Bill HangDental Practitioner, Lecturer at OrthO2Health

The Case for The Esthetic Line - William M. Hang DDS MSD

8 May 2013 · 3 min

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2:54

In this lecture Dr. William M. Hang explains the "aesthetic line," a simple visual tool for gauging lower‑face fullness by aligning a straight edge from the nose to the chin and observing lip position. He critiques the outdated term "bimaxillary protrusion," arguing that everyone has a single maxilla and introducing the more accurate label "bialveolar protrusion," which he describes as the most misdiagnosed condition in orthodontics. Hang warns that misreading the aesthetic line often leads to unnecessary extractions to flatten the profile, a practice he calls dangerous. He illustrates how chin position affects perceived lip prominence and how orthodontic space reopening can restore facial fullness. Real‑world cases are presented: a 30‑something patient who traveled from North Carolina to have extraction spaces reopened, resulting in a fuller face and planned implants; and a mother‑daughter pair who drove 75 miles for BioBlock Orthotropics treatment, showing marked profile improvement and resolution of TMJ clicking and grinding. The talk underscores the clinical importance of correctly interpreting the aesthetic line, avoiding over‑extraction, and considering functional jaw positioning in treatment planning.

Chapters

The aesthetic line. It measures the fullness of the lower face. This has been around since 1947. So you draw— this is so simple to do. You take a mirror handle or anything and just lay it on the nose and the chin and then look from the side Say, oh my gosh! Look at the lips are ahead or the lips are behind, whatever. So in our profession, if the lips are ahead of that line, oh, you are bimaxillary protrusive. Now, more recently, someone actually discovered that people only have one maxilla. How many people here have two maxillas? I have one. So now we don't call it bimaxillary; we call it bialveolar protrusion. It's the most misdiagnosed thing in all of orthodontics, and it has deadly consequences. And I'll show you why. If you have your lips ahead of this line, they're gonna say, oh my gosh, you have to have 4 teeth taken out, and we have to flatten your profile, because the world exists for people with flat profiles. Now, what about the position of the lower jaw? If it's back, these lips are appearing full. The farther back the chin is, the farther forward the lips are going to appear. Am I right? Yes. Okay. And if you look at this and see caved-in faces, orthodontics to reopen spaces where tooth extraction, orthodontics have dished into the face can often bring the lips forward. Now, I just had a patient see Kathleen, a patient yesterday, Who flew in to see me from North Carolina, and I'm reopening extraction spaces for her. She's in her mid-30s. She is absolutely thrilled because her face is fuller now. And she's going to get 2 implants in, and she's absolutely thrilled because of that. And it's all about this little line right here, which she perceives like crazy. We can create spaces where no teeth are missing in certain instances, too. So let's look at this and see just what a big deal it is. Here's a woman and her daughter. This woman is from— and they drove 75 miles from— tons of orthodontists to see me— 75 miles away, so I could do BioBlock Orthotropics for her daughter. And that's the difference in profile. This is a 4-on-the-floor case, and she's got clicking jaw joints and grinding noises in her joints.