Lip Incompetence Research Articles

Maximum voluntary molar bite force in subjects with malocclusion: multifactor analysis.

ObjectiveThis study was performed to determine the maximum voluntary molar bite force (MVMBF) in relation to age, sex, lip competency, midline shifting, dental and skeletal malocclusion, overjet, overbite, and crowding.MethodsOne hundred Saudi patients with orthodontic malocclusion aged 14 to 25 years (51 male and 49 female patients) were investigated in this cross-sectional study. The baseline MVMBF on the right and left side was evaluated in all patients before commencing any orthodontic treatment. The MVMBF was registered with a portable occlusal force gauge in the first molar region during maximal clenching.ResultsThe MVMBF significantly varied with respect to all nine confounding variables. The MVMBF significantly increased with an age of >18 years, male sex, right-side lip competency, no midline shift, dental and skeletal Class I malocclusion, normal overjet, normal overbite, and mild crowding.ConclusionAll nine variables examined in the present study significantly influenced the MVMBF.

Correction of post-traumatically scarred upper lip with hyaluron filler

Introduction. It is generally known that dermal fillers are widely used in anti-aging medicine, to provide volume in healthy skin and mucous tissue. Fillers can also be successfully used with concave scars in order to lift the tissue and to give third dimension to the retracted skin surface. The aim of this case report was to show successful non-surgical treatment with hyaluron filler of the post-traumatically deformed upper lip. Case outline. We report a case of a woman with asymmetric partly incompetent upper lip, after trauma and primary surgical reconstruction. After almost 12 years, reconstruction with hyaluron filler was performed, using linear retrograde and bolus technique. Conclusion. Presented case correction of the posttraumatic scar of the upper lip illustrates that good aesthetic results could be achieved with hyaluron fillers.

Single phase correction of tongue thrust habit alongside fixed orthodontic treatment for closure of spaced dentition and midline diastema in a male patient with class I malocclusion without need for a two phase appliance therapy - A case report

Maxillary midline diastema is one of the most frequently encountered esthetic problems in mixed and permanent dentition. Several causes have been attributed to the midline diastema, including developmental, pathologic or iatrogenic. It can also be seen as a transient malocclusion in which case any intervention is contraindicated. A wide range of possible treatments like restorative procedures, composite build up, surgeries (frenectomies) can be done, based on etiology. Thus, correct diagnosis of etiology and specific early intervention plays a major role in deciding the treatment plan.Class I malocclusion is one of the most common problems around the globe affecting around one-third of the patients who come for orthodontic treatment. This case report evaluates the management of Class I malocclusion with spaced dentition and a tongue thrusting habit in a male patient with the help of a single phase appliance therapy without the need for 2 phase correction, i.e, 1st the correction of tongue thrusting with the help of a habit breaking appliance followed by Fixed appliance therapy with braces. This modality not only saves time, but also promotes faster habit breaking as intervention is done in the earlier stages of life when the patient is still growing. Severe maxillar incisor proclination with a convex Orthognthic facial profile, increased mandibular plane angle, incompetent lips and increased overjet was observed on clinical and cephalometric analysis. Orthodontic treatment resulted in a marked improvement of the patient’s smile and a remarkable increase in self-confidence and quality of life. The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with fixed appliance therapy.

Rhinoplasty, septoplasty and genioplasty with fixed orthodontic mechanotherapy for non-surgical correction of a patient with “Long face syndrome” Having a class III malocclusion on a class II skeletal jaw base - A case report

This case report emphasizes on the management of a male patient having a Long Face Syndrome and a unique malocclusion with a Class III dental malocclusion over a Class II Skeletal Base. This patient showed the presence of an increased lower anterior facial height with the chin deviated slightly towards the left. The patient also complained of difficulty in breathing and presented with a history of Deviated Nasal septum and Nasal Polyps. This case was corrected non surgically merely by employing simple mechanics with the help of Fixed Orthodontic Mechanotherapy by extracting both the mandibular 1 premolars followed by retraction and closure of spaces. After Orthodontic treatment was completed, a Septoplasty was performed to correct the deviated nasal septum and the nasal polyp was excised thus addressing the difficulty in breathing experienced by the patient. Both Septoplasty and Polyp removal were performed using Non Invasive FESS (Functional Endoscopic Sinus Surgery). This was followed by Rhinoplasty for correction of nasal contour of the patient. Lastly, 2 types of Genioplasties were performed to correct the backwardly positioned chin, to reduce the vertical height of the chin and also to correct the deviated chin position. Following fixed orthodontic treatment and minor surgical procedures, marked improvement in patient's smile, facial profile and lip competence were achieved and there was a remarkable increase in the patient's confidence and quality of life The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with fixed appliance therapy. The Long Face of the patient was corrected merely by minor elective surgical procedures, thus eliminating the need for a major surgery. Total treatment duration was 18 months.

Correction of bimaxillary dentoalveolar protrusion in a growing male with class I malocclusion by extraction of premolars and profile improvement using conventional fixed orthodontic treatment- A case report on orthodontic camouflage

This case report evaluates the management of a Bimaxillary Dentoalveolar protrusion with a Class I malocclusion in a male patient with extraction of 1 premolars for correction of the prognathic profile of the patient. Clinical and cephalometric evaluation revealed skeletal Class I malocclusion with crowding with a convex facial profile, a Horizontal growth pattern, potentially incompetent lips, a posterior divergent face, average overjet and overbite. Following fixed orthodontic treatment by removal of 1 premolars in the upper and lower arch with retraction of anterior segment , a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with Fixed appliance therapy.

TREATMENT OF CLASS I MALOCCLUSION WITH MILD CROWDING AND MIDLINE SHIFT

ABSTRACT Background: The main goal of orthodontic treatment is to obtain a normal relationship of the teeth with facial structures and it is generally accepted that orthodontic treatment will have effects on facial proportion. Nowadays, facial appearance has a big influence on someone's appearance. Aesthetic facial appearance will produce a proportional, harmonious, and youthful facial profile. Case: this case report aims to describe that non extraction orthodontic treatment in class I malocclusion with mild crowding and mildline shift is a treatment with considerable success. Case management: A 19 years old female came with a chief complaint of crowding in upper and lower jaw. Intraoral examination revealed bilateral Class I molar and canine relationship. Patient had crowding in upper and lower jaw, and midline shift in lower jaw. Extra oral findings included a flat profile with competent lips. Cephalometric analysis showed skeletal class I with orthognati maxilla and mandible. Patient was bonded with 0.022-inch MBT brackets orthodontic appliance without extraction. After 20 months of treatment, an ideal arch coordination was achieved, the patient felt confident and satisfied with the treatment outcome. Conclusion: Decision to extract a tooth has to be made, not only by considering the amount of crowding, but also the eventual influence of orthodontic tooth displacement on the soft tissue surface of the face. Keywords: Crowding, Midline shift, Non – extraction.

Electromyographic Comparison of Lips and Jaw Muscles between Children With Competent and Incompetent Lips: A Cross Sectional Study.

This cross-sectional study evaluates the electromyographic (EMG) activity of lips and anterior temporalis muscles of children with competent or incompetent lips. Forty children were classified clinically according to their lip competence into two groups of 20 each: 1) competent lips group (CLG), and 2) incompetent lips group (ILG). Surface EMG activity of the superior orbicularis oris (SOO), inferior orbicularis oris (IOO), and anterior temporalis (AT) muscles was recorded with the children seated in the upright position during the following tasks: 1) at rest; 2) speaking; 3) swallowing; 4) puffing out the cheeks. ILG showed lower EMG activity than CLG in the SOO and IOO muscles at rest, similar activity in both muscles during speaking, similar activity in the SOO muscle and lower in the IOO during swallowing. ILG showed significantly higher activity than CLG in both muscles while puffing out the cheeks. In the AT muscle, ILG showed lower activity than CLG at rest, during speaking and swallowing, whereas activity was similar while puffing out the cheeks. The difference in EMG activity recorded in children with incompetent lips and with competent lips suggests that the status of their musculature could affect the position and stability of their upper/lower anterior teeth.

Prevalence of Malocclusion and Occlusal Traits in Children with Autism Spectrum Disorders.

BackgroundThe purpose of this cross-sectional study was to evaluate the prevalence of malocclusion in children with autism spectrum disorders (ASDs) and to determine the most common occlusal traits.Materials and MethodsThe present cross-sectional study was conducted among 7–15 years old children with ASDs and randomly selected healthy children with the same demographic characteristics. Molar relationship, lip incompetence, overbite, overjet, midline deviation, crossbite, and crowding/spacing were recorded. A descriptive analysis was performed for all variables. A comparison of the presence or absence of malocclusion traits between children with and without ASDs was assessed using the chi-square test. Univariate and multivariate logistic regressions were used to calculate odds ratio (OR) and 95% confidence intervals (95% CI) to assay various parameters between autism and non-autism group.ResultsA total of 96 patients were assessed, 47 patients in the ASD group, and 49 in the control (non-ASD) group. The results showed no significant difference between the ASD and control groups in terms of the overall prevalence of malocclusion (P>0.05). However, the prevalence of increased overjet and Class II molar relationship was significantly higher in the ASD group compared to the control group (P=0.03). Patients in the control group showed a higher prevalence of midline deviation (P=0.001).ConclusionDespite a higher prevalence of overjet and Class II molar relationship in children with ASDs, the prevalence of malocclusion was not higher in this group of patients.

“TRIPLET APPROACH”- COMBINATION OF ORTHOPEDIC, MYOFUNCTIONAL AND FIXED MECHANOTHERAPY

Abstract-
 A 13 year old female patient came to our department with chief complain of excessive gum show. On Clinical examination patient presented with convex facial profile, obtuse nasolabial angle, mesocephalic, mesoprosopic, incompetent lips and increased interlabial gap. Intraorally she had class II canine and molar relation bilaterally with crowding irt 31, 32, 33, 41, 42, 43. Patient was really concerned about her facial profile. So we decided to manage the same with triplet approach i.e the combination of orthopedic, myofunctional and fixed mechanotherapy. The total treatment time was 28 months which include 13 month phase I therapy and 15 months phase II therapy and the results were exuberant.

The short evaluation of orofacial myofunctional protocol (ShOM) and the sleep clinical record in pediatric obstructive sleep apnea

IntroductionMultiple anatomic and functional risk factors contribute to Obstructive Sleep Apnea (OSA) in children, most of the screening tools only evaluate clinical symptoms. The aim was to describe the evaluation of the short orofacial myofunctional protocol (ShOM) in OSA children, and to analyze if the inclusion of orofacial myofunctional aspects would influence the screening sensitivity/specificity of the Sleep Clinical Record (SCR). MethodsChildren from Brazil and Italy with sleep disordered breathing were evaluated by full night polygraphy, the SCR and the ShOM. For the analysis of the correlations, we normalized the distribution of the children based on the percentiles of the Apnea and Hypopnea Index (AHI). The children were divided in: Group1: first percentile AHI up to25% (cut-off value: AHI≤1.9); Group 2: second percentile from 25% to 75% (cut-off values: 1.9˂AHI≤7.9); Group3: third percentile AHI˃75% (cut = off value: AHI˃7.9). The findings of SCR and ShOM were compared for each group. ROC curve of the sensitivity and specificity of OSA diagnosis were compared for SCR alone and the combined results of SCR plus ShOM. Results86 children, 47 girls, 4–11 years, were included, 34 children were obese and 20 overweight. OSA severity and obesity showed a positive correlation (p = 0.04). Mean ShOM score was 5.64 ± 2.27, with a positive correlation to the SCR (p = 0.002). In Group1, the SCR showed more nasal obstruction, arched palate and OSAS score/positive Brouilette questionnaire and the ShOM scored more alterations to breathing mode, breathing type (p = 0.01) and lip competence. In Group 3, we found more tonsillar hypertrophy, Friedman tongue position alteration (p < 0.001), malocclusion and obesity at SCR and more alterations in tongue resting position, tongue deglutition position and malocclusion at ShOM. ConclusionsThe myofuntional evaluation contributed to the screening of OSA in children, while alterations of the tongue (resting and deglutition position) were observed in children with the highest AHI percentile. The combination of SCR and ShOM improved the sensitivity and specificity for the identification of pediatric OSA when compared to SCR alone.

Management of a Skeletal Class II Malocclusion Using 2-Phase Treatment: An Indian Board of Orthodontics Case Report

PK, a 12-year-old female patient, was diagnosed with skeletal Class II due to retrognathic mandible, average growth pattern, Angle’s Class II, Division I malocclusion with Class II canine relation, mild upper anterior spacing, upper anterior proclination, uprighted lower anterior, lingually tipped 35, increased overjet and overbite, scissor bite Irt 24, 25, acute nasolabial angle, tongue thrust habit, incompetent lips, and lower lip trap. The nonextraction approach to orthodontic treatment was involved. The skeletal malocclusion was corrected using the twin-block appliance, followed by upper and lower pre-adjusted edgewise appliances (0.022 × 0.028 slot) with the MBT prescription.

Bimaxillary protrusion and gummy smile treated with clear aligners: Closing premolar extraction spaces with bone screw anchorage

Inadequate posterior anchorage is a serious limitation for aligner treatment involving extraction of four first premolars. Inappropriate axial inclinations may compromise intermaxillary occlusion and stability. OrthoBoneScrew® (OBS) anchorage is designed to augment the Invisalign® clear aligner G6 solution to produce more predictable outcomes as illustrated by the current case report. An 18-year-old female presented with two chief complains: (1) Protrusive, incompetent lips, and (2) excessive gingival exposure when smiling (“gummy smile”). Clinical evaluation revealed bimaxillary protrusion, hypermentalis activity, anterior crowding, and excessive anterior axial inclinations, particularly of the lower incisors (116°). The American Board of Orthodontic (ABO) discrepancy index (DI) was 21. The treatment plan was extraction of all four first premolars, and clear aligner (Invisalign®) therapy anchored with four OBSs: Infra-zygomatic crest (IZC), and between the roots of the upper central and lateral incisors (Incisal) bilaterally. Eighteen months of initial treatment with 45 aligners retracted and intruded the anterior segments in both arches by closing the extraction spaces with supplemental anchorage provided by IZC and Incisal OBSs. The final series of 20 refinement aligners achieved an excellent outcome as evidenced by an ABO cast-radiograph evaluation (CRE) score of 10, and a pink and white (P&amp;W) dental esthetic score of 3. Post-treatment analysis revealed multiple opportunities for improvement. The patient was well satisfied with the final outcome.

Deep slow nasal respiration with tight lip closure for immediate attenuation of severe tics

BackgroundSevere intractable tics, which are associated with Tourette syndrome and chronic tic disorder (TS/CTD), severely affect the quality of life. Common less-invasive treatments are often unable to attenuate tics with deep brain stimulation currently being the only effective treatment. We aimed to assess the anti-tic effect of deep slow nasal respiration with tight lip closure using patients with TS/CTD. MethodsWe retrospectively analyzed 10 consecutive patients (9 men, 1 woman; 23–41 years old). We instructed the patients to perform the procedure for 120 s and to obtain a video recording of before and during the procedure. The videos were used to count tics and determine lip competency or incompetency. The counted tics were rated using the modified Rush Video Rating Scale. ResultsCompared with before the procedure, there were significantly lower frequencies of motor and phonic tics, as well as video scored, during the procedure. Eight patients presented with lip incompetency before the procedure and none after the procedure (P = 0.041). There were no side effects associated with the procedure. ConclusionOur findings indicate that deep slow nasal respiration with tight lip closure ameliorates tics in patients with TS/CTD. In accordance with our results, lip opening and oral breathing could be causes of tics, in addition to heritability. Therefore, this novel procedure could improve tics. Furthermore, our findings could contribute toward the development of tic treatments and elucidate their pathophysiology regarding the reward system, hypersensitivity, autonomic nerves, and nasal airway.

The relation of severe malocclusion to patients' mental and behavioral disorders, growth, and speech problems.

SummaryBackgroundSevere malocclusions appear in up to 20 per cent of the population. Many neuropsychiatric diseases are likely to have a neurodevelopmental, partially genetic background with their origins as early as fetal life. However, the possible relationship between neurodevelopmental disorders and severe malocclusions is unclear. The aim of this study was in a population-based setting (270 000 inhabitants) to investigate whether patients with severe malocclusions have more mental and behavioural disorders and growth or speech problems than controls without severe malocclusion.Material and MethodsThe study group consisted of patients from the Espoo Health Care Center, Finland, born in year 2000, who were retrospectively screened for their medical and dental records, including their possible mental and behavioural disorders (i.e. attention deficit hyperactivity disorder, Asperger’s syndrome, autism, mood disorder, or broadly defined behavioural abnormalities, learning problems, mental disorders, sleep disturbances, anxiety symptoms, depressive symptoms, and eating-related symptoms) and their need of orthodontic treatment according to the Treatment Priority Index (TPI). The study group consisted of a severe malocclusion group (n =1008; TPI 8–10) and a control group (n = 1068) with no severe malocclusion (TPI 0–7).ResultsPatients with severe mandibular retrognatia (P < 0.000), lip incompetence (P = 0.006), or neurodevelopmental disorders (mental and behavioural; P = 0.002) were found to have significantly more speech problems than the controls. The patients with severe malocclusions were leaner, that is, body mass index (kg/m2) <17, underweight; 17–25, normal weight; >25, overweight) than controls (P = 0.003), and underweight patients had a significant association with retrognathic maxilla (P < 0.000) compared to normal or overweight patients. No significant relationship between neurodevelopmental disorders and severe malocclusions, that is, retrognatia of maxilla, hypodontia, and severe dental crowding was observed.ConclusionOur results indicate that patients with severe mandibular retrognatia, lip incompetence, or neurodevelopmental disorders were found to have significantly more speech problems than controls. During orthodontic treatment of patients with severe malocclusion, special attention should be paid to patients with severe mandibular retrognatia, lip incompetence, and speech problems to detect signs of possible neurodevelopmental disorders and record if potential follow-up measures are in place.

Clear aligner therapy for adult patient - A case report

Clear aligner therapy for adult patient - A case report - IJODR- Print ISSN No: - 2581-9356 Online ISSN No:- 2581-9364 Article DOI No:- 10.18231/j.ijodr.2020.009, IP Indian Journal of Orthodontics and Dentofacial Research-IP Indian J Orthod Dentofacial Res

Dental Trauma Experience, Attitudes and Trauma Prevention in 11- to 13-Year-Old Lithuanian Schoolchildren.

To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports. A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed. Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet. In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed.

Case Report: Orthosurgical Management of Skeletal Class III Malocclusion

VG, 25-year-old male, presented with c/c of forwardly placed lower jaw and history of unsatisfactory previous orthodontic treatment. Extraorally, the patient had asymmetrical face and concave profile, competent lips, positive lip step, and chin deviated toward left side by 2 mm. Intraorally, the patient had Angle’s class III type 3 malocclusion with an overjet of (–1) mm, overbite of 0%, and cross-bite wrt 12, 21. The patient was skeletal class III due to macrognathic and prognathic mandible with hypodivergent growth pattern, and proclined upper and retroclined lower incisors. The patient was managed orthosurgically with bimaxillary surgery (maxillary advancement 3 mm + mandibular setback 7 mm) after presurgical decompensation. The case report discusses in detail the diagnosis and comprehensive management of the skeletal class III case.

Effects of Age, Sex, Disease, and Exercise Training on Lip Muscle Strength

Lip muscle strength has been shown to influence daily functional activities such as facial expression, speech production, and eating. In this review, recent literature regarding lip strength and exercise training responses are summarized, highlighting the influence of sex, age, and disease (e.g., stroke). A search using five electronic databases was conducted. Twelve studies were identified from the search, which included five studies using healthy adults and seven studies using patients with diseases or chronic ailments. Regardless of the population, lip strength training multiple times a day for a relatively short term (&lt;24 weeks) has resulted in improvements of lip muscle strength. This change in lip strength has been observed in both young and old participants. Although changes in strength have been observed in both men and women, we are unaware of any studies that have tested whether there are sex differences in this response. The same directional change can be expected for patients with stroke and patients with lip incompetence, but the magnitude of the training effect seems to be higher in healthy people.

Prevalence and Occlusal Risk Factors for Fractured Incisors among 11-12-Year-Old Children in the Trinidad and Tobago Population.

This cross-sectional survey was carried out to ascertain the prevalence of fractured incisors in 11–12-year-olds. In addition we explored the relationship with overjet, incompetent lips, incisor inclination and to determine if there was any association with ethnicity and gender. All permanent incisors were examined in 672 children comprising 356 females (53.1%) and 315 males (46.9%). The sample comprised 11–12-year-olds in high schools across Trinidad and Tobago. Statistical analysis was undertaken using Chi-square test, independent t-test, and binary logistic regression. The prevalence of fractured incisors was 18.9%. Boys presented with an increased incidence of fractured incisors than girls. 86.3% of dental trauma was untreated. The average overjet of subjects with fractured incisors was 4.2 mm. 18.62% of subjects with fractured incisors had incompetent lips. The most common malocclusion (18.81%) with fractured incisors was class 2 division 1. The Afro-Trinidadian ethnicity had the highest prevalence of fractured incisors (11.0%) when compared to mixed ethnicities, which was statistically significant. Maxillary central incisors were the most commonly injured teeth. Most patients delayed in seeking dental treatment for fractured incisors in our population. Early orthodontic treatment is recommended to help reduce the risk of dental trauma.

Do malocclusions affect oral health related quality of life?

Design A prospective interdisciplinary, multi-centre, cohort study.Cohort selection A total of 250 patients were recruited from three university departments of orthodontics and one orthodontic dental practice. The cohort size was decided by a sample size calculation performed and the participants were selected over 14 months. Four psychological questionnaires were used, each targeting specific psychological characteristics, combined with orthodontic assessments. Only questionnaires in English, with German translations, were chosen for international comparability. The COHIP-19 was used to assess Oral Health Related Quality of Life (OHRQoL), the KIDSCREEN-10 index was used to assess HRQoL, the RSES was used to assess self-esteem and the SDQ was used for behavioral problems. To record the orthodontic parameters, standardised orthodontic diagnosis consisted of detailed anamnesis, functional diagnosis, extra-oral photos, an orthopantomogram, lateral cephalomentrics and plaster impressions. The same assessor examined the questionnaires and the orthodontic measurements.Data analysis Statistical programme (SPSS) was used to assess the data. Simple linear regression models were tested to assess the predictive values of all the specific orthodontic parameters individually (= predictors) on the COHIP-G19 (= criterion). Further to this, multiple linear regression analysis was used to assess which of the independent predictors can be assessed in combination to relate to OHRQoL.Results The questionnaire was completed by 248 participants. From the simple linear regression, there was a statistically significantly impact on COHIP-G19 score in patients with competent lip closure, straight chin position, little-index-upper, overjet, overbite and ANB.For the multiple linear regression analysis, age, KIDSCREEN-10 index, RSES, SDQ and all six orthodontic parameters that had a statistically significant impact on COHIP-G19 (P <0.05) in the simple linear regression were assessed. Of these five (SDQ, KIDSCREEN-10, overjet, little-index-upper and overbite) parameters resulted in a multi-linear regression model that was statistically significant and explained 32.3% of the total variance in OHRQoL. Adding additional parameters did not significantly improve the R2-change.Conclusions Further longitudinal studies are required to investigate if the treatment of these malocclusions also improves the OHRQoL of children and adolescents.