Lip Incompetence Research Articles

Changes in the lower lip soft tissue after bone graft harvesting from the mandibular symphysis

Following the surgical release of the mentalis muscle, lip incompetence and/or an increase in lower incisor exposure may be seen due to undesirable attachment of the muscle fibres. The aim of this study was to evaluate the extent of lip ptosis, lower incisor exposure, and other soft tissue changes following bone graft harvesting from the mandibular symphysis when the mentalis muscle is reapproximated precisely to its original position. Seventeen consecutive patients who underwent bone graft harvesting from the mandibular symphysis were included in this study. The mentalis muscle was isolated, identified, marked, and reapproximated precisely during the bone harvesting operation. Digital lateral cephalograms obtained preoperatively and at 6 months postoperative were analyzed and compared by paired samples t-test to determine the horizontal and vertical soft tissue changes in the lower lip and chin. Although the soft tissue thickness at soft tissue point B and at soft tissue pogonion had increased significantly at 6 months after chin bone graft harvesting, there were no significant changes in lower incisor exposure or other positional alterations of the lower lip (P<0.05). Precise reattachment of the mentalis muscle in its original position helps to avoid significant vertical positional changes in the lower lip. Increases in soft tissue thickness can be observed following bone graft harvesting from the mandibular symphysis.

Foreign Language Education and Dynamics of Foreign Language Competence

The aim of the current research study was to examine the dynamics of foreign language competence as applied in a programme designed for foreign language competence development in an academic environment. The programme, named The Linguistic Intervention Programme, represented a variety of active social learning techniques, self-regulated learning and a set of specific foreign language teaching strategies. One hundred and three university students participated in the research experiment. The research method utilized a foreign language proficiency test to serve as the appropriate tool to study the effects of the LIP techniques on the sample. The findings reveal that the result of the LIP in foreign language competence does not depend on the selection of foreign languages, meaning that the LIP is efficacious no matter what language is used in application of the techniques.

Study of training for improving lip incompetence

PurposeWe have been using myofunctional therapy in orthodontic treatment to improve orofacial disorders. Our previous study showed that lip training increased orbicularis oris muscle strength and endurance. The aim of this study was to determine the effectiveness of hypoxic lip training for improving lip incompetence.Subjects and methods: Twenty healthy subjects (10 males and 10 females, 23.6±2.3years old) with lip incompetence participated in this study. We recorded the sealed lip ratio calculated by using the formula “(lip-sealing time/total recorded time)×100″ during relaxation (listening to soothing music) and during concentration (performing a mathematical calculation). Then the subjects performed a standardized hypoxic lip training (5 repetitive contractions with 80% of maximum tensile strength of the orbicularis oris muscle) with a traction plate. Training was repeated daily for 4weeks. To estimate training effects, the sealed lip ratios during relaxation and concentration were recorded before training (T1), at 2weeks (T2) and 4weeks (T3) after the start of training, and at 4weeks (T4) and 8weeks (T5) after the end of training. ResultsThe sealed lip ratios in both the relaxation and concentration conditions significantly (p<0.003 after Bonferroni correction) increased during the training period. Although the sealed lip ratios slightly decreased during the post-training period, they were not significantly different from those at T3. ConclusionsHypoxic lip training increases the sealed lip ratio and is thus effective for improving lip incompetence. Sealed lip ratios were maintained after 8weeks of training.

Correction of gummy smile by superior repositioning of maxilla in Bangladeshi people

Vertical maxillary excess is associated with gummy smile, incompetent lip, bimaxillary proclination, Angle’s class-I or class-II malocclusion with or without retogenia. After proper evaluation preoperative orthodontic treatment was performed in every cases and superior repositioning of the maxilla by Le Fort-I osteotomy is presented. Three patients with maxillary excess associated with retrogenia or microgenia were treated with this technique in combination with genioplasty. The maxillary segment was repositioned a maximum of 7.0 mm superiorly at point A. The mandible autorotated anterosuperiorly to achieve sound occlusion. Point B moved 1.0–3.0 mm anteriorly and 5.0–8.0 mm superiorly. The pogonion moved 4.0 mm anteriorly in a case done without genioplasty and the pogonion moved maximum 8.0mm in case done in combination with genioplasty. All patients obtained sound occlusion and a good profile after the operation. Almost no skeletal relapse was observed during 3 years of postoperative follow-up. Amount of gingiva showing during smile was ranges from 5.0mm –7.0mm which was 0-2.0mm after superior repositioning of the maxilla.&#x0D; Ban J Orthod &amp; Dentofac Orthop, April 2016; Vol-6 (1-2), P.1-5

Indian Board of Orthodontics Case Report: Orthodontic Management of Vertical Excess Using Skeletal Anchorage

B.B., a 21-year-old girl, presented with the chief complaint of forwardly placed upper front teeth and gummy smile. Diagnosis revealed prognathic maxilla and average mandible, Class II skeletal base with vertical growth pattern, end-on molars and Class II canine relationship bilaterally, convex profile, potentially incompetent lips, gummy smile, and protrusive lower lip. The patient's treatment plan was extraction of all first bicuspids and retraction using temporary anchorage devices. Anchorage was reinforced using microimplants in the maxillary arch and second molar banding in the mandibular arch. The implants were placed high up in the vestibule to have more of an intrusive component and to reduce gummy smile at the end of the treatment.

"Modified Oblique Le Fort III Osteotomy" New Concepts.

The purpose of this study is to demonstrate the surgical technique for the correction of midfacial deformities; vertical excess and posteroanterior hypoplasia. This situation obligates the need to move the whole osseous structure in an oblique posteroanterior movement that should correct both midfacial deformities. This should also correct the lip incompetence while improving the malar projection on a profile view of the patient. We also present a mathematical formula that gives the angulation needed for moving the midface complex in a simultaneous vertical and posteroanterior direction. Once given the correct angulation for the desired oblique movement, the surgeon can reproduce this angulation with custom made surgical guides over the stereolithographic model, that can then be used during surgery to achieve the desired movement accurately. This technique exemplified on this paper will give maxillofacial surgeons a new and affordable tool for the correction of midfacial deformities in an accurate and easily reproducible manner and amplifying the surgical repertoire. Patients seen in the specialty hospital "Dr. Bernardo Sepulveda" National Medical Center XXI Century, IMSS, during the period from February 2013 to November 2014 with Modified Oblique Le Fort III osteotomies, with the application of two trigonometric formulas for the accuracy of the technique. The application of the formulas give accurate results as well as the enlargement of the upper airway and esthetic results.

Surgical-orthodontic treatment in a skeletal class III patient. A case report

A 24-year-old patient attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research, Faculty of Dentistry, UNAM, with a previous orthodontic treatment and absence of lower 1st premolars. The chief complaint was an unattractive facial appearance due to a forward position of the mandible and anterior open bite. Upon facial examination, in the frontal view, a leptoprosopic face, collapsed paranasal areas and incompetent lips were observed. In the vertical facial proportions, the lower third was increased. The lateral and oblique view showed a greater projection of the chin, a concave profile and an increased mentocervical length. Intraorally, the molar relationship was class III; a 2 mm anterior open bite and complete anterior cross bite of 1 mm were also observed. The patient presented a mild discrepancy of the dental midline as well. Orthodontic treatment was carried out in three phases: presurgical, surgical and postsurgical. In the presurgical phase dental decompensation was performed and the patient was prepared for surgery. In the surgical phase a segmental maxillary surgery from lateral incisor to lateral incisor was performed in order to produce a movement of sagittal rotation thus projecting the nasogenian area and improving incisor inclination. A mandibular setback via bilateral sagittal osteotomy was also performed. In the postsurgical phase ideal occlusal relationships were achieved in terms of canine class, molar class, overjet, overbite, centered dental midlines as well as a more harmonious profile.

When is enough, enough?

Mrs Kim is a cheerful 63-year-old who has been agreeable to any treatment plan you have proposed. Her initial presentation was complex. Her maxillary left canine was extracted in adolescence; consequently, there was a significant maxillary-to-facial midline discrepancy of 4 mm. Bilateral fixed bridges have replaced the absent mandibular first molars. The patient had mild bimaxillary protrusion, with facial convexity that only slightly exceeds ethnic norms. Despite Mrs Kim's lip incompetence, few would have considered her unattractive. To add to the treatment complexity, there was 50% generalized crestal bone loss that preexisted her treatment course, but her periodontist considered her status to be stable. Also of note is her long-term use of oral bisphosphonates to treat osteoporosis. You elected to initiate her treatment without extractions. As treatment progressed, you gave Mrs Kim thorough autonomy by discussing the option of premolar extractions to coordinate her midlines and provide incisor retraction. Her consistent response was, “Whatever you think, doctor. I truly trust you.” But at today's debonding appointment, you feel a bit disturbed. Although she proclaimed her delight with the treatment result, her maxillary midline remains conspicuously deviated to the left and mild protrusion remains. She appreciates the excellent alignment your therapy has provided and confirms her commitment to long-term retention to maintain her result. Is there justification for your own dissatisfaction with her treatment outcome? After all, from a dental health perspective, you've successfully managed a periodontally susceptible patient who is on prolonged bisphosphonate therapy—both of which had the potential to increase the risk and complexity of treatment. And an extraction strategy would have involved replacement of both mandibular fixed bridges—a costly endeavor that she is not prepared to face. Mrs Kim is happy with the result. You had been forthright by repeatedly explaining the shortcomings of the nonextraction plan. How much information about her treatment result should you tell her without undermining her satisfaction? Are you obligated to offer any explanation of her treatment's shortcomings to fulfill your ethical responsibility? Should her less-than-perfect outcome remain as an emotional burden to you—especially since she has been such a conscientious patient? The relationship between a patient and the doctor is one of fiduciary responsibility, comprising trust that the commitment between the doctor and the patient will be upheld.1Rule J. Veatch R.M. Autonomy and informed consent.in: Bywaters L. Harmon L. Ethical principles in dentistry. 2nd ed. Quintessence, Chicago2004: 142Google Scholar By definition, this involves fidelity, but the ethical principles of veracity, beneficence, and nonmaleficence also pertain. As one component of the fiduciary relationship, the patient expects that the doctor will deliver a level of care to the best of his or her ability and be truthful regarding all aspects of treatment. Yet “truth” can often involve not only what is said, but also what is unsaid. Omission of selected details of a treatment result can be misleading or deprive patients of certain aspects of their status that may have future pertinence. For example, is explaining a posttreatment marginal ridge discrepancy between the mandibular first and second molars relevant to a patient? Is your inability to fully correct a unilateral Class II molar relationship or a 60% overbite pertinent? Such a distinction between the relevant and the irrelevant, or the trivial and the consequential, can form a fine line indeed. Mrs Kim knows nothing about the instability of proclined incisors and is unconcerned about her facial-to-maxillary midline discrepancy. She is delighted that her 2 mandibular fixed bridges do not need to be replaced. And her periodontist is pleased with her recent examination and charting results, confirming that her condition has remained stable despite her 2-year treatment course. Since you have fully disclosed her present status and its shortcomings—and she accepts both—have you fulfilled your ethical duty to maintain your fiduciary responsibility? Perhaps. But at the very least, your obligation to participate in her long-term maintenance will follow you for years to come.

English

Abstract Myiasis is a rare condition caused due to larvae infestation of body tissues. This can be caused by several species of Dipteran fly larvae and may be secondary to serious medical conditions. Common predisposing factors for oral myiasis are incompetent lips, poor oral hygiene, severe halitosis, anterior open bite, mouth breathing, facial trauma, extraction wounds, ulcerative lesions and carcinoma. Here, we describe a case of oral myiasis in the anterior palatal region in a mentally challenged patient caused by the larvae of Musca Nebulo whose clinical features, management and treatment outcome are discussed and case was followed up periodically. Keywords: Oral myiasis; House fly; Necrosis Introduction The term myiasis (Greek: myi= fly, asis= disease) is applied to infestation of living tissues of humans and animals, by dipterous larvae [1]. Zumpt descriptively defined myiasis as “the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host’s dead or living tissue, liquid body substances, or ingested food” [2]. Myiasis is well recognized in the animals, but rare in humans [2,3]. Human myiasis is extremely rare in developed countries, but it is not an uncommon parasitic infestation in the tropics and subtropics [4]. Myiasis can target any body tissue or cavity that is accessible to egg-laying and development of larvae, but most common anatomic sites involved are the nose, eye, lung, ear, anus, vagina, and more rarely, the mouth [3,5].Oral myiasis was first described by Laurence in 1909 [5]. Predisposing factors for development of oral myiasis are anterior open bite, mouth breathing, neglected mandibular fractures, Cancrum Oris, extraction sockets and patient with neurologic deficit, diabetes, and peripheral vascular disease [3].In this article a case of oral myiasis in the anterior palatal region in a patient with neurological deficit is presented.

Stein's Double Cross-Lip Flaps Combined with Johanson's Step Technique for Subtotal Lower Lip Reconstruction.

In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson's step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster-related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson's step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction.

Prevalence of Traumatic Dental Injuries to Anterior Teeth of 12-Year-Old School Children in Kashmir, India.

BackgroundTraumatic dental injuries to anterior teeth are a significant public health problem, not only because their prevalence is relatively high, but also because they have considerable impact on children’s daily lives. Traumatic dental injuries (TDIs) cause physical and psychological discomfort, pain and other negative impacts, such as tendency to avoid laughing or smiling, which can affect social relationships.ObjectivesThis study aimed to assess the prevalence of traumatic dental injuries to anterior teeth among 12-year-old school children in Kashmir, India.Patients and MethodsA cross-sectional study was conducted in private and government schools of India among 1600 schoolchildren aged 12 years. In addition to recording of the type of trauma (using Ellis and Davey classification of fractures, 1970), over jet, Angle’s molar relation and lip competence were also recorded. The socioeconomic status and academic performance of the study subjects were registered. The data obtained were compiled systematically and then statistically analyzed. The statistical significance for the association between the traumatic injury and the variables was analyzed using the chi-square test. Logistic regression was used to identify potential risk predictors of TDIs.ResultsThe overall prevalence of TDI to anterior teeth was found to be 9.3%. The TDI to anterior teeth in male was more than female, but the difference was statistically nonsignificant (P < 0.01). Falls and sports were the most common causes of trauma in the present study. The highest potential risk factor for the occurrence of trauma was over jet. Academic performance was found to be significantly associated to TDI to anterior teeth, when analyzed in a multiple regression model.ConclusionsIt was concluded that the prevalence of traumatic dental injuries was 9.3%. Traumatic dental injuries among children exhibit complex interaction between the victims’ oral conditions and their behavior. Therefore, prevention should consider a number of characteristics such as oral predisposing factors, environmental determinants and human behavior. It is recommended that specific and proper public places for leisure and sports activities, with impact-absorbing surfaces around the items on which children are most likely to fall, should be provided.

Maxillary incisor trauma in patients with class II division 1 dental malocclusion: associated factors.

The aim of this study was to assess the association between the presence of maxillary incisor trauma (MIT) with age, gender, dentition type, the degree of overjet (OJ), lip form, respiratory type and dental arch form in patients with Class II division 1 dental malocclusion. 256 patients (mean age: 15.80 ± 2.2) were included in this study. The patients' gender, dentition type, superior lip form, dental arch form and respiratory type were recorded. Participants were divided into four groups according to the severity of OJ: 3.5 mm<Group 1 (OJ I) ≤6 mm with competent lip, 3.5 mm<Group 2 (OJ II) ≤ 6 mm with incompetent lip, 6 mm<Group 3 (OJ III) ≤9mm, 9 mm<Group 4 (OJ IV). Mann Whitney-U test was used to examine the group differences for trauma and non-trauma groups. Logistic regression analysis was used to assess the factors for trauma and their risk indicators. 3.5 mm<OJ II≤ 6 mm with incompetent lip had the highest odds of experiencing MIT among the OJ groups with an odds ratio (OR) of 3.143 and 95% confidence interval (CI) 1.125-2.779. The odds were 3.572 times higher in the group with short lip form than found in the group with normal lip form (OR 3.572, 95% CI 1.130-2.340). The age, gender, respiratory type and dental arch form were not significantly associated the risk of MIT. OJ between 3.5 mm and 6 mm (with incompetent lip) and short lips increased the risk of having maxillary incisor trauma in patients with Class II division 1 malocclusion.

Traumatic Dental Injuries and Associated Risk Factor among Sudanese School Children

Aims: To determine the prevalence of traumatic dental injuries in the anteriorsegment and associated risk factors for 9-12 years old school children in Wad-Madani locality, Al-Gazira state, Sudan.Material and method: A cross-sectional school base study for six hundred and eighty 9-12 year- old school children (boys and girls) selected randomly from 25 basic schools. Andresen’s criteria were used to record traumatic dental injuries by visual examination and no radiographs were taken. Associated risk factors were assessed (age, gender, over jet and lip Competency). Chi-square test was used to test association between the different variables. P -value < 0.05 was considered statistically significant.Results: The prevalence of traumatic dental injuries was 9.1%. Boys experienced more injuries than girls 1:2.2. Enamel fracture (63%) was most common types followed by enamel and dentine fracture (27%). The maxillary central incisor was the most common affected tooth (79.7%). Collisions were the main cause of trauma and home the most common place. Most of the traumatized teeth were not treated. The high percentage of traumatized teeth associated with increased over jet (P = 0.000) and inadequate upper lip coverage (P = 0.000). Conclusion: The present study revealed a relatively low prevalence of dental trauma, but still high when compared with literature. Significant association between dental trauma and associated factors (age, gender, over jet and lip Competency) were found. Educational programs should be initiated for the community regarding causes, prevention and treatment of traumatic dental injuries is mandatory to elaborate preventive strategies and efficient treatment plans.

Management of Idiopathic Gingival Enlargement.

A 25-year-old male reported to the department with a chief complaint of swollen gums since 10 years involving all the teeth. The swelling was aesthetically unpleasing and also causing difficulty in speech and mastication. Patient did not undergo any kind of dental treatment for the above problem. Patients dental, personal, medical, family histories were non-contributory. Patient was not under any anti-epileptic, anti-hypertensive, immunosuppressive medication and there was no history of fever, anorexia, weight loss, seizures, hearing loss or any physical or mental disorder. On extraoral examination the patient has incompetent lips with convex facial profile. Intraoral examination revealed generalized diffused nodular enlargement of gingiva on both buccal and lingual/palatal sides [Table/Fig-1,​,22 and ​and3].3]. Gingival enlargement score of grade III (Bokencamp 1994) [1] was given, that is enlargement covers three quarters or more of the crown. Gingiva was pink in colour with superimposed melanin pigmentation, firm and fibrous fibrous in consistency. The teeth were barely visible as enlargement extended up to incisal/occlusal third of all the teeth except 11, 21, 13 and 23. Stippling was absent and slight bleeding on probing was present with altered gingival contour. Gingival enlargement was not superimposed by any secondary inflammatory changes. [Table/Fig-1]: Labial view. [Table/Fig-2]: Mandibular arch. [Table/Fig-3]: Maxillary arch. Panoramic radiograph revealed no bone loss [Table/Fig-4]. Oclusal radiographs were not taken. Haematological investigation was done which was within normal limits. Histopathological examination revealed hyperparakeratinized stratified squamous epithelium showing pseudoepitheliomatous hyperplasia with thin elongated interconnecting retepegs [Table/Fig-5]. The underlying connective tissue showed extensive collagen consisting of coarse collagen fibres arranged in irregular fascicles [Table/Fig-6]. The fibroblasts were few with compressed blood vessels and scanty chronic inflammatory cell infiltrate. These findings were suggestive of fibrotic gingival enlargement. [Table/Fig-4]: Panoramic view. [Table/Fig-5]: Histological picture hyperparakeratinized stratified squamous epithelium showing pseudoepitheliomatous hyperplasia. Haematoxylin and Eosin stain (Original maginification x 20). [Table/Fig-6]: Histological picture showing extensive collagen consisting of coarse collagen fibres. Haematoxylin and Eosin stain (Original maginification x 20). On the basis of detailed case history and histological findings, the case was diagnosed as generalized idiopathic gingival enlargement. A treatment plan was devised for the patient Which included phase I therapy, followed by maintenance phase and phase II therapy. Adjunctive antimicrobial administration of systemic amoxicillin 500mg thrice daily and metronidazole 400mg twice daily for seven days was prescribed along with use of chlorhexidine mouthwash twice daily. The surgical phase included quadrant wise full mouth gingivectomy. Kirkl and knife was used for incisions on facial and lingual surfaces and Orban knife for interdental incisions [Table/Fig-7]. All granulation tissue was completely curetted and calculus remnants if any were scaled to make the areas clean [Table/Fig-8]. Patient was recalled after one month [Table/Fig-9] and two months [Table/Fig-10,​,1111 and ​and12].12]. Healing was satisfactory. [Table/Fig-7]: Gingivectomy done with Kirkland knife. [Table/Fig-8]: Removal of calculus remnants with curette. [Table/Fig-9]: Postoperative view of after 1 month. [Table/Fig-10]: Postoperative view of after 2 months. [Table/Fig-11]: Postoperative maxillary occlusal view after 2 months. [Table/Fig-12]: Postoperative mandibular occlusal view after 2 months.

Correction of Class II malocclusion and soft tissue profile in an adult patient

Treatment of Class II malocclusion in nongrowing individuals is a challenging situation for the clinician. Class II malocclusion with bialveolar protrusion often dictates premolar extractions with maximum anchorage. The present article describes the case of an adult female with skeletal Class II malocclusion, bimaxillary protrusion, increased overjet, deep bite, lip protrusion, everted lower lip, deep mentolabial sulcus, and lip incompetence. To correct the malocclusion, all four first premolars were extracted. Direct anchorage from miniscrews was used for retraction of the anterior segment. The mandibular buccal segment was protracted into the extraction space using Class II mechanics. Ideal Class I canine and molar relation were achieved in 24 months. There was a significant improvement in facial profile and smile esthetics of the patient.

Malocclusion and early orthodontic treatment requirements in the mixed dentitions of a population of Nigerian children.

Introduction:The aims of this study were to establish the prevalence of dental features that indicate a need for early intervention and to ascertain the prevalence of different methods of early treatment among a population of Nigerian children in mixed dentition.Methods:Occlusal relationships were evaluated in 101 children in mixed dentition between the ages of 6 and 12 years who presented at the Orthodontic Unit, Department of Child Dental Health, Lagos University Teaching Hospital over a 2 years period. The need for different modes of early orthodontic treatment was also recorded.Results:Anterior tooth rotations (61.4%) and increased overjet (44.6%) were the most prevalent occlusal anomalies. Others included deep bite (31.7%), reverse overjet (13.9%), and anterior open bite (14.8%). Severe maxillary spacing and crowding were exhibited in 12.0% and 5.0%, respectively. About a third (35.7%) of the subjects presented with crossbite while lip incompetence was observed in 43.6% of the subjects. About 44% of the subjects also presented with various oral habits with digit (15.8%) and lip sucking (9.9%) being the most prevalent. Subjects were recommended for treatment with 2 by 4 fixed orthodontic appliances (22.3%), habit breakers (20.7%), removable orthodontic appliances (16.5%), and extractions (15.7%).Conclusions:Increased overjet and anterior tooth rotation were the majority of occlusal anomalies seen, which are not only esthetically displeasing but may also cause an increased susceptibility to trauma to these teeth. Treatment options varied from extractions only to the use of appliance therapy.

Management of Adult Transverse Malocclusion with Surgically Assisted Rapid Palatal Expansion.

An-18-year old male patient reported to the Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar, with a chief complaint of irregularly placed upper and lower front teeth and restless sleep. On extra oral examination the patient presented with mild convex profile, competent lips and normal nasolabial angle and mentolabial sulcus with no gross asymmetry. Intraoral examination showed severe crowding in both the arches, Class I molar and canine relationship bilaterally, narrow maxillary arch, blocked out upper right canine, upper right lateral incisor and posterior unilateral cross bites, upper midline shifted to right side by 3mm. Cephalometric examination showed that patient exhibited Class I skeletal jaw bases (ANB: 20) with normal mandibular plane angle (FMA: 260), upright upper anteriors (UI-SN: 1020) retroclined lower anteriors (LI-MP: 720), with normal nasiolabial angle (1080) as shown in [Table/Fig-1]. Model analysis suggested 7mm expansion is possible in the upper arch and 5mm of space can be gained in the lower arch.

Miniscrew implants. An effective means of absolute anchorage.

Bimaxillary dentoalveolar protrusion is the condition characterized by procumbency of lips due to increased protrusion of maxillary and mandibular incisors. This condition can be due to tooth size arch length discrepancy, weak lip musculature unable to withstand strong tongue pressure. This results in severe labial tipping of incisors, which causes upper and lower lip protrusion. This case report describes the treatment of a 21-year old girl with bimaxillary protrusion and convex profile with incompetent lip seal. The treatment of choice for the patient was extraction of four first premolars and utilization of extraction space to reduce the facial convexity by retraction of anterior teeth. The anchorage requirement was maximum for complete correction of facial profile. Mini implants were used to retract the anterior teeth and improve facial aesthetic. Treatment was completed in 20 months. Patient`s facial profile improved significantly with reduced dental protrusion and lip eversion.

Treatment of a Class II Division I malocclusion using miniscrews: A case report

This case report describes the use of temporary anchorage devices for an 18-year-old Indian girl with a skeletal Class II malocclusion. Class II skeletal base indicating a vertical growth pattern with prognathic maxilla and orthognathic mandible in relation to the anterior cranial base, bilateral Angle's Class II molar and canine relationship with proclined and forwardly placed upper and lower incisors with an overjet of 7 mm and an overbite of 2 mm, and a convex soft tissue profile with an acute nasolabial angle and potentially competent lips. The treatment includes the extractions of the maxillary first premolars and mandibular second premolars, fixed appliance mechanotherapy, miniscrew-aided maxillary anterior retraction, and protraction of mandibular molars. The Angle's Class II Division I malocclusion, proclined upper and lower anteriors, overjet of 7 mm, and convex soft tissue profile with potentially competent lips were corrected. The crowding and rotation along with proclined incisors were corrected significantly improving patient's facial profile. The trending use of implants in orthodontics for everyday troublesome and complicated protocols is comparatively much efficient and quicker with the aids of mini-implants.

Evaluation of blood flow and electromyographic activity in the perioral muscles.

Although the electromyographic (EMG) activity of the perioral muscles, including the orbicularis oris and mentalis muscles, has been described in individuals with lip incompetence during lip sealing, blood flow through these muscles remains to be elucidated. The purpose of this study was to examine the blood flow associated with EMG activity in the perioral muscles using laser speckle imaging in individuals with lip incompetence. Blood flow and EMG activity of the superior and inferior orbicularis oris and mentalis muscles were measured with the lips in contact (C condition) and apart (O condition) in lip incompetence (experimental) and control subjects (n = 15 in each group; mean age: 29.5 years). The change ratios of blood flow and EMG activity in the C condition versus O condition (C/O ratios) were calculated and plotted in a scattergram. The Mann-Whitney U-test, Wilcoxon signed-rank test, discriminant analysis using the Mahalanobis generalized distance, and Spearman correlation were used for statistical analysis. In the experimental group, blood flow and EMG activity in all muscles were significantly greater in the C condition than in the O condition. The plots of C/O ratios in the experimental group showed a distinct and wide distribution and were significantly different than those in the control group. In both groups, a significant positive correlation was observed between blood flow and EMG activity in the mentalis muscle. The present findings suggest that observing blood flow in the mentalis muscle is an effective and easily performed method of evaluating lip incompetence.