Perioral Soft Tissue Research Articles

Oral Chronic Graft-versus-Host Disease and Oral Health after Allogeneic Hematopoietic Cell Transplantation — What the Care Team Needs to Know

Oral chronic graft-versus-host disease (cGVHD) can present with a multitude of clinical signs and is associated with morbidity and lower quality of life. Oral cGVHC may affect the oral mucosa (reticular white striae, erythema, and/or ulcerations), the salivary glands (hyposalivation and/or xerostomia) and the peri-oral soft tissues (fibrosis and trismus). This review provides a practical and concise approach to the diagnosis and management of oral health needs in pediatric and adult alloHCT recipients within the first 2 years post-transplantation.

Impact of Overjet Severity and Skeletal Divergence on the Perioral Soft Tissue Area

Overjet (OJ) and skeletal divergence affect the perioral soft tissue. However, no previous study has investigated the combined effects on perioral soft tissue, which includes the upper lip (UL), lower lip (LL), and chin projection. We explored the impact of OJ severity and skeletal divergence on the perioral soft tissue. Lateral cephalograms of 133 untreated skeletal Class II adult patients were allocated into three categories according to the degree of skeletal divergence: hypodivergence (Hypo), normodivergence (Normo), and hyperdivergence (Hyper). Furthermore, OJ was classified as normal OJ (NOJ), moderately excessive OJ (MEOJ), and severely excessive OJ (SEOJ). A matrix of skeletal divergence and OJ variables produced the following groups: NOJ-Hypo, MEOJ-Hypo, SEOJ-Hypo, NOJ-Normo, MEOJ-Normo, SEOJ-Normo, NOJ-Hyper, MEOJ-Hyper, and SEOJ-Hyper. The skeletal, dental, and soft tissue parameters were measured. Statistical analyses showed that increased hyperdivergence and OJ severity corresponded with a more retruded mandibular perioral soft tissue (MPST), except for the Pog’ in the SEOJ-Hypo group, which was insignificantly more prominent than the MEOJ-Hypo group. Unlike the LL, the UL was similar among the groups. Multiple regression indicated that greater OJ and skeletal divergence significantly influenced MPST retrusion and increased vermilion lower lip thickness (VLLT) while independently affecting deeper mentolabial sulcus depth (MSD) and a more obtuse lip-chin-throat angle (P < 0.05). The effect of OJ was most significant at the LL and gradually decreased down to the chin; conversely, divergence increased downwards. The SEOJ-Hyper group displayed the greatest retruded MPST, thickest VLLT, and deepest MSD, which highlighted the combined effect of OJ and divergence.

Changes in Soft Tissue Variable of Lips Following Retraction of Anterioir Teeth- A Cephalometric Study.

The purpose of this study was to assess the short-term perioral soft tissue variations of the lips before and after treatment cases in 15 patients with bi-maxillary protrusion using treated lateral cephalograms who had already achieved active growth. Fifteen pre-treatment and post-treatment lateral cephalometric radiographs of 18-25-year-old individuals with bimaxillary protrusion treated with all four 1st premolar extractions were accessed from the records. From the reference planes and landmarks, 13 horizontal, 10 vertical, and 2 angular measurements were noted. Statistical comparisons between pre-treatment and post-treatment measurements were measured by a paired t-test to assess the importance of the mean variations at the predetermined significance level. Pearson's correlation coefficient (R) was utilized to assess the strength and significance of the linear relationship between the mean differences for paired (dependent and independent) variables. Pearson's correlation exhibited a noteworthy positive association between the horizontal changes in upper lip position and the horizontal changes of the upper incisor tip point (H-tU1) (R = 0.748), the upper incisor cervical point (H-cU1) (R = 0.707), the lower incisor tip point (H-tL1) (R = 0.839), and the lower incisor cervical point (H-cL1) (R = 0.767). This indicated that upper lip changes are the aftermath of the retraction of the upper and lower incisors in class I bi-maxillary protrusion malocclusion. Thick upper lips showed more retraction of the upper lip in correlation with retraction of the incisors as compared with thin lips. The lower incisor cervical point displayed the strongest association with lower lip retraction.

Three-dimensional evaluation of orofacial movements during articulation in patients with skeletal Class III malocclusion with mandibular asymmetry

ABSTRACT Purpose This study aimed to compare the perioral soft tissue movements in patients with skeletal Class III malocclusion with and without mandibular asymmetry during sound articulation. Materials and Methods Patients with skeletal Class III facial deformity with mandibular asymmetry (asymmetric facial deformity; AFD, n = 21), without mandibular asymmetry (symmetric facial deformity; SFD, n = 27), and control skeletal Class I healthy individuals (n = 24) participated in this study. Perioral soft tissue movements were recorded during the articulation of /apa/, /ipi/, /upu/, /epe/, and /opo/ using a three-dimensional motion capture system. The asymmetry index (AI) of the range of movements of the commissure points on both sides was compared among the three groups by Kruskal–Wallis test and Dunn–Bonferroni test. Additionally, the correlation between the AI and the range of menton (Me) deviation was examined among patients in the SFD or AFD group by Spearman’s correlation test. Results AI on the vertical and sagittal dimensions during the /ipi/ sound articulation in the AFD group was significantly lower than in the other two groups (p < 0.05). In the AFD and SFD groups, AI on the vertical dimension was significantly correlated with Me deviation during /ipi/ sound articulation, as well as on the sagittal dimension during /apa/, /ipi/, /upu/, and /epe/ sound articulation (p < 0.05). Conclusion AFD patients displayed more asymmetric perioral soft tissue movements than SFD patients during bilabial sound production.

Immediate effect of clear aligners and fixed appliances on perioral soft tissues and speech.

To compare the immediate three-dimensional (3D) perioral soft-tissue changes and impact on speech induced by clear aligners and fixed appliances. In this repeated-measure experimental study, stereophotogrammetric 3D photographs of 40 participants were recorded before and immediately after the introduction of clear aligners and fixed appliances. The 3D surface meshes were registered to quantify changes in the direction and magnitude of nine soft tissue landmarks located on the upper and lower lips. Self-reported speech disturbance was evaluated using a questionnaire. Data were analysed using repeated-measures analysis of variance. In the vertical plane, the clear aligners induced inferior displacement (range 0.4-1.5 mm) for all nine landmarks (P < .01), whereas fixed appliances induced inferior displacement only of A-point (0.4 ± 0.9 mm), right crista philtri (0.5 ± 1.1 mm) and left crista philtri (0.7 ± 1.1 mm). The clear aligners induced greater vertical changes than fixed appliances for all landmarks (P < .05). In the sagittal plane, both clear aligners and fixed appliances slightly advanced all perioral landmarks, except subnasale. Fixed appliances caused greater changes than clear aligners for right cheilion (+0.8 mm), left cheilion (+0.8 mm) and labrale inferius (+0.9 mm) (P < .01). Both orthodontic appliances had a significant self-perceived effect on speech, with clear aligners affecting speech to a greater degree. Clear aligners and fixed appliances produced immediate effects on perioral soft tissues, which are most evident in the vertical plane for clear aligners, and in the sagittal plane for fixed appliances. Speech was affected by both appliances.

Expanding the Spectrum of Perioral Myogenic Tumors in Pediatric Patients: An SRF::NCOA2 Fused Perivascular Tumor of the Philtrum.

Perivascular tumors, which include myopericytoma and myofibroma, are rare benign soft tissue neoplasms composed of perivascular smooth muscle cells. Most demonstrate characteristic morphology and are readily diagnosed. However, a recently identified hypercellular subset shows atypical histologic features and harbor unique SRF gene fusions. These cellular perivascular tumors can mimic other more common sarcomas with myogenic differentiation. Clinical, radiological, morphological, immunohistochemical, and molecular findings were reviewed. A slow-growing, fluctuant mass was noted within the philtrum at 16 months. Ultrasonography revealed a well-circumscribed cystic hypoechoic lesion. A small (1.0 cm), tan, well-circumscribed soft-tissue mass was excised after continued growth. Histologically, the encapsulated tumor was hypercellular and composed of spindle cells with predominantly-storiform architecture, focal perivascular condensation, dilated branching thin-walled vessels, increased mitoses, and a smooth muscle immunophenotype. An SRF::NCOA2 fusion was identified. We report the first case of an SRF-rearranged cellular myopericytoma in the perioral region in a young child. This case expands the differential diagnosis of perioral soft tissue tumors with myogenic differentiation. We highlight key clinical, pathological, and molecular features. As we illustrate, these rare tumors pose a considerable diagnostic challenge, and risk misdiagnosis as sarcoma, most notably spindle cell rhabdomyosarcoma.

Restoration of Hybrid Prosthesis for Misplaced Implants – A Case Report

An implant-supported hybrid prosthesis is an acrylic resin complete fixed dental prosthesis and supported by implants might be a solution in extreme cases that the need of the restoration for esthetics, function, lip support, and speech. This clinical report aims to present the esthetic and functional prosthetic rehabilitation of a borderline case with implant-supported hybrid prostheses. A 31yrs old female patient was referred to the department of prosthodontics for rehabilitation of angulated implants. The intra-arch dimension of the patient was excessive and an insufficient peri-oral soft tissue support was observed. The clinical and radiologic examinations showed satisfactory implant health. After 3 years of follow-up, no functional, phonetic, or esthetic problems with the restorations were noted. This case reports suggest that implant-supported hybrid prostheses can be a reliable alternative treatment procedure when a porcelain-fused metal fixed restoration does not satisfy a patient's requirements for esthetics, phonetics, oral hygiene, and oral comfort.

Incorporating the Osseous Genioplasty Into Rejuvenation of the Lower Face.

The chin plays a critical role in the shape, projection, and soft tissue support of the lower face. Osseous genioplasty is a powerful tool in facial rejuvenation as it allows for optimal control of the resulting chin dimensions and improvement in submental and submandibular laxity. Osseous genioplasty can be used alone or in combination with other facial rejuvenation procedures to achieve an optimal result. The aim of this study was to present the senior author's approach to skeletal analysis of the lower facial third and propose an algorithm that can be used to optimize skeletal support of the overlying soft tissue laxity while maintaining an aesthetic facial shape and proportion of the chin. All patients undergoing cosmetic osseous genioplasty for soft tissue rejuvenation of the lower face and/or perioral region with the senior author between 2010 and 2021 were retrospectively reviewed. Complications, including infection, numbness, and prolonged ecchymosis, were recorded. A total of 37 patients underwent cosmetic osseous genioplasty. The average age of the cohort was 44.5 years. Twenty-six patients (70.3%) were female. Eleven patients (29.7%) underwent genioplasty alone. In addition to genioplasty, 8 patients (21.6%) underwent orthognathic surgery, 5 patients (13.5%) underwent platysmaplasty and liposuction, and 2 patients (5.4%) underwent facelift. The authors propose an algorithm to guide evaluation of the lower facial third to help determine the possible role of osseous genioplasty for facial rejuvenation based on each patient's unique facial characteristics. In properly selected patients, osseous genioplasty can improve lower facial projection, submandibular laxity, and perioral soft tissue support while also optimizing facial shape and proportion.

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach.

The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision. This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured. A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip. This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Alteration of Oral and Perioral Soft Tissue in Mice following Incisor Tooth Extraction.

Oral and perioral soft tissues cooperate with other oral and pharyngeal organs to facilitate mastication and swallowing. It is essential for these tissues to maintain their morphology for efficient function. Recently, it was reported that the morphology of oral and perioral soft tissue can be altered by aging or orthodontic treatment. However, it remains unclear whether tooth loss can alter these tissues’ morphology. This study examined whether tooth loss could alter lip morphology. First, an analysis of human anatomy suggested that tooth loss altered lip morphology. Next, a murine model of tooth loss was established by extracting an incisor; micro-computed tomography revealed that a new bone replaced the extraction socket. Body weight was significantly lower in the tooth loss (UH) group than in the non-extraction control (NH) group. The upper lip showed a greater degree of morphological variation in the UH group. Proteomic analysis and immunohistochemical staining of the upper lip illustrated that S100A8/9 expression was higher in the UH group, suggesting that tooth loss induced lip inflammation. Finally, soft-diet feeding improved lip deformity associated with tooth loss, but not inflammation. Therefore, soft-diet feeding is essential for preventing lip morphological changes after tooth loss.

Effect of Prosthodontic Rehabilitation on Perioral Units in Edentulous Patients

Background: Complete edentulous patients experience loss in fundamental mastication functions, the progressive absorption of the alveolar bone, and variation in facial appearance. Complete dentures (CD) fundamentally target edentulous patients and not only increase functionality but also restore the appearance of the face. This study aims to evaluate the effect of rehabilitation with removable CD on perioral wrinkles in complete edentulous patients, in line with growing aesthetic demand.&#x0D; Methods: Patients who had CD rehabilitation performed due to total edentulism were photographed before and after rehabilitation from the same angles to evaluate the perioral soft tissue changes. The photographs were scored using verified ranking scales and through evaluation by two observers. To evaluate the repeatability of the scales, measurements were repeated with the same method one month later.&#x0D; Results: When the effect of prosthetic rehabilitation administered successfully on perioral aesthetics and lip volume was analyzed, a significant improvement was observed in all other parameters evaluated, except for in the labiomental crease. The improvement in the labiomental crease was not statistically significant. In addition, re-measurement reliability was high (≥0.80) for all four perioral units (nasolabial folds, corners of mouth, labiomental crease and upper radial lip). In addition, all correlations were statistically significant (p

Periorbital and Perioral Defect Reconstruction Using the Split Pre-Expanded Medial Arm Flap Aided by Using Indocyanine Green Angiography.

The pre-expanded medial arm flap provides suitable skin for the resurfacing of a periorbital or perioral defect. However, the flap must be intraoperatively split to imitate the appearance of the oral or ophthalmic fissure, which can compromise flap perfusion. This study aimed to evaluate the safety and effectiveness of splitting pre-expanded medial arm flaps with the aid of indocyanine green angiography. All 8 patients underwent periorbital or perioral soft tissue reconstruction using a split pre-expanded medial arm flap. Flap splitting was aided by indocyanine green angiography. It was used during 2 stages of the procedure, tissue expander placement and flap transfer. The pedicle was divided 3 weeks later, and the flaps were used to resurface the defect. The distal portion of the flap was split into a fishmouth pattern in 5 patients and a window pattern in 3 patients. The donor sites were closed directly or by using a latissimus dorsi myocutaneous flap. There were no perioperative complications or flap necrosis. A pre-expanded split medial arm flap could be an option for the reconstruction of periorbital and perioral defects. With the assistance of indocyanine green angiography, vessel distribution and distal flap perfusion can be reliably evaluated, facilitating the safe splitting of the flap for the reconstruction of defects.

Evaluating safety in hyaluronic acid lip injections

ABSTRACT Introduction Soft tissue filler augmentation has become increasingly popular due to its perceived ease and impressive results. Unfortunately, although the results are impressive, so are the reported complications. This article describes complications specific to peri-oral soft tissue filler injection and then discusses evidence-based, anatomic prevention and treatment guidelines. Areas Covered The authors aimed at providing an overview of the complications associated with peri-oral soft tissue filler. Hyaluronic Acid (H.A) fillers may have devastating complications which are oft undisclosed or published. This narrative review aims to describe the various complications and provide preventative strategies. Expert opinion Given the paucity of prospective, randomized clinical trials on the subject and in light of complication underreporting, the authors believe that efficacy and safety literature on the subject is lacking. Injectors must rely on the one strength which exists in the lip literature to date, that is anatomy. The basis of all successful injections is a mandatory understanding of normal as well as variations of vital structures in an area, combined with meticulous injection techniques, deposition of small aliquots of product and the ability to recognize unwanted adverse events early enough to act on them.

Biomechanical properties of the lips in a pre-orthodontic sample of adolescents and young adults.

To assess biomechanical properties of the lip muscles and to investigate their relationship with sex, age, body mass index (BMI), and cephalometric variables. Demographic information and BMI were collected from 83 study participants seeking orthodontic treatment at the University of Otago. Tone, stiffness, and elasticity of the lip muscles were measured thrice at four different anatomical sites using a digital palpation device. To estimate method error, a duplicate set of measurements in a subsample of 20 participants was taken a week later. Sagittal and vertical cephalometric classifications were based on ANB and FMPA angles, respectively. Data were analysed using mixed models. Biomechanical properties of lip muscles were remarkably consistent both within and between different recording sessions. The lower lip had higher tone and stiffness than the upper lip. Both the upper and lower lip stiffness and tone were higher in females than in males, whereas upper lip elasticity was higher in males. Thinner upper lips had higher tone and were stiffer than thicker upper lips, whereas thinner lower lips were less elastic than thicker lower lips. Muscle tone and stiffness of both the upper and lower lips were lower in Class III than in Class I and Class II individuals. The upper lip of hyperdivergent individuals was less elastic than that of normodivergent and hypodivergent individuals, and stiffer than that of hypodivergent individuals. The biomechanical properties of perioral soft tissues can be reliably measured and vary with anatomical site, sex, and cephalometric measurements.

Use of bufferized dental anesthetics in dental surgery

Introduction and objective: The addition of epinephrine to the anesthetic solution reduces the pH of the solution to a range between 2.9 and 4.4.The acidity of the anesthetic may delay onset and contribute to injection pain. Objective: to determine the intensity of pain during a mandibular third molar surgery after using buffered 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration. Materials and methods: an observational and descriptive clinical study was performed. The buffered solution was alkalinized with 8.4% sodium bicarbonate with a ratio of 9:1, using a hand-mixing methodology, the sample were patients who required a mandibular third molar surgery. After standardizing the anesthetic technique, it was used the inferior alveolar nerve block followed by buccal infiltration. Results: 32 patients (20 female - 62.5% and 12 male - 37.5%), with an average age of 21.12 years (mean ± standard deviation [SD]: 21.12 ± 3.61) were admitted to the study. When assessing the pain puncture and during the injection, 94% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 62%. Only a small percentage of patients required complementary anesthesia. Conclusion: buffered 4% of articaine with epinephrine in the inferior alveolar nerve block with buccal infiltration significantly decreased onset time, injection pain and need for complementary anesthesia in third molar surgery.

Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis.

SummaryBackgroundMiniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy.ObjectivesThis systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects.Search methodsSeven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020.Selection criteriaRandomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes.Data collection and analysisInclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality.ResultsEight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days.LimitationsOne of the main drawbacks was the lack of high-quality prospective studies in the literature.Conclusions and implicationsMARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended.RegistrationPROSPERO (CRD42020176618).FundingNo grants or any other support funding were received.

Pain assessment after application of 4% articaine with epinephrine 1:100000 during mandibular dental procedures

Inferior alveolar nerve block in the mandibular technique is the blockade that presents most failures in the dental practice, so this technique is considered the less effective of those used in Dentistry and the most frustrating to the dentist. This study aimed to determine pain intensity during dental procedures after using 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration in patients who were attended in the dental clinic of the University of Cartagena, Colombia. A clinical randomized trial was performed. The sample was of patients who required dental procedures in the jaw with local anesthesia. After standardization of the anesthetic technique, and use of 4% articaine with epinephrine 1:100000, the inferior alveolar nerve was blocked with 0.9 mL (half cartridge) followed by buccal infiltration with 0.9 mL in the first mandibular molar. Fifty patients (30 men - 60% and 20 women - 40%), with an average age of 25.3 years old (mean ± standard deviation [SD]: 25.3 ± 6.6) were included in the study. When assessing the pain puncture and during the injection, 92% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 97%. Only a small percentage of patients required complementary anesthesia. The authors recommend the use of 4% of articaine with epinephrine in mandibular procedures that require deep pulp anesthesia, using this with a buccal infiltration.

Oral and perioral soft tissue lesions and oral functions in patients with dystrophic epidermolysis bullosa

Background/Aim. Dystrophic epidermolysis bullosa (DEB) is characterized by distinct systemic and skin changes, as well as numerous oral manifestations. The aim of the study was to examine oral and perioral soft tissues and oral functions in DEB patients by monitoring changes over a period of one year. Methods. Twenty-four patients (1 month to 36 years old) were clinically examined initially (T0), after 6 months (T6), and after 12 months (T12). Appearance and localization of perioral and oral bullae and scars, maximum mouth opening, reduced vestibule depth, absence of lingual papillae and palatal rugae, and restricted tongue movement due to scarring were monitored. The values of maximum mouth opening at the initial examination were compared to those measured in the healthy con-trol group of the same age. The age of patients and differences between the dominant and recessive subtypes of DEB were analyzed. Results. The average maximum mouth opening was significantly lower in DEB patients compared to healthy individuals. Oral and perioral bullae and scars, microstomia, and reduced vestibule depth were very common, with no statistically significant difference among T0, T6, and T12. The prevalence of restricted tongue movement due to scarring and the absence of lingual papillae and palatal rugae increased significantly over one year. Patients with microstomia, vestibule depth, and restricted tongue movement due to scarring were significantly older than patients without these characteristics. Lingual papillae and palatal rugae were more frequently absent in recessive than dominant DEB. Conclusion. DEB causes significant changes in oral and perioral soft tissues and oral functions impairment.

Facial fillers in lip reconstruction

The lips are a critical aesthetic landmark of the lower face, and defects in this area have significant implications for functional and cosmetic symmetry. Facial fillers are commonly viewed as an adjunctive technique to surgical lip reconstruction but can also be used as a standalone, temporary management option for oral incompetence and contour defects. Facial fillers make use of a patient's existing perioral soft tissue framework while achieving immediate results that avoid the recovery time associated with surgery. We describe the different types of FDA-approved facial fillers, indications for use, injection techniques, local anesthetic approaches, and complication management.

Comparative evaluation of perioral soft tissue of skeletal normal Class I and Class II Division 1 subjects: A lateral cephalometric study

Objective: This study aimed to evaluate and compare shape variability of soft-tissue outline of skeletal Class II Division 1 patients with various vertical patterns (low, moderate, and high SN-MP angles) and skeletal normal Class I occlusion patients and to evaluate correlative skeletal and dental variables affecting soft-tissue thickness using cephalometric analysis. Materials and Methods: Sixty patients were selected with Class I normal occlusion and Class II Division 1 and divided into four groups based on horizontal and vertical skeletal pattern (SN-MP angles) on lateral cephalograms as Group I (normal occlusion), Group II-L (low angle Results: The skeletal Class II patients with a high mandibular plane angle had significantly greater values than the skeletal Class II patients with a low mandibular plane angle for basic lower lip thickness and lower lip length. The measurements in perioral soft-tissue thickness were correlated with an inclination of the upper and lower incisors along with facial depth and facial length in skeletal Class II Division 1 patients. Conclusion: Lip strain, lip thickness, and dental inclination must be evaluated based on various skeletal patterns for balanced perioral muscle activity.