Midfacial Soft Tissue Changes Research Articles

What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study

ObjectivesTo evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE).Materials and methods3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS.ResultsTwenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0–T1). These changes persisted as an overall effect (T0–T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06).ConclusionsOur findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited.Clinical relevanceMARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.

Immediate implant placement with or without immediate provisionalization: A systematic review and meta-analysis.

To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes, and clinical parameters following single immediate implant placement (IIP). Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized controlled trials (RCTs) comparing IIP with IP (test) and IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow-up, marginal bone-level changes, probing depth at final follow-up, and bleeding on probing at final follow-up. Of the 8213 records, 7 RCTs reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP: 162 implants in 162 patients) were selected with a mean follow-up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for five RCTs and high risk for two RCTs. Meta-analysis on the cases with intact alveoli demonstrated 0.87 mm (95% confidence interval [CI] [0.57; 1.17], p< .001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone-level changes, probing depth, and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes and PES. IP may contribute to midfacial soft tissue stability at immediate implants. However, high-quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines.

Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.

The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n= 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n= 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p< 0.001). Similarly, changes in mesial papilla (test=-0.64 ± 0.95 mm, control=-1.20 ± 0.81 mm), distal papilla (test=-0.56 ± 1.17 mm, control=-1.26 ± 0.63 mm), horizontal soft-tissue (test=-0.82 ± 0.95 mm, control=-1.84 ± 0.88 mm; p< 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

Immediate implant placement with or without socket grafting: A systematic review and meta-analysis.

To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP). Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible. Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p< 0.001) or 54% less horizontal buccal bone resorption following IIP + SG when compared to IIP alone. In addition, 0.58 mm (95% CI [0.28; 0.88], p< 0.001) less apical migration of the midfacial soft tissue level was found when immediate implants were installed with SG. A trend towards less distal papillary recession was found (MD 0.60 mm, 95% CI [-0.08; 1.28], p= 0.080) when SG was performed, while mesial papillae appeared not significantly affected by SG. Vertical buccal bone changes were also not significantly affected by SG. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes, pink esthetic score, marginal bone level changes, probing depth and bleeding on probing. Based on GRADE guidelines, a moderate recommendation for SG following IIP can be made. SG may contribute to horizontal bone preservation and soft tissue stability at the midfacial aspect of immediate implants. Therefore, SG should be considered as an adjunct to IIP in clinical practice.

Midfacial Soft Tissue Changes After Reduction Malarplasty: A Computed Tomographic Study.

The reduction malarplasty has become one of the most popular esthetic surgeries among Asian women to improve facial contour. However, it is still controversial whether midfacial soft tissue changes after surgery, and more studies are needed. This retrospective observational study reviewed 30 patients who underwent L-shaped reduction malarplasty during January 2018 and August 2019. The preoperative and postoperative soft tissue thickness and the angle of nasolabial fold of the midfacial were assessed using photographs, three-dimensional skull computerized tomography images, and the Wrinkle Severity Rating Scale. The postoperative average level of nasolabial fold angle was lower than that observed in preoperative conditions, with the difference being statistically significant (t = -10.262, P < 0.001). The postoperative fifth and sixth layers of soft tissue in the midface were significantly higher than those observed in preoperative tissues. Although L-shaped reduction malarplasty has evident effects on soft tissue changes of middle face, they are within acceptable ranges and do not affect patient satisfaction.

Midfacial soft tissue changes after maxillary expansion using micro-implant-supported maxillary skeletal expanders in young adults: A retrospective study.

ObjectiveThe aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implant-supported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage.MethodsTwenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data.ResultsAverage lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05).ConclusionsMaxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.

A comparative evaluation of midfacial soft tissue and nasal bone changes with two maxillary protraction protocols: Tooth-borne vs skeletal-anchored facemasks.

Greater advancement of the maxilla can be achieved with skeletal-anchored facemasks (SAFM) using miniplates than with conventional tooth-borne facemasks (TBFM). The purpose of this study was to compare the effects of TBFM and SAFM on midfacial soft tissue and nasal bone up to twoyears after treatment. Sixty-seven growing patients with Class III malocclusions were treated with facemasks. They were divided into a SAFM group with 31 subjects (average age 11.1years) and a TBFM group with 36 subjects (average age 11.0years). Cephalometric analysis was conducted using linear and angular midfacial measurements. Lateral cephalograms were taken initially (T0), after treatment (T1) and at twoyears post-treatment (T2). Significance was assessed between the two groups. Comparing changes in the midfacial area between the SAFM and TBFM groups during the traction period (T0-T1), angular measurements such as SNOr (1.34°), nasolabial angle (4.20°), nasal angles 1 and 2 (1.23°, 2.14°) and linear measurements such as Prn, Sn, A' distance (approximately 2mm) increased significantly more in the SAFM group. Over the entire treatment period (T0-T2), the changes in SNOr (1.33°), nasolabial angle (6.54°), nasal angles 1 and 2 (1.45°, 2.99°) and Prn, Sn, A' distance (approximately 2mm) remained significant (P<.05). In the treatment of growing patients with Class III malocclusions with maxillary deficiency, it was possible to achieve significantly greater advancement in the midfacial area with SAFM treatment than with TBFM treatment. This significant difference was well maintained at twoyears post-treatment.

Three-Dimensional Analysis of Midfacial Soft Tissue Changes After Maxillary Posterior Impaction and Intraoral Vertical Ramus Osteotomy for Mandibular Setback in Class III Patients.

This study investigated the correlation between the 3-dimensional changes in midfacial soft tissues, including the parasagittal area and maxilla-mandible complex, after Le Fort I maxillary posterior impaction and bilateral intraoral vertical ramus osteotomy (B-IVRO), using cone-beam computed tomography (CBCT). This retrospective study included 22 skeletal Class III patients (6 men and 16 women; mean age 21.6 years) who underwent orthognathic surgery. Three-dimensional CBCT images taken before and 1 year after surgery were superimposed based on the cranial base. Midfacial soft tissues, including those in the parasagittal area (paranasal area, anterior cheek area, lateral cheek area) and midsagittal areas of the face, were evaluated using reconstructed CBCT images. Correlations and the ratios between soft tissue and hard tissue movement were calculated. After surgery, both paranasal areas showed significant forward movement (about 2.0 mm) and the largest upward movement (about 0.15 mm) among the 3 areas. The paranasal areas moved forward with a ratio of 0.5, according to vertical movement of B. Orthognathic surgery using Le Fort I maxillary posterior impaction with B-IVRO mandibular setback results in forward movement of midfacial soft tissues, even though sagittal movement of the maxilla is limited because facial muscles and retaining ligaments pull the redundant soft tissues, which are caused by vertical movement of the maxilla-mandible. This midfacial soft tissue change with maxillary posterior impaction could be advantageous to patients who have paranasal depression and protrusion of the upper lip owing to proclined upper incisors, which are prevalent among Asian Class III patients.

Midfacial Soft-Tissue Changes after Paranasal Augmentation with Porous Polyethylene.

The aim of this study was to determine the effect of porous polyethylene in paranasal augmentation on the overlying soft tissue. Thirty-three patients underwent paranasal augmentation using 3-mm-thick porous polyethylene and mandibular setback, and 35 patients underwent mandibular setback only. Lateral cephalograms were taken before and 6 months after the surgery to compare the soft-tissue changes in the paranasal area. Complications and patient satisfaction following the surgery were also analyzed. The average soft-tissue change in the paranasal area after the augmentation was 2.42 ± 0.33 mm, while there was no definite soft-tissue change in the paranasal area after mandibular setback alone. The ratio of soft-tissue changes to paranasal implant thickness was 80.7%. All patients in the augmentation group were satisfied with their surgical outcomes, which led to convex lateral profile with increase in midface volume. There were no complications such as postoperative infection or foreign body reaction requiring removal of implants. Paranasal augmentation using porous polyethylene is a predictable method providing minimal morbidity in patients with paranasal deficiency.

Midfacial Volumetric and Upper Lip Soft Tissue Changes After Le Fort I Advancement of the Cleft Maxilla

To analyze, using 3-dimensional photogrammetric data, midfacial soft tissue and volumetric changes in the cleft maxilla after 1- or 2-piece Le Fort I (LF1) advancement. This was a retrospective study of patients with cleft and maxillary hypoplasia who underwent LF1 advancement. The primary predictor variable was the type of advancement (1 piece vs 2 pieces). Outcome measurements were changes in soft tissue linear measurements (subnasale [Sn], labium superius [LS], and stomion [SO]) and midfacial volume after maxillary advancement. Eleven patients (7 male, 4 female) underwent LF1 advancements (4 underwent 2-piece advancement). The mean maxillary advancement was 6.2 ± 1.7 mm. Soft tissue changes at the Sn, LS, and SO were 5.2 ± 2.0, 5.8 ± 2.5, and 5.2 ± 1.8 mm, respectively. The average volume change was 12.2 ± 5.7 cm(3). The mean ratios of soft tissue change to the amount of maxillary advancement (millimeters per millimeter) at the Sn, LS, and SO were 0.89 ± 0.49, 0.97 ± 0.44, and 0.89 ± 0.34, respectively. Volume increased by 2.1 ± 1.3 cm(3)/mm. Patients undergoing 1-piece advancement had greater mean advancement and greater soft tissue changes at the LS and SO (P < .03). After controlling for the amount of advancement, 1-piece LF1 osteotomy showed significantly greater improvements at the LS and SO (P<.04). Midface advancement at the LF1 level in patients with cleft consistently expands upper lipsoft tissue and midfacial volume. Greater changes at the LS and SO were seen with 1-piece than with 2-piece osteotomy.

Effects of Antibiotics on Bone and Soft-Tissue Healing Following Immediate Single-Tooth Implant Placement Into Sites With Apical Pathology.

Overprescription of antibiotics can cause bacterial resistance problems, leading to life-threatening illnesses and public health crises. Clinicians often believe antibiotics can prevent dental implant failure and postoperative complications. In conjunction with implant surgery, antibiotics are therefore routinely prescribed for all cases. In this double-blind, randomized controlled trial, the effects of antibiotics on the clinical outcomes of immediate implant placement upon replacing a tooth with an apical pathology were examined to compare antibiotics (n = 10) and placebo (n = 10). In each subject, a tooth with a chronic apical lesion was extracted, thoroughly curetted, irrigated, and replaced with single implant with a screw-retained custom provisional abutment/crown. Postoperative pain/discomfort was measured at 1- and 4-week postsurgical follow-up visits using visual analog scales. Facial alveolar bone and soft-tissue changes were measured using pre- and postoperative cone-beam computerized tomography and impressions. We found survival rates of 100% (antibiotics) and 78% (control). However, there was no statistical difference in means for any clinical outcome (t tests with Bonferroni adjustment for multiple testing), except for midfacial soft-tissue changes: 0.43 mm (SD, 0.76) in the antibiotics group and 1.70 mm (SD, 1.06) in the placebo group (t15 = -2.89, P = .011). The average change of the midfacial alveolar plate was 0.62 mm (SD, 0.46) and 1.34 mm (SD, 0.91) for the antibiotic and placebo groups, respectively, which did not significantly differ statistically. No significant correlation (Spearman correlation) existed between the changes in facial alveolar bone and the facial gingival margin. Antibiotics appear to have little effect on immediate implant treatment outcomes.

Effect of setback Le Fort I osteotomy on midfacial soft-tissue changes as evaluated by cone-beam computed tomography superimposition for cases of skeletal Class III malocclusion

This study employed the cone-beam computed tomography (CBCT) superimposition method to evaluate postoperative midfacial soft-tissue changes in cases of skeletal Class III malocclusion after double-jaw surgery with setback and vertical reduction Le Fort I osteotomy. A retrospective study was carried out on 15 patients who had undergone maxillary setback Le Fort I osteotomy and mandibular setback sagittal split ramus osteotomy with alar cinch suturing and V-Y soft-tissue closure. Three dimensional CBCT volume scans were recorded preoperatively (T0) and 6 months postoperatively (T1) to measure soft-tissue changes of the upper lip and midface. Post-surgery, soft-tissue landmarks in the cheek and paranasal areas had moved forward; the soft-tissue thickness at the A-point had markedly increased (P<0.05); there was no significant change in the subnasale, and the midline of the soft-tissue of the upper-lip area had moved backward. The extent of the mean soft-tissue change at the labrale superius was greater than that at the other soft-tissue landmarks of the upper lip. The results suggest that maxillary setback movement of the maxilla by alar cinch suturing has a beneficial effect on paranasal soft-tissue and lip contours for patients with protrusive lip and acute nasolabial angle.

Midfacial soft-tissue changes after mandibular setback surgery with or without paranasal augmentation: Cone-beam computed tomography (CBCT) volume superimposition

The aim of this article is to compare the soft-tissue changes in the midfacial areas of patients who had undergone mandibular setback sagittal split ramus osteotomy (SSRO) with that of mandibular setback SSRO with paranasal augmentation. The subjects included 15 patients (group I), SSRO with paranasal augmentation and 20 patients (group II), SSRO alone. To evaluate the difference of the midfacial soft-tissue changes between groups, cone-beam computed tomography superimposition was utilized and the soft-tissue changes were measured both preoperatively and postoperatively by a 10 × 27 grid. In group I, the soft tissues were changed at the areas bounded superiorly by the infraorbital foramen, zygomatic eminence, posteriorly by the masseteric muscle and medially by the lateral aspect of the nose and following the nasolabial fold. In group II, the midfacial soft-tissue measurements were unchanged. This study may help clinicians to predict improvement in the midfacial region from mandibular setback SSRO with or without a paranasal augmentation procedure in class III deformities.

Midfacial soft tissue changes after leveling Le Fort I osteotomy with differential reduction

To compare the short- and long-side soft tissue changes in the midfacial areas of patients who have undergone superior repositioning Le Fort I osteotomies for the correction of occlusal cant. The null hypothesis was that there were no significant differences in the midfacial soft tissue changes between the greater- and lesser-reduction sides. The subjects included 25 patients who had undergone Le Fort I osteotomy with superior repositioning and mandibular setback sagittal split ramus osteotomy. Using the cone-beam computed tomography volume superimposition method, the soft tissue changes were measured and determined both preoperatively and postoperatively. A 10 × 27 grid at 4.5-mm (vertical) and 5-mm (horizontal) intervals was used for the hard to soft tissue response. The mean difference in the reduction from leveling Le Fort I osteotomy was 3.2 ± 1.2 mm between the short and long sides (P < .05). The mandibular setback movement averaged 5.4 ± 3.3 mm on the long side and 5.0 ± 3.6 mm on the short side (P > .05). The soft tissue areas below the Frankfort horizontal (FH) plane to 13.5 mm showed different changes after the differential leveling Le Fort I osteotomies. The distinctly changed areas, which showed differences between the greater- and lesser-reduction sides beyond the 2.5-mm average for the soft tissue response, were below the FH plane to 13.5 mm and lateral to the midsagittal reference plane to 30 mm. In light of this, oral surgeons and orthodontists should be concerned about the volumetric midfacial difference after leveling the maxillary occlusal plane at the preoperative stage and thus should take appropriate measures to improve it.

Midfacial Soft-Tissue Changes After Advancement of Maxilla With Le Fort I Osteotomy and Mandibular Setback Surgery: Comparison of Conventional and High Le Fort I Osteotomies by Superimposition of Cone-Beam Computed Tomography Volumes

To compare the soft-tissue changes in the midfacial areas of patients who underwent conventional and high Le Fort I osteotomies with maxillary advancement, using voxel-by-voxel registration at the cranial bases, and to evaluate the influence of the level of the osteotomy cut on those soft-tissue changes. The subjects included 42 patients (28 in group 1 and 14 in group 2) who had undergone conventional or high Le Fort I osteotomy with maxillary advancement and mandibular setback sagittal split ramus osteotomy. Using the method involving superimposition of 3-dimensional cone-beam computed tomography volumes, we evaluated the soft-tissue changes preoperatively and postoperatively. The midfacial area was measured with a 10 × 27 grid at 4.5-mm (vertical) and 5-mm (horizontal) intervals. The maxillary advancement in group 1 averaged 3.35 ± 1.06 mm at the A-point and 3.23 ± 0.98 mm at the same location in group 2. Both of the Le Fort I osteotomies induced an overall hard-to-soft tissue response in the midfacial area (P < .05). In group 1, the distinctly changed soft tissue was marked near the osteotomy line and upper lip. The distribution of the changed points was within a roughly triangular area between the 2 nasolabial folds and the upper lip. In group 2, the soft-tissue changes were concentrated just below the infraorbital foramen. The distribution of the affected soft tissue after the high Le Fort I osteotomy was within the rectangular malar region between the 2 infraorbital foramens and the upper lip.

Three-Dimensional Analysis of Midfacial Soft Tissue Changes According to Maxillary Superior Movement After Horizontal Osteotomy of the Maxilla

Three-dimensional diagnostic and treatment planning is a promising means of improving orthognathic surgical results from the standpoint of facial aesthetics. In such planning, cone-beam computed tomography is a useful tool. The purpose of the present study was to evaluate three-dimensional soft tissue changes in the midfacial region, with specific reference to post-Le Fort I osteotomy maxillary superior movement. Twenty-two patients underwent both Le Fort I osteotomy superior impaction and bilateral sagittal split ramus osteotomy of the mandible (ie, double-jaw surgery). Reference planes and 27 × 10 grids were used in evaluating the midfacial soft tissue areas. The extent of soft tissue change before and after surgery was calculated and analyzed. The results showed no statistical difference between the male and female subjects (P > 0.05). For both the male and the female patients after double-jaw surgery, the soft tissue in the triangular area, which includes both the nasolabial grooves and the upper lip, moved in the anterior direction and maxillary superiorly. It is essential that clinicians concerned about the management of soft tissue and the quality of treatment outcomes understand the pattern of soft tissue change after double-jaw surgery.