Soft Tissue Profile Changes Research Articles

Soft Tissue Changes after Orthognathic Surgery: A Study

Aim and objective: The main aim and objectives of this study was to determine the changes in the facial soft tissue profile following orthognathic surgery, to evaluate eventual treatment effects on stability of facial aesthetics and degree of predictability of these changes.
 Materials and method: 15 numbers of patients underwent with le fort I, anterior maxillary osteotomy, genioplasty and bimaxillary surgery. The alar base cinch suture and the V-Y closure techniques were used in each maxillary procedure. The criteria applied included an average follow-up of 6 months post-operatively.
 Results: In this study preoperative and postoperative cephalometric tracing were compared to analyze the soft tissue profile changes in relation to hard tissue changes in both upper and lower lip and chin regions after double jaw surgery. Only horizontal changes were analyzed for which an X-Y coordinate system was used. The upper lip responded variably to the direction and amount of maxillary positioning. The predictability and the significance of changes of soft tissue in relation to hard tissue are variable as it reaches towards the nose.
 Conclusion: It is important for the clinician to realize that numerous factors of variability exist so that he can understand that the soft-tissue profile will sometimes deviate quite markedly from what is expected, in spite of careful planning.

Dentoskeletal and Soft Tissue Profile Changes Associated with Mandibular Setback Osteotomy: A Cephalometric Study

Dentoskeletal and Soft Tissue Profile Changes Associated with Mandibular Setback Osteotomy: A Cephalometric Study

A longitudinal three-center study of craniofacial morphology at 6 and 12 years of age in patients with complete bilateral cleft lip and palate

In this longitudinal study, the craniofacial morphology and evaluated soft tissue profile changes, at 6 and 12 years of age in patients with complete bilateral cleft lip and palate (CBCLP) were compared. Lateral cephalograms from 148 patients with CBCLP, treated consecutively at three European cleft centers, Gothenburg (n A = 37), Nijmegen (n B = 26), and Oslo (n C = 85), were evaluated. Eighteen hard tissue and ten soft tissue landmarks were digitized. Paired t test, Pearson’s correlation coefficients, and multiple regression models were applied for statistical analysis. ANOVA and Tukey-B, as a post hoc test, were used to evaluate the increments and compare centers. Hard and soft tissue data were superimposed using the generalized Procrustes analysis. For Nijmegen, the increments of the variables SNA, ANB, SN-NL, SN-ML, NL-ML, Snss, and Snpg were significantly different than the two other centers (p = 0.041 to <0.001). SNPg increments were significantly different between Nijmegen and Oslo (p = 0.002). The three cleft centers followed different treatment protocols, but the main differences in craniofacial morphology until 12 years of age were the growth pattern and the maxillary and upper incisor variables. Follow-up of these patients until facial growth has ceased, which may elucidate components for improving treatment outcome.

Factors Influencing the Accuracy of Cephalometric Prediction of Soft Tissue Profile Changes Following Orthognathic Surgery

The cephalometric prediction of orthognathic treatment outcome is an important part of the surgical planning and the process of informed consent. The orthodontic and surgical changes must be described accurately prior to treatment in order to assess the treatment's feasibility, to optimize case management and to increase patient's understanding and acceptance of the recommended treatment. The aim of the present article was to investigate on the factors that could influence the accuracy of cephalometric prediction in planning orthognathic surgery. Review of the literature revealed that, besides factors directly related to the prediction method and its use, there exist a considerable number of factors which could affect significantly the accuracy of soft tissue response. These factors could be biological ones such as relapse, centre of mandibular rotation and individual variation in response to treatment and others such as gender, race, pre-operative soft tissue thickness and data bases for mean ratios of soft to hard tissue movement changes. Some of the factors affecting the accuracy of prediction of soft tissue response following orthognathic surgery are inevitable and there are others, difficult to control and predict. However, patients should be informed that predictions are only a guide, may not represent the actual result of the surgical outcome, and as such they should be implemented.

Residents’ journal review

Residents’ journal review

Soft tissue profile changes after rapid maxillary expansion with a bonded expander

The aim of this study was to evaluate the short- and long-term treatment effects of rapid maxillary expansion (RME) on the soft tissue facial profile of subjects treated with a modified acrylic-hyrax device. The sample comprised 10 males and 10 females in the mixed dentition. Their average age was 9.3 years ± 10 months pre-treatment (T1), with a narrow maxilla and posterior crossbite, treated with a modified fixed maxillary expander with an occlusal splint. Lateral cephalometric radiographs obtained at T1, immediately post-expansion (T2), and after retention (T3) were used to determine possible changes in the soft tissue facial profile. The means and standard deviations for linear and angular cephalometric measurements were analysed statistically using analysis of variance and Tukey's test (α = 0.05). The measurements at T2 differed significantly from those at T1 and T3. However, RME did not produce any statistically significant alteration (P > 0.05) in the soft tissue profile for any of the cephalometric landmarks evaluated when compared at T1 and T3. The use of a fixed expander associated with an occlusal splint did not cause significant alterations in the soft tissue facial profile at T3. This modified device is effective for preventing the adverse vertical effects of RME such as an increase anterior face height in patients with a crossbite.

Retrospective Analysis of Nasal Soft Tissue Profile Changes With Maxillary Surgery

The aim of this study was to analyze the changes in the position of the nasal and labial soft tissue profile of patients undergoing bimaxillary orthognathic surgery, with special emphasis on the effect on the nasal tip projection. The lateral cephalometric radiographs of 27 consecutive patients (16 female and 11 male patients; mean age, 22 years) who had undergone maxillary advancement and mandibular setback were studied. The pretreatment and end-of-treatment lateral cephalometric radiographs were selected. The pretreatment and end-of-treatment radiographs were superimposed on the sella-nasion plane, and the case was only included if there had been no change in sella-nasion length (ie, no growth). Analyses of Pearson correlation coefficient and stepwise linear regression tests were used to compare the cephalometric measurements at the beginning and at the end of treatment. Paired-sample t tests were also performed to analyze changes in nasolabial angle (NLA) and columella-lobular angle (CLA). The correlations between vertical movement of nasal tip, A-point, and maxillary incisal tip were important. Although there was an important correlation between nasal and incisal tip, interestingly, there was no correlation between nasal tip and A-point in horizontal movement. According to stepwise linear regression analysis, the best model for horizontal movement of nasal tip was as follows: Nasal anteroposterior movement = 0.241 + 0.188 × Incisal tip anteroposterior movement + 0.153 × Incisal tip superoinferior movement. For vertical movement of nasal tip, the best model was as follows: Nasal superoinferior movement= -1.117 + 0.399 × Incisal tip superoinferior movement + 0.323 × A-point anteroposterior movement. There was no significant relation in angular measurements of NLA and CLA before and after treatment. The results of our study suggest that both horizontal and vertical movements of nasal tip were related to incisal tip and A-point movements; however, angular changes in CLA and NLA did not affect the nasal tip.

Hard and soft tissue profile changes before and after treatment in severe maxillary protrusion —Comparison of surgical orthodontic treatment using maxillary anterior alveolar osteotomy and orthodontic treatment alone with extraction of maxillary molars

"Hard and soft tissue profile changes before and after treatment in severe maxillary protrusion —Comparison of surgical orthodontic treatment using maxillary anterior alveolar osteotomy and orthodontic treatment alone with extraction of maxillary molars." Orthodontic Waves, 70(1), p. 48

Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Setback: A Systematic Review

To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation. A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion. The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long term. The upper lip showed mainly protrusion, but the amount was highly variable. This systematic review shows that evidence-based conclusions on soft tissue changes are difficult to draw. This is mostly because of inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measurements. Well-designed prospective studies with sufficient samples and excluding additional surgery, ie, genioplasty or maxillary surgery, are needed.

Effects of the functional regulator III on profile changes in subjects with maxillary deficiency

The aim of this study was to determine the hard and soft tissue profile changes in Class III malocclusion subjects following functional regulator III (FR-3) treatment. The material comprised the cephalometric films of 15 patients (11 males and four females; mean ages 10.22 and 10.44 years, respectively) with a Class III malocclusion and a concave profile treated with the FR-3, and a control group of 15 subjects (11 males and four females; mean ages 10.39 and 10.27 years, respectively) with a Class I malocclusion matched for chronological age and observation period with the study group. Fourteen linear and seven angular measurements were measured on the cephalometric films taken before (T1) and after (T2) treatment/observation. The results of the Student's t-test showed that the treatment group had a concave facial profile when compared with the controls. At the end of treatment, the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001 and P < 0.01, respectively), whereas mandibular growth was restricted. The vertical dimensions increased, the upper incisors proclined, and the lower incisors retroclined significantly (P < 0.001). The FR-3 appliance produced significant improvements in the hard and soft tissues of Class III subjects with a concave profile.

Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Advancement: A Systematic Review

The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5 years for WF. The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were 50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the soft tissue pogonion to pogonion in BSSO with RIF; they tended to be greater than a 1:1 ratio. The upper lip mainly showed retrusion but with high variability. Despite a large number of studies on the short- and long-term effects of mandibular advancement by BSSO, the results of the present systematic review have shown that evidence-based conclusions on soft tissue changes are still unknown. This is mostly because of the inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measures. Well-designed prospective studies with sufficient sample sizes that have excluded patients undergoing additional surgery (ie, genioplasty or maxillary surgery) are needed.

Soft tissue profile changes following maxillary protraction in Class III subjects

The dentoskeletal effects of maxillary protraction (MP) therapy have been extensively investigated, while those relating to soft tissue profile changes are limited. Thus, the aim of this study was to determine the degree of soft tissue profile changes following MP therapy. The material consisted of the cephalometric films of 24 female subjects (12.69 +/- 1.08 years) with a Class III malocclusion who underwent MP therapy; these were compared with a control group of 15 females (12.13 +/- 0.63 years) with a Class I occlusion and matched for chronological age and observation period. Cephalometric films were available for all subjects before (T1) and after (T2) treatment/observation. The initial measurements and treatment/control changes were compared between the groups by means of a Student's t-test. The subjects in the MP group had a concave facial profile when compared with the controls. Comparison of the changes induced by MP therapy showed that the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001), whereas the mandible and surrounding soft tissues showed a backward and downward rotation. The improvement in facial profile predominantly resulted from maxillary soft tissue changes and mandibular hard tissue changes. The concave soft tissue profiles of the Class III subjects were corrected by anterior movement of the maxilla and a concomitant increase in the fullness of the upper lip. The concave skeletal profiles were, however, corrected mainly by backward and downward rotation of the mandible.

Camouflage treatment in adult skeletal Class III cases by extraction of two lower premolars

Objective: The purpose of this study was to evaluate the dentoskeletal and soft tissue profile changes after extraction of two lower first or second premolars in “borderline” adult skeletal Class III cases. Methods: Twenty-eight patients with “borderline” skeletal Class III malocclusion were studied. All of them were treated by extraction of two lower first or second premolars. Lateral cephalometric radiographs taken at the start and end of treatment were analysed. Twenty-five cephalometric variables were calculated and paired t-tests were performed. Results: After treatment, no significant changes were noted in the skeletal parameters (p ≥ 0.05). Regarding the dental parameters, the L1-MP angle decreased by 8.1˚, the U1-L1 angle increased by 7.7˚ (p ＜ 0.01), the overjet distance increased by 5.7 mm (p ＜ 0.01), the L1-NB angle decreased by 7.3˚ and the L1-NB distance decreased by 4.8 mm (p ＜ 0.01). The soft tissue parameters of Li-E, Li-H and Li-RL2 distance decreased by 3.2 mm, 3.4 mm and 4.1 mm respectively (p ＜ 0.01). Conclusions: Orthodontic camouflage treatment by extraction of two lower first or second premolars provides a viable treatment alternative for “borderline” skeletal Class III cases to achieve a good occlusal relationship. (Korean J Orthod 2010;40(5):349-357)

Changes in soft tissue profile and electromyographic activity after activator treatment

Abstract Background To date, few studies have correlated the changes in muscle activity and specific soft tissue variables in adolescents with malocclusions. Objective To determine associations between the soft tissue profile and electromyographic activities in temporalis, masseter and orbicularis oris muscles in children with Class II division 1 malocclusions treated with activators. Methods For this prospective study, 25 subjects with Class II division 1 malocclusions were randomly assigned to either a Treatment group (N = 15) or a Control group (N = 10). The mean skeletal ages of the subjects in the Treatment and Control groups were 11.3 ± 1.1 and 11.0 ± 1.3 years, respectively. The subjects in the Treatment group were treated with activators and the subjects in the Control group were untreated. Lateral cephalometric radiographs and EMG recordings of the anterior temporalis and masseter muscles during clenching, chewing and swallowing and the orbicularis oris muscle during whistling were obtained at the start of the study and 12 months later. Changes in the soft tissue profile were correlated with changes in the EMG activities in anterior temporalis, superficial masseter and orbicularis oris muscles. Results The upper lip to E line distance (UL-E) decreased more in the Treatment group than the Control group (p &lt; 0.05) and the H angle decreased in the Treatment group, but increased in the Control group (p &lt; 0.01). The EMG activities of temporalis and masseter muscles increased significantly in both groups. All between-group EMG differences were statistically significant with the exception of the activities in the temporalis and masseter muscles during swallowing. In the Treatment group, a significant positive correlation (r = .57) was found between the changes in UL-E and anterior temporalis activity during swallowing, and significant negative correlations were observed between the EMG activity of masseter muscle during swallowing and changes in LL-E (r = -.54), OLp-UL (r = -.55) and OLp-LL (r = -.67). Conclusions Activator therapy is accompanied by changes in the lips and temporalis and masseter activities during swallowing.

Longitudinal profile changes in an Anatolian Turkish population

The goal of this study was to assess longitudinal changes in the facial soft tissue profile in relation to age and gender in young Anatolian Turkish subjects. A total of 30 subjects (15 females and 15 males) with an Angle Class I occlusal relationship and normal antero-posterior (ANB, 2-4 degrees) skeletal relationships were selected from the archive of Dicle University. All subjects were of Anatolian Turkish heritage, and none had any apparent facial disharmony or had undergone orthodontic therapy. Lateral cephalometric radiographs taken at T1 (mean age 8.8 years), T2 (mean age 13.8 years), and T3 (mean age 17.8 years) were separately investigated. Non-gender-specific research was also carried out at the same time periods. In total, 24 measurements were analysed longitudinally. Differences between the genders were determined using independent t-tests. Repeated measures analysis of variance tests were used to evaluate repeated measurements, and paired sample t-tests to compare inside effects between the genders. Significant increases (P < 0.05) were found with age for both females and males. Generally, the increases were greater in males than in females. Nasal prominence increased more than chin prominence, resulting in a tendency to have convex profiles.

Effects of Flapless Implant Surgery on Soft Tissue Profiles: A Prospective Clinical Study

Flapless implant surgery has been suggested as a suitable treatment modality for the preservation of soft tissue after implant placement. The purpose of this study was to determine the extent of soft tissue profile changes around implants after flapless implant surgery. A total of 44 patients received 76 implants using a flapless implant procedure. The marginal level of the peri-implant soft tissue was evaluated using dental casts 1 week, 1 month, and 4 months after implant placement. The mean soft tissue levels around implants showed 0.7 ± 0.3 mm of coronal growth 1 week after surgery. At 1 month, the levels were 0.2 ± 0.2 mm coronal growth and at 4 months, the values were 0.0 ± 0.3 mm. Soft tissue profiles assessed 4 months after flapless implant placement were similar to profiles assessed immediately before implant placement. Flapless implant surgery is advantageous for preserving mucosal form surrounding dental implants.

The Soft Tissue Profile, Growth And Treatment Changes

Abstract No Abstract Available. *The author gratefully acknowledges the kindness of Dr. B. Holly Broadbent in making available serial cephalometric films from the files of the Bolton Fund, Western Reserve University.

Accuracy of combined maxillary and mandibular repositioning and of soft tissue prediction in relation to maxillary antero-superior repositioning combined with mandibular set back: A computerized cephalometric evaluation of the immediate postsurgical outcome using the TIOPS planning system

The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary antero-superior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic surgical planning system (TIOPS). Out of 100 prospectively and consecutively treated patients, 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and so were included. All patients were managed with rigid internal fixation (RIF) and without intermaxillary fixation (IMF). Preoperative cephalograms were analyzed and treatment plans and prediction tracings produced by computerized surgical interactive simulation. The planned horizontal and vertical hard tissue positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. The mean accuracy of the planned and predicted hard and soft tissue outcome was relatively high varying from 0.0mm to 0.5mm from one cephalometric reference point to another. At the cephalometric reference points where significant differences between planned/predicted, and actually obtained hard and soft tissue positional changes were demonstrated, these significant inaccuracies were, except for the predicted horizontal position of the lower lip, relatively small, varying from 0.2mm to 1.1mm. However, the variability of the predicted hard and soft tissue individual outcome was relatively high. The current study demonstrates from a mean point of view relatively high predictability of the immediate postsurgical hard and soft tissue outcome. However, as the variability of the predicted individual outcome seems to be relatively high, caution should be taken when presenting the planned and predicted hard and soft tissue positional changes to the individual patient, preoperatively.

Changes in soft tissue profile after mandibular setback surgery in Class III subjects

The aim of this study was to investigate changes in hard and soft tissue profile after mandibular setback surgery. Lateral cephalograms of 25 Class III subjects were assessed before and 1.5 ± 0.4 years after mandibular setback surgery. Paired t test, Pearson correlation test and linear regression analysis were used to evaluate the changes in soft tissue profile. Significant changes were found in skeletal (SNB −3.6 ± 0.9°, ANB 3.7 ± 1.0°, overjet 5.0 ± 1.2 and overbite 2.5 ± 1.1 mm, P < 0.001), soft tissue (facial convexity 5.9 ± 1.6°, P < 0.001; labiomental fold 0.6 ± 0.6 mm, P < 0.001; upper and lower lip protrusion 0.5 ± 0.8 mm, P < 0.01; −3.3 ± 1.2 mm, P < 0.001), and upper and lower lip lengths (0.9 ± 1.2 mm, P < 0.01; −1.8 ± 2.1 mm, P < 0.001). Correlations were found between facial convexity and SNB and ANB angles and between upper lip length and SNB and ANB angles. The change in lower lip length was correlated with SNB, ANB, overjet and overbite. Lower lip retrusion was correlated with overjet and a significant correlation was found between the retrusion of lower incisor and lower lip. Mandibular setback surgery was effective in producing an orthognathic profile in adult Class III subjects with mandibular prognathism.

The changes of soft tissue profile in skeletal class II patients with mandibular retrognathy treated by the extraction of maxillary first premolars

The purpose of this research is to measure the change of soft tissue profile, both anteroposteriorly as well as vertically in skeletal class II patients with mandibular retrognathy cases, treated with extraction of the maxillary first premolars. Pre and post treatment result of 16 patient treated with the Standard Edgewise fixed appliance were compared using a Canon D646u series scanner and Corel Draw 12 computer programme, utilizing the TVL line as a plane of orientation. The result was analyzed with a paired t-test. Statistical analysis shows significant anteroposterior and vertical soft tissue changes in facial profile in skeletal class II patients with mandibular retrognathy treated with extraction of maxillary first premolars using the Standard Edgewise fixed appliance, measured with the STCA-VTL method.