Get a sneak peak of Update 2018: Facial Esthetics and Orthodontics with Dr. David Dana and POS CEO Miles McGann. In Part 1 of this interview, they discuss why consideration of facial esthetics is paramount to orthodontic success, and share the research that went into the creation of this seminar. Continue on to Part 2 here.
MILES MCGANN: Hi my name is Miles McGann. I'm the CEO of Progressive Orthodontics. Today I'm here with my good friend Dr. David Dana our head instructor and we are here today to talk about the Update 2018.
DR. DAVID DANA: This year I selected to do the seminar on Facial Esthetics and Orthodontics. I know it might sound like a broad topic but the reason I selected this topic is most of what you see in ortho is people focus on making a set of straight teeth and giving them a good bite, but the overall facial esthetics kind of like fall into the background. How many times do we see beautiful straight teeth and faces that are not harmonious or in balance with the smile that the patient got, or straight teeth and bite that the patient got. So adding facial esthetics to what we do in ortho I think is paramount.
MILES MCGANN: Yeah I mean I think what you're saying is that taking a step back and looking at what the patient actually wants, and I think my father, Dr. Don McGann, who kind of started this whole program, we always kind of focused on the teeth, the teeth, the teeth, the teeth, the teeth…and I think the ortho specialty as a whole is so worried about class one, class two, and how the finish looks from the teeth and what you're saying is hey let's take a look at what the patient wants, take a step back and look at it from that perspective.
DR. DAVID DANA: Correct. Actually during the seminar I put a couple of title slides of how I interview my patients. Everybody knows when a patient comes in to an ortho office, or a general dentist like we are that do orthodontics, we all know that the patient wants straight teeth. Most patients don't even recognize a bad bite, but we talk about oh you want your teeth straight, or your teeth are crooked let's make them straight. But we never ask, ‘how do you like the position of your lips, would you like to bring them back, would you like to bring them forward, how about your chin,’ questions about soft tissue and facial harmony that are pretty much ignored in most orthodontic questionnaires. If you don't understand what the patient expectations are, no matter how good your treatment orthodontic treatment ends, it's not going to be successful.
MILES MCGANN: The primary goal of an orthodontist, or of any dentist, is to make the patient happy at the end of the day and the patient needs to be happy with their look and I think orthodontists and general dentists doing ortho get so caught up in the mouth they tend to skip over the idea of what is the patient going to end up looking like, and are they going to be happy because your patients are never going to know did I finish class one. They're going to know do I look good?
DR. DAVID DANA: Do I look good, exactly.
MILES MCGANN: And so even if it's your first case, you still want to see if this patient going to look good.
DR. DAVID DANA: Correct, and one of the problems that we have to be able to see or visualize if the patient's going to look good or not, is that the cephalometric analysis that we use does not focus on soft tissues and whatever they do about soft tissues, it really doesn't have the value of esthetics. I will be discussing different soft tissue analysis, not only ours but different soft tissue analysis that are out there in the literature that really does not give you the full story of how the harmony between bone, teeth, and cheeks, lips, and chin balance. I'm going to be talking about how to extrapolate some of the measurements we're familiar with from the skull to the face so we can get a more in-depth evaluation of the facial esthetics of the patient so as we plan our treatment, we don't put the teeth where the ceph number says because many times you do that and you end up with a face that suffers rather than gets better.
MILES MCGANN: So in that answer you had one little point in there that I know we've had discussions about I think most guys don't realize. You said what the literature says. Talk to me about your literature and how you have approached the Update not just this year but for the last four or five years.
DR. DAVID DANA: Whenever I write a lecture I do a very in-depth literature review. Actually, I try to go as far back in time as possible as we were talking a couple of days ago. There are some things in dentistry that become classics and it doesn't matter if it was written in 1920 or if it was written in 1970, that's a classic and you have to study it and evaluate it and learn from it. So I tried to go as far back as I can so I can get a broader view of what has been done. Where have we gone and where are we going. I reviewed about 12 different cephalometric analysis work and the perspective of each one of the researchers. As I was looking at everything that was out there I really couldn't find a true aesthetic measurement that will tell me this is what's going to enhance the patient's facial traits. Actually, a lot of very famous orthodontic authors tell you there is no cephalometric analysis that can really tell you anything about the face. There are a couple of analyses that I actually am going to be presenting at the Update that are all about the face, so I'm not going to move into hey don't diagnose your cases from the teeth, but we need to come and start diagnosing our cases also from the face.
MILES MCGANN: You've been preparing for this for what about two years, because I know how your cycle works with these things. During these two years you just mentioned you did a whole literature review, as you're kind of doing a deep dive into this, grabbing concepts from outside of POS as well, who else and where else did you go to learn things to gain a perspective that has been useful as you went into this?
DR. DAVID DANA: As you said this has been about a two-year process, and this is probably one of the most laborious seminars I ever have written. A lot of work, a lot of effort. I actually had to go and interview your brother. I spent the whole afternoon with Grant.
MILES MCGANN: Just for all you who don't know, my brother [Dr. Grant McGann] is a maxillofacial surgeon down in San Diego. He's also taken POS so he knows POS as well, but does work with many of the very top orthodontists in the world and so has a very interesting perspective. Why did you go talk to a maxillofacial surgeon about an orthodontic topic?
DR. DAVID DANA: Here's the reason. Maxillofacial surgeons, in order to provide good results, they have to have a good orthodontic setup. The orthodontic setup has to be not only plan on how I'm going to make the teeth bite, but how am I going to enhance what the patient has? Make the patient look by far better from what they have. Grant is very knowledgeable of orthodontics. He actually sat at the lectures, he took the whole [POS] series, he understands orthodontic setups properly but he takes it a step beyond. I've always been puzzled with how do they set their facial esthetics to end up with great results, and that was the main reason I went to interview him.
MILES MCGANN: Right and I know my brother's practice, obviously I know him very well, his practice is based upon facial design. Even the title of his practice name is McGann Facial Design, and so I know from the surgeons perspective that's all he worries about; how does the face end up looking. So I think it was a fascinating decision to go talk with a maxillofacial guy who this is all he's focused on, is the end result and how they get there. Now with that conversation, you obviously are going to be talking a bit about how surgical setups work. Talk to me about where you think that surgical orthodontics fits into the POS system?
DR. DAVID DANA: We cannot ignore orthognathic surgery or surgical ortho in any type of orthodontic system. We have gotten so used to thinking that we can correct anything with braces, screws and a little bit of bone cutting that we now tend to ignore the soft issues, but we have to remember that the inside supports the outside and if you don't place the inside in the right place, the outside is not going to look good. During the Update actually I show a couple of cases that were treated to almost perfect cephalometric norms, that's when I used to do everything based on cephalometric norms and to my surprise I deterred from the facial esthetics of the patients and made patients age dramatically in two years just by not looking at the outside. See we need to have a good foundation to have a good facade.