Lip Position Research Articles

Cephalometric Assessment of Lips in Skeletal Class II Patients by Steiner’s Line

Abstract Introduction: Steiner's (S) Line has been used as reference line to assess antero-posterior position of lips cephalometrically and has been an effective diagnostic aid in this era of soft tissue paradigm. Norms for S-line has been established for different populations and it has been used widely to assess treatment outcomes in Skeletal Class II malocclusion, however antero-poste-rior position of lips and determinants of lip position in Skeletal Class II has not been explored. Study Design: This Prospective study was aimed to find out the antero-posterior position of lips on cepha-lograph using S-line in patients with retrognathic pro-file and to establish correlation between determinants of lip prominence. Data was collected using non-pro-bability convenience sampling technique following the selection criteria. Materials and Methods: The study was conducted on 65 subjects, with retrognathic profile as judged by orthodontists in consensus and confirmed by lateral cephalogram (ANB > 4°). S-Line was drawn on lateral cephalograph to assess the prominence of upper Lip and lower lip. SPSS 17.0 was used for statistical evalu-ation. Results: Antero-posterior position of upper and lower lip in patients with retrognathic profile with reference to S-line was 1.96 ± 2.6 mm and 3.09 ± 3.16 mm res-pectively. Moreover it was found that statistically sig-nificant correlation existed between lower lip promi-nence as assessed by S-line and upper lip prominence using the same reference line (r = 0.411), Lower inci-sor inclination (r = 0.535) and Skeletal Class II as as-sessed by ANB angle (r = 0.27). Upper lip prominence as assessed S-line was found to be statistically signi-ficantly correlated with lower incisor inclination and lower lip prominence. Discussion: Results were compliant with the previous studies. Conclusion: In the present study both upper and low-er lips were more prominent in Skeletal Class II patie-nts as compared to Steiner's norms for skeletal class I. Keys: Retrognathic Progile, Skeletal II Class Maloc-clusion, Lip Prominence, S-Line.

Associations between orbicularis oris thickness and skeletal and dental variables in mixed dentition

AIM: To evaluate the association between orbicularis oris thickness and skeletal and dental variables in children with mixed dentition. MATERIAL AND METHOD: A convenience sample of 22 children, aged 7 to 12 years, with skeletal Class I and Class II malocclusion and subdivisions were selected. The upper and lower fascicles of the orbicularis oris thicknesses were measured using ultrasound (US) by one calibrated examiner, at rest and in the contracted state. Cephalometric radiograph measurements of the hard and soft tissues were calculated by one trained examiner. The results were analyzed by the Pearson and Spearman coefficients. RESULT: The upper and lower fascicles of the orbicularis oris in the contracted state showed a negative correlation with the distance between Ricketts' E-line and the labrale superius (E ┴ Ls). There were positive correlations between the lower face height and the distance between the AB plane and the labrale superius (AB-Ls) and between the ANB angle and the distance between E ┴ Ls and Ricketts' E-line and the labrale inferius (E ┴ Li). The lower-incisor distance from the N-Pg plane correlated positively with the distance between AB-Ls and the distance between the E ┴ Ls and E ┴ Li. Overbite and interincisal angle were negatively correlated with the distance between the pogonion and the soft tissue pogonion and the distance between E ┴ Li, respectively. CONCLUSION: Skeletal and dental variables were associated with upper and lower lip position and pogonion thickness, while the upper and lower fascicles of the orbicularis oris thicknesses in the contracted state were associated only with upper lip retrusion.

Monkey See, Monkey Do? The Effect of Nonverbal Conductor Lip Rounding on Visual and Acoustic Measures of Singers’ Lip Postures

If singers, without prior prompting, mimicked a conductor’s nonverbal behavior and if this mimicry changed their vocal sound in less than a second, then such a phenomenon could interest vocal music teachers as a time-efficient pedagogical strategy. We tested this claim (“What they see, you will get”), which appears in choral methods literature, by measuring visual and acoustic responses to one nonverbal conductor behavior in a particular singing context. Specifically, we sought to determine whether singers ( N = 114) performing the first phrase of Mozart’s motet, “Ave Verum Corpus,” would mimic a conductor’s rounded lip posture on two /u/ vowels. We also wondered whether conductor lip rounding affected these singers’ tone quality. Visual measures (within-subjects photo comparisons and photo grid analyses) indicated that more than 90% of participants displayed more lip rounding on both /u/ vowels in the experimental condition as compared with baseline. Formant frequency profiles indicated that more than 90% of singers lowered all four examined formant frequencies each time the conductor rounded his lips. We discussed these converging visual and acoustic data in terms of the study’s limitations, potential pedagogical implications of mimicry by vocal performers, and directions for future research.

An evaluation of preferred lip positions according to different age groups

The purpose of this study was to compare preferred facial profiles rated by different age groups. An average profile of each gender was constructed from subjects with normal occlusions. Each average profile was located in the centre, and then the lips were protruded or retruded in six 1mm increments in each direction. 70 lay people were divided into 3 groups: young adult (20-39 years); middle-aged (40-54 years); and senior (55-70 years). They were asked to rank their 3 most preferred profiles for each gender. The distribution of the most pleasing profile was compared according to age groups by the Kruskal-Wallis test and according to the rater's gender by the Mann-Whitney U-test. There was a significant difference between the three age groups regarding the preferred male and female profiles (P<0.001). Both the middle-aged and the senior groups tended to select a slightly more retruded lip/flat profile than the young adult group. There was no gender dimorphism in the selection of the preferred profile. The young adult group preferred the straight profile while the middle-aged and senior groups favoured the slightly retruded profile. This may provide useful information for treatment planning in orthodontics and orthognathic surgery.

Evaluation of Lip Profile in Adolescent Subjects with Skeletal Class I Occlusion and Class III Malocclusion

Aims: To examine the difference of anteroposterior lip position using lateral cephalometric radiograph in a sample of Class I and Class III malocclusion adolescents. Materials and Methods: The study comprised 80 adolescent subjects (40 males and 40 females) who were divided according to the type of occlusion into two groups; dental and skeletal Class I group (40 subjects) and the dental and skeletal Class III group (40 subjects). On lateral cephalometric radiograph, lip position was assessed using 7 linear and 2 angular measurements. The data were analyzed using independent samples t–test. Results: Significant differences were noticed between the two groups for most of the variables. The combined sample showed more retrusive position of the upper lip in Class III group in relation to Steiner, Burtone and Canuts lines. While significantly more retrusive position of the lower lip in Class III group was noticed in relation to Burstone and Harmony lines. In addition, Class III sample showed a significantly smaller H angle and greater Z angle than Class I group. When these reference lines were compared for sensitivity, H line and B line were found to have the greatest power to differentiate between the 2 groups. Sexual dimorphism was noticed in both groups. In Class I group, males showed more protru-sive lips in relation to Steiner line. While in the Class III lines group, males showed more protrusive upper lip in relation to Burton and Canuts lines and in both groups males showed significantly larger H angle and smaller Z angle than females. Conclusions: The skeletal Class III malocclusion tend to have lip profile that differs significantly from skeletal Class I occlusion and is characterized by retrusive upper lip, protrusive lower lip, smaller H angle and more obtuse Z angle. These findings emphasize the importance of integumental evaluation as an aid in orthodontic diagnosis and treatment planning of this type of malocclusion.

Outcomes Following Temporalis Tendon Transfer in Irradiated Patients

To compare objective outcomes and complications following temporalis tendon transfer in patients with and without a history of radiation to the parotid bed. Retrospective medical chart review comparing dynamic movement of the oral commissure and resting symmetry achieved in 7 irradiated patients (group R) and 7 nonirradiated patients (group N) after temporalis tendon transfer for unilateral facial paralysis. There were no significant differences between the 2 groups of patients in terms of age, additional facial reanimative procedures, baseline lip position, or follow-up time. Postoperatively, good resting symmetry was achieved in both groups. The mean commissure excursion was significantly inferior in the irradiated group of patients (-1.5 mm in group R vs 2.1 mm in group N; P < .05). Two patients in the irradiated group experienced surgical site infections requiring hospital admission and eventual debridement of their tendon transfers. Temporalis tendon transfer seems to produce less dynamic movement in patients who have received radiation to the parotid bed, and these patients may also be at higher risk of postoperative infection. Temporalis tendon transfer can achieve good resting symmetry in both irradiated and nonirradiated patients.

Leonardo da Vinci's Aesthetic Analysis of Nasal Tip Prominence

Leonardo da Vinci's Aesthetic Analysis of Nasal Tip Prominence

Evaluation of immediate soft tissue changes after rapid maxillary expansion

OBJECTIVE: To evaluate immediate soft tissue changes following rapid maxillary expansion (RME) in growing patients, using cone beam computed tomography (CBCT). METHODS: Twenty-three consecutive patients (10 male, 13 female) treated by RME were selected. Patients were scanned using CBCT prior to placement of the rapid maxillary expander (T0), then immediately following full activation of the appliance (T1). Defined landmarks were then located on the pre- and post-treatment orientated images. Change in landmark position from pre- to post-treatment was then measured. In addition to landmarks, 10 direct measures were made to determine distance change without regard to direction to measure soft tissue change of the lips. RESULTS: Significant transverse expansion was measured on most soft tissue landmark locations. All the measures made showed significant change in the lip position with a lengthening of the vertical dimension of the upper lip, and a generalized decrease of anterior-posterior thickness of both the upper and lower lips. CONCLUSIONS: Significant changes in the soft tissue do occur with RME treatment. There is a transverse widening of the midface, and a thinning of the lips.

A cephalometric investigation of horizontal lip position in adult Nigerians

The aims of this study were to (1) identify soft tissue cephalometric norms for horizontal lip position in an adult Nigerian population; (2) compare values for Nigerian males and females; and (3) compare Nigerian norms with established norms for Caucasians and other populations. A cross-sectional descriptive study. Lagos University Teaching Hospital Dental Clinic, Idi-araba, Lagos, Nigeria. One hundred students (44 males and 56 females) of the College of Medicine, University of Lagos, aged 18-25 years, of Nigerian ancestry, with a normal class I occlusion and no facial asymmetry. Lateral cephalometric radiographs of the subjects were taken in natural head position. Radiographs were manually traced and 11 soft tissue cephalometric parameters measured. These were derived from the Steiner, Ricketts, Burstone, Merrifield and Holdaway soft tissue analyses. Male and female values were compared using Student's t-test with a level of significance at P<0·05. Statistically significant differences were observed between Nigerian males and females in eight of the variables studied, with males having more protrusive upper and lower lips than the females. Variables, which did not vary by sex, were soft tissue facial angle, nose prominence and soft tissue chin thickness. In addition, Nigerian norms were higher than norms reported by Steiner, Ricketts, Burstone and Holdaway for Caucasian populations, while the Z-angle was lower than the norm established by Merrifield. Gender-specific soft tissue norms for horizontal lip position should be used for orthodontic treatment planning in Nigerian subjects. Nigerians have more protrusive upper and lower lips compared to Caucasians.

Three-dimensional evaluation of changes in lip position from before to after orthodontic appliance removal

Our objectives were to develop a reproducible method of superimposing 3-dimensional images for measuring soft-tissue changes over time and to use this method to document changes in lip position after the removal of orthodontic appliances. Three-dimensional photographs of 50 subjects were made in repose and maximum intercuspation before and after orthodontic appliance removal with a stereo camera. For reliability assessment, 2 photographs were repeated for 15 patients. The images were registered on stable areas, and surface-to-surface measurements were made for defined landmarks. Mean changes were below the level of clinical significance (set at 1.5 mm). However, 51% and 18% of the subjects experienced changes greater than 1.5 mm at the commissures and lower lips, respectively. The use of serial 3-dimensional photographs is a reliable method of documenting soft-tissue changes. Soft-tissue changes after appliance removal are not clinically significant; however, there is great individual variability.

A prospective comparative study between differential moments and miniscrews in anchorage control

The purpose of this study was to measure the efficacy of anchorage control between differential moments mechanics and temporary anchorage devices in a clinical trial. Forty-six patients requiring extraction of maxillary first premolars were allocated into 2 treatment groups. The differential moments group (G1) received a nickel titanium (NiTi) intrusion arch and a 150g NiTi closing coil spring for separate canine retraction, followed by a continuous mushroom loop archwire for the retraction of the incisors. The TAD group (G2) received one miniscrew placed between maxillary second premolars and first molars with a 150 g NiTi closing coil spring connecting the miniscrew to a hook placed in the archwire between the lateral incisor and canine. Lateral cephalograms were taken before (T1) and after incisor retraction (T2). The ratio of molar protraction to incisor retraction was calculated and intragroup and intergroup changes in upper lip, maxillary incisor and molar position were analyzed by paired and independent t-tests. Twenty-eight patients were analyzed after 18 patients did not receive the intervention, were lost to follow-up, or discontinued treatment. The ratio of molar protraction to incisor retraction in G1 was 0.44 and in G2 was -0.11, which was significantly different. There was a statistically significant change in upper lip from T1 to T2 but no difference between the two groups. Moreover, there was a significant distal molar tipping and lingual incisor tipping in G2. There is a significant difference in the amount of anchorage control using differential moments mechanics compared to TADs. Although statistically significant retraction of upper lip was observed in both groups, there was no significant difference between the two groups.

Factors influencing attractiveness of soft tissue profile

The factors affecting the attractiveness of the soft tissue profile are assessed in only very few nonmatched and controversial studies. We aimed to evaluate these factors in a matched comprehensive study. Profile photographs of 100 students with good occlusion were sorted according to facial beauty by 20 judges. After excluding 40 unmatched subjects or those with marginal scores, 12 soft tissue variables were compared among profiles of 30 attractive and 30 unattractive matched participants (t test, α = 0.05). As the most important factor, excessive mandibular retrusion made both men and women unattractive. Both attractive men and women tended to have less prominent noses with higher nose tips, protruded upper lips compared with the position of lower lips, and deeper lower faces. Closeness of lips to the middle of vertical chin-nose distance enhanced female beauty only. Straight profiles and more protruded maxillae merely made men more attractive.

Three-dimensional analysis of dentolabial relationships: effect of age and sex in healthy dentition

Morphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided into a youthful group (21–34 years, mean 26 years, SD 4) and an older group (45–65 years, mean 53 years, SD 5). Stone labial and dental models were made, digitized and 3D virtual reproductions of dentolabial morphology were obtained. From the digital reconstructions, the relative positions of the labial commissure and of the maxillary dental clinical crowns in the vertical direction were obtained. Sex and age effects were compared using two-way analysis of variance. Lip position relative to the teeth was significantly different in youthful and older subjects (P<0.01). No statistically significant effects of sex in dentolabial relationship were demonstrated, but a sex×age effect was found in the anterior labial segments (P<0.05). The perioral soft tissues drop down in older subjects and the soft tissue descends on the entire labial arch. These differences may help the clinician when estimating, planning and evaluating surgical, orthodontic and prosthetic treatments.

Motor Equivalent Strategies in the Production of German /∫/ under Perturbation

The German sibilant /∫/ is produced with a constriction in the postalveolar region and often with protruded lips. By covarying horizontal lip and tongue position speakers can keep a similar acoustic output even if the articulation varies. This study investigates whether during two weeks of adaptation to an artificial palate speakers covary these two articulatory parameters, whether tactile landmarks have an influence on the covariation and to what extent speakers can foresee the acoustic result of the covariation without auditory feedback. Six German speakers were recorded with EMA. Four of them showed a covariation of lip and tongue, which is consistent with the motor equivalence hypothesis. The acoustic output, however, does not stay entirely constant but varies with the tongue position. The role of tactile landmarks is negligible. To a certain extent, speakers are able to adapt even without auditory feedback.

Comparative cephalometric study of Class I malocclusion in Egyptian and Japanese adult females

Orthodontic diagnosis is the key factor for conducting a successful orthodontic treatment. It typically includes comparing a patient's cephalometric measurements to standard values. However, lateral cephalometric norms, may be specific to an ethnic group and cannot always be applied to other ethnic types. Thus the purpose of this study was to compare the cephalometric features of Class I malocclusion in Egyptian and Japanese adult females inorder to understand the ethnic differences between these two groups. The lateral cephalograms of 50 Egyptian adult females and 50 Japanese adult females were traced and digitized by one investigator. Seventeen angular measurements and thirteen linear measurements of facial form were computed. A comparison of the vertical dimensions showed that, the Japanese had a significantly steeper mandibular plane angle. Also, Japanese females had a significantly larger lower face height together with increased distances of the posterior teeth to the mandibular plane. For the soft tissue dimensions, the Japanese subjects had a significantly less prominent nose, protruded lip positions, and a more retruded chin compared with Egyptians. These characteristic skeletal and soft tissue different features should be taken into consideration when formulating an orthodontic treatment plan for patients of varying ethnic backgrounds to optimize the final results.

Photos vs silhouettes for evaluation of African American profile esthetics

Patient photos and silhouettes are commonly used in clinical evaluations and orthodontic research to evaluate profile esthetics. The purpose of this study was to determine whether the use of photos or silhouettes is a more appropriate method of evaluating African American profile esthetics and whether there are different profile esthetic preferences among clinicians when using photos compared with silhouettes. Pretreatment records of 20 adolescent African American patients were selected (10 male, 10 female) from the orthodontic clinic at the Albert Einstein Medical Center in Philadelphia. Each patient's profile photo was digitally changed with imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to fabricate a series of 7 photos and 7 silhouettes with lip positions at uniform distances relative to Ricketts' E-line standard. Fifteen raters consisting of orthodontic faculty and residents were asked to select the most esthetically pleasing profile from each patient's photo series and silhouette series. More rater preferences for the photographs (86%) were within the acceptable esthetic range (within 2 mm of the E-line in either direction) than were their preferences for silhouettes (66%) (P <0.001). Flatter profiles with less lip projection than the esthetic norm were more often preferred in the silhouettes than in the photos. Thirty-one percent of the silhouettes preferred by the raters were flatter than the norm compared with 9% of the photos (P = 0.003). Fuller profiles were preferred in only 3% of the silhouettes and 5% of the photos (P = 0.6). Esthetic attractiveness of faces of African American orthodontic patients is rated differently in photos and silhouettes. When evaluating soft-tissue esthetic profile preferences, rater preferences in the photographs were closer to the established esthetic norm than were their preferences in the silhouettes. Using silhouettes to evaluate patient esthetics could influence clinicians or researchers to select profiles that are flatter than the established esthetic norm.

Postura, tônus e mobilidade de lábios e língua de crianças respiradoras orais

OBJETIVO: caracterizar a postura, o tônus e a mobilidade dos lábios e da língua de crianças respiradoras orais. MÉTODO: participaram do estudo realizado em São Paulo, SP, Brasil, 40 crianças respiradoras orais, sendo 26 (65%) do sexo masculino e 14 (35%) do sexo feminino, com idades entre 7 e 10 anos. Utilizou-se o protocolo MBGR para avaliação dos aspectos analisados. RESULTADOS: foram encontrados os seguintes achados para postura dos lábios: entreabertos (32,5%), alternância entre abertos e fechados (27,5%), abertos (22,5%) e fechados (17,5%). Em relação ao tônus do lábio superior: 90% apresentaram tônus normal, 10% diminuído e nenhuma com tônus aumentado. Quanto ao tônus de lábio inferior, 80,0% das crianças apresentaram tônus diminuído e 20,0% normal. No item mobilidade dos lábios, 100,0% apresentaram mobilidade mais próxima dos melhores escores. Em relação à postura habitual da língua, em 57,5% esta estrutura permaneceu no assoalho, em 32,5% não foi possível observar sua posição e em 10,0% se encontrava em posição interdental. Quanto ao tônus da língua, 52,5% apresentaram tônus diminuído e 47,5% normal. Na avaliação de mobilidade de língua, 100,0% apresentaram mobilidade mais próxima dos melhores escores. CONCLUSÃO: as características de postura, tônus e mobilidade dos lábios das crianças respiradoras orais estudadas foram: lábios entreabertos, lábio superior com tônus normal, lábio inferior com tônus diminuído e mobilidade normal. Em relação à língua: postura no assoalho da boca, tônus diminuído e mobilidade normal.

Soft and hard tissue changes after bimaxillary surgery in Japanese class III asymmetric patients

Objectives:To assess the effects of bimaxillary surgery on Class III subjects with mandibular asymmetry, and to compare the effects of the type of surgery performed in the mandible on the facial profile especially in the presence of facial asymmetry.Materials and Methods:Thirty-six patients in whom imbalance between the maxilla and the mandible were corrected by Le Fort I osteotomy combined with bilateral intraoral vertical ramus osteotomy (BIVRO group, n=9), bilateral sagittal split ramus osteotomy (BSSRO group, n=14), or a combination of intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) (IVRO + SSRO group, n=13). Cephalograms were taken before surgery (T1), and 1 year after surgery (T2). Hard and soft-tissue changes were compared.Results:The postsurgical findings showed that greater mandibular backward displacement and greater upper lip forward movement were more pronounced among BIVRO group when compared with BSSRO group. Upper lip relation to E-line showed greater improvement in BIVRO group than BSSRO and IVRO + SSRO groups. The ratios of corresponding mandibular soft to hard tissue movements were higher than that of maxillary movements and were more pronounced in IVRO + SSRO and BSSRO groups when compared with BIVRO group.Conclusion:IVRO surgical technique appears to be more effective in positioning the mandible more posteriorly and improving upper and lower lips position and competence.

Upper lip changes and gingival exposure on smiling: Vertical dimension analysis

Our objectives were to evaluate and quantify upper lip soft-tissue changes in the vertical dimensions both at rest and at maximum smile, and to examine the correlation between upper labial vestibular attachment height and maxillary gingival exposure on smiling. Seventy-two volunteers (36 men, 36 women) aged 20 to 40 (mean, 30.49 years) were recruited for this study. For each subject, 9 measurements of upper lip position and maxillary incisor crown height at rest and in maximum smile were recorded. A statistically significant sexual dimorphism was apparent in most of the measured variables. Relaxed external upper lip length was 3.1 mm shorter in the women than in the men. The mean maxillary central incisor display at rest was 1.78 mm greater in the women than in the men. A high smile line was 2.5 times more prevalent in the women. The upper lip was shortened by 30% in subjects with a high smile line compared with 23% in subjects with a low smile line. The following findings were observed in subjects with a high smile pattern: (1) short upper lip length, (2) low smiling/resting upper lip length ratio, (3) inferior attachment of the upper labial vestibule, and (4) prominent upper lip vermilion.

Speech Pathology Findings in Patients with Oral Breathing According to the Etiology

Some authors claim that alterations in speech, language, voice, chewing and deglutition are characteristics of oral breathing children. Because it is a symptom and it has causes, that many times are multifactorial, it is necessary to clarify more details about the clinical aspects of this entity. This study aimed to identify and compare the findings of alterations in: speech; orofacial functions; positions of lips and tongue; voice and language in children, 2 to 16 year old, with a history of oral breathing, according to the following diagnoses: allergic rhinitis; adenoidal hypertrophy; allergic rhinitis and adenoidal and functional hypertrophy. 414 patients of both genders, from 2 to 16 year old, of the Care Center for Oral Breather were evaluated by a team made up by speech pathologists, allergists, and otolaryngologists who carried out clinical and integrated examinations (CBC, X-ray, nasal endoscopy, audiometry) of all patients. The diagnosis of oral breathing etiology was based on specific serum measurements of IgE (imunoglobolineE), X-ray of paranasal sinuses and/or nasal endoscopy. Data were statistically analyzed. The patients were divided according to otologic diagnosis for oral breathing. The etiology, most present in the sample, was allergic rhinitis. The most observed speech-language diagnosis was the presence of alterations in orofacial functions; position of lips and tongue and tone, separately or accompanied by other alterations. The studied sample showed presence of 82.2% relative to speech-language alterations. There were no statistically significant associations between the etiology of the patients and presence and/or number of alterations in speech-language diagnosis.