Recent modifications of the Aesthetic dogma include: 1-Vertical upper lip to incisor relationship in view of the soft tissue modifications with age (Zachrisson) 2- Antero Posterior placement of the maxillary incisor at the level of the Anterior Nasal Spine (Cocconi-Rafaini;Sassouni), 3- ethnic effect on aesthetic rating ( Liu and co-workers).
Those aims will be critically analysed and the results of a study concerning compromised treatment including asymmetrical extractions (Maxillary first molars) will be presented including Stability of results, Functional status, and facial modifications. This discussion is of the utmost importance in view of the increasing use of T A D (Temporary Anchorage Devices) giving the same long term results (maxillary dental distalisation).

The breaking point between dental correction and surgical mandibular advancement being the key to correct treatment planning.