Assessment of the Effect of Simulated Rhinoplasty and Genioplasty on the Facial Profile Attractiveness of Patients with a Convex Face.

AIM: This study was performed to evaluate the effect of rhinoplasty and genioplasty on facial profile attractiveness assessed by orthodontists and laypersons. MATERIALS AND METHODS: In this study, posttreatment cephalo-grams of 30 class II patients with convex profile and nasal hump who had undergone camouflage treatment were traced. These profile outlines were modified by computer software to simulate rhinoplasty and genioplasty. Then, all these outlines were converted into silhouettes. There were four groups: no modification, rhinoplasty (R), genioplasty (G), and rhinoplasty plus genioplasty (RG). Esthetic assessment of all patients was done by two panels: six orthodontists and six laypersons. Data were analyzed using Friedman's and Wilcoxon's test with a significance level of 0.05. RESULTS: The highest mean esthetics scores belonged to RG (3.9 ± 0.6), followed by R (3.5 ± 0.5), G (2.4 ± 0.5), and the initial image of the patients (2.13 ± 0.5). There was a significant improvement following all surgeries as determined by all evaluators (p < 0.001), except for orthodontists who did not find genioplasty more esthetic than no modification (p = 0.139). The mean score of esthetics by orthodontists was more than laypersons in all groups (p > 0.05). CONCLUSION: Both rhinoplasty and genioplasty improved the attractiveness of the patients' facial profiles. The greatest improvement in the facial profile attractiveness in convex faces was observed after simultaneous nasal hump elimination and chin argumentation procedures. CLINICAL SIGNIFICANCE: Although both rhinoplasty and genioplasty could improve patients' profile, the best result is achieved when combination of them is used for treatment of convex facial profile patients.

Lateral facial profile may reveal the risk for sleep disordered breathing in children--the PANIC-study.

OBJECTIVE: To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. MATERIALS AND METHODS: The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. RESULTS: The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992. CONCLUSION: In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Perceived Effects of Orthognathic Surgery versus Orthodontic Camouflage Treatment of Convex Facial Profile Patients.

Increased facial profile convexity has a common occurrence in the population and is a primary reason for seeking orthodontic treatment. The present study aimed to compare the perceived changes in facial profile appearance between patients treated with combined orthognathic/orthodontic treatment versus only orthodontic camouflage treatment. For this reason, 18 pairs of before- and after-treatment facial profile photos per treatment group (n = 36 patients) were presented to four types of assessors (surgeons, orthodontists, patients, laypeople). Ratings were recorded on 100 mm visual analogue scales depicted in previously validated questionnaires. All rater groups identified minor positive changes in the facial profile appearance after exclusively orthodontic treatment, in contrast to substantial positive changes (14% to 18%) following combined orthodontic and orthognathic surgery. The differences between the two treatment approaches were slightly larger in the lower face and the chin than in the lips. The combined orthodontic and orthognathic surgery interventions were efficient in improving the facial appearance of patients with convex profile, whereas orthodontic treatment alone was not. Given the significant influence of facial aesthetics on various life aspects and its pivotal role in treatment demand and patient satisfaction, healthcare providers should take these findings into account when consulting adult patients with a convex facial profile.

Factors that affect lip changes following incisor retraction in Vietnamese adults with a convex facial profile.

OBJECTIVE: This study aimed to evaluate the factors that influence lip change through the results of tooth anterior retraction by fixed orthodontic treatment in Vietnamese adult patients with a convex facial profile. MATERIALS AND METHODS: This prospective study included 32 Vietnamese adults who have convex facial profiles. Digital software measurements according to Arnett's analysis and the superimposition method were performed to evaluate the changes in dentoskeletal structures, and soft tissue variables included lip change. A multiple logistic regression model was applied with various explanatory variables to analyze the correlation. RESULTS: The study revealed a strong correlation of lip change at the site of the cervical point and incisal edge of the upper incisors, and the cervical position demonstrated a stronger correlation. The ratio between lip change and incisor retraction in patients is approximately 1:2.3 at the incisal edge and 1:1.3 at the cervical point. CONCLUSION: Lip change was associated with incisor retraction at the cervical and incisal edge, but it did not correlate with the rotation axis of the upper incisors.

Anclaje esquelético para el tratamiento de las anomalías de clase II y mordida abierta anterior: informe de un caso / Skeletal anchorage for the treatment of class II anomalies and anterior open bite: report of a case

El reporte de este caso tiene como objetivo demostrar la utilidad de los anclajes esqueléticos temporarios como son las miniplacas cigomáticas y los microimplantes "buccal shelf" en el tratamiento ortodóncico, en una paciente de 17 años 10 meses de edad, clase II vertical, dólicofacial, con mordida abierta anterior y aumento de la altura facial inferior. Después de la primera fase de tratamiento, siguiendo la secuencia de arcos para completar la alineación, se utilizaron anclajes esqueléticos extrarradiculares con una mecánica de intrusión con fuerzas elásticas durante 10 meses. Se intruyeron sus piezas posteriores superiores e inferiores y se distalizó la arcada superior, corrigiéndose la oclusión. El mentón retrognático y su perfil convexo mejoraron con la autorrotación de la mandíbula (AU)

The objective of this report case is to demonstrate the usefulness of temporary skeletal anchors such as zygomatic miniplates and buccal shelf microimplants in orthodontic treatment, in a 17-year-old 10-month-old, vertical class II, dollicofacial patient with anterior open bite and increased lower facial height. After the first treatment phase, following the arch sequence to complete the alignment, extra-radicular skeletal anchors were used with intrusion mechanics with elastic forces for 10 months. Its upper and lower posterior pieces were intruded and the upper arch was distalized, correcting the occlusion. e retrognathic chin and its convex profile improved with autorotation of the jaw (AU)