In this presentation, Bill Hang outlines his six foundational principles for achieving optimal orthodontic (orthotropic) results, deliberately contrasting them with traditional orthodontic goals that focus on teeth. He explains each key with clinical case images, showing how treatment can convert vertical facial growth to forward horizontal growth, enlarge or preserve the airway, maintain healthy temporomandibular joints, create fuller cheeks, broaden the smile to the mouth corners, and establish an ideal rest posture without muscle strain. Throughout, Hang emphasizes that these outcomes are achieved without extracting teeth or relying on retractive mechanics, highlighting aesthetic, functional, and health benefits such as improved breathing, immune function, and overall facial harmony.
Chapters
Welcome back. This segment is entitled Hang's 6 Keys to Optimal Orthotic Outcomes. And you may wonder why we've chosen 6 keys. I chose 6 keys because Larry Andrews has 6 Keys to Normal Occlusion, which he published on in the 1970s, and all of those keys involve the teeth. None of my keys involve the teeth. The first thing I think is important is to Have the face more balanced and not less, with unfavorable vertical growth converted to favorable horizontal forward growth with treatment. Here we have a girl whose face was growing very vertically, as noted by the Bolton norm superimposed on her face prior to any treatment. Her lip-apart posture would have had her face grow very much vertically down and back. Doing orthotropics, we were able to get her face to move forward, as shown in the middle picture. By the time she graduated high school, on the right, her face face was still dramatically forward and not long the way it would have been, all due to her cooperation with orthotropic treatment. Here you see someone else who had a long face, and with orthotropics, the vertical growth was converted to more horizontal growth, and the lower face height was actually reduced non-surgically. The second Key, is airway bigger post-treatment, or minimally, at least not smaller? Here you see a Class II patient with a Class II malocclusion where the maxilla was moved forward, followed by moving the mandible forward, and you can see a dramatic improvement in the posterior airway space. This should be what we're seeking to achieve for all of our patients, certainly never to have the airway reduced in any way whatsoever. Number 3, healthy TMJs with the condyles not distalized. We want the condyles concentric within the fossa. Many times with retractive orthodontics, the condyles can be distalized, which is not good. The 4th key is cheeks fuller, not flatter. If you draw a tangent from the lower eyelid to the cheek, the closer that line is to paralleling the line along the edge of the nose, The more attractive the face is. The girl has undergone orthotropic treatment and has a dramatically beautiful face with nice forward growth. The gentleman on the right has undergone traditional retractive orthodontics and has a very flat cheek and a longer face. The difference is obvious. The aesthetics is a big, big issue here, but underlying that is the fact that the maxilla is back, meaning the soft palate is back, the mandible is back, meaning the tongue is back and the airway is compromised on the patient on the right. When their jaws are forward, as they are on the girl on the left, the airway is likely to be more open. Here's that same girl who has a modeling career, and you can see how attractive it is to have the maxilla so well developed. Number 5, a smile complete to the corners of the mouth. The woman on the left has had orthodontics but has not had her smile broadened in the buccal segments. On the right, here she is after having orthodontics the second time. You can see what a smile complete to the corners of the mouth really is all about. If you look at her teeth prior to treatment, you see that she had a Class I deep bite occlusion. And what was done in her case was merely to align her teeth and not advance the lower— not expand laterally the arches. So, the incisor teeth were Advanced a bit without extracting any teeth. Later on, with a second orthodontic treatment, they were— the arches were broadened out approximately 3.5 millimeters on each side, which then results in the dramatic improvement with the smile being more broad. Here's another example of the same kind of thing. The woman on the left has had bicuspid teeth extracted and has been retracted back. She does not like it at all aesthetically. We reopened her spaces for her and broadened her arches out laterally and brought them— brought things forward. She also underwent some restorative treatment, but you can see the dramatic difference between the left pretreatment and the right after treatment. A smile complete to the corners of the mouth. Finally, number 6 is ideal restoral posture with no muscle strain. That means teeth together lightly, tongue to the palate, lips together, breathing through the nose without any strain of the lips at all. This girl in this picture was pre-orthotropic treatment. In the beginning, you can see mentalis strain on her face, flattening of her chin necessary to get her lips together. Post-orthotropic treatment, you can see how nicely relaxed all of her muscles are of her face, and she's a complete nasal breather. What this means is that she's a healthier person with an immune system working properly. So, these are Hang's 6 Keys to Optimal Orthodontic Outcomes, and realize that none of them involve the teeth.
