Soft Tissue Changes In Class Research Articles

Effects of Extraction vs. Non-Extraction Treatment on Soft Tissue Changes in Class I Borderline Malocclusion Cases

Effects of Extraction vs. Non-Extraction Treatment on Soft Tissue Changes in Class I Borderline Malocclusion Cases

Comparative evaluation of Skeletal, Dental, and Soft Tissue Changes in Class II Division 1 Malocclusion Cases Treated with Twin Block and innovative Clear Block Appliance - A Prospective Interventional Study

The present study was undertaken to evaluate and compare the skeletal, dental, and soft tissue changes in skeletal Class II division 1 cases treated with Twin Block and Clear Block appliances using a cephalogram. A total of 40 patients of age between 12-14 years were randomly divided into two equal groups. Group 1: treated with Twin Block appliance and Group 2: treated with Clear Block appliance. The pre-treatment lateral cephalogram was taken and skeletal, dental, and soft tissue parameters were evaluated and the appliance was delivered. After 8 months, another lateral cephalogram of all the cases was taken and analyzed. The pre and post-treatment values were compared between the two groups. The pre-treatment cases were almost comparable in skeletal, dental, and soft tissue features in both groups. There was a significant change in mandibular growth by SNB angle. The retrusion and extrusion of maxillary incisors as well as a proclination and extrusion of mandibular incisors were seen in group 1 while no change was observed in group 2. Treatment with Clear Block appliances has shown significant and favorable Skeletal, Dental and Soft tissue changes which are similar to already proven by the Twin Block appliance. Clear Block provides an esthetic and less bulky option for growth modification with similar results as compared to conventional Twin Block with the additional benefit of preventing lower incisor proclination.

Maxillary premolars extraction or molar distalization with or without TADs: cephalometric evaluation of soft tissue changes in Class II treatment

Introduction: Problem solving in Class II malocclusion treatment performed with premolars extractions or distalizing techniques in relation to the profile modification.
 Aim: To cephalometrically compare soft tissue changes produced either by maxillary premolar extraction, tooth-borne Pendulum appliance or bone-borne MGBM appliance.
 Materials and Methods: Both pre- (T1) and post-treatment (T2) lateral cephalograms of 89 skeletal Class II patients (36 M, 53 F), treated during pubertal growth spurt, were retrospectively selected. Three groups were formed based on the therapy performed: 30 patients had been treated with maxillary first premolars extraction (U4), 31 patients with a conventional tooth-borne distalizing with Pendulum appliance (PA), and 28 patients with a skeletally anchored distalizing appliance (MGBM). Soft tissue was analyzed comparing upper (UL) and lower (LL) lip’s points with regard to True Vertical Line (TVL) and Esthetic plane (E-plane). Skeletal and dental values have been recorded in order to cephalometrically compare ΔT2-T1 changes among groups and to correlate dental and skeletal changes to profile modifications. One-way ANOVA was employed to compare groups at T1. Paired sample t-tests were employed to assess significant intra- and intergroup differences between T2 and T1. Significance level was set at 0.05
 Results: UL and LL showed a slight but not significant retrusion relative to TVL in all three groups. UL and LL distances to E-plane were not statistically significant among U4, PA, and MGBM groups. Independently of the treatment, UL was tangent to TVL in all groups. No statistically significant differences have been shown in skeletal records. Significant differences were recorded in Overjet among U4 than PA and MGBM groups.
 Conclusions: Class II malocclusion treatment with maxillary first premolar extraction, conventional or skeletal distalization did not significantly affect the profile producing similar changes in the soft tissue.

Dentoskeletal and soft-tissue changes comparison between the Jasper Jumper and Twin Force Bite Corrector in Class II malocclusion patients: A retrospective study

This retrospective study aimed to compare the dentoskeletal and soft-tissue changes in Class II malocclusion patients treated with Jasper Jumper and Twin Force Bite Corrector associated with fixed orthodontic appliances. The sample comprised 60 subjects divided into 3 groups. Patients with Class II malocclusion, mandibular retrusion, slight or no crowding and with no previous orthodontic treatment were eligible. Group 1 comprised 20 patients treated with the Jasper Jumper (JJ), with an initial age of 12.39 years. Group 2 comprised 20 patients treated with the Twin Force (TF), with an initial age of 11.83 years. The control group consisted of 20 untreated Class II subjects with an initial age of 12.13 years. Intergroup pretreatment comparisons were performed with One-way analysis of variance and intergroup treatment changes were compared with the Analysis of Covariance, both followed by Tukey test. The TF group showed greater increase in mandibular length (6.23mm±4.64, P=0.004) than the control group (2.94mm±1.75). The mandibular incisors in the experimental groups presented significantly greater labial inclination and protrusion than the control (Md1.NB; JJ: 4.19°±2.09; TF: 4.46°±6.83; control: 1.13°±2.08, P=0.000/Md1-NB; JJ: 1.95mm±1.45; TF: 1.74mm±1.79; control: 0.31mm±0.81, P=0.000). In addition, the treated groups also showed significantly improvement of the dental relationships (Overjet; JJ: -4.05mm±4.64; TF: -3.80mm±2.12; control: 0.05mm±1.12, P=0.000/Overbite; JJ: -2.52mm±1.46; TF: -2.93mm±2.13; control: -0.63mm±1.35, P=0.000). The Jasper Jumper and Twin Force associated to fixed appliances were effective in correcting Class II malocclusion with a combination of skeletal and dentoalveolar changes. However, the TF seems to provide more skeletal effects with greater maxillary growth restriction and mandibular length increase when compared to the JJ.

Lower facial height and soft tissue changes in bimaxillary protrusion cases

Background: Bimaxillary protrusion is frequently treated by extracting the four first premolars and retracting the incisor with maximum anchorage. This treatment may result in soft tissue changes, particularly in lip retraction, lip thickness, upper lip angle and nasolabial angle. However, the changes in facial height after orthodontic treatment often trigger controversies. Objectives: To determine the effects of incisor retraction on lower facial height and soft tissue changes in Class I malocclusion with bimaxillary protrusion treated by the extraction of the four first premolars. Methods: Pre-treatment and post-treatment lateral cephalometric radiograph samples of 25 patients treated with the standard Edgewise fixed appliance were collected. Each sample was traced and a reference line perpendicular to Sella-Nasion minus 7o through the true vertical line (TVL) was established. Arnett analysis was applied to calculate incisor retraction, lower facial height, lip retraction, lip thickness, upper lip angle and nasolabial angle changes. The results of the measurements were statistically analyzed using a paired T-test and Pearson correlation. Results: No statistically significant changes were found between upper incisor retraction and lower facial height ( p > 0.05) and upper lip thickness ( p > 0.05). The same lower incisor retraction occurred with lower facial height ( p > 0.05) and lower lip thickness ( p > 0.05). Significant positive correlation was found between upper incisor retraction and the changes in the upper lip retraction (r = 0.959, p < 0.05), upper lip angle (r = 0.775, p < 0.05) and nasolabial angle (r = 0.647, p < 0.05), while the lower incisor retraction had a positive correlation with the changes in lower lip retraction (r = 0.902, p < 0.05). Conclusion: The extraction of the four first premolars followed by the retraction of the incisor can cause changes in lip retraction, upper lip angle and nasolabial angle but not in lower facial height and lip thickness.

Dentoskeletal and soft tissue changes in class II subdivision treatment with asymmetric extraction protocols

BackgroundThis study cephalometrically compared the dentoskeletal and soft tissue changes consequent to one and three-premolar extraction protocols of class II subdivision malocclusion treatment.MethodsA sample of 126 lateral cephalometric radiographs from 63 patients was selected and divided into two groups. Group 1 consisted of 31 type 1 class II subdivision malocclusion patients treated with asymmetric extractions of two maxillary premolars and one mandibular premolar on the class I side, with an initial mean age of 13.58 years. Group 2 consisted of 32 type 2 class II subdivision malocclusion patients treated with asymmetric extraction of one maxillary first premolar on the class II side, with an initial mean age of 13.98 years. t test was used for intergroup comparison at the pre- and posttreatment stages and to compare the treatment changes.ResultsGroup 1 had greater maxillomandibular sagittal discrepancy reduction and greater maxillary first molar extrusion. Group 2 had mandibular incisor labial inclination and protrusion, and group 1 had mandibular incisor lingual inclination and retraction. Maxillary molar asymmetry increased in group 2, while mandibular molar asymmetry increased in group 1.ConclusionsThe treatment changes produced by these two class II subdivision protocols are different to adequately satisfy the different needs for types 1 and 2 class II subdivision malocclusions.

Soft-tissue changes in Class II malocclusion patients treated with extractions: a systematic review

Concerns about the effects caused by premolar extractions on the soft-tissue profile have motivated many investigations in different malocclusions. To evaluate the cephalometric facial soft-tissue changes after orthodontic treatment with premolar extractions of Class II division 1 malocclusion subjects. Electronic databases PubMed, Web of Science, Embase, and Scopus were searched. Abstracts that appeared to fulfil the initial criteria (premolar extraction; cephalometric soft-tissue analyses/changes) were selected. The full-text original articles were then retrieved. Their references were also hand-searched. By consensus of two researchers, the articles that fulfilled the selection criteria and quantified facial soft-tissue changes were individually analysed. Some methodological flaws were identified and some articles were excluded. The studies were rated according to the type of study, sample description and homogeneity, malocclusion severity, consideration of confounding factors, validity of the method, and statistical analyses. Heterogeneous information about malocclusion severity before treatment was found in most articles. Statistically significant soft-tissue changes reported included nasolabial angle (NLA) increasing from 2.4 to 5.40degrees in 2-premolar extraction protocol and from 1 to 6.84degrees in 4-premolar extraction protocol. Retrusion of the upper and lower lips were also verified, with less retraction of the lower lip in 2-premolar extraction groups. When Class II division 1 malocclusion is treated with premolar extractions, the NLA increases and the lips are retracted. However, there is less retraction of the lower lip in the 2-maxillary premolar extraction protocol.

Surgical Prediction of Skeletal and Soft Tissue Changes in Class III Treatment

The purpose of this study was to study the treatment outcomes and accuracy of the digital prediction using Dolphin Imaging Software and the actual postoperative outcome in subjects presenting Class III malocclusions. Maxillary advancement surgery was performed in group 1, and maxillary advancement was combined with mandibular setback surgery in group 2. Predictive cephalometric tracings were made using Dolphin Imaging Software. Before surgery, the maxillary deficiency was significantly greater in group 1 than in group 2, and the mandibular length was significantly greater in group 2. Surgical reductions in mandibular length and angle were significantly greater 12 months after surgery than indicated by the predictive cephalometric tracings. In groups 1 and 2, maxillary advancement surgery was performed in accordance with the Dolphin Imaging Software. The mandibular setback surgery performed was beyond the established plan, but without clinical implications. Mandibular dentoskeletal measurements showed a greater correlation with the profile than the maxillary measurements.

The impact of extraction vs nonextraction treatment on soft tissue changes in Class I borderline malocclusions

To obtain through the use of discriminant analysis a relatively bias-free sample of extraction and nonextraction, Class I, equally susceptible to both treatments' malocclusions and to analyze retrospectively the soft tissue changes between the two different treatment groups. The cephalometric, model, and demographic data of 215 patients (females and males) fueled a stepwise discriminant analysis that provided the borderline homogenous subsample (30 extraction and 32 nonextraction cases). The pretreatment and postreatment cephalograms of the borderline sample were then subjected to a thorough soft tissue cephalometric analysis. The results indicated that the three variables that played the most important role in the clinician's treatment decision were indicators of lower crowding, soft tissue convexity, and lower incisor protrusion. Significant differences (P < .001) regarding upper and lower lip protrusion, upper lip thickness (P < .05), and the nasiolabial angle (P < .05) occurred. Extraction treatment of Class I borderline malocclusions led to significant soft tissue changes regarding the upper and lower lip position and thickness as well as the nasiolabial angle, whereas the nonextraction treatment resulted in significant upper lip retraction and lower lip protraction.

Skeletal, dental and soft tissue changes in Class III patients treated with fixed appliances and lower premolar extractions

Abstract Background: Mild Class III malocclusions can be treated by upper incisor proclination and lower incisor retroclination following extraction of the lower first premolars. Aims: To compare the skeletal, dental and soft tissue changes in Class III patients treated with fixed appliances, Class III traction and lower first premolar extractions with the changes in a group of untreated Class III patients. Methods: The Treatment group consisted of 30 Class III patients (Mean age 13.69 ± 1.48 years) who were treated by upper and lower fixed appliances, Class III intermaxillary traction and lower first premolar extractions for 2.88 ± 1.12 years. The Control group consisted of 20 untreated Class III patients (Mean age 13.51 ± 0.95) matched for age and gender. The T1 to T2 changes in the treated and untreated groups were compared using a paired t-test while differences between the two groups were compared with an independent t-test. Results: During treatment, the upper incisors were proclined about 1 degree and the lower incisors were retroclined 8 degrees. Small, but statistically significant changes in SNB, Wits and the overlying soft tissues accompanied the changes in incisor inclination. At the end of treatment a positive overbite and overjet were achieved. The increase in lower facial height in the Treatment group was comparable with the change in the Control group. Conclusions: A range of mild to moderate Class III malocclusions can be treated by dentoalveolar compensation.

Three-dimensional evaluation of soft tissue change gradients after mandibular setback surgery in skeletal Class III malocclusion

To evaluate whether mandibular setback surgery (MSS) for Class III patients would produce gradients of three-dimensional (3D) soft tissue changes in the vertical and transverse aspects. The samples consisted of 26 Class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalograms and 3D facial scan images were taken before and 6 months after MSS, and changes in landmarks and variables were measured using a Rapidform 2006. Paired and independent t-tests were performed for statistical analysis. Landmarks in the upper lip and mouth corner (cheilion, Ch) moved backward and downward (respectively, cupid bow point, 1.0 mm and 0.3 mm, P < .001 and P < .01; alar curvature-Ch midpoint, 0.6 mm and 0.3 mm, both P < .001; Ch, 3.4 mm and 0.8 mm, both P < .001). However, landmarks in stomion (Stm), lower lip, and chin moved backward (Stm, 1.6 mm; labrale inferius [Li], 6.9 mm; LLBP, 6.9 mm; B', 6.7 mm; Pog', 6.7 mm; Me', 6.6 mm; P < .001, respectively). Width and height of upper and lower lip were not altered significantly except for a decrease of lower vermilion height (Stm-Li, 1.7 mm, P < .001). Chin height (B'-Me') was decreased because of backward and upward movement of Me' (3.1 mm, P < .001). Although upper lip projection angle and Stm-transverse projection angle became acute (Ch(Rt)-Ls-Ch(Lt), 5.7 degrees; Ch(Rt)-Stm-Ch(Lt), 6.4 degrees, both P < .001) because of the greater backward movement of Ch than Stm, lower lip projection angle and Stm-vertical projection angle became obtuse (Ch(Rt)-Li-Ch(Lt), 10.8 degrees ; Ls-Stm-Li, 23.5 degrees , both P < .001) because of the larger backward movement of Li than labrale superius (Ls). Three-dimensional soft tissue changes in Class III patients after MSS exhibited increased gradients from upper lip and lower lip to chin as well as from Stm to Ch.

Facial soft-tissue changes in skeletal Class III orthognathic surgery patients analyzed with 3-dimensional laser scanning

Patients undergoing orthognathic surgery show considerable changes in both hard and soft tissues. The purpose of this study was to use a 3-dimensional (3D) laser scanner to evaluate the soft-tissue changes after the correction of skeletal Class III malocclusions with orthognathic surgery. The subjects consisted of 20 Korean patients with skeletal Class III malocclusion who underwent LeFort I osteotomy with maxillary advancement and posterior nasal spine impaction, along with bilateral intraoral vertical ramus osteotomy for mandibular setback. Ten patients (group 1) had 2-jaw surgery with genioplasty, and the other 10 (group 2) had 2-jaw surgery without genioplasty. Three-dimensional images of the patients were acquired with a 3D laser scanner. The ratios of soft-tissue changes to hard-tissue movements were analyzed and compared between the 2 groups. In addition, the changes in the soft-tissue landmarks in the 3D coordinates and the 3D linear, angular, and proportional changes were measured preoperatively and postoperatively, and compared. There was no significant difference between the groups in the horizontal ratios of the soft-tissue to hard-tissue changes. In both groups, the ratios of the horizontal changes in the paranasal area were higher than in the subnasal area. There were more changes in the subalar area than in the supracommissural area, and more changes in the chin and labiomental areas than in the subcommissural area. Ala moved anterolaterally, and cheilion moved posteroinferiorly. The distance between upper-lip point and cheilion increased significantly (P <0.05). In the 3D angles, transverse nasal prominence and transverse upper lip prominence increased significantly (P <0.05). The 3D analysis in this study can be used to estimate the soft-tissue changes in Class III patients who undergo orthognathic surgery.

Five-year outcome and predictability of soft tissue profiles when wire or rigid fixation is used in mandibular advancement surgery

The purpose of this study was to follow the covariation of hard and soft tissue changes in Class II malocclusion subjects who received a bilateral sagittal split osteotomy. The subjects were randomized to receive wire or rigid fixation after the surgery. Subjects in the rigid group (n = 78) received 2-mm bicortical position screws, and those in the wire group (n = 49) received inferior border wires and 6 weeks of skeletal intermaxillary fixation with 24-gauge wires. Additionally, some subjects received genioplasty in both the rigid (n = 35) and the wire groups (n = 24). Soft and hard tissue profile changes were obtained from cephalometric films immediately before surgery and at various times up to 5 years postsurgery. Soft and hard tissue profile changes were referenced to a cranial-base X-Y coordinate system. Horizontal changes in mandibular incisor, lower lip, B-point, soft tissue B-point, pogonion, and soft tissue pogonion were calculated at each time. There was considerable skeletal relapse in the wire fixation group. Bivariate correlations and ratios between the hard and soft tissue changes were calculated for each time period. Hard to soft tissue correlations were the highest at the earlier times, although the ratios varied among the 4 groups. These results provide a solid basis for both short-term and long-term prediction.

Dentofacial and soft tissue changes in Class II, Division 1 cases treated with and without extractions

The purpose of this study was to compare the changes in subjects with Class II division 1 malocclusions treated with and without the extraction of four first premolars. Iateral cephalograms on 91 patients (44 extraction and 47 nonextraction) were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. The present findings indicate that before treatment, the upper and lower lips were more protrusive relative to the esthetic plane among the subjects treated with four first premolar extractions. After treatment the upper and lower lips were more retrusive in the extraction group, and more protrusive in the nonextraction groups. The extraction group tended to have straighter faces and slightly more upright maxillary and mandibular incisors, whereas the nonextraction group had the opposite tendencies. The average soft tissue and skeletal measurements for both groups were close to the corresponding averages derived from the lowa normative standards. In general, differences between the groups after treatment were preserved into retention. The present findings indicate that the extraction or nonextraction decision, if based on sound diagnostic criteria, seem to have no deleterious effects on the facial profile. (A M J O RTHOD D ENTOFAC O RTHOP 1995;107:28-37.)

A cineradiographic study of functional soft tissue changes in Class II, Division 1 malocclusions

A cineradiographic study of functional soft tissue changes in Class II, Division 1 malocclusions

A cephalometric appraisal of hard and soft tissue changes in Class II, Division 1 (angle) malocclusions following orthodontic therapy: By Raymond T. Matsunaga, Tufts University School of Dental Medicine, Department of Graduate Orthodontics, Boston, Mass.

A cephalometric appraisal of hard and soft tissue changes in Class II, Division 1 (angle) malocclusions following orthodontic therapy: By Raymond T. Matsunaga, Tufts University School of Dental Medicine, Department of Graduate Orthodontics, Boston, Mass.