Introduce the concept of beauty:

      We all agree that the objectives of orthodontics are harmony of profile (Facial esthetics), denture stability, healthy denture and gum tissue and having efficient functional chewing. These objectives and their attainment offer a constant challenge and final evaluation of our techniques. Therefore the orthodontist must be a specialist and possess an artistic flair. Facial esthetics is a common sense facial beauty guide as with E-line, S-line, Z-angle etc. Caucasian and oriental people have different face profiles. Caucasian people have a high nose and a bigger chin, but oriental people have a lower nose and a small chin, with bimaxillary protrusion often present. So if we want to get a beautiful E-line, the anchorage evaluation is very important and the doctor's technique must be skillful. With Caucasians the S-line is more suitable. I think that treating one oriental patient is more challenging than treating one Caucasian patient.

Case Reports:

    Case 1. The patient is a 12yrs old girl. Cephalometrics and clinical finding diagnosed the dental and skeletal as both Class I with bimaxilla protrusion present. The patient complained of a space in the lower anterior teeth, the parents just asked for the space to be closed. They noted nothing about the facial beauty or esthetic concept. After enough communication following my anchorage diagnosis, the 4-bicuspids (upper and lower) were recommended for extraction. 18 months later, the patient had finished the braces course. The parents are very happy to get a faithful and beautiful daughter. We all very happy, the initial suggestion made having proved to be the correct one.

    Cases 2~4. These were all diagnosed to extract 4-bicuspids (upper and lower) and to be followed by the full mouth fixed type edgewise braces technique. Generally extracting teeth during orthodontic treatment will not give rise to argument with doctor and or parents, if correct negotiations are undertaken before and during the procedures. It is unfortunate that some doctors extract teeth just for alignment. They don't setup the treatment plan nor calculate the saving space of the extraction for retracting anterior teeth back. Therefore, the patient profile can't change. As the result, if we want to know how much trouble it is not just to take cephalometrics and model only, you have to study analysis and make a treatment plan, including the volume of growth expected. However, the doctors can't be God. We need patients and parent cooperation and help.

    Case 5. She is a 12yrs old girl, Angle class III with anterior cross-bite. Following our analytic diagnosis, the upper jaw under development is noted, and we know that the lower jaw growth is followed by age. We decide to protrude the upper jaw growth, because the dental treatment is not limited by age. Be on guard against caries, periodontal disease and oral hygiene. These can be treated at anytime. In general, the length of body growth follows the mandible growth peak. Female growth almost stops at 15~16yr old, and the peak is 10~12yr old. Male growth almost stops at 17~18 or 20yr old, and the peak is 12~15yr old. However, the class III case needs follow-up over long term. Even if it is looking good at present, it may need an operation in the future.

    Cases 6~15. We used the lateral photo and cephalometric film to diagnose: They are almost class II div.1 and upper anterior protrusion cases. I am thinking their mandibles were under developed and required to enforce of growth. We used the Modern Bionator appliance plus short hp-hg with-in 2 years to induce the mandible growth upward and forward. In this way we used the oral force (tongue and oral envelope) to do some of teeth alignment. I am very impressed with this appliance since it appeared in a Japan orthodontist's training textbook in 1998.

    Cases 16,17. They are adult class III cases. They are diagnosed as falling between non-surgery and need surgery cases. They are the challenge to me. We have communicated with parents and patients and they understand the situation. Case 16 was extracted on the lower both sides of 1^st bicuspid and 3^rd molars only. Case 17 was taken off both sides of 3^rd molars only. Procedures took 2 years to complete with edgewise technique. Our goals were achieved. We are happy with the results.

    Case 18. I have encountered two surgical cases of this type within my 10 years of practice. The patient was my second surgical case. When she came to my office she was 19 years of age. She had cleft palate and upper maxilla under development because of a scar. Her two jaws were widely separated (12mm) when closed, and in need of orthodontic treatment and lower jaw setback surgery. We carried out full mouth orthodontic treatment and surgery and fixation of both jaws with class III and up & down elastic for six months. After removing all braces we changed to retainer stage and observed for 3 years. The patient's oral condition is still stable and she is very happy. However, we doctors still need to consider the problems of the patient more carefully with greeter consideration. Perhaps operations are unnecessary in many cases.

Conclusion

    Some website friends have asked me to describe a number of my cases briefly. If you require further details or have questions concerning these cases, do not hesitate to E-mail me please.

                                 Thank you !!! Alleluia !!!! Alleluia !!!!!!!

                  Doctors do their best for patients. We need God and patient's help.

                                             Don't you think so?