patient’s natural beauty. The smile is level with her eyes and with her natural head position relative to the earth. Her teeth extend into the corners of her face allowing for a smile effect that maximizes her facial happiness & balance.

Notice how the right and left sides have been adjusted to allow for this change to match the face. Without control the smile would have followed the lower lip slant. Moreover, despite the asymmetric muscle pull in her mid face (common to all of us), it rocks in her face!

BAM! I love my job!