CRITERIA FOR FACIAL HARMONY

CRITERIA FOR FACIAL HARMONY

Plan 

Introduction 

Interest of the question 

I – Generalities/Notion of beauty and aesthetic ideal:

1. Theories and philosophies

2. The era / role of the media

3. Racial type

4. Authors

5. Mathematical criteria

6. Cephalometric criteria 

II – Normality criteria in ODF

1. The balance of facial proportions

 – From the front 

 – In profile

2. The balance of facial contours

3. The beauty of the mouth 

4. The beauty of teeth

5. The beauty of the smile

6. the nose

7. The chin

III- Aesthetic therapeutic objectives

Conclusion  

Introduction

Aesthetics finds its origin in the Greek word “esthanesthai”, which means to feel, to perceive. It covers the theory of beauty, of beauty in general and of the feeling that it arouses in us. 

Aesthetics is that which arouses in us a particular type of emotion, a feeling of harmony, delight and fullness. Beauty arouses various sensations, such as emotion, pleasure and admiration. 

The face is very important to us because it is through it that the first contact is established between individuals.

 From then on, the face has been the subject of several studies and experiments since the dawn of time, the first, through designers and sculptors who tried to represent their observed subjects as best as possible.

Orthodontists have managed to establish well-defined laws through statistical, clinical and radiological studies in order to obtain proportionality, normality and above all facial beauty.

Interest of the question  

1. Know the criteria for normal facial and dental health

2. Be able to detect imbalance when it exists

3. Maintain or improve the aesthetic appearance of our patients, strive for what is “beautiful”!!!

I – Generalities / Concept of beauty and aesthetic ideal:

1. Theories / philosophies: 

Classical Greece seems to be the first culture to express the sensory qualities of facial beauty through philosophy and sculpture: Plato and Aristotle introduced the notion of aesthetics both into the study of beauty and into the philosophy of art.

Philosophers are certain that geometric laws are the key to the beauty of a work, or of a face: this is the beginning of the Greek canons which dictate harmonious anatomical relationships and ideal proportions. 

In the statue of the Doryphoros by Polykleitos we find the famous golden ratio, respecting perfectly harmonious proportions, both between the different parts of the face and as a whole. It has a face divided into 4 equal levels (subnasal, nasal, frontal, hair level) which is inscribed in a square. 

Others, on the contrary, consider beauty to be subjective ; the criteria for facial beauty vary from one population to another. 

(Example of giraffe women, Chinese women’s feet, Mursi’s spread lower lip, etc.)

For some, inner beauty is more important than physical appearance. 

And we can well understand that an irregular face, but open to the world, can be softer and more pleasant than a hard look in a regular and harmonious face.

2. The era:

• The Pharaohs: The representation of Queen Nefertiti is still a legendary reference today. She has fine and harmonious features, a nose in the extension of her forehead, a slightly marked nasal saddle and a fairly developed mandible. 
• The Greeks: The face of the sculptures of classical Greece was oval, with a prominent forehead in profile, not very high. A slight concavity at the root of the nose breaks the straight line from the forehead to the tip of the nose. The upper lip has a “Cupid’s bow” shape and the lower lip is slightly hemmed. The chin, quite fleshy, emphasizes the labio-mental groove
• The aesthetics of the smile varies with its time and the influence of the Church. In the 17th century, the smile represented is labial, then in our days, it becomes dento-labial in parallel with the detachment from religion 
• Role of the media: TV, magazines, advertising… On a daily basis, we are invaded by images conveying socio-cultural ideals of beauty. Cinema, television, photographs, magazines, advertisements, fashion, etc. glorify new Hollywood stars and top models who sometimes embody true popular icons. These images evolve over time: in the last century, the roundness and voluptuousness of a face were fashionable, while today, the trend is towards more angular, more linear faces. 
• Contemporary times: Currently with the media, beauty is identified with the image that reflects youth, sensuality, elegance and freedom, without essentially fulfilling the predefined beauty criteria.

3. Racial type:  

• The black race type with thick, protrusive lips
• The Asian type with wide, flat cheekbones
• The Nordic type with an elongated and narrower face
• The Mediterranean type with a broad face and brachygnathic tendency

4. Authors / scientists:

Aristotle stated the concrete foundations of aesthetics as follows: 

– Precision: well-defined shape 

– Symmetry: a slight asymmetry can be accepted

– Coordination of the parts of the whole: harmonious whole

For Julien Philippe,  facial beauty comes from the combination of three elements: 

• Form: harmony of proportions
• Smooth surface: no wrinkles, scars, pimples
• Beauty of expression: facial expression (sensuality, intelligence, wickedness). 

For Hegel: beauty is defined as the sensible manifestation of the idea (inner beauty)

5. The mathematical criteria: 

Since antiquity the golden ratio has been considered to express the proportion most pleasing to the eye.

The golden ratio or “divine proportion” (so called because the ancients thought it reflected the thoughts of the creator of the universe), is the division of a length or surface, which is translated by mathematicians as follows: 

   For a space divided into two unequal parts to be aesthetic and pleasing to the eye, the ratio between the smaller part and the larger part must be the same as between the latter and the whole.

This is only possible if the small part is equal to 0.618, the large part to 1 and therefore the whole to 1.618

ABC

AB = BC

BC AC

 The golden ratio is found everywhere, in architecture, sculpture, painting but especially in the human body. Indeed, if we divide the total height of the body by the height from the navel to the foot, we find the golden ratio

This “golden” ratio is frequently found in nature. Thus the nautilus has a structural organization following the golden ratio. The same is true for the structure of certain leaves and seeds (sunflower, dandelion, dahlia, pine cone). 

The golden ratio was introduced in orthodontics by Ricketts in 1982. The latter applied this principle in aesthetic research and in the analysis of facial harmony using the golden compass.  

6.  Cephalometric criteria: 

Classical cephalometric analyses have established very precise angular relationships between the different skeletal structures called “standard values” or “ideal values”. 

The goal of orthodontic treatment is to give the patient measurements as close as possible to these values. 

Some measurements establish a relationship between the skeleton and the skin profile, others, more interesting from an aesthetic point of view, establish this relationship between the different elements of the skin profile (lip, chin and nose). 

To examine the consequences on the aesthetics of classical cephalometric analyses, it should be noted that the skin and mucous membrane covering, while being influenced by the underlying skeleton, does not follow it faithfully, because the soft tissues of the face, more or less muscular, fatty, sagging or developed (nose), have their own shapes.

      Therefore, giving the skeleton perfect normality in view of standard values ​​does not in any way ensure the beauty of the face.

Ultimately, there are no precise criteria that could translate the beauty of a face; beauty remains subjective.

The beauty of an individual comes from the fact that his silhouette and his face meet certain criteria of harmony linked to the balanced arrangement, the proportions and the symmetry between the different elements of the face.

                        Facial beauty Facial harmony

II – Normality criteria in ODF: 

1. The balance of facial proportions: 
2. From the front: 

           Face shape  

The face must be absolutely symmetrical in relation to the median sagittal plane which passes between the two eyes, through the middle of the forehead, crosses the tip of the nose to fall at the level of the philter gutter and ends in the middle of the chin. 

It is straight.  

The horizontal lines: 

• ophryac
•  bipupillary,
• bicommissural
• bitragual 
• bigoniac 

must be parallel to each other and perpendicular to the median sagittal plane

The floors:  

• Frontal (or superior from the trychion to the ophryon)
• Nasal (or middle of the ophryon to the subnasal) 
• Buccal (or inferior from subnasal to gnathion) should be equal. 

The oral floor itself comprises three levels which are also substantially equal:

• Upper lip: subnasal point → stomion
• The lower lip: stomion → labiomental groove
• The chin: labiomental groove → chin point

However, there may be slight variations in the transverse and vertical direction without altering the beauty of the face.

In conclusion, the harmony of the face implies that of the proportions between the width and the height of the face as well as between the lower and upper floors.

It is therefore important that the orthodontist does everything possible to reduce the disproportions or at least take care not to make them worse.

2. In profile: 

The profile type can be assessed by:

1.2.1.  Schwartz’s photo analysis: 

• Allows the evaluation of the relative position of the upper lip and chin between them and in relation to the frontal planes perpendicular to the Frankfurt plane, the Simon orbital plane and the Dreyfus nasal plane 
• In the average right profile , the subnasal point is in the nasal plane, the cutaneous pogonion is located at the limit of the middle 1/3 and the posterior 1/3 of the profile field.
• When there is a sagittal shift between the subnasal point and the cutaneous pogonion, this results in a disharmony of the profile (oblique profiles): 

Medium straight profile

1. oblique profile towards the back ,   the subnasal point is displaced towards the back of the nasal plane of Dreyfus, and the cutaneous pogonion is even more posterior 
2. oblique profile forward,  the subnasal point is located in front of the nasal plane and the cutaneous pogonion is proportionally more projected forward. 

1.2.2. The study of the profile curvature: 

• it consists of the analysis of the angulation existing between two lines: 

1. line 1: line connecting the forehead to the free edge of the upper lip  
2. line 2: straight line connecting the free edge of the upper lip to the cutaneous pogonion. 

• by connecting these two lines, we obtain 3 possible types of profiles: 

1. straight profile  : when the two lines form a straight line 
2. convex profile  : the two lines form an angle greater than 180°, indicating a relative retroposition of the cutaneous pogonion  
3. concave profile  : the two lines form an angle of less than 180°, indicating a relative anteposition of the cutaneous pogonion  

         Straight profile Convex profile Concave profile 

1.2.3. Profile teleradiography: 

Blue: Steiner’s S line uses a line (S) that connects the cutaneous pogonion to the middle of the nasal S ; the lips being tangent to this line

Red: Ricketts aesthetic line E connects the tip of the nose to the tip of the chin. 

– Straight profile is characterized by an upper lip that is 1 to 2 mm behind line E and the lower lip is flush with line E. 

– Convex profile where the two lips are flush with line E.

– Concave profile where the two lips are behind the E line. 

With maturation the profile undergoes modifications. The skin convexity (including the nose) tends to decrease with age. 

The nasolabial angle: 

  Between 85° and 105°, it is the indicator of the shape of the nose, the anterior projection of the maxillae, the alveolo-dental support of the upper lip and its characteristics (length and thickness in particular).

The labio-dental relationship and the labio-mental groove generally reflect the relationship between the dental arches. 

Nasolabial angle 

Korkhaus’s lip staircase theory: 

Positive labial staircase, negative labial staircase 

                                                 discreetly negative important 

                                                   (normal situation)

2. The balance of facial shapes:  

The important element that the orthodontist must take into consideration during treatment lies in the balance of the models between the protrusions (forehead, nose, lips, chin) and the depressions (nasal saddle, nasolabial angle, labiomental groove)                       

The projections must be in balance with the depressions 

A pointed nose is harmonious if the lips and chin are marked, it is not harmonious if the lips are flat.

3.  The beauty of the mouth: 

Lip shape and position 

• In a harmonious face, the height of the upper lip (distance between the subnasal point and the stomion) should represent 1/3 of the lower facial level, the height of the lower lip (distance between the stomion and the chin) should represent 2/3. 

• As for the width of the mouth, the corners should be located vertically above the pupils according to Cretot, whereas for Ricketts, the corners are located halfway between the wings of the nose and the vertical pupillary planes. 

The Crétot definition corresponds to the widest mouths in the Ricketts classification (number 5 on a scale of 1 to 5 values).

Beautiful lips are appreciated when they are full and plump, evoking a certain sensuality. 

Pursed and thin lips give a face a severe character, especially in women. 

The upper lip should be neither too short nor too long and well-defined in a “Cupid’s bow”. 

The lower lip is slightly larger than the upper lip. At rest, they come together effortlessly, without perioral contraction.

The labio-nasal and labio-mental furrows highlight the lips if they have a slight concavity. 

4. The beauty of teeth: 

The teeth are characterized first by their surface appearance : they are white, smooth, shiny, and free of cavities. 

Its bright whiteness must contrast with its surroundings (lips and skin). Then, it must give a pleasant contour to the lips.

The position of the incisors directly affects lip support. At rest, the free edge of the lower incisor is 2.5 mm lower than the stomion . 

To be pleasing to the eye, they are oriented in the anteroposterior direction parallel to the plane of the face (forehead, cheekbones, chin).

The harmony between the shape of the teeth and that of the face is not a decisive criterion of beauty. 

The dentition should be symmetrical (the inter-incisal midpoint is aligned with the median sagittal plane), regular, homogeneous and well aligned. Diastemas are very little appreciated among Caucasians. 

Lateral incisors are slightly smaller than central ones. A rhizoidal lateral incisor is very unsightly. A slightly rounded shape brings softness to the female face. 

The slightly pointed canines give an impression of aggressiveness. 

5. The beauty of the smile  

When smiling, the upper lip is located at the level of the neck of the upper incisors, revealing only the free gum. Beyond that, a gummy smile revealing a strip of marginal gum is considered very unaesthetic.

Women reveal more than men when smiling. The Caucasian smile exposes the teeth more easily because the upper lip is generally shorter than that of blacks or Asians.

The lower edge of the upper lip should observe a straight or concave curve from bottom to top.

The lower lip is parallel to the upper incisal edge and has little or no contact with it. It should never cover the maxillary teeth. 

A pleasant smile should have a certain symmetry with respect to the midsagittal plane and reveal up to the 2nd premolar. 

The red, full lips contrast with the whiteness of the teeth when smiling. 

How smiles change with age  

6. The nose 

– The size, shape and position of the nose are elements of facial architecture that certainly most influence the appearance of facial aesthetics. 

– the appearance of the nose is important for the aesthetic prognosis of an ODF treatment, certain types of noses cannot be modified by an ODF treatment and may require a secondary rhinoplasty.

– the shape of the nose is not only hereditary or ethnic but can also be modified by traumas that occurred in childhood.

– A beautiful nose should be straight, slightly pointed with nostrils that are symmetrical in shape and volume.

7. The chin  

• The configuration of the chin depends not only on the underlying bone structure but also on the thickness of the soft tissues and the tone of the muscles of the chin tuft. 
• The morphology and craniofacial architecture of the mandible are also determining factors  

• The development of the chin height (distance between the labiomental groove and the chin) is of great interest in ODF, an excess of chin height leads to a modification of the lower labial position as well as the labial occlusion. 

• In case of chin asymmetry, it is important to identify the middle of the mandible 

III-AESTHETIC THERAPEUTIC OBJECTIVES 

They are functions of 4 parameters: typology, lips, convexity and aesthetic analyses. 

• The therapeutic objectives will not be the same if the subject has a short face or a long face. The treatment will aim to compensate for the vertical problem or at least not to aggravate it. 
• Achieving a Resting Lip Occlusion Effortlessly 
• Values ​​too far from the average convexity are very unaesthetic. The orthodontist will have to correct the anteroposterior shifts and in severe cases, will indicate a surgical solution.
• Aesthetic lines represent an ideal and can therefore constitute an aesthetic objective.

Conclusion

• Man is eternally in search of beauty: he has been trying to normalize it for centuries. Despite all the artistic movements that have occurred throughout history, it seems that the aesthetic rules of the Greek canons still represent solid references. 
• The orthodontist’s therapeutic objectives are to restore psychological, aesthetic and functional balance. However, most patients are motivated by purely aesthetic reasons. They want a quick and limited treatment. It is essential to explain to patients the different therapeutic solutions, with their advantages and disadvantages. 
• Orthodontic standards seem insufficient to fully define a person’s beauty. According to Philippe, for whom it goes beyond the simple balance of the face. What he calls the surface condition (complexion, skin texture, etc.) but above all the potential for expression of a face , an exceptional means of communication, are non-negligible factors. 

CRITERIA FOR FACIAL HARMONY

  Deep cavities may require root canal treatment.
Dental veneers correct chipped or discolored teeth.
Misaligned teeth can cause uneven wear.
Dental implants preserve the bone structure of the jaw.
Fluoride mouthwashes help prevent cavities.
Decayed baby teeth can affect the position of permanent teeth.
An electric toothbrush cleans hard-to-reach areas more effectively.
 

CRITERIA FOR FACIAL HARMONY