Abstract
Flattening of the profile as a consequence of lingual positioning of the incisors is a subjective determination, perceived by many as aging the face prematurely. Our society is attached to the notion of a “full face,” with a radiant smile and beautiful white teeth matching an image of good health and everlasting youth. Esthetics consequently are a major element in the therapeutic decision-making process. Discussed are the factors that contribute to normal facial changes with age, such as long-lasting nasal growth, mandibular growth, and shape and harmony of lip curves. Also discussed are the effects and influence of choice of extractions on the profile that depend on whether the profile needs flattening, lip length, thickening, and toning, and which premolars should be extracted. The final section of the article deals with identifying the elements that contribute to an attractive smile, how they are influenced by extractions, and how those influences can be limited or even eliminated.
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