Neo-FACEism


Several months ago, I received a rather disturbing email from a group operating under the name FACE. The group consists of several Western European orthodontists. They offer courses and proprietary aligner systems. This is nothing special. The concern arises from their promotion of what they term the “FACE philosophy.” In my view, this “philosophy” is just a collection of insufficiently substantiated concepts presented in a way that implies superiority over conventional orthodontic practice.

Below, I outline three principal claims promulgated by the group that, in my assessment, lack adequate scientific support.

1. Airway friendliness

FACE orthodontists assert that routine orthodontic treatment has a meaningful impact on the airway. In the presentation they distributed, cone-beam computed tomography (CBCT) images were used to measure airway dimensions and to support claims regarding treatment benefits.

This approach is problematic. CBCT has well-documented limitations in the assessment of the upper airway, particularly given the dynamic and functional nature of respiration [1]. Moreover, the available evidence suggests that conventional orthodontic treatment has limited and inconsistent influence on airway volume. Importantly, the gold standard for diagnosing sleep-related breathing disorders remains polysomnography, not radiographic airway measurement [2].

Equating static CBCT-derived airway measurements with clinically relevant respiratory outcomes is, therefore, not supported by current evidence.

2. TMJ Friendliness

A second key element of the FACE philosophy is the assertion that there exists an "ideal" condylar position within the glenoid fossa. In the materials emailed to me by the FACE
group, patient’s condyles were depicted in supposedly “stable” positions inside the glenoid fossae, implying that deviation from this configuration is undesirable.

However, contemporary studies employing CBCT and magnetic resonance imaging (MRI) demonstrate that healthy, asymptomatic individuals may exhibit anterior, centric, or posterior condylar positions [3,4]. These variations can be stable and compatible with normal function. The concept of a single, universally ideal condylar position is therefore inconsistent with current scientific understanding of biological variability and adaptation.

3. Full-Time Splint Therapy and Routine Articulator Use

FACE orthodontists advocate prolonged, full-time wear of a so-called “centric splint” as a routine initial phase of treatment, with the aim of establishing an “ideal” condylar position.

From an evidence-based perspective, this approach is difficult to justify. There is no compelling scientific basis for routine 24/7 splint use or systematic alteration of the patient’s initial condylar position [5]. Furthermore, prolonged 24/7 splint therapy may introduce iatrogenic occlusal changes [6].

The group also promotes routine articulator mounting. Yet the foundational assumptions underlying this practice were critically examined and effectively challenged decades ago [7]. As such, its routine use in orthodontic treatment planning appears unsupported by contemporary evidence.

Historical Background

On closer inspection, these ideas are not new. Similar concepts were originally promoted in a course bearing the same name—FACE— first held in 1974 in Burlingame, California. The initiative began with a group of prosthodontists and was later joined by the orthodontist Ronald Roth, whose influence facilitated the dissemination of these concepts to Europe [8].

It is crucial to recognize the historical context in which the original FACE concepts were developed. They predate the routine clinical use of CBCT, MRI, and polysomnography. At that time, objective diagnostic technologies capable of rigorously testing such
hypotheses were not available. Today, however, we possess a substantial body of scientific evidence that challenges several of these foundational assumptions. Nevertheless, the contemporary iteration—what might be termed “neo-FACEism”— continues to gain visibility.

Target Audience and Regional Context

Notably, I have not encountered significant promotion of neo-FACEism among my American or British colleagues. It appears that current marketing efforts are directed primarily toward Eastern Europe. In several countries within this region, postgraduate orthodontic training opportunities remain limited, and some clinicians face language barriers that hinder full engagement with the English-language scientific literature. Such circumstances may increase susceptibility to dubious “philosophies” that are insufficiently grounded in robust empirical evidence.

Conclusions

In summary, neo-FACEism appears to rest on a series of claims—regarding airway management, ideal condylar positioning, prolonged splint therapy, and routine articulator use—that are not adequately supported by contemporary evidence.
Orthodontics, as a healthcare discipline, must remain grounded in science rather than in doctrine. While historical perspectives deserve respect, they must be continuously re- evaluated in light of modern diagnostic capabilities and evolving scientific knowledge. From my perspective, the growing traction of neo-FACEism in parts of Eastern Europe warrants precisely such critical scrutiny.

Dr. Alex Ditmarov



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8. https://www.estheticprofessionals.com/facedentistry/