Improvement In Facial Esthetics Research Articles

Optimizing Esthetics and Function in a Case of Moderate Reduced Bone Support.

The aim of this article is to report the orthodontic treatment of a woman aged 53 years 6 months whose chief complaint involved her facial esthetics and crowding. She presented a moderate reduction in bone support, but no periodontal disease, over the past 15 years. The maxillary left first premolar and both mandibular first premolars were extracted. The dental protrusion was reduced and all the spaces were closed, resulting in a significant improvement in facial esthetics. After 16 months, the satisfactory results in terms of the functional position of the teeth were maintained with the bone level remaining unchanged.

Orthodontic principles and guidelines for the surgery-first approach to orthognathic surgery

The surgery-first approach has become a new paradigm in orthognathic surgery. With the surgery-first approach, most of the patient's teeth are in their original positions and have not undergone orthodontic treatment prior to the patient undergoing orthognathic surgery. A ‘treatable’ malocclusion should be attained following orthognathic surgery. Orthodontists must ensure that they can manage the ‘treatable’ malocclusion by actively participating in the patient's surgical plan. Therefore, orthodontic principles and guidelines must be established. Three-dimensional computed tomography should be used to construct the midfacial plane and then to assess discrepancies in the midfacial structures as well as yaw and roll of the bilateral facial structures. Orthognathic surgery should be performed to improve the alignment of such discrepancies to attain a skeletal class I relationship and to attain an aesthetically pleasing face. The surgery-first approach uses osteotomy to solve most of the skeletal and dental problems and to simplify postoperative orthodontic treatment by providing a treatable malocclusion for which mostly only anteroposterior orthodontic movement is required, with minimal transverse or vertical orthodontic movements. Numerous studies have documented the efficacy and long-term stability. Patients undergoing the surgery-first approach benefit from an immediate improvement in facial aesthetics, oral function, and self-confidence, with a shorter total treatment period.

Orthodontic camouflage treatment in skeletal Class II patient

Orthodontic camouflage is a method of correcting malocclusion without involving the correction of skeletal problem. Planned extraction of some teeth will help us achieve favorable dental occlusion. The challenge lies in proper diagnosis and case selection so as to decide on dental camouflage as a treatment option in skeletal discrepancy cases. Case of Class II malocclusion with severe crowding, vertical growth pattern and Class II skeletal base with ANB 6° has been discussed. Treated with four premolar extractions and finished the case with Class I canine and molar relationship. Planned extraction of indicated teeth to bring about dental compensation and camouflage the underlying skeletal discrepancy gives an overall improvement in facial esthetics, occlusion and also satisfaction to the patient.

A single complete denture with cheek plumpers to improve facial aesthetics

Presence of teeth in one arch makes it difficult for the operator to fabricate a single denture on the edentulous arch due to altered occlusal schemes, supraerupted teeth and resorbed edentulous ridges. Natural teeth should be preserved but at the same time one should be aware that the edentulous ridge may be destroyed by forces exerted against the denture support. In this case the occlusal correction of the mandibular teeth is done using an acrylic template. Along with replacement of missing teeth emphasis, should be on improvement of facial esthetics. Slumped cheeks are unaesthetic and add to the person’s age. This case shows a way to improve facial aesthetics and function in a maxillary single arch edentulous patient. The missing teeth in the lower arch were rehabilitated with fixed partial denture.

Treatment of Osteochondroma in the Mandibular Condyle and Secondary Dentofacial Deformities Using Surgery Combined With Orthodontics in Adults

Osteochondroma is a benign tumor that is rare in the craniofacial region. When it does occur, the condyle and coronoid process have been the most commonly affected sites. The secondary progressive malocclusion and facial asymmetry will be common physical signs in most cases. The traditional surgical treatment of osteochondroma of the mandibular condyle has been condylectomy, with or without reconstruction of the condyle. We believe more attention should be paid to restoring joint function, improving the facial appearance, correcting malocclusion, and re-establishing harmony among them. From January 2000 to March 2013, 27 patients (17 women and 10 men) who had been diagnosed with osteochondroma of a unilateral mandibular condyle underwent condylectomy and condylar reconstruction using a pedicled posterior mandibular border obtained by ramus osteotomy. The secondary dentofacial deformities were simultaneously corrected using orthognathic and facial contouring procedures, followed by orthodontic treatment, when necessary. Occlusion and temporomandibular joint pain and function, including the maximal mouth opening and maximal protrusion, were recorded preoperatively and postoperatively. The patients were followed for an average of 13 months (range 24 to 48). The outcomes of, and feedback information from the patients showed apparent improved joint function, with no cases of osteochondroma recurrence. The secondary dentofacial deformities were corrected significantly. Satisfactory occlusion was achieved with orthognathic and orthodontic treatment. Our data suggest that condylectomy and condylar reconstruction, with simultaneous correction of the secondary dentofacial deformities using orthognathic procedures, might be a better approach to manage osteochondroma accompanied by dentofacial deformities. In addition to facial contouring procedures, orthodontic treatment should be considered for better improvement in facial esthetics and occlusion.

Extraction and non-extraction therapy in class II/1 patients

Introduction: Class II malocclusion is characterized by distoclusion and is divided into two divisions depending on the inclination of the upper front teeth. The first division is characterized by protrusion of the upper front teeth. Treatment possibilities of class II/1 malocclusion depend on the skeletal form. Therapy of dentoalveolar types of class II/1 malocclusion is exclusively orthodontic. More emphasized skeletal forms of class II/1 malocclusion may require surgery apart from orthodontic therapy. Casse raport: In this paper, the extraction and nonextraction treatment of 13 years old patients - M.P.(boy) and I.T. (girl) was shown, respectively. The diagnosis was based on clinical and functional intraoral findings, analysis of dental casts, face photos, orthopatomogram and profile x-ray. Nonextraction therapy was suggested for a boy and extraction therapy for a girl, combined with the use of upper and lower fixed appliances. In the treatment, technique of straight arch, Dentaurum brackets, root prescriptions, slot 22 were used. In the male patient, there was a slight maxillary prognathism, mandibular retrognathism, anterior type of growth, protrusion of the upper incisors and retrusion of the lower ones. The body of maxilla was shorter by 4 mm with regard to the cranial base. In the female patient the extraction of the upper first premolars was performed because of maxillary prognathism, mandibular retrognathism, increased length of the body of maxilla, decreased length of the body of maxilla and severe protrusion of the upper frontal teeth. After the treatment, functional occlusion and improvement in facial aesthetics was achieved in both patients. Facial changes were more apparent in the patient who underwent the extraction treatment. After completion of treatment, it is necessary to maintain the obtained results.

Comparison in the assessment of facial aesthetics and personality traits between patients with a dysgnathia and a naive control group

Background and objectives: Improvement of facial aesthetics is one of the main reasons for orthognathic surgery. In respect of aesthetics and also the assignment of personality traits skeletal dysgnathia patients benefit markedly from orthognathic surgery. Aim of this study was to find out how patients, affected by a skeletal dysgnathia, rate photographs of patients with a skeletal dysgnathia before and after orthognathic surgery in respect of aesthetics and some personality traits, and if there is a difference to a naive control group.

Class III malocclusion with severe anteroposterior discrepancy

This study aims at reporting the clinical case of a patient with Class III skeletal malocclusion with severe maxillary deficiency, producing a reduced midface associated with severe mandibular prognathism. The pre-surgical orthodontic preparation was composed mainly by dentoalveolar expansion and repositioning of the incisors in the lower arch. Then, a combined maxillary and mandibular orthognathic surgery was performed. The treatment objectives were achieved, with significant improvement in facial esthetics and occlusion, followed by post-treatment stability. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requirements for obtaining the title of Diplomate by BBO.

Staged Treatment of Temporomandibular Joint Ankylosis With Micrognathia Using Mandibular Osteodistraction and Advancement Genioplasty

Distraction osteogenesis can be used to correct micrognathia after temporomandibular joint (TMJ) ankylosis. However, there is still some controversy over the proper sequencing of management for the ankylosed patients. The objective of the present study was to evaluate a staged treatment of TMJ ankylosis accompanied by micrognathia using arthroplasty, mandibular distraction osteogenesis, and advancement genioplasty. A total of 12 bilateral TMJ ankylosis patients with micrognathia (aged 17 to 27 years) underwent arthroplasty as the initial surgical procedure, followed by orthodontic treatment and correction of mandibular micrognathia by osteodistraction and advancement genioplasty as the second surgical procedure. The clinical results were evaluated by mouth opening, radiography, medical photography, and respiratory function. The patients were followed up for a minimum of 8 months to a maximum of 36 months. The TMJ ankylosis was released successfully in all the patients, showing an increase in average mouth opening from 3.3 mm preoperatively to 35.8 mm postoperatively. Micrognathia was corrected, and, remarkably, the obstructive sleep apnea and hypopnea syndrome was cured. Satisfactory occlusion was achieved with orthodontic treatment. Our data suggest that a staged and surgical orthodontic treatment might be a better approach to manage TMJ ankylosis accompanied by mandibular hypoplasia. In addition to mandibular osteodistraction, advancement genioplasty should be considered for better improvement in facial esthetics and respiratory function.

Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry

PurposeSince improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes.Material and methodsTwenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4 ± 0.6 months).ResultsFacial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios.ConclusionsThis study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.

Simultaneous Le Fort III and Le Fort I osteotomies for correction of midface hypoplasia in Crouzon syndrome

Le Fort III osteotomy is commonly indicated for the treatment of midface hypoplasia in Crouzon syndrome. However, if there is significant maxillary dentoalveolar protrusion associated with midface hypoplasia, the use of Le Fort III osteotomy alone for midface advancement will result in a poor facial aesthetic outcome. We have recently published a new treatment strategy of correcting this form of deformity by a combination of simultaneous Le Fort III and Le Fort I osteotomies for non-syndromic cases. We would like to report a case of 16-year-old girl presenting with Crouzon syndrome with orbital proptosis, which is caused by a combination of zygomatico-naso-maxillary hypoplasia, as well as maxillary and mandibular dento-alveolar hyperplasia. A combined orthognathic surgical procedure of simultaneous Le Fort III and Le Fort I osteotomies were performed to correct the midface hypoplasia and maxillary dentoalveolar protrusion, while the mandibular dentoalveolar hyperplasia was corrected by a mandibular sub-apical osteotomy. The operation went uneventfully with 10 mm advancement of the midface achieving eye protection, occlusal correction and significant facial aesthetic improvement. At 12 months post-operatively, the aesthetic and occlusal results were stable and the patient was very pleased with the clinical outcome. This case was performed in collaboration between the Oral Health Division, Ministry of Health Malaysia and the Faculty of Dentistry, The University of Hong Kong. The report illustrates the clinical outcomes of the simultaneous Le Fort III and Le Fort I osteotomies for the correction of midface hypoplasia and maxillary dentoalveolar protrusion presenting in a Crouzon syndrome patient.

Vertical-dimension control during en-masse retraction with mini-implant anchorage

Vertical dimension control with fixed appliance mechanotherapy has always been a matter of concern in moderate to severe high-angle patients with severe proclination of the anterior teeth. Extrusion of the posterior teeth is an inevitable sequela of conventional mechanics in such patients, especially if they are adults. This article reports on 3 patients who were treated with mini-implants (diameter, 1.3 mm; length, 8 mm) placed between the roots of the second premolar and the first molar for en-masse retraction of the anterior teeth. The biomechanical force system that developed not only maintained absolute anchorage, but also provided effective control over the posterior dentoalveolar dimension so that dramatic improvement in facial esthetics could be achieved. Small but significant autorotation of the mandible was noted; this led to increased chin prominence in all 3 patients. With accurate diagnosis and treatment planning, mini-implant anchorage can be a possible alternative to orthognathic surgery in similar borderline patients.

Panel perception of change in facial aesthetics following orthodontic treatment in adolescents

The aim of the study was to evaluate the influence of the characteristics of panel members, the effects of gender and Angle Class of adolescent patients on their change in facial aesthetics following orthodontic treatment, and to assess the optimal panel size for epidemiological studies on changes in facial aesthetics after orthodontic treatment. A panel of 74 adult laymen (35 males and 39 females) and a panel of 87 orthodontists (37 males and 50 females) evaluated sets of three post-treatment standardized photographs (one frontal, one three-quarter smiling, and one lateral) of 64 adolescent orthodontic patients in relation to the pre-treatment sets of the same patient on a five-point scale. The main effects of professional background, age, gender, and geographic region of the panel members on the aesthetic scores, as well as their first order interactions were evaluated by multilevel models. Professional background, age, gender, and geographical region of panel members have an influence on the evaluation of the change of facial aesthetics following orthodontic treatment. The effect of gender and Angle Class of the patients on the scores was evaluated by two-way analysis of variance. There was no difference in the mean scores for boys and girls. Improvement of facial aesthetics by orthodontic treatment was significant for Class I, Class II division 1, and Class II division 2 patients, but not for Class III patients. Based on the intraclass correlation coefficient, a panel of nine randomly selected orthodontists, a panel of 14 randomly selected laymen, or a mixed panel of 13 individuals is sufficient to obtain reliable results in the aesthetic evaluation of adolescent faces, using photographs and a five-point scale.

Five year follow‐up of mandibular distraction osteogenesis on the dentofacial structures of syndromic children

To determine long-term treatment outcomes of mandibular distraction osteogenesis (DO) in syndromic children with severely hypoplastic lower jaws. Descriptive clinical study. Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital. Ten children (mean age 7.6 years) with various syndromes (craniofacial microsomia, Treacher Collins syndrome, Nager syndrome). Ten growing children with severely retrognathic lower jaws were distracted with an extraoral bicortically fixed DO device (mean, 34 days) followed by a consolidation period (mean, 9 weeks). Orthodontic treatment was performed pre- and/or postoperatively with fixed or functional appliances (mean 14 months). The landmarks on standard lateral cephalometric X-rays were digitized and angular and linear measurements were compared using Student's t-test to assess changes in pre-distraction, post-distraction, post-consolidation and 1 year follow-up. Long-term follow-up (2 and 5 years) was interpreted according to mean values. The measurements of SNB, ANB, facial convexity angle, overjet and overbite, and soft tissue facial profile showed significant correction of the mandibular retrognathia and malocclusion. The mandibular divergence decreased and mandibular, corpus, and ramus lengths remained stable during the consolidation period. The regression of mandibular measurements towards pre-distraction values was observed in skeletal and dental parameters and soft tissue profiles during the first postoperative year and continued during the 2- to 5-year follow-up period. The achieved mandibular corpus and ramus lengthening was stable while the mandible displayed considerable posterior rotation but no further growth. Orthodontic treatment could not overcome the regression of mandibular measurements to their original values. The maxilla continued its normal growth during the long-term follow-up. Two patients had tracheostomies, but the tube was removed from both during or immediately after distraction. CONCLUSION - Excellent short-term structural results of mandibular DO are not stable during the growth of syndromic children because of restricted mandibular growth. Thus, a re-evaluation of DO timing in the improvement of facial aesthetics must be considered. However, mandibular DO in children with severe airway problems is recommended.

Rehabilitation of Severely Atrophied Mandible Using Free Iliac Crest Bone Grafts and Dental Implants: Report of Two Cases

The purpose of this study was to reveal the improvement in facial esthetics and maintenance of mastication in severely atrophied mandibles with inadequate alveolar ridges in 2 patients. Bone graft harvested from iliac crest was used for the reconstruction in the first case, followed by the application of 2 dental implants after 6 months. A free iliac bone graft and 2 dental implants were also used simultaneously with a 1-stage surgery in the second case; the patient had previously had a mandibular reconstruction with a rib graft. Both of the patients achieved remarkably functional and esthetic improvements after treatment. Free iliac bone graft is considered to be a favorable alternative for the maintenance of satisfactory functional and esthetic results in patients with severely atrophied alveolar ridges.

Cosmetic dentistry

Patients seeking the expertise of facial plastic surgeons for facial aesthetic improvement may also desire or benefit from dental aesthetic procedures. This paper reviews current treatment options available in cosmetic dentistry. Many techniques exist to improve dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Although orthodontic therapy is still an important modality for smile aesthetics, some simpler procedures can provide acceptable aesthetic results. Comparison of external dental bleaching techniques reveals similar long-term results for in-office and at-home bleaching; in-office treatments, however, may provide the benefit of faster results. Internal dental bleaching is an effective method for correcting nonvital teeth coloration. Enamel shaping via either direct tooth contouring or the application of resins or veneers to tooth surfaces can correct defects, asymmetries and shape or rotation problems. Veneers or crowns are also options to correct intrinsic dental stains not amenable to bleaching techniques. Treatments to refine gingival margins and borders are another proven beneficial cosmetic procedure. A myriad of techniques exist to correct a patient's particular concerns. Correction of discoloration is usually feasible as is the improvement of a patient's smile and overall dental aesthetics.

Cutis Laxa: Improvement of Facial Aesthetics by Using Botulinum Toxin

Cutis laxa is characterized by the total loss of skin elasticity, which is also called generalized elastosis that leads to the appearance of early aging. The authors report a patient with cutis laxa in which botulinum toxin was used for the improvement of facial aesthetics. This is a case report with a literature review. Botulinum toxin was injected into the classical sites usually used for the treatment of dynamic wrinkles. The patient showed improvement of the aging appearance. The use of botulinum toxin may represent an additional, less invasive resource to improve facial defects in these patients.

Cutis Laxa

BACKGROUND Cutis laxa is characterized by the total loss of skin elasticity, which is also called generalized elastosis that leads to the appearance of early aging. OBJECTIVE The authors report a patient with cutis laxa in which botulinum toxin was used for the improvement of facial aesthetics. This is a case report with a literature review. Botulinum toxin was injected into the classical sites usually used for the treatment of dynamic wrinkles. RESULTS The patient showed improvement of the aging appearance. CONCLUSION The use of botulinum toxin may represent an additional, less invasive resource to improve facial defects in these patients.

Unexpected events during mandibular distraction osteogenesis.

Various unexpected events during mandibular distraction osteogenesis are described in 16 syndromic children with severely retrognathic or asymmetric lower jaws who were treated with unilateral or bilateral extraoral distraction. The mean total time with the distraction devices attached was 14 weeks (range 10-19). Although improvement in facial aesthetics and the desired occlusion was achieved in all but one case, there were unexpected events associated with mandibular distraction. These included pain not related to the operation, functional disturbance in movement of the jaw, dietary problems, weight loss, unfulfilled expectations of decannulation, temporary unilateral facial nerve palsy, and transient unilateral hypoaesthesia of the inferior alveolar nerve. Reoperation was required in 5 of the 16. In addition to these events, psychosocial problems within one family complicated the procedure. Patients and their families should be informed of the lesser-known aspects of distraction osteogenesis before the procedure is used.

PENGGUNAAN FACE-MASK & EKSPANSI PALATAL PADA PERAWATAN MALOKLUSI KLAS III (Studi Pustaka)

Class III skeletal anomaly is one of the most difficult malocclusions to correct in orthodontics. Orthodontist usually involved chincup appliances to restrain mandibular growth, camouflage techniques to advances maxillary incisors and retract mandibular incisors or waiting untul growth ceased to pursue orthognathic surgery. Many studies found that most of Class III malocclusions were characterized by maxillary retrognathism. In the late 1960s, the Delaire mask was popularized to protract the maxilla. The development of maxillary protraction with facemask and palatal expansion have provided a predictable and effective approach to managing treatment that was once considered difficult. Although no significant difference was found between early or late treatment group, the effect of improvement in facial aesthetics on psychosocial development resulted in a significant advantage for early treatment. However, the effects of face mask therapy should be evaluated over the long term in order to determine the relaps tendency.