Causes of Philtrum Deviation During Orthodontic Treatment and How It Can Be Corrected

Hello, many patients notice that their philtrum appears to shift off-center during orthodontic treatment compared to before treatment, making them worry that braces may cause facial asymmetry. The doctor will analyze each aspect from an orthodontic and anatomical perspective to help you understand the true nature of this issue and determine when intervention is necessary.

What Is Philtrum Deviation During Orthodontic Treatment?

Orthodontic treatment associated with philtrum deviation refers to a condition in which the philtrum (the groove between the nose and the upper lip) is no longer aligned with the facial midline when compared with the maxillary central incisors or the dental midline after a period of orthodontic treatment.

In orthodontics, the doctor evaluates not only whether the teeth are aligned but also the alignment of three important reference axes: the facial midline, the philtrum, and the maxillary central incisor midline. When one of these three axes is misaligned, the face may appear asymmetrical, even though the teeth are actually moving in the correct direction.

An important point to understand is that orthodontic treatment does not create a new philtrum; rather, it may make pre-existing underlying asymmetry more noticeable.

Causes of Philtrum Deviation During Orthodontic Treatment

Philtrum deviation during orthodontic treatment is usually not caused by a single factor but rather by a combination of structural factors.

Malocclusion

When the upper and lower jaws are not properly aligned (midline discrepancy, crossbite, or unilateral bite deviation), the incisors are moved to achieve a functional occlusion. During this process, the dental midline may become misaligned with the philtrum, making it appear that the philtrum has shifted, even though the teeth are actually moving into their biologically correct positions.

Underlying Jawbone Asymmetry

Many individuals have mild jawbone asymmetry that is not easily noticeable before treatment. Once orthodontic treatment aligns and straightens the teeth, the underlying skeletal asymmetry becomes more apparent, leading to the impression that the philtrum has become deviated after orthodontic treatment.

Uneven Orthodontic Tooth Movement Between Both Sides

If the orthodontic forces are not balanced on both sides, or if space closure and tooth movement are not carefully controlled relative to the facial midline, the maxillary central incisors may drift off-center, making philtrum deviation during orthodontic treatment more noticeable over time.

Will Philtrum Deviation Resolve on Its Own During Orthodontic Treatment?

The doctor’s answer is: it may—or it may not, depending on the stage of treatment and the underlying cause.

• If the philtrum appears off-center during the early or middle stages of orthodontic treatment, it is often a temporary phenomenon because the teeth are being aligned in phases. During the finishing stage, the orthodontist will refine the tooth positions, and the philtrum may appear more centered again.
• If the philtrum deviation results from jawbone asymmetry, orthodontic treatment alone cannot completely reposition the philtrum to the facial midline. In such cases, the doctor will carefully balance aesthetic outcomes, functional improvement, and the extent of intervention required.

Therefore, not every case of philtrum deviation during orthodontic treatment indicates an error or treatment failure. It must be evaluated within the context of the overall treatment plan.

When Should the Orthodontic Treatment Plan Be Adjusted?

You should discuss your concerns with your orthodontist and schedule an examination promptly if you notice any of the following signs:

• The philtrum deviation becomes increasingly noticeable at each follow-up appointment without showing signs of improvement.
• The maxillary central incisor midline is significantly displaced from the facial midline.
• The condition is accompanied by chin deviation, facial asymmetry, or an unstable bite.
• Your orthodontic treatment is nearly complete, yet the philtrum remains noticeably off-center after treatment.

In these situations, the orthodontist may adjust the orthodontic force, modify the space-closure strategy, or perform additional skeletal evaluation using lateral cephalometric radiographs and Cone Beam CT imaging to optimize the treatment outcome.

Advice from the Orthodontist

Orthodontic treatment is a process of correcting the entire dental system, occlusion, and facial aesthetics, not merely straightening the teeth. Therefore, monitoring the philtrum, dental midline, and facial midline is an essential part of comprehensive orthodontic treatment.

At Gangwhoo Cosmetic Hospital, orthodontic treatments are carried out using personalized treatment plans that include analysis of the facial axis, jawbone structure, and philtrum from the very beginning. This approach helps minimize philtrum deviation during orthodontic treatment while ensuring harmonious and long-lasting treatment outcomes.

If you are currently undergoing orthodontic treatment or have noticed signs of philtrum deviation that concern you, you should schedule a direct examination with your orthodontist for an accurate evaluation and timely adjustment, helping prevent unwanted aesthetic issues after your braces are removed.