Dr. David Sarver, P-I Brånemark Award for Lifetime Achievement Recipient

After five years of developing surgical treatment plans for patients with facial deformities, Dr. David Sarver reached out to his trusted mentor with one message: clinicians had been treatment planning wrong for 100 years.

Instead of brushing him off, that mentor, Dr. Bill Proffit, encouraged Dr. Sarver to plead his case. The problem was clear: when he followed the standard methodology—focused solely on the teeth—the results fell short. Patients who had already undergone unsuccessful orthodontic treatment two or even three times still weren’t satisfied with the outcome after jaw surgery.

It became evident that to create truly beautiful, life-changing smiles, he had to look beyond the teeth. He needed to evaluate the entire picture, starting from the moment he first saw the patient.

“If you’re going to have jaw surgery, what is the criteria of a good outcome? If you’re living with a skeletal deformity, it’s not how perfect the bite is, it’s how you look after,” Dr. Sarver said. “So, I did my research. I learned a great deal about plastic surgery from cosmetic surgeons and started incorporating it into my evaluation and approach.”

Adding rhinoplasties to his jaw surgery procedures, unheard of at the time, was among the most impactful (and controversial) changes he made. He found it led to better results and reduced the need for additional surgeries, allowing patients to complete all necessary treatment at once.

For 46 years, Dr. David Sarver’s full-face, multidisciplinary philosophy has transformed the way clinicians approach orthodontics. His focus on the whole face, rather than just the teeth, has not only reshaped the profession but also earned him a loyal following.

This year, Dr. Sarver was recognized with the P-I Brånemark Award for his significant contributions to the field. Past recipients include leaders such as Drs. Myron Nevins, Tiziano Testori, Istvan Urban, Maria Lopez Howell, Massimo Simion, Michael Cohen, Leslie Fang, Elaine Halley and Lisa Germain.

Like his mentor Dr. Bill Proffit, as well as Dr. Brånemark and other esteemed winners, Dr. Sarver sees himself as both a perpetual student and a teacher. 

“If you are a perpetual student, there’s something new to learn each day,” he said. “And if you research like I have, there’s that joy of discovery, of realizing you found something nobody else knows. You can stop there, or you can share what you learned. It’s almost an obligation of the professional. That’s what Brånemark was all about. He made contributions, not for money, but because he was a professional. You do things because it’s right, not because it’s going to make money. That’s my connection to Dr. Brånemark.”

Early Patients

After completing his orthodontic residency at the University of North Carolina (UNC), where he met Dr. Proffit, he accepted a faculty position at the University of Alabama-Birmingham. There, he was charged with establishing a formal orthognathic surgery program, similar to the one he had previously worked with at UNC. It was in this role that he began shifting his perspective—learning the importance of focusing on the entire face.

As he began designing surgical treatment plans, one of his first cases was a 27-year-old patient whom “nobody knew what to do with.” He did and achieved a beautiful, transformative result.

Another pivotal case came in 1983. With this patient, it was clear that if he followed the standard, tooth-focused approach, she would likely require jaw surgery in 20 years. Unwilling to set her on that path unnecessarily, he chose a different strategy—an outside-in approach centered on facial harmony and esthetics. Instead of labeling her a surgical case, he recommended braces. The outcome was striking, and it “really got his attention.”

A few years later, he included that pivotal case when he took the American Board of Orthodontics exam, almost “daring them to flunk him.” They didn’t.

“I broke all the rules, but I said, look at her bite. Look at her face. It turned out spectacular,” Dr. Sarver said, noting this was the case that prompted the career-changing call to Dr. Proffit. “She’s married and lives in Atlanta, but she brings her children here to see me. She won’t go anywhere else. She makes the 2.5-hour drive to ensure her children get that level of care.”

When Dr. Sarver treats patients, he does what’s best for every patient, even if that means deviating from the standard. In this case, had he followed the rule book, it would have negatively impacted that patient’s entire life. It’s proof that treatment planning for everyone following the same method doesn’t work. Everybody is different, making his full-face approach a critical advancement.

“What makes a face beautiful? It depends on who’s looking at it and how they feel about it,” Dr. Sarver said. “You don’t design a treatment plan by a set of numbers, with every patient getting squished into the same diagnostic category and getting the same treatment plan. Not everyone fits into one diagnostic criteria. You must look at the full face.”

Defending His Case

Dr. Sarver and mentor Dr. Proffit made a great pair.

“He put the onus on me to show him,” Dr. Sarver said. “His mantra was, I’m not going to just teach you how to do things, I’m going to teach you how to think for yourself. And that’s how I approach every case. I think before I do things. And sometimes, to achieve the best result, you must think differently than what’s accepted.”

And Dr. Sarver did the research. For example, he found it was better to move the maxilla down after bone grafting in cases where there’s vertical maxillary deficiency. Back then, the accepted treatment was to bone graft the maxilla and then move it back up.

In his research, Dr. Sarver found published down-graft cases that supported his thinking. So, he pivoted. When he was ready, he showed Dr. Proffit a case with a 20-year follow-up as well as 30 cases he’d completed himself. Everything was rock-solid, so Dr. Proffit decided they should include his research in the textbook they were working on, documenting Dr. Sarver’s findings.  

The Approach

Dr. Sarver’s patient evaluations begin the minute he walks into the room. As he talks with patients, he observes how they interact socially. He wants to see and evaluate their social smile, the one that comes out when they’re with family and friends, rather than the one you get when taking a posed picture at the dentist’s office. The only way to do that, he said, is to observe without patients realizing it.  

When it comes to diagnostics, these observations are the most critical part of the first visit, Dr. Sarver said. And you can evaluate it all empirically just by talking to patients for five minutes.

“You can’t not take the time,” Dr. Sarver said. “As dentists, we’re the first people to make decisions on how children will look for the rest of their lives. If you screw that up, the Miss America I treated doesn’t become Miss America.”

Mentorship Matters

Dr. Sarver has been mentored by doctors “who were at the top of their game,” something he is very thankful for. He’s fortunate these doctors saw promise in him, he said, and supported him when he decided to stray from tradition.

Through his lectures and the various textbooks he’s authored over the years, Dr. Sarver has done the same for other clinicians. Today, he lectures alongside up-and-coming dentists who will lead the field in the future. These dentists are actively engaged with emerging techniques, ensuring the profession not only adapts effectively to change but also leverages it to improve patient outcomes. Merging their technological savvy with Dr. Sarver’s rich legacy will ensure the field continues to move in the right direction.

While he isn’t quite ready to retire, Dr. Sarver is scaling back and starting to hand the reins to the younger generation. As he winds down, he reflects on a career that has given him numerous professional connections and, most importantly, the opportunity to positively impact the lives of many patients. That, he said, is the most gratifying part. And he couldn’t have done it without the support of his wife, Valerie.

The couple, who have been married for 50 years, both had separate careers, but it was never about them as individuals. She supported him as he pursued his passions, and he did the same for her.

“She had her career, but she knew her family’s happiness was more important than anything,” Dr. Sarver said. “There were times I was up in my office and all you could see was the back of my head for six months because I was working on a book.”

Reshaping Orthodontics  

Dr. Sarver has helped substantially advance the field of orthodontics, setting a benchmark for clinical excellence and establishing a new way of thinking about the smile, facial harmony and comprehensive care. He consistently pushes the boundaries of traditional orthodontics, questioning the standard rather than just blindly following the rules. That’s his legacy. And even though he was met with pushback, he forged ahead. He knew his outside-in approach was the best for his patients, and this is evident in the many beautiful smiles he has created over the course of his career and the lives he has changed for the better.