When Esthetics Meet Ethics: A Modern Orthodontic Dilemma

Abstract

Esthetic orthodontics is that branch of orthodontic practice primarily concerned with improving facial and dental aesthetics — has grown rapidly in recent years, driven by social trends, advances in technology (such as clear aligners, lingual braces, digital VTOs), and patient demand for “perfect smiles.” However, this growth has unveiled a number of ethical dilemmas that challenge the traditional remit of orthodontics, which historically emphasised function, health, and occlusal stability. In this article we explore the major ethical issues arising in esthetic orthodontics, structured around the four-core biomedical-ethical principles of autonomy, beneficence, non-maleficence and justice. We examine patient demands and informed consent, the risk of overtreatment or purely cosmetic treatment, marketing and commercial pressures, supervision of new technologies, timing and indication of treatment especially in children and adolescents  and issues of social justice and access. We also reflect on the role of the orthodontic practitioner in navigating between patient desires, professional responsibility, and business imperatives. Finally, we propose a framework for ethical decision-making in esthetic orthodontics and suggest areas where professional guidelines, education and research need to develop further.