One-Year Treatment Outcome of Profile Changes After Transcutaneous Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip and Palate.

OBJECTIVE: To evaluate the long-term stability of LeFort I osteotomy followed by distraction osteogenesis with a transcutaneous rigid external device for the treatment of severe maxillary hypoplasia in patients with cleft lip and palate. PATIENTS AND METHODS: Nine patients with cleft lip and palate underwent rigid external distraction after a LeFort I osteotomy for maxillary advancement. Lateral cephalometric films were analyzed for assessment of treatment outcome and stability in 1 month, 6 months, and 1 year after distraction. RESULTS: Significant maxillary advancement was observed in the horizontal direction, with the anterior nasal spine (ANS) distance of the maxilla increasing by an average of 20.5 ± 5.1 mm after distraction. The ANS relapse rates in 6 months and 1 year were 8.7% and 12.8%, respectively. The mean inclination of upper incisors to the palatal plane was almost unchanged (before: 109.8° ± 6.6°; after: 108.9° ± 7.5°). The movement ratios at the nasal tip/ANS, soft tissue A point/A point, and the upper vermilion border/upper incisor edge were 0.36:1, 0.72:1, and 0.83:1, respectively. CONCLUSION: Considerable maxillary advancement was achieved with less change of incisors inclination after distraction. Moreover, the relapse rate after 1 year was minimal. The concave facial profile was improved as well as the facial balance and aesthetics.

Can anteroposterior skeletal pattern be determined from a silhouetted profile photograph? A cross-sectional study.

OBJECTIVE: To determine the degree to which the anteroposterior (AP) skeletal jaw relation can accurately be determined from a silhouetted clinical profile photograph and whether the level of agreement is influenced by patient vertical proportions. DESIGN: Cross-sectional study. SETTING: University Dental Hospital of Manchester, United Kingdom. PARTICIPANTS: Specialist orthodontists. METHOD: Eight specialist orthodontists assessed 37 silhouetted profile photographs of individuals aged 11-19 years and determined the class and severity of AP skeletal pattern. These assessments were compared to corresponding lateral cephalometric radiographs, where ANB values, supplemented by an Eastman Correction and a Wits Appraisal, where appropriate, were used for sagittal skeletal classification. RESULTS: The agreement between silhouette and cephalometric AP determination yielded a weighted kappa score of 0.207 (95% confidence interval [CI] 0.135-0.278), which indicates only a fair level of agreement. The silhouetted sagittal skeletal pattern classification, along with severity, agreed with the lateral cephalometric radiograph in 29% of instances. Class III individuals were identified correctly 19.2% of the time. There was a statistically significant difference in kappa scores between the high angle (K= 0.439; 95% CI 0.310-0.568) and low angle (K = 0.068; 95% CI 0.007-0.130) patients (P < 0.001), as well as the high and average angle (K= 0.151; 95% CI 0.031-0.270) patients (P < 0.05). CONCLUSION: AP skeletal pattern, as determined from a lateral cephalometric radiograph, has only a fair level of agreement to that from a silhouetted profile photograph. Vertical proportions were shown to have a significant effect on the determination of the sagittal skeletal pattern and class III skeletal patterns were shown to be the most difficult to identify from profile silhouettes.

Dental and soft tissue changes following extraction of second premolars in females with bimaxillary protrusion: A retrospective study.

BACKGROUND: Bimaxillary protrusion is a condition wherein esthetic concerns are the main reason behind seeking orthodontic treatment. AIM: The aim of this retrospective cephalometric study was to evaluate the soft tissue profile and dental changes among female Saudi bimaxillary protrusion patients treated with extraction of all second premolars followed by retraction of the anterior teeth. Subjects and Methods: Pre and posttreatment cephalometric radiographs of adult female patients (ages 18-30 years) who underwent orthodontic therapy for Class I bimaxillary protrusion were obtained. Data were analyzed with SPSS® software. A paired t-test and Pearson's correlation coefficients were conducted with the statistical significance set at 95% (P value < 0.05). RESULTS: At posttreatment, there was an overall decrease in the mean values among the majority of the soft tissue and dental cephalometric angles and linear measurements. Among soft tissue variables, there was a marginal increase in the upper lip length by 1.49 mm (P < 0.001), and the nasolabial angle increased markedly by 7.64° (P < 0.001). Similarly, a marked increase in retroclination by 5.95° (P < 0.001) was observed among the dental variables. Conversely, no significant changes were noted in the lower incisors. Pearson's correlation analysis revealed a significant correlation between all the different dental variables. Within the soft tissue variables, there was a significant positive correlation between changes in the upper lip protrusion, lower lip protrusion, upper lip thickness, and the distance from the upper and lower lips to the S-line.

Soft tissue profile changes after Functional Mandibular Advancer or Herbst appliance treatment in class II patients.

OBJECTIVE: The objective of the present study is to compare the effects on soft tissue profile in class II patients after treatment with either "Functional Mandibular Advancer" (FMA) or Herbst appliance. MATERIALS AND METHODS: The study included n = 42 patients treated with either FMA (n = 21) or Herbst appliance (n = 21) by the same experienced orthodontist. The treatment followed a single-step advancement protocol. Lateral cephalograms were analyzed through a set of customized measurements. The actual therapeutic effect was calculated using data from a growth survey. After testing for normal distribution and homogeneity of variance, data were analyzed by one-sample Student's t tests and independent Student's t tests. Statistical significance was set at p < 0.05. RESULTS: For both FFAs, significant upper lip retrusion, increase in lower lip's thickness, and length of the lower face occurred. Additionally, significant lower lip retrusion and straightening of the profile were found in FMA and Herbst appliance patients. All remaining variables revealed no significant differences. CONCLUSIONS: Treatment-related changes on the facial soft tissue profile could be regarded similar in class II patients treated with FMA or Herbst appliance. No treatment-related changes that were specific for FMA or Herbst appliance could be identified. Only moderate changes were noted comparing pre- and posttreatment soft tissue profiles. CLINICAL RELEVANCE: Despite proven differences in skeletal and dental treatment effects, the facial profile has not to be taken into consideration when choosing between FMA and Herbst appliance for class II treatment.

Photogrammetric analysis of facial profile in Persian adults.

When facial photographs are analyzed for the purpose of identifying esthetics norms, differences in dentofacial relationships among ethnic and racial groups must be taken into consideration. Therefore, it is necessary to establish standards for various populations. The purpose of this study was to establish norms of photogrammetric soft tissue profile analysis for Persian adults. Pretreatment lateral photographs of 147 subjects (66 men and 81 women aged 18-35 years) with a Class I skeletal pattern were collected. Twelve angular parameters were evaluated in the subjects. Values for men and women were compared with a t test. Statistically significant sexual dimorphism was found for nasofrontal (P < 0.059), nasal (P < 0.059), nasal dorsum (P < 0.001), cervicomental (P < 0.001), facial convexity (P < 0.004), and total facial convexity (P < 0.002) angles. The mean values obtained from this study can assist in orthodontic diagnosis and treatment planning for Persian adults.

Relationship between malocclusion, soft tissue profile, and pharyngeal airways: A cephalometric study.

BACKGROUND AND OBJECTIVE: The recent years have been marked by a search for new interrelations between the respiratory function and the risk of the development of malocclusions, and algorithms of early diagnostics and treatment have been developed. The aim of the study was to evaluate the relationships between hard and soft tissues and upper airway morphology in patients with normal sagittal occlusion and Angle Class II malocclusion according to gender. MATERIALS AND METHODS: After the evaluation of clinical and radiological data, 114 pre-orthodontic patients with normal or increased ANB angle, were randomly selected for the study. The cephalometric analysis was done by using the Dolphin Imaging 11.8 computer software. RESULTS: Comparison of the cephalometric values of soft tissue and airway measurements performed statistically significant negative correlation between the width of the upper pharynx and the ANB angle was found: the ANB angle was decreasing with an increasing width of the upper pharynx. The airways showed a statistically significant negative correlation between the width of the lower pharynx and the distance from the upper and the lower lips to the E line. Logistic regression analysis was performed to evaluate significant factors that could predict airway constriction. The upper pharynx was influenced by the following risk factors: a decrease in the SNB angle, an increase in the nose tip angle, and younger age; while the lower pharynx was influenced by an increase in the distance between the upper lip and the E line and by an increase in the upper lip thickness. CONCLUSIONS: During critical period of growth and development of the maxillofacial system, the patients with oral functional disturbances should be monitored and treated by a multidisciplinary team consisting of a dentist, an orthodontist, a pediatrician, an ENT specialist, and an allergologist. Cephalometric analysis applied in our study showed that Angle Class II patients with significantly decreased facial convexity angle, increased nasomental, upper lip-chin, and lower lip-chin angles, and upper and lower lips located more proximally to the E line more frequently had constricted airways.

Nasal profile changes with le fort I maxillary advancement surgery.

Introduction : The purpose of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement surgery by using lateral cephalograms taken before and after the operation. Materials and Methods : The study group consisted of 20 patients (10 women, 10 men; mean age 23.4 ± 1.4 years) having a Class III skeletal deformity caused by a retrognathic maxilla. All patients were treated by Le Fort I maxillary advancement osteotomy. Lateral cephalograms were taken before and 1.6 ± 0.4 years after surgery. Results : The anteroposterior position of A-point and anteroposterior position of maxillary incisor were significantly protracted (-2.69 ± 3.34 and -2.68 ± 3.21, respectively; P < .01). The nasal anteroposterior and superoinferior positions (NASALAP and NASALSI, respectively) were significantly changed (-2.70 ± 6.81, P < .01, and -2.55 ± 5.80, P < .05, respectively) and nasal elevation and protraction were observed after Le Fort I maxillary advancement surgery. Conclusions : The changes in anteroposterior and superoinferior positions of A-point were correlated with the nasal superoinferior position (r = -0.71 , P < .05; r = 0.72, P < .05) after Le Fort I maxillary advancement surgery.

Assessment of the Acceptable Range of Lips and Chin Position in Two Different Geographical Zones of Iran among Laypersons.

Statement of the Problem: The position of the chin and lips are important components in the lower third of the face and can be changed by orthodontic treatment. It seems that factors such as diversity in culture, ethnicity, and place of residence are among the factors affecting people's perception of beauty. Iran, as a vast country, contains different ethnicities and cultures, and of course, it is not exempt from this point of view. Purpose: Our purpose of conducting this study is to investigate the impact of the difference in living environment and culture on people's aesthetic perception. Orthodontists and oral surgeons can use these data to choose the best treatment plan for the patients according to their geographical zones. Material and Method: A descriptive cross-sectional study was conducted to evaluate the perception of lips and chin position. A series of 25 profile images were prepared in 5 sets. Each set contained 5 profile images. Northern and Southern lay people and orthodontists were asked to evaluate the profile series of each set in 1 session and score them from 1 to 5: 1, very unattractive; 2, unattractive; 3, neither attractive nor unattractive; 4, attractive; or 5, very attractive. Results: 652 participants in 3 groups, including 16 orthodontists (10 men and 6 women), 318 lay people of the North of Iran (172 men and 138 women), and 318 lay people of the South of Iran (175 men and 139 women) participated in this study. Regardless of the chin position, normal lip position and slight changes of that (in both protruded and retruded positions) were more favorable for all three groups. The images with moderately retruded lips were scored as the least attractive by all three groups and orthodontist gave the lowest score to these profiles. Southern people could better tolerate moderately retruded lips than other two groups. In the fifth series, orthodontists preferred slightly and moderately protruded lips in comparison to other two groups of laypeople. Conclusion: Regardless of the chin position, normal and slightly (-2mm to +2mm) protruded and retruded lips were more favorable in all three groups. Southern people could better tolerate moderately retruded lips than the two other groups.

A comparative study on anterior teeth retraction-related hard and soft tissue changes with physiologic anchorage control technique.

Aim of this comparative cross-sectional study was to evaluate the effect of anterior teeth retraction and related hard and soft tissue change under physiologic anchorage control in patients with chief complain of protrusive teeth. 68 Class I or II orthodontic patients undergoing four-premolar extraction and requiring maximum or medium anchorage were included. Patients were treated with physiologic anchorage control technique (PASS group, n = 34, 18.6 ± 7.7 years, 10 male and 24 female) and self-ligation technique (Damon group, n = 34, 17.5 ± 5.4 years, 13 male and 21 female), respectively. TADs were used for anchorage reinforcement in Damon group. Pre- and post-treatment cephalograms were collected. Twenty-six skeletal, dental and soft tissue items were measured and analyzed using a blinded method. T test and paired rank-sum test were used for statistical analysis. The baseline characteristics were similar between groups (P > 0.05). After treatment, inter-group comparison showed statistically significant differences in the decrease of skeletal measurements ∠ANB (- 0.73 ± 1.05° in PASS group and - 0.25 ± 0.84° in the Damon group), Wits value (- 2.56 ± 2.29 mm in PASS group and - 0.47 ± 2.15 mm in Damon group) and soft tissue measurement UL-E (- 2.75 ± 1.36 mm in PASS group and - 2.03 ± 1.30 mm in Damon group) and the increase of FCA and Z angle, which was 2.03 ± 2.12°and 9.52 ± 4.78°in PASS group and 0.97 ± 2.12°and 6.96 ± 4.43°in Damon group, respectively (P < 0.05). Our results indicated that significant anterior teeth retraction and profile improvement could be achieved with PASS technique without additional anchorage devices. Appropriate application of physiologic anchorage control could reduce the dependence of TADs for anterior teeth retraction.

Esthetic preferences of orthodontists, dentists, and plastic surgeons for balanced facial profiles.

PURPOSE: The aim of this investigation was to determine whether the facial esthetics of subjects rated as "attractive" can be related to specific cephalometric soft tissue parameters. METHODS: The profile silhouettes of 100 subjects (45 males and 55 females) were rated by 60 esthetics specialists (20 orthodontists, 20 dentists, and 20 plastic surgeons) using a Likert scale, and 30 of the subjects were selected as being "attractive". The cephalometric measurements of the attractive group were then compared with norms for the general Caucasian population. RESULTS: The effects of specific measured parameters on profile beauty grades were assessed using the median test, and the following variables were found to show significant correlations between the Caucasian norms and the attractive profile group: the ratio of the upper to lower face height (P = 0.011), the ratio of the subnasale - labrale inferius (Sn-Li) and labrale inferius - menton (Li-Me`) lines (P = 0.011), the distance between the chin and the subnasale perpendicular (P = 0.002), upper lip thickness (P = 0.021), soft tissue chin thickness (P = 0.021), vertical height ratio (P = 0.021), and nasolabial angle (P = 0.021). CONCLUSION: A straight profile with a fuller and more protruded upper lip, a higher nasal tip, and a smaller lower facial third are considered to be the most attractive facial features, and may be useful for improvement of facial esthetics.

Study on the effect of chin morphology on orthodontic treatment.

OBJECTIVES: To investigate the effect of different soft-tissue morphologies on the treatment of skeletal class Ⅰ malocclusion patients by analyzing measurement data before and after treatment. METHODS: Pre- and post-treatment lateral cephalograms of 55 adult female Angle class Ⅰ patients were collected in the Department of Orthodontics, Hospital of Stomatology, Jilin University from January 2012 to December 2020. Chin soft-tissue morphologies in the lateral cranial radiographs were used to divide the patients into an abnormal chin morphology group (flat and retracted chins, n=27) and a normal chin morphology group (rounded and prominent chins, n=28). Relevant soft- and hard-tissue indexes were selected to study in-group varieties and intergroup differences in the varying chin morphologies before and after treatment. RESULTS: The chin-lip angle, mandibular chin angle, mandibular chin vertex angle, PP-MP, LL-E, UL-E, Po-Pos, and B-B' thickness in the abnormal chin morphology group were significantly higher than those in the normal chin morphology group (P<0.05). Furthermore, m∶BMe and n∶B'Mes in the abnormal chin morphology group were signi-ficantly lower than those in the normal chin morphology group (P<0.05). After treatment, the mandibular chin angle, mandibular chin vertex angle, U1-SN, L1-MP, LL-E, UL-E, SNA, SNB, and B-B' thickness of the abnormal chin morphology group significantly decreased (P<0.05), whereas the nasolabial angle, m∶BMe, n∶B' Mes, and Po-Pos significantly increased (P<0.05). In the normal chin morphology group, the U1-SN, L1-MP, LL-E, UL-E, and B-B' thicknesses decreased significantly (P<0.05), whereas the nasolabial angle significantly increased (P<0.05). Among them, m∶BMe and n∶B' Mes were positively correlated. CONCLUSIONS: Chin morphology affects the formulation of treatment plans. Compared with the normal chin morphology group, the abnormal chin morphology group required a larger retraction of incisors. Although the chin of soft-tissue morphology is related to the morphology of bones, the changes in soft tissue chin after treatment cannot be directly predicted according to the bone changes. Soft-tissue chin morphology affects the aesthetic assessment of the soft-tissue lateral profile and the change in soft tissue before and after treatment. The method of predicting the change in soft-tissue chin after treatment should consider the morphology of the soft-tissue chin.

Polyetheretherketone patient-specific implants (PPSI) for the reconstruction of two different mandibular contour deformities.

BACKGROUND: This study aims to prospect the soft and hard tissue changes after augmentation of two different local mandibular contour defects using polyetheretherketone (PEEK) patient-specific onlay implants. METHODS: Six patients with disfiguring local mandibular deformities were included in this study (five males and one female) and received seven PEEK patient-specific implants (PSI), virtually designed and surgically settled to augment seven mandibular defects, three deficient chins, and four mandibular angels. The analysis of the soft and hard tissue changes utilized the superimposition of the preoperative and the 6-month postoperative sagittal and coronal CT views, after standardizing the radiographic interpretation. RESULTS: The soft tissue gain for the chin was 6.8 mm ± 0.98 with a 45.8% increase versus 4.42 mm ± 0.41 with a 22.9% increase for the angle. The difference in the soft tissue gain between the two groups was statistically significant (P = 0.0001). Comparing the soft tissue gain to the planned implant thickness, the percentage of the soft tissue gain for the chin recorded 109.2% versus 65.57% for the angle. The difference between the two groups was also statistically significant (P < 0.0001). CONCLUSION: PEEK patient-specific onlay implants represented an efficient and straightforward modality to augment local mandibular contour deformities with favorable esthetic outcomes; the total soft tissue profile gain of the chin region markedly exceeded that of the mandibular angle.

A Comparative Study of Skeletal and Dental Outcome between Transcutaneous External Maxillary Distraction Osteogenesis and Conventional Rigid External Device in Treating Cleft Lip and Palate Patients.

BACKGROUND: Traditional distraction osteogenesis (DO) with the tooth-borne rigid external device (RED) system was regularly used in treating patients with cleft-related maxillary hypoplasia. However, the bone-borne RED system with miniplates and bone screws has currently become an effective treatment. This retrospective study was to compare bone-borne RED with traditional tooth-borne RED in distraction effectiveness, blood loss, operative time, and long-term stability. METHODS: Twenty-two growing patients who underwent RED therapy were divided into two groups: eleven patients utilizing the bone-borne RED system with the transcutaneous wire attached with skeletal anchorage; another eleven patients using the traditional tooth-borne RED system with the intra-oral device attached with dental anchorage. Serial lateral cephalograms were analyzed for comparing treatment outcomes and stability in 1 month, 6 months, and 1.5 years after distraction. RESULTS: In bone-borne RED group, the maxilla was advanced by 19.98 mm with slight clockwise rotation of 0.40° and minimal palatal inclination change of incisor by -3.94°. In traditional tooth-borne RED group, the maxilla showed less advancement by 14.52 mm, with significant counter-clockwise rotation of -11.23° and excessive palatal inclination change of incisor by -10.86°. Although operative time was longer in the bone-borne RED group by 38.4 min, this did not bring about greater blood loss. CONCLUSIONS: the bone-borne RED via transcutaneous wire system provides an easy, simple, and comfortable procedure as well as favorable long-term stability in maxillary distraction.

Alterations in Integumental Facial Dimensions after Orthodontic Treatment.

BACKGROUND: It is documented that the facial profile changes, morphology changes, and continued facial growth in early adults and late adolescents. AIMS: The present trial was aimed to quantitatively assess the changes in facial growth from adolescents to adults. MATERIALS AND METHODS: In the present study, 16 facial distances (transverse) and craniocaudal facial distances were measured, and growth changes were assessed. The collected data were subjected to statistical evaluation, and the results were formulated. RESULTS: Upper face width was statistically significantly increased in males than females from posttreatment to recall with the P < 0.0001. The decrease in outer canthus was seen in females as compared to males, which was statistically significant with the P < 0.0001. An increase in mouth width was seen in both males and females with higher in females. CONCLUSION: The present study showed an increase in facial dimensions in both genders with age where transverse changes were higher than the craniocaudal alterations.

[Linear correlation between tooth movement and facial profile change in patients with class â ¡ division 1 malocclusion].

Objective: To investigate the correlation between tooth movement and profile change in patients with class Ⅱ division 1 malocclusion. Methods: Pre- and post-treatment lateral cephalograms of 42 patients [10 males and 32 females, (23.8±6.3) years old, mean treatment time: 1.9 years] with class Ⅱ division 1 malocclusion were collected in Department of Oral & Cranio-Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from June 2012 to November 2017. The patients were treated with extraction of four first premolars or two maxillary first premolars. Cephalometric analysis was carried out before and after treatment. Thirty parameters were measured. The changes of soft and hard tissue after orthodontic treatment and their correlations were analyzed using bivariate linear regression. Related factors affecting the upper and lower lip, nasolabial angle (NLA) and mentolabial angle (MLA) were analyzed according to the standardized regression coefficient (Beta). Results: Among all the 30 parameters, 18 parameters were statistically different before and after treatment. After treatment, upper central incisor sagittal distance [(63.87±7.14) mm] and upper lip sagittal distance [(77.73±7.60) mm] were significantly decreased (P<0.05). The changes in 14 parameters after treatment showed linear relationship including strong positive correlation between upper lip sagittal retraction and upper central incisor sagittal retraction (r=0.649, P<0.01). There were moderate positive correlations between upper lip and upper central incisor vertical movement (r=0.544, P<0.01). While the sagittal change of gnathion and the Y-axis angle showed moderate negative correlations (r=0.537, P<0.01). The stepwise multiple linear regression showed that the retraction of upper lip process was correlated with the retraction of upper central incisor, the increase of occlusal plane angle and the increase of upper central incisor angle, which was most correlated with the retraction of upper central incisor (Beta=0.79). The downward displacement of upper lip process was correlated with the downward displacement of upper incisor, the decrease of upper central incisor angle, the decrease of the distance between maxillary first molar and palatal plane, and the increase of occlusal plane angle, which was more correlated with the downward displacement of upper incisor and the increase of occlusal plane angle (Beta=0.59). The downward displacement of lower lip process was correlated with the downward displacement of upper incisor and lower incisor, which was more correlated with the upper incisor (Beta=0.36). Conclusions: The relationship among nose, lips and chin was more coordinated. Incisor retraction had significant influence on lip prominence, and the lower lip position was highly related to the movement of upper incisor in sagittal and vertical dimension after orthodontic treatment in patients with class Ⅱ division 1 malocclusion. However, tooth movement had limited impact on the chin position.

Effects of different surgical techniques and displacement distances on the soft tissue profile via orthodontic-orthognathic treatment of class II and class III malocclusions.

BACKGROUND: Orthognathic surgery can be carried out using isolated mandibular or maxillary movement and bimaxillary procedures. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile. METHODS: The changes in the soft tissue profile of 187 patients (Class II: 53, Class III: 134) were investigated. The treatment approaches were differentiated as follows: Class II: mandible advancement (MnA), bimaxillary surgery (MxS/MnA), upper extraction (UpEX), or Class III: maxillary advancement (MxA), mandible setback (MnS), bimaxillary surgery (MxA/MnS), and lower extraction (LowEX) as well as the extent of skeletal deviation (moderate Wits appraisal: - 7 mm to 7 mm, pronounced: Wits <- 7 mm, > 7 mm, respectively). This resulted in five groups for Class II treatment and seven groups for Class III treatment. RESULTS: In the Class II patients, a statistically significant difference (p ≤ 0.05) between UpEX and moderate MnA was found for facial profile (N'-Prn-Pog'), soft tissue profile (N'-Sn-Pog'), and mentolabial angle (Pog'-B'-Li). In the Class III patients, a statistically significant differences (p ≤ 0.05) occurred between LowEX and moderate MxA for facial profile (N'-Prn-Pog'), soft tissue profile (N'-Sn-Pog'), upper and lower lip distacne to esthetic line (Ls/Li-E-line), and lower lip length (Sto-Gn'). Only isolated significant differences (p < 0.05) were recognized between the moderate surgical Class II and III treatments as well between the pronounced Class III surgeries. No statistical differences were noticed between moderate and pronounced orthognathic surgery. CONCLUSIONS: When surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. However, it must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment. In contrast, moderate maxillary advancement in Class III therapy led to a significantly more convex facial and soft tissue profile by decreasing distances of the lips to the E-Line as well as the lower lip length.

Longitudinal changes in the dental arches and soft tissue profile of untreated subjects with normal occlusion.

AIM: The aim of this study was to analyze dental and soft tissue profile development in children with normal occlusions to establish age- and gender-specific reference intervals for German children during their active growth period. SUBJECTS AND METHODS: The study group consisted of a sample of 31 untreated Caucasian subjects with normal occlusions. Dental casts were analyzed at four different stages of dentitional development. Extraoral profile photographs were available for 19 subjects at stages T2-T4. In these subjects 11 angular measurements and 14 indices were analyzed. Statistical comparisons of gender-specific differences were performed by Mann-Whitney U tests (p ≤ 0.05). RESULTS: Upper and lower posterior and total arch perimeters were recorded to be significantly larger in male subjects until the late mixed dentition. Subsequently, there was a tendency toward larger dimensions in males for those parameters. Upper and lower intercanine, interpremolar and intermolar widths were significantly larger in males throughout the entire observation period. There were no statistically significant gender differences with regard to most angular measurements in the dental arches, including molar rotation, palatal volume, overbite, overjet and molar relationship at later dental stages. CONCLUSION: In untreated subjects with normal occlusion, dental arch and soft tissue parameters can be considered age-dependent. For some dental parameters, gender-specific differences were found that should be taken into consideration during diagnosis and treatment planning of growing children. The obtained longitudinal data of untreated children provide useful information for orthodontic diagnosis, treatment planning and future research projects.

Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: A long-term prospective case series.

AIM: Although alveolar ridge preservation (ARP) procedures appear to limit bone resorption after dental extraction, long-term outcomes remain limited. The objective of this prospective case series was to evaluate the long-term hard and soft tissue changes after ARP procedure in the aesthetic area, using deproteinized bovine bone mineral (DBBM) and saddle connective tissue graft. MATERIALS AND METHODS: Fifteen patients were subjected to ARP and impressions and CT scans were taken at baseline and 3 months. After 5 to 7 years, a secondary long-term clinical and radiological analysis was carried out. Horizontal alveolar bone changes, soft tissue profiles and implant outcomes were assessed. RESULTS: Although a limited hard and soft tissue remodeling occurred during the first 3 months after ARP, from 3 months to the long-term evaluation, the alveolar bone dimensions remained stable and the soft tissue profiles significantly increased, in the more cervical levels. The implant survival rate after 5 to 7 years yielded 100% and peri-implant bone levels and soft tissue health were good. CONCLUSION: Within the limits of the study, the present data confirms the long-term effectiveness of ARP using DBBM and a saddle connective tissue graft offering stable hard and soft tissue conditions up to 5 to 7 years.

Predictors of favorable soft tissue profile outcomes following Class II Twin-block treatment.

OBJECTIVE: The aim of this study was to determine cephalometric factors that help predict favorable soft-tissue profile outcomes following treatment with the Class II Twin-block appliance. METHODS: Pre- and post-treatment lateral cephalograms of 45 patients treated with the Class II Twin-block appliance were retrospectively analyzed. Profile silhouettes were drawn from the cephalograms and evaluated by three orthodontists in order to determine the extent of improvement. Samples were divided into a favorable group (upper 30% of visual analogue scale [VAS] scores, n = 14) and an unfavorable group (lower 30% of VAS scores, n = 14). Skeletal and soft-tissue measurements were performed on the cephalograms and an intergroup comparison was conducted. RESULTS: An independent t-test revealed that the following pre-treatment values were lower in the favorable group compared to the unfavorable group: lower incisor to mandibular plane angle, lower incisor to pogonion distance, point A-nasion-point B angle, sella-nasion line (SN) to maxillary plane angle, SN to mandibular plane angle, gonial angle, and symphysis inclination. The favorable group had a larger incisor inclination to occlusal plane. Moreover, the favorable group showed larger post-treatment changes in gonial angle, B point projection, and pogonion projection than did the unfavorable group. CONCLUSIONS: Class II malocclusion patients with a low divergent skeletal pattern and reduced lower incisor protrusions are likely to show more improvement in soft-tissue profile outcomes following Class II Twin-block treatment.

Differential Benefit of Two Different Tooth-Borne Rapid Maxillary Expansion Appliances in Female Subjects.

OBJECTIVE: The aim of the present study was to evaluate the effects of tooth-borne acrylic-bonded rapid maxillary expansion (RME) appliances with or without the anterior teeth anchorage on the skeletal and dentoalveolar structures, as well as soft tissues. METHODS: This study included 44 patients who were treated with two different tooth-borne bonded acrylic RME appliances. Lateral cephalometric radiographs were taken before the treatment (T0) and in the post-retention (T1) phase of the RME treatment. The posterior-bonded RME appliance group and full-bonded RME appliance group were created as the two different groups of treatment. The following statistical analyses were performed: intra- and inter-group comparisons were made using the paired t-test, Wilcoxon test, independent t-test, and Mann-Whitney U-test for normal and non-normal distribution data. RESULTS: Significant increases were observed in R1-A, R1-ANS, R1-U1, R1-AR, R1-St, R1-Li, and R1-Pn in both groups. R1-PNS, R1-Ls, R1-Sn, and R1-B' were found to be significantly larger at T1 than at T0 in the posterior-bonded RME appliance group. R2-A, R2-ANS, R2-L1, R2-A', and R2-Pn were significantly larger at T1 than at T0 in the full-bonded RME appliance group. The R2-A' was significantly different between the groups. CONCLUSION: The soft tissue A point appears to be the most important differing matter between the two different RME appliances, and a full acrylic-bonded RME appliance may be beneficial for subjects with a maxillary retrognathic profile.