Diagnoses should be based on the face and not the teeth.
Orthodontists sometimes get this backwards. If I straighten teeth and don’t consider the lips, nose, chin, and soft tissue first, I could negatively affect the entire face.
I must view facial skeletal asymmetries as challenges and not road blocks to success. If I discount the middle of the top teeth relative to the nose and the center of the lip, I create facial imbalance beyond esthetic repair.
Moreover, if I move teeth the fastest possible way when I prescribe extractions, I lose support for the lips, affecting the nose, changing the soft tissue, and most importantly, I could predispose someone to TMJ (temporomandibular joint dysfunction).
To ensure ideal bite health and stability, I treat every extraction situation like I never want anyone to know the patient had teeth removed. I want the smile to be as glamorous as someone with all their teeth present.
This means using more complicated mechanics than textbook strategies. With the right amount of finesse and patient commitment, we always finish with an amazing result.