Soft and hard tissue changes after bimaxillary surgery in Chinese Class III patients.

Soft Tissue Changes Measured With Three-Dimensional Software Provides New Insights for Surgical Predictions

Correlation Between Soft and Hard Tissue Changes in the Zygomaticomaxillary Region After Bone Contouring Surgery for Fibrous Dysplasia—A Preliminary Study

The aim of this study was to describe hard and soft tissue changes after mandibular advancement surgery and to investigate the possible differences between Class II facial patterns. Lateral cephalograms of 109 patients who underwent combined orthodontic treatment and bilateral sagittal split osteotomy (BSSO) were studied. Radiographs were taken within 6 weeks before surgery (T0) and at least 6 months postoperatively (T1). Patients were classified into 3 groups according to the preoperative mandibular plane angle. Hard- and soft-tissue changes were analysed with an x-y cranial base coordinate system. Measurements were evaluated statistically. Soft and hard tissues of the chin moved forward and downward. The position of the upper lip remained unchanged, while the lower lip moved forward and upward and decreased in thickness. The soft tissue points of the chin follow their corresponding skeletal points almost completely, while the change of the lower lip was only 76 per cent of the movement of the underlying hard tissue. The increase of SNB was more evident in the low-angle group, as well as improvement of the facial convexity. Stomium superius moved more forward in the low- and medium-angle cases. Ratios of hard and soft tissue changes showed no differences for different facial patterns. Limitations derived from the retrospective study design. Only short-term changes could be addressed. The distinction between surgical changes and changes due to skeletal relapse is difficult to assess. Also, the difficulty to reproduce a relaxed lip position during imaging may influence our results. Class II characteristics improved after mandibular advancement. Soft tissues of the chin follow their skeletal structures almost in a 1:1 relationship, while movement of the lower lip was less predictable. The facial pattern of Class II patients should be considered in treatment planning.

Skeletal change at surgery as a predictor of long-term soft tissue profile change after mandibular advancement

Assessing three-dimensional soft tissue changes and the prediction of hard tissue changes after orthognathic surgery with a novel digital workflow.

Introduction: This study evaluate the soft tissue changes to the upper lip and nose after Le Fort I maxillary posterosuperior rotational movement. Materials and Methods: Twenty Skeletal class III patients, who had undergone bimaxillary surgery with a maxillary Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included in the study. The surgical plan for maxilla was posterosuperior rotational movement, with the rotation center in the anterior nasal spine (ANS) of maxilla. Soft and hard tissue changes were measured by evaluating the lateral cephalograms obtained prior to surgery and at least 6 months after surgery. For cephalometric analysis, four hard tissue landmarks ANS, posterior nasal spine [PNS], A point, U1 tip), and five soft tissue landmarks (pronasale [Pn], subnasale [Sn], A' Point, upper lip [UL], stomion superius [StmS]) were marked. A paired t test, Pearson's correlation analysis and linear regression analysis were used to evaluate the soft and hard tissue changes and assess the correlation. A P value <0.05 was considered significant. Results: The U1 tip moved 2.52±1.54 mm posteriorly in the horizontal plane (P<0.05). Among the soft tissue landmarks, Pn moved 0.97±1.1 mm downward (P<0.05), UL moved 1.98±1.58 mm posteriorly (P<0.05) and 1.18±1.85 mm inferiorly (P<0.05), and StmS moved 1.68±1.48 mm posteriorly (P<0.05) and 1.06±1.29 mm inferiorly (P<0.05). The ratios of horizontal soft tissue movement to the hard tissue were 1:0.47 for the A point and A' point, and 1:0.74 for the U1 tip and UL. Vertically, the movement ratio between the A point and A' point was 1:0.38, between U1 tip and UL was 1:0.83, and between U1 tip and StmS was 1:0.79. Conclusion: Posterosuperior rotational movement of the maxilla in Le Fort I osteotomy results in posterior and inferior movement of UL. In addition, nasolabial angle was increased. Nasal tip and base of the nose showed a tendency to move downward and showed significant horizontal movement. The soft tissue changes in the upper lip and nasal area are believed to be induced by posterior movement at the UL area.

The objective of this study was to assess the hard and soft tissue changes following immediate placement and provisional restoration of single-tooth implants in the aesthetic zone. Thirteen patients with immediately placed and restored implants were included in this study. All participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, and connection of a screw-retained provisional restoration. Three months following implant placement, the temporary crowns were replaced by the definitive restorations. Implant survival rates, and hard and soft tissue changes were measured using periapical X-rays and photographs. The range of the observation period was between 12 and 37 months with a mean period of 23.2 ± 7.6 months. At the time of follow-up, all implants were present with no complications. Radiographic evaluation revealed a mean mesial bone gain of 1.20 ± 1.01 mm and a mean distal bone gain of 0.80 ± 1.14 mm, which reached statistical significance. The mean mid-buccal recession was 0.20 ± 0.78 mm, whereas the mesial and distal papillae height loss was 0.50 ± 1.26 mm and 0.30 ± 0.82 mm, respectively. The changes in the soft tissues did not reach statistical significance. Notwithstanding the limitation of a small sample size, this study shows that immediate implant placement and provisional restoration in the maxillary aesthetic zone can result in favorable treatment outcomes with regards to soft and hard tissues changes over a follow-up period of 23.2 ± 7.6 months. Most clinical trials investigating immediate implant placement and immediate restoration in the maxillary anterior zone have focused on implant survival and implant success, with particular emphasis on radiographically assessed hard tissues changes. However, this study assesses the soft tissue changes associated with this procedure, which is an important area of study given the esthetic demands of implant therapy in the maxillary anterior region.

Three-Year Follow-Up of a Single Immediate Implant Placed in an Infected Area: A New Approach for Harvesting Autogenous Symphysis Graft

The soft tissue profile is crucial to esthetics after orthognathic surgery. The aim of this study was to assess the soft tissue changes of the subnasal and submental regions more than 1year after a sagittal split ramus osteotomy (SSRO) in patients with skeletal class III malocclusion. A total of 22 patients with mandibular prognathism were included in this study. Patients had lateral cephalograms before and more than 1year after they underwent an isolated SSRO. Soft and hard tissue changes were assessed using the lateral cephalograms. The lower lip, labiomenton, and soft tissue menton moved posteriorly by 85, 89, and 88% compared with the corresponding hard tissue, and the movement of the soft tissue B point and the top of the chin nearly reflected the displacement of the hard tissues, at 96 and 99%, respectively. The labiomenton, stomions, and naso-labial angles were changed after the mandibular set-back and the changes in these angles correlated with either the width of the soft tissue or skeletal displacement. The naso-labial angle could be altered even if an isolated mandibular osteotomy is performed. Changes to the stomions and naso-labial angles were affected by hard tissue movement, while changes to the labiomental angle were affected by the width of the soft tissue after the mandibular osteotomy. It is important to create an accurate preoperative prediction of the esthetic outcomes after a mandibular osteotomy by considering the interrelations between the hard and soft tissues.

Change in soft tissue in relation to that in hard tissue following orthognathic surgery was evaluated. Twenty-five patients were enrolled in the study. The diagnosis in all was jaw deformity (maxillary retrusion and mandibular protrusion) and all underwent a Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy. Three-dimensional (3D) computer-aided design (CAD) models (polygon models) of the hard and soft tissue of the maxilla and mandible were constructed and superimposed. Reference points were established on the pre- and postoperative hard and soft tissues. Specific elements of each reference point were divided into X, Y, and Z components, respectively, and the distances in each direction and 3D distance (normal distance) measured. The Wilcoxon signed-rank test was used to determine differences in the mean values for the distance moved of each element as the error between pre- and postoperatively. The results revealed statistically significant differences in the Y-direction in the maxilla and the X- and Z-directions in the mandible. A significant difference was also observed in the 3D distances of the maxilla and mandible. Little evidence was found of linearity between the amount of hard and soft tissue movement in the X- and Z-directions in the maxilla. This means that 3D movement in the maxilla was masked more by changes in the morphology of the soft tissue than in the mandible, making it less evident. The results of this study suggest that the 3D analysis method used enables changes in hard and soft tissues to be understood qualitatively, and that it can be used in diagnosis and treatment in orthognathic surgery. It may also be useful in simulation of morphological change in soft tissue.

Temporomandibular joint subluxation is defined as self-reducing partial dislocation of the TMJ during which the condyle passes anterior to the articular eminence. The study consisted of 30 patients, 19 females and 11 males with 14 unilateral and 16 bilateral cases of chronic symptomatic subluxation. Treatment consisted of arthrocentesis followed by 2ml of autologous blood injection into upper joint space and 1ml into pericapsular tissues using an autoclaved soldered double needle with single puncture technique. Parameters evaluated were pain, maximum mouth opening, excursive jaw movements, deviation on mouth opening and quality of life, hard and soft tissue changes on X-ray TMJ view and MRI. At 12month follow-up, average reduction in maximum interincisal opening, deviation on mouth opening, range of excursive movements on right and left sides and VAS scores were 20.54%, 32.84%, 29.59%, 27.37% and 74.53%, respectively. Out of 93.3% who responded to therapy, 66.7%, 20% and 6.7% responded after 1st, 2nd and 3rd AC + ABI, respectively. Remaining 6.7% patients had persistent painful subluxation and underwent open joint surgery. 93.3% patients responded to therapy, 80% were relieved of painful subluxation, 13.3% had painless subluxation and kept on follow-up. X-ray TMJ and MRI did not show any hard and soft tissue changes. A soldered double needle, single puncture, AC + ABI are a simple, safe, cost-effective, repeatable and minimally invasive nonsurgical therapy for treatment of CSS without any permanent radiographically evident soft or hard tissue changes.

Profile radiographs of 16 adult patients before, subsequent to, and one year following a total maxillary osteotomy were studied. The purpose of the study was to evaluate (1) osseous stability, (2) the relation between hard and soft tissue changes, and (3) the predictability of soft tissue changes on the basis of operative changes. The displacement of the maxilla in relation to the cranial base was expressed as a translation and a rotation. Correlation and stepwise regression analyses were the statistical methods applied. Conclusions: Hard tissue changes were stable in the horizontal plane whereas maxillary intrusion continued following the operation. The ratio between hard and soft tissue changes was low for nose and subnasal structures whereas the upper lip seemed to follow the underlying structures. Soft tissue changes had a low predictability when related to x and y coordinates of the underlying hard tissue but were markedly influenced by the rotational changes with maxillary plane.

This systematic review aimed to compare immediate protocols with conventional protocols of single-tooth implants in terms of changes in the surrounding hard and soft tissue in the esthetic area. Electronic and manual searches were performed in PubMed, EMBASE, Cochrane, and other data systems for research articles published between January 2001 and December 2014. Only randomized controlled trials (RCTs) reporting on hard and or soft tissue characteristics following a single-tooth implant were included. Based on the protocol used in each study, the included studies were categorized into three groups to assess the relationships between the factors and related esthetic indexes. Variables such as marginal bone level changes (mesial, distal, and mean bone level), peri-implant soft tissue changes (papilla level, midbuccal mucosa, and probing depth), and other esthetic indices were taken into consideration. The data were analyzed using RevMan version 5.3, Stata 12, and GRADEpro 3.6.1 software. A total of 13 RCTs met the inclusion criteria. Four studies examined immediate implant placement, five studies examined immediate implant restoration, and four studies examined immediate loading. Comparing the bone level changes following immediate and conventional restoration, no significant differences were found in the bone level of the mesial site (standard mean difference [SMD] = -0.04 mm; 95% confidence interval [CI]: -0.25 to 0.17 mm), the distal site (SMD = -0.15 mm; 95% CI: -0.38 to 0.09 mm), and the mean bone level changes (SMD = 0.05 mm; 95% CI: -0.18 to 0.27 mm). The difference in the marginal bone level changes between immediate and conventional loading was also not statistically significant (SMD = -0.05 mm; 95% CI: -0.15 to 0.06 mm for the mesial site and SMD = -0.02 mm; 95% CI: -0.09 to 0.05 mm for the distal site). Soft tissue changes following immediate and conventional restoration reported no significant differences in the papillae level of the mesial site (SMD = 0.18 mm; 95% CI: -0.00 to 0.37 mm), the papillae level of the distal site (SMD = -0.12 mm; 95% CI: -0.34 to 0.09 mm), and the midbuccal mucosa (SMD = -0.22 mm; 95% CI: -1.29 to 0.85 mm). Within the limitations, it can be concluded that immediately placed, restored, or loaded single-tooth implants in the esthetic zone result in similar hard and soft tissue changes compared with conventional protocols.

In part I, to derive ratios of soft to hard tissue profile changes after mandibular setback surgery and to report postoperative changes in soft tissue thickness at the lip and chin areas and, furthermore, to test the hypothesis that soft tissue thickness can act as one of the predictors of soft tissue response after surgery. In part II, to compare the predicted profile lines, using either the customized or the pre-programmed ratios, with the actual postsurgical outcomes. A retrospective study with the sample divided into two groups for different purposes. Department of Orthodontics and Department of Oral and Maxillofacial Surgery at Göteborg University, Sweden. Forty-one Caucasian subjects in need of mandibular setback surgery only. Hard and soft tissue movements and changes in soft tissue thickness after surgery were calculated using a customized analysis. Comparisons of the predicted profile outcomes with the actual postsurgical outcomes were carried out with another customized analysis. Distance measurements of certain landmarks in relation to constructed reference lines, both in horizontal and vertical planes, were calculated. The upper lip thickness decreased and the lower lip thickness increased after surgery. The hypothesis that the soft tissue thickness at the lip and chin areas could act as predictors of the ratios of soft to hard tissue changes after surgery, was not supported. Ratios for the lower lip of about 83% of the horizontal and 14% of the vertical movement of the PM point on the bony chin were found in Part I. In Part II, these ratios were introduced and the predicted profile moved significantly closer to the actual postsurgical outcome than if using the pre-programmed ratios (p < 0.05). Being able to customize the ratios of soft to hard tissue changes after a particular type of orthognathic surgery will enhance the accuracy of a patient's predicted profile outcome. These ratios should be pre-programmed in future versions of the software.

The objective of the present study is to test the null hypotheses that there were no significant differences for hard and soft tissue changes induced by mini maxillary protractor (MMP) and face mask and rapid maxillary expansion (FM/RME). Thirty-two patients who met the criteria were randomly divided into two groups: 16 patients (males/females 7/9) in the MMP group and 16 patients (males/females 6/10) in the FM/RME group. The patients in both groups were instructed to wear the appliances for at least 20 h per day until a 2-mm positive overjet was achieved. Hard and soft tissue profile changes observed by MMP and FM/RME were compared using paired and Student's t tests. Class III malocclusion and negative overjet were improved by means of skeletal changes in conjunction with upper incisor proclination and lower incisor retroclination in both groups. Maxilla and surrounding soft tissues (SNA, Ls-E, and Ls-PMV) were significantly moved anteriorly with less rotation of the palatal plane in the MMP group. Mandibular incisors were found to be more retrusive in the FM/RME group (p = 0.024). Both groups showed similar effects except more anterior movement of the maxilla and surrounding soft tissues with less rotation of the palatal plane and retrusion of lower incisors in the MMP group. This is the first study to compare the soft and hard tissue changes induced by MMP appliance with a conventional FM /RME.