By Marc Bernard Ackerman

Imitation is the greatest form of flattery. With that being said, there is a difference between imitation and reinterpretation. When I write a peer-reviewed journal paper or a blog piece, I am never sure how it will be received by the specialty at that time and I am certainly not sure how it might be reinterpreted years later. In all honesty, I’m one of those ready-fire-aim guys who would rather put new ideas out there than mull over them so long that they become stale or irrelevant. By in large this strategy has worked for me, albeit to the chagrin of those whose warmly held beliefs are shattered by my missives.

Earlier this week I read a paper in this month’s Journal of Clinical Orthodontics that began with the words, “Ackerman recently wrote…” My gut reaction was uh-oh. I read the first paragraph several times and still wasn’t sure of the spirit in which I was referenced. So I called my best friend who bluntly said, “Ackerman, quit your whining and realize that it’s better to be mentioned than not to be mentioned.”

Next year will be 20 years since I coined the term “Smile Arc” (Orthodontics and Clinical Research-1998). I wasn’t the first person to describe the parallelism between the incisal edges of the teeth and the curvature of the lower lip; that had been done by removable prosthodontists in the 1950’s. What I did was give a name to this feature of anterior tooth display and studied how it was affected by conventional orthodontic treatment. Orthodontic treatment flattened the smile arc. I have to thank David Sarver for popularizing this term and showing case studies in his widely read 2001 American Journal of Orthodontics and Dentofacial Orthopedics paper. Since that time, there have been many resident research theses and published papers that have studied smile arc as it pertains to orthodontic diagnosis and treatment mechanics. The JCO paper that moved me to write this blog was on the mechanics (i.e.-which bracket and wire you should buy) for “smile arc preservation.”

My original concept was simple. A patient either had a consonant, flat, or reverse smile arc. This dentofacial trait was examined clinically and later described to the patient via digital photo or digital video clip. It was never my intention to use consonance as a normative standard by which the smile arc was to be compared. If the patient, while looking at the flat screen display and listening to my description of their smile characteristics, happened to mention the smile arc as something that they were seeking to change, it became part of the problem list. However, if they weren’t moved by this single trait, the conversation moved on. After performing thousands of examinations, I can say with great certitude that not all patients want consonant smile arcs and frankly most patients couldn’t care less about their smile arc. And who could possibly criticize them for that?

It has been 15 years since I published the JCO article that was the follow up to the original smile arc paper. The second paper discussed using digital videography for a more reliable recording of the smile and orthodontic mechanics; in particular bracket placement, ectopic maxillary canines, and the effect of Class II elastics on the occlusal plane. It was a potpourri of clinical pearls devoid of any sales pitch.

I am dumbfounded that the consonant smile arc has been reinterpreted as the central canon of smile enhancement. It shouldn’t be a complete shock, though. Orthodontists are expert at complicating what we do in order to look more competent. In the words of Leonardo da Vinci, “Simplicity is the ultimate sophistication.”

See links to referenced articles below:



One thought on “Caveat Lector: Let the Reader Beware

  1. Mark, having been around while Tom was working through that article, I can attest that the intention was to provide credit for a wonderful concept to one of the fathers of it. David’s decades of championing the smile arc concept are finally bringing fruit.

    You will also find it interesting that the current stampede towards DSD involves digital videography heavily, and we reference your article as “well before it’s time” in that concept also.

    Thanks for being one of the leaders in the esthetic charge!

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