Malocclusion treatment and prosthetic rehabilitations are considered a succesful therapies when a correct occlusion and an excellent facial aesthetic result. In the third Millenium, aesthetic has been really emphasized and clinical procedures and materials used for rehabilitations has to meet this need. Methodological and rehabilitative principles have been adapted to aesthetic requirements: in philosofical terms, this conceptual evolution is defined a change of paradigm. It means a complex of methodological rules, explanatory patterns and problem solving criterions that connect a Clinicians community in a specified moment of historical evolution of their field. A correct function has not to be second to this aethetic need: it has to allow to stomatognathic system to mantain in health anathomical structures, restored and/or modified by Dentist, as long as possible.

The aim of the study is comparing the so-called «hard tissue paradigm» (Htp) to the so-called «soft tissue paradigm» (STp). Planned therapies referring to skeletrical basis are compared to ones referred to facial soft tissues. Functional check has been constantly evaluated thanks to masticatory muscles recordering.

Material and methods. 40 cases treated by Tweed original diagnostic philosophy (Htp) (referring point: hard tissues) and 40 ones trated by new paradigm (referring point: soft tissues) have been evaluated. In the first sample (Htp) the diagnosys has been realized by Tweed cephalometry on teleradiography, considering as starting point the position of lower incisive compared to mandubular basis (IMPA angle) and to Frankfurt plane (FMIA). Incisive position has been modified in relation to skeletrical basis and remaining dentation has been adapted to this new anterior limit. In the second sample (STp) the diagnosys has been realized with a new software (CephBear) by overlapping the lateral face photo teleradiography in order to have as constant referring point the face aspect. As starting point of diagnosthic procedure, the upper incisive position compared with lips and nose is evaluated. The incisive position has been corrected in function to aesthetic relation of incisives with the wing of the nose and lips in rest position and in dynamic smiling one. The remaining dentation has been adapted to this new anterior limit of dentation. Aestethic result has benn evaluated by each patient by a satisfaction rating. The functional effect of treatments has been evaluated before and after therapy by masticary muscle’s surface electromyography, standardazed by UniversitĂ  degli Studi of Milan protocol. Clinician has used the obtained information in order to manage the vertical dimension during the whole treatment and to decide the best moment to stop the orthodontic therapies.

Results. The HTp sample has expressed a 64% satisfaction rating while the STp sample has expressed a 93% rating. The rating difference is significative and it could be supposed that diagnosing and managing a treatment by a soft tissues paradigm (high point: the smiling aesthetic) have a great influence in patient satisfaction rating and in improving the self-esteem. The ideal aesthetic reach gets an high level of reliability if it supports the permanent functional monitoring.