Esthetic Facial Profile Research Articles

Evaluation of Anteroposterior Lip Position in Different Skeletal Malocclusions

Introduction: The horizontal position of upper and lower lips have been of great concern when planning a treatment plan of an orthodontic patient, because the purpose of orthodontic treatment is to establish an esthetic facial profile and not just a functional occlusion.
 Objectives: The objective of this research was to determine anteroposterior lip position in three skeletal malocclusion groups and to analyze different soft tissue lines.
 Material and Methodology: This study comprised of eighty one subjects and lateral cephalographs were taken in natural head position. Five reference lines—Sushner, Steiner, Burstone, Holdway, and Ricketts were drawn after radiographs were traced. The linear measurement between the lips and the five reference lines was recorded. For statistical analysis, SPSS 21 was used.
 Results: Using five soft tissue reference lines, a significant difference between the anteroposterior position of the lips in various skeletal malocclusions was discovered.
 Conclusion: The skeletal malocclusion pattern was shown to be related to the sagittal lip positions. For sagittal lip position analysis, Every group of skeletal malocclusions had a different preferred reference lines.

Correction of Severe Skeletal Class II High Angle with Mandibular Retrusion and Gummy Smile by Double-Jaw Surgery.

This report describes the treatment of severe skeletal Class II malocclusion in a young woman with a gummy smile and pronounced lower anterior facial height. Overjet and overbite were +12.0 mm and -1.0 mm, respectively. Cephalometric analysis revealed inferior positioning of the maxilla and severe mandibular retrusion with clockwise rotation. Both the upper and lower anterior teeth showed labial inclination. Based on a diagnosis of a skeletal Class II high angle with mandibular retrusion and a gummy smile, double-jaw orthognathic surgeries for upper and lower premolar extraction were chosen to gain ideal occlusion and an improvement in the esthetic facial profile. Le Fort I osteotomy was performed to move the anterior and posterior teeth upward by 4.0 mm and achieve mandibular counterclockwise rotation. Short lingual sagittal split ramus osteotomy was performed to move the mandible forward by 3.0 mm. As a result, normal overjet and overbite were achieved together with a straight profile and a good smile. After surgery, electromyographic evaluation of anterior temporal muscle activity showed an improvement in the percentage overlapping coefficient value (a symmetric index of bilateral muscle activity) from 28.1% to 63.2% compared to at pre-treatment. The pattern of jaw movement also showed an improvement. These results suggest that orthognathic surgery in skeletal Class II cases can improve not only malocclusion and the skeletal relationship of the jaws, but also masticatory function and jaw movement.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population. Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20years), group II (20 to 39years), group III (40 to 59years), and group IV (over 60years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ2 test, and analysis of variance were used for statistical analysis according to age and gender. The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P=.281) and female (P=.442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank. An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

Posterior bending osteotomy: An effective measure to secure facial symmetry in orthognathic surgery

This study aimed to compare the effectiveness of posterior bending osteotomy and grinding techniques for orthognathic surgery in patients with facial asymmetry. Patients who had undergone Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, and who presented with a menton shift and setback difference exceeding 4 mm, were enrolled. Cone-beam computed tomography was performed before surgery (T0), immediately after surgery (T1), and 6 months after surgery (T2). Overall, 38 patients were included and divided into posterior bending osteotomy (n = 23) and grinding (n = 15) groups.Significant differences were observed between the posterior bending osteotomy and grinding groups on the treated side. In the grinding group, the gonion on the treated side was displaced slightly outward, resulting in a significant difference between both sides (non-treated side: 50.52 ± 4.20 [T0] and 48.67 ± 4.37 [T2]; treated side: 50.88 ± 4.55 [T0] and 51.00 ± 3.95 [T2]; p = 0.038). In the posterior bending osteotomy group, bilateral inward movements of the gonion were observed, and the distance from the midsagittal plane to the gonion did not differ significantly between the sides (non-treated side: 46.74 ± 4.41 [T0] and 45.54 ± 3.95 [T2]; treated side: 47.43 ± 4.93 [T0] and 45.18 ± 3.52 [T2]; p = 0.224). The yawing movement of the proximal segment was greater in the grinding group than in the posterior bending osteotomy group (non-treated side: p = 0.839; treated side: p = 0.025).Posterior bending osteotomy is recommended over the grinding method for patients with severe facial asymmetry, in order to ensure a symmetric and esthetic facial profile by allowing passive adaptation between the mandibular segments.

Evaluation of post-surgical stability in skeletal class II patients with idiopathic condylar resorption treated with functional splint therapy

PurposeTo assess postsurgical stability of mandibular advancement combined with orthodontic treatment, following functional splint therapy, in patients with idiopathic condylar resorption (ICR). Patients and methodsSixteen patients who were treated with functional splint therapy followed by orthognathic surgery combined with orthodontic treatment between 2010 and 2017 were included in this retrospective study. The primary outcome variable was skeletal stability, measured on the y-axis to point B (y-axis–B). Cephalometric analysis, including measurement of temporomandibular joint spaces, was carried out on serial magnetic resonance images (MRI) prior to orthognathic surgery (T0), immediately after surgery (T1), and after at least 1 year of follow-up (T2). The differences in the data between time points were compared using statistical analyses. ResultsAll patients obtained an esthetic facial profile after orthognathic surgery, with normal occlusion as well as normal protrusive and laterotrusive excursion after treatment. Mean advancement of the mandible immediately following surgery (y-axis–B, T1 − T0) was 7.28 ± 5.79 mm. This was the only skeletal measurement that showed a sagittal positional change of the mandible. Mean backward movement (T2 − T1) was −1.04 ± 2.35 mm (p2 = 0.116). Thirteen out of 16 patients experienced no postsurgical relapse or less than 2 mm of mandibular backward movement (81.25%), while two out of 16 patients showed more than 2 mm of mandibular backward movement (12.5%). ConclusionsPatients who underwent mandibular advancement combined with orthodontic treatment, following functional splint therapy, exhibited a stable mandibular position at the 1-year follow-up. This study indicated that functional splint therapy prior to orthognathic surgery for mandibular advancement may be a good adjuvant treatment for ICR patients.

Conventional surgical-orthodontic approach with double-jaw surgery for a patient with a skeletal Class III malocclusion: Stability of results 10 years posttreatment

This case report presents the treatment of a young man with a skeletal Class III malocclusion. He was treated with a conventional surgical-orthodontic approach in which 2 jaw surgeries were performed. The esthetic facial profile, pleasant smile, appropriate occlusion, and overall good treatment outcome remained stable10years after active orthodontic treatment.

Change in the Upper Airway of Patients With Obstructive Sleep Apnea Syndrome Using Computational Fluid Dynamics Analysis

The aim of the study was to compare the effect of conventional maxillomandibular advancement (MMA) and modified MMA with anterior segmental setback osteotomy (MMA-ASSO) on the airway changes in patients with obstructive sleep apnea syndrome (OSAS) using three-dimensional computational fluid dynamics (3D-CFD) analysis. Two adult male patients with Class I malocclusion, lip protrusion, acute nasolabial angle, and OSAS were treated with conventional MMA (Case 1) and modified MMA-ASSO (Case 2). Individualized 3D airway models were fabricated using computed tomography data obtained 1 month before (T0) and at least 6 months after surgery (T1). A total of 7 cross-sectional areas of the airway were established, starting just above the hard palate (plane 1) with interval of 1 mm caudally. Airflow velocity and negative pressure were investigated using CFD analysis, and polysomnography studies were performed at T0 and T1. There were improvement of apnea-hypoapnea index and the lowest O2 level (T0 versus T1; 43.2 versus 15.2, 79% versus 90% in Case 1; 61.0 versus 6, 89% versus 92% in Case 2). At plane 2 (retropalatal area) in Cases 1 and 2, there were increase in the smallest cross-sectional areas (57.9% versus 28.4%), decrease in the airflow velocity and increase in the negative pressure at the peak of expiration (49.5% versus 31.7%; 88.4% versus 54.3%), end after expiration (53.2% versus 32.2%; 83.2% versus 47.9%), and peak of inspiration (53.1% versus 29.2%; 75.3% versus 48.2%). Modified MMA-ASSO method might be an effective treatment option for OSAS patients with improvement of airway problems and esthetic facial profile.

Simultaneous retraction and intrusion using a single palatal micro-implant

This case report describes the treatment of a case with skeletal Class II, gummy smile, anterior deep bite and convex facial profile. While treating such a severe case, the outcome may not always be successful with orthodontic therapy alone. For this reason, surgical therapy is often chosen to gain an esthetic facial profile and a good smile. However, sometimes the patients reject surgical treatment and an alternative method must be considered. Skeletal anchorage systems such as miniscrews are now frequently used for correcting severe malocclusion that should be treated by orthodontics and surgical therapy. In this case report, we treated a skeletal Class II malocclusion with convex profile and gummy smile using miniscrews, which were placed in the mid-palatal region for simultaneous intrusion and retraction of upper anteriors.

Ratings of profile attractiveness after functional mandibular advancement

Considerations involving orthodontic treatment and facial esthetics have directed the investigation of the optimal treatment, especially in the correction of Class II, division 1 malocclusions, both esthetically and functionally. The aim of this study is to determine whether the use of a Twin force bite corrector in combination with Edgewise mechanics yields a more esthetic facial profile than Edgewise treatment alone. Methods: The present retrospective study compared matched two groups of adolescent patients, (total n=20) The first, treated with functional orthopedic therapy using a TFBC in combination with preangulated Edgewise appliances, (n=10). The second, matched group (n=10) was treated using standard Edgewise mechanics alone. A panel of ten orthodontic graduate evaluators investigated silhouettes of lateral photographs of perceived post treatment facial esthetics of Egyptian adolescents with Class II, division 1 malocclusions treated by one of the two methods. They scored each silhouette's attractiveness on a 100% visual analogue scale (modified VAS). Independent samples t test at 0.05 level of significance was used to compare the VAS scores. Results: the evaluators showed wide range of agreement among the two treated groups in selecting the most attractive profiles. The evaluation of pre/post treatment for each group and randomized post treatment of both goups for facial attractiveness showed insignificant difference statisticaly. Conclusion: TFBC treatment in combination with Edgewise mechanics has measurable benefits.

Assessment of facial profile changes in patients treated with maxillary premolar extractions

OBJECTIVE: Evaluate the facial profile changes of orthodontic treatment with extraction of two upper first premolars, from the perspective of orthodontists, dentists and lay people. METHODS: Facial profiles of radiographs taken before and after treatment of 70 patients with Class II, division 1 malocclusion were traced. The silhouettes of the 70 patients were randomly assembled in an album with, being two profiles on each sheet of the same patient. Then, 30 orthodontists, 30 dentists and 30 lay people chose the more esthetic facial profile (A or B), and the amount of change they perceived between the two profiles before and after treatment, according to a visual analog scale (VAS). RESULTS: The results revealed that 83 examiners preferred the post-treatment profiles, and only three dentists and four lay people chose the profiles pre-treatment more frequently. Thus, the orthodontists often chose the profiles after treatment, followed by dentists, with no statistically significant differences found between dentists and lay people. There were significant differences within groups in the preference of pre- and post-treatment profile. Furthermore, the three groups of evaluators indicated that pre and post-treatment profiles did not differ substantially. CONCLUSIONS: The treatment of Class II, division 1 malocclusion with extraction of two first premolars has a positive effect on facial profile esthetics.

Gummy smile and facial profile correction using miniscrew anchorage

This case report describes the treatment of a case involving a skeletal Class II facial profile with a gummy smile. While treating a facial profile and a gummy smile, the outcome may not always be successful with orthodontic therapy alone. For this reason, surgical therapy is often chosen to gain an esthetic facial profile and a good smile. However, sometimes the patients reject surgical treatment and an alternative method must be considered. Skeletal anchorage systems such as miniscrews are now frequently used for correcting severe malocclusion that should be treated by surgical therapy. In this case report, we treated a skeletal Class II malocclusion with a convex profile and a gummy smile using miniscrews, which were placed in the upper posterior and anterior areas. The active treatment period was 3.5 years, and the patient's teeth continued to be stable after a retention period of 36 months.

Inter-relação entre o perfil dos lábios superiores e a posição da maxila e dos incisivos superiores em pacientes adultos

INTRODUÇÃO: tanto as avaliações profissionais quanto as avaliações de pessoas leigas não indicam um claro relacionamento entre as características de perfil duro e do perfil mole em pacientes ortodônticos. Por outro lado, há evidências concretas de que o ortodontista possa alterar o perfil facial de seus pacientes. OBJETIVOS: este trabalho visou mensurar a contribuição das características ósseas da maxila e a inclinação dos incisivos superiores à posição do lábio superior. MÉTODOS: uma amostra de 147 pacientes adultos, 58 homens e 89 mulheres, com idades de 15 a 49 anos, sendo a maioria caucasiana, foi retrospectivamente selecionada na clínica particular de um dos autores. Presumiu-se que o perfil estético facial depende dos tecidos ósseos que o suportam e de sua própria constituição, como espessura, tonicidade e composição. O modelo de pesquisa não havia sido desenhado para controlar as características intrínsecas do tecido mole. Para compor as linhas estéticas de Ricketts e de Burstone, as variáveis cefalométricas de maior interesse foram SNA e U1PP, quando simultaneamente avaliadas. RESULTADOS: os coeficientes de regressão, embora estatisticamente significativos, não contribuíram definitivamente para explicar as variáveis de interesse, as linhas estéticas pré-determinadas. Além disso, os resultados encontrados sugeriram uma correlação negativa entre a posição maxilar (SNA) e a inclinação anteroposterior dos incisivos superiores (U1PP), possivelmente devido às compensações impostas pelos lábios e pela língua. CONCLUSÕES: os resultados não apresentaram evidências científicas conclusivas sobre a contribuição dos tecidos duros para o perfil facial de tecido mole.

Treatment of Class II Protrusion with Severe Crowding Using Indirect Miniscrew Anchorage

This report describes the nonsurgical treatment of a patient with skeletal Class II protrusion and severe crowding. A 20-year-old woman presented with the chief complaint of lip protrusion and crowding. To correct the Class II relationship, severe crowding, and lip protrusion, distal movement of the maxillary first molars using indirect miniscrew anchorage and nickel-titanium coil springs, along with extraction of the first premolars and maxillary second molars, was planned. After the distal molar movement phase was complete, the maxillary first molars had moved 8.0 mm to the distal, and the first premolars, which were splinted to the miniscrews, had moved 0.5 mm to the mesial. The results show that the distal molar movement mechanics were efficient and stable. After treatment, all of the patient's chief complaints were relieved and an esthetic facial profile was obtained.