Dentofacial Esthetics: From Macro to Micro

Dr. Larry White reviews a new textbook by Dr. David Sarver, called Dentofacial Esthetics. He calls the book, “one of the most valuable and useful additions to the orthodontic bibliography.”

David M. Sarver, DMD, MS • 2020, Quintessence Publishing Co. •

Dr. David M. Sarver has offered the dental profession a valuable tome whose esthetic premise he explains in the following three categories:

  • Macro-esthetics, which regards the attributes of the face
  • Mini-esthetics, which considers the several features of the smile
  • Micro-esthetics, which reviews the multiple traits of the teeth

Dr. Sarver provides a conversational narrative that invites readership and displays spectacular photographs and diagnostic images, which give readers a new appreciation for their value in diagnosis and treatment planning. He emphasizes the importance of the initial examination and the use of imaging forecasts to help patients and parents fully understand the goals he envisions for their malocclusions rather than the orthodontic problems they have. Dr. Sarver spends much time emphasizing the value of developing a smile arc that avoids arranging the teeth with traditional bracket placement, which often leaves maxillary incisors out of sync with the lower lip, but fails to alert readers as to where those brackets need placement for developing the arc.

Fortunately, and it is about time to find this in a textbook, Dr. Sarver challenges the classical concept of diagnosis and therapy that relies on osseous tissue and the mandibular incisor as the axis around which clinical decisions are made. Others such as Holdaway, Bass, Alvarez, Creekmore, and White as long as 4 decades ago suggested in published journal articles that the maxillary incisor and subsequently the soft tissue merit consideration as the basis for diagnosis and treatment planning rather than the mandibular incisor. But to my knowledge, this is the first time such a sensible idea has appeared in a published book, and rather than simply mentioning such a departure from the classical orthodontic canon, Dr. Sarver amply and beautifully displays the value of such strategy. I wish the author had left some measurable quantities that could guide readers into goals for determining the limits of a handsome face. Still, it refreshes this reviewer to finally discover a clinician that places diagnostic and treatment planning emphasis where it needs to be — soft tissue and the maxillary incisor.

Dr. Sarver also fully exploits the therapeutic advantages of surgeries such as blepharoplasty, rhytidectomy, lip augmentation, and the possibilities of rhinoplasty, mandibular and maxillary advancements, maxillary impaction, etc. He also illustrates the value of gingivoplasty with a diode laser to display more enamel of the teeth, which can greatly magnify the smile. Additionally, he describes and shows the advantages of tooth reshaping and composite augmentation of enamel.

Dr. Sarver displays excellent results by using maxillary canine substitutes as lateral incisors and subsequently the use of premolars as canines, which may cause distress among those still clinging to D’Amico’s theory of canine-protected occlusion as sacrosanct and inviolable. But the proof of the pudding is in the tasting, and Dr. Sarver’s results are delicious.

Dr. Sarver’s new textbook is one of the most valuable and useful additions to the orthodontic bibliography, and once dentists see it, they too will understand. Of course, as with all Quintessence publications, this one provides readers with thick, durable pages, unsurpassed images and illustrations, along with exquisite layouts and readable fonts. In this, author and publisher have merged to produce a remarkable experience for orthodontic clinicians and other dental professionals.

Review by Dr. Larry White

Dr. David Sarver was a speaker at the LightForce Orthodontics first user conference. Read about how leaders of the orthodontic community have embraced their vision.

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