Soft Tissue Pogonion Research Articles

The Evaluation of Facial Artery Position in Related to Soft Tissue Pogonion and Soft Tissue Gonion: A Cadaver Study.

This anatomic study was designed to assess the position of the facial artery concerning the soft tissue landmarks, pogonion (Pog)and Gonion (Go). Sixty freshly frozen cadavers were used in this study. On the right side, the mean distance between the facial artery and Pog was 7.05±0.66cm. The mean distance between the facial artery and Go was 3.34±0.36cm. The results indicated that the facial artery was 32.32%±2.05 of a mandibular length to Go and 67.78%±2.05 Pog. On the left side, the mean distance between the facial artery and Pog was 7.10±0.65cm. The mean distance between the facial artery and Go was 3.23±0.34cm. The results indicated that the facial artery was 31.30±2% of the mandibular length at Go and 68.71±2% at Pog. The ratio of the facial artery distance to Pog and Go did not correlate with the mandibular length (P>0.05). However, the distance between the facial artery, Pog, and Go correlated with mandibular length. (P<0.001). The ratio of the cross-point of the facial artery with the mandibular border to the length of the mandible about Go and the Pog was generally found to be independent of mandibular length.

Optimizing Esthetic Outcomes and Bone Stability: Chin Advancement Through Inverted V Osteotomy.

Traditional horizontal osteotomies for small and short chins often yield suboptimal results due to limited bone advancement, resulting in deep labiomental folds and heightened bone resorption risks. This study investigates the effectiveness of an innovative inverted V-shaped osteotomy technique in enhancing esthetic outcomes for patients with such chin concerns. Thirty-eight patients who underwent inverted V-shaped osteotomy for recessed chins between January 2018 and June 2022 were included. Excluding cases involving simultaneous mandibular contouring surgery, patients were followed up for a median duration of 1.2±0.5 years. Preoperation and postoperation soft tissue pogonion (Pg') and labiomental fold depth (LMF) changes were measured. IBM SPSS (version 27.0) was used for statistical analysis, with significance defined as P <0.05. Patient satisfaction was assessed using a visual analog scale. Successful advancement genioplasty was performed on all patients without any severe complications. The average change in soft tissue pogonion (Pg') measured 6.2 (1.9)mm, and the mean alteration in labiomental depth was 0.42 (0.4)mm. The procedure achieved a bone to soft tissue movement ratio of 1:0.96. Patient satisfaction was notably high, with a mean VAS score of 8.7. An inverted V-shaped osteotomy enables greater bone advancement for small and short chins, leading to improved esthetic outcomes and offering a mechanically advantageous condition for bone segments.

Comparison of Soft Tissue Chin Thickness in Adult Patients With Various Mandibular Divergence Patterns.

Objective This study aimed to compare the soft tissue chin (STC) thickness at different levels in patients presenting for orthodontic treatment with different vertical facial types. Materials and methods This comparative cross-sectional study was conducted at Sharif Medical & Dental College, Lahore, Pakistan, on 195 subjects. Patients presenting for orthodontic treatment, both genders, aged from 18 to 32 years, and Pakistani nationals were included. Patients with any craniofacial deformity, syndrome, cleft lip and palate, previous orthodontic or orthognathic treatment, and multiple missing teeth and prostheses in edentulous areas were excluded. Vertical facial patterns and STC thickness were recorded from pre-treatment lateral cephalograms. One-way analysis of variance (ANOVA) was applied to compare STC among various vertical facial patterns. Post-hoc analysis was done using the Tukey test. Results There were 126 females (64.62%) and 69 males (35.38%). The mean age was 21.66 ± 3.44 years. All three soft tissue chin thickness distances significantly differed among vertical facial patterns (p<0.001). Multiple comparisons show that the distance between soft and hard tissue pogonion was insignificant between low and normal anglefacial heights (p=0.5). Similarly, no significant difference was observed for the distance between softand hard tissue menton in low and normal angle subjects (p=0.4). The rest of the multiple comparisons were statistically significant (p<0.05). Conclusion The STC thickness is significantly associated with vertical facial divergence. While planning orthognathic surgery or genioplasty of the mandible, due consideration should be given to vertical divergence of the face to avoid unwanted facial changes.

Automated Cephalometric Landmark Detection: A Novel Software Model Compared with Manual Annotation Method

Introduction AI-based automated cephalometric landmark detection streamlines orthodontic diagnosis and treatment planning, providing accurate, efficient, and reliable results. Benefits include saving time, minimizing subjectivity, improving precision, and facilitating continuous improvement. However, they should complement clinician expertise, ensuring qualified orthodontists make the final diagnosis and treatment plan. Aim To propose a method that automatically detects cephalometric landmarks on the X-ray images and compare these values with the manual annotation method. Methodology A dataset of 600 X-ray images, each containing 19 landmarks, was collected. Two orthodontists manually marked the 19 landmarks in 300 cephalograms and their coordinates were automatically extracted. The dataset was cleaned for errors, and a pre-trained CNN model with an EfficientNetB7 backbone was used for landmark detection. The model was trained on 80% of the dataset and tested on the remaining 20%. The two-step method included ROI extraction and landmark detection. The RMSE score was used to evaluate inter-examiner reliability and the R2 score was used to compare manual and automated models. Result Model landmark locations were compared to the manual method. The mean deviation of the predicted landmarks from the actual landmarks was calculated using RMSE, and the model showed acceptable accuracy compared to manual annotation. EfficientNetB7 was found to have detection accuracies similar to the manual annotation method. For landmarks like Porion, articulare, and soft tissue pogonion, the model outperformed the human annotation method and provides a consistent better result, and for points like Point A, pogonion, gnathion, and menton, the manual methods show more accurate results. Conclusion The study introduced an automated approach using deep learning to predict landmark locations, and the results demonstrate its accuracy in comparison with the manual annotation method. This approach effectively detects cephalometric landmarks, suggesting its potential for clinical use with orthodontist’s supervision.

Aesthetically acceptable cephalometric treatment goal differences for straight, concave, and convex facial profiles between genders

ABSTRACT Purpose Modern orthodontics focus on achieving functional and aesthetically pleasing results. However, traditional cephalometric norms do not necessarily correspond to facial aesthetics, leading to unsatisfactory treatment outcomes. This study aimed to establish cephalometric treatment goals for each facial profile (concave, straight, and convex) by comparing the cephalometric variables of each type. Materials and methods The post-treatment lateral cephalograms of 180 orthodontic subjects (18–37 years old) were assessed. Profile silhouettes were scored for attractiveness by 15 Thai laypersons using a 5-point Likert scale. Cephalograms scoring above 3 were divided into the three facial profile groups (n = 60). Fifty-five cephalometric variables were measured, and the statistical analysis was performed using SPSS software. Results One-hundred and eighty aesthetically acceptable silhouettes comprised concave, straight, and convex facial profiles with a 1:1 male-to-female ratio. All types shared similarities in the cranial base and maxilla. The convex profiles more frequently displayed skeletal and dental base Class II, skeletal open bite, retruded and retroclined upper incisors, protruded and proclined lower incisors, obtuse nasolabial angles, protruded upper and lower lips, and retruded chins. The opposite findings were observed in the concave profiles. However, all profile types had similar upper and lower teeth relative to A point to pogonion line; and upper and lower lip positions relative to subnasale to soft tissue pogonion line and the true vertical line passing through soft tissue nasion. Conclusion Universal treatment goals for all profile types combined with customized values for each profile type to achieve an aesthetically acceptable facial profile are recommended.

Comparisons of soft tissue changes after Herbst appliance treatment in three different growth phases

This study aimed to compare the soft tissue effects of Herbst appliance in Class II malocclusion patients treated in three different craniofacial growth phases: prepubertal (PRE), circumpubertal (CIR), and postpubertal (POS). In total, 95 patients with Class II Division 1 malocclusion previously treated with a Herbst appliance were analyzed. Through the cervical vertebral maturation stages method, patients were allocated into three groups depending on the growth craniofacial phase at the beginning of treatment: PRE, CIR, and POS. Seventeen cephalometric measures were evaluated from each lateral radiograph before and after Herbst therapy using the Radiocef 2 software (Radio Memory, Belo Horizonte). Intragroup and intergroup treatment changes were compared statistically using a paired t test and MANOVA test, respectively. Soft tissue thickness changes were related only to mandible; all three mandibular measurements (L1_LL, B_B', and Pog_Pog') showed thickening for the PRE group ranging from 0.92 mm (Pog_Pog') to 2.02 mm (B_B'), and only lower lip thickened overtime for the POS group (L1_LL = 0.99 mm). Soft and hard tissue pogonion displaced anteriorly, but only the soft tissue showed differences among groups; PRE group presented more anterior displacement than POS group (3.61 mm and 1.39 mm, respectively). Hard and soft tissue facial convexity decreased more in the PRE and CIR groups than in the POS group. Mentolabial sulcus depth reduced more in the PRE (1.07 mm) and CIR (1.29 mm) groups than in the POS (0.55 mm) group. Horizontal movement of the skeletal and soft pogonion presented a moderate-high positive correlation (r = 0.783), and hard and soft facial convexity showed a moderate-low positive correlation (r = 0.403). Herbst appliance therapy produces soft tissue improvements in the three phases of craniofacial growth, being greater in patients in the PRE and CIR phases.

Longitudinal changes of the natural craniofacial and dentoalveolar complex in the fourth decade of life

This study aimed to longitudinally examine the changes in craniofacial and dentoalveolar regions during the third and fourth decades of life. The data from this study constitute the cephalometric films and plaster models of 8 female and 8 male dental students or dentists. The mean chronological ages of the subjects at the first observation period was 22.09 years for females and 22.64 years for males. The material was collected over 3 intervals: 1985-1989, 1998-2000, and 2016-2017. The observation period was approximately 28 years. Acquired cephalometric recordings and dental models were assessed for subjects in their 20s (baseline), 30s, and 40s. Maxillary, mandibular, maxillomandibular, soft-tissue, and dentoalveolar cephalometric variables were measured with a cephalometric analysis software, and dental cast measurements were made with a digital caliper. Changes in the cephalometric films and dental casts were evaluated statistically. Statistical analysis showed that the length of the midfacial region increased with age. The height of the lower face increased significantly in females and the mandible can be seen mildly rotating to the posterior as it increased in length. The nose moved slightly forward and downward in males and females. Upper lip height was significantly increased in females; however, there was a significant reduction in upper lip thickness for males and females. Soft-tissue pogonion measurements showed a significant forward and downward chin movement in females. Overjet was significantly increased in females, whereas the mandibular arch length was significantly decreased for both sexes, although it was more prominent in females. There was a loss of space in the anterior segments of males and females, resulting in increased crowding. However, the loss of space was only significant in the mandible. We observed significant changes in skeletal, soft-tissue, and dentoalveolar variables of subjects in their third and fourth decades of life. The fact that many changes have occurred throughout this study demonstrates that the process of maturation and aging is ongoing.

The Correlation of a Novel Photographic Parameter for Facial Profile Assessment in Subjects With Different Sagittal Malocclusions: A Prospective Study.

Aim The soft tissue paradigm shift is the current trend in orthodontic diagnosis and treatment planning. This study's aim was to assess the correlation of newly derived photographic Frankfort horizontal plane-subnasale to soft tissue pogonion (FSA) angle with other established soft tissue cephalometric angles, such as the Z angle and the Holdaway (H) angle, for estimating facial profile convexity in subjects with all classes ofsagittal malocclusions. Materials and methods This prospective study included a sample of 60 Dravidian population subjects consisting of 30 males and 30 females with different skeletal sagittal malocclusions (Class I, Class II, and Class III) based on the radiographic criteria (ANB angle). The Z and Holdaway angles on lateral cephalograms were compared with the FSA angles in cephalograms and digital profile photographs. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS)software version 23.0 (IBM SPSS Statistics, Armonk, NY). Pearson's correlationwas done to assess the correlation between soft tissue FSA angle on digital photographs and cephalometric angle (Z angle and Holdaway angle). Results The overall Pearson's correlation was significant (p < 0.05) between the Z and FSA angles in ClassI, II, and III malocclusions, which had a high positive correlation. There was a significant positive correlation (p < 0.05) between the Holdaway and FSA angles in subjects with Class Iand Class II malocclusions. A moderate positivecorrelation was noted between the Holdaway and FSA angles in Class III. Conclusion Photographic FSA anglecan be used to evaluate the facial profile of subjects with different sagittal malocclusions. This angle has a good correlation with other cephalometric profile measures, such as the Z and Holdaway angles used to assess facial profile convexity.

Hard and Soft Tissue Relapse After Different Genioplasty Procedures: A Scoping Review.

The chin is a crucial component of facial aesthetics, and 20% of craniofacial problems require repair of the chin size, shape, and position. Genioplasty is used to treat irregularities in all three planes of the chin. Specific hard and soft tissue relapses following various genioplasty techniques have not been adequately studied in the literature to date. The purpose of this scoping review was to investigate the stability of hard and soft tissue changes achieved by different genioplasty procedures, six months after the procedure. A literature search was performed on PubMed, Web of Science, Embase, Wiley Online, Scopus, Google Scholar, Science Direct, and Cochrane databases from January 1, 2011to October 31, 2022. Prospective and retrospective cohorts, case-control studies, observational studies, and randomized control trials, with at least 10 patients, which were written in English and evaluated the stability of different genioplasty procedures, with a follow-up period of at least six monthswere included. The manual and electronic search yielded 523 articles, and after complete screening, seven articles were selected (five with advancement genioplasty and two with reduction genioplasty) that met the eligibility criteria for review. The patients undergoing reduction genioplasty had a mean age of 24.15 years, compared to 20.5 years for augmentation genioplasty. The average follow-up period was 18.64 months for augmentation genioplasty and 10.5 months for reduction genioplasty technique. The relapse was assessed at pogonion, and it was noted that the average surgical advancement at hard tissue pogonion was 7.04 mm with a relapse of 0.69 mm after six months post-treatment. The average vertical movement of the hard tissue pogonion was 1.8 mm with a relapse of 0.74 mm. The average reduction at hard tissue pogonion was 3.2 mm in the vertical direction with a relapse of 0.2 mm and 0.8 mm reduction in soft tissue pogonion with a relapse of 0.3 mm. The soft to hard tissue ratio mentioned in the different studies ranged from 0.89 to 0.97. Both reduction and augmentation genioplasty are stable and reliable for altering the chin position for aesthetic purposes. The recommended mode of fixation is rigid fixation.

Lateral Cephalometric Analysis of Nasal Morphology in Patients Visiting Nishtar Institute of Dentistry

Nasal morphology is the keystone of facial aesthetics. Being the most prominent part of the face, the shape and position of the nose greatly influence the facial profile and nasal soft tissue thickness also plays a vital role in orthodontic diagnosis and treatment planning. Objective: To evaluate the soft tissue nasal morphology in individuals presenting with different skeletal patterns such as skeletal class 1 and skeletal class 2 jaw relationship. Methods: It was Comparative Cross-sectional study conducted in Orthodontics Department of Nishtar Institute of Dentistry for the period of six months (5th Mar 2020 to 6th Jun 2021). Study sample consisted of Lateral cephalometric radiographs of 65 subjects. Age range of sampled subjects was 19-26 years (mean age 20.93). The sample was divided into two groups on basis of the Skeletal jaw relationship as class-1 and class-2. An Independent t-test was applied for evaluation of the difference in lateral nasal morphology between both groups. Results: Notable differences were found between skeletal class 1 and skeletal class 2 groups for the prominence of the mandible and Linear distance between soft tissue Pogonion and Pronasale. Considerable differences in measurements of nasal depth, nasofrontal angle, nasal tip projection angle, nasofacial angle and nasomental angle were found. Conclusions: It is concluded that nasal morphology was greatly influenced by not only the underlying skeletal jaw relationship yet other factors e.g., dentition along with soft tissue thickness were also responsible for nasal morphology differences among various skeletal patterns. Gender dimorphism also exists for various nasal features.

Accuracy of Soft Tissue Prediction in Skeletal Type III Relationship Using a Computer-Aided Three-Dimensional Surgical Simulation Planning Program

Using a computer-aided, three-dimensional surgical simulation planning program, soft-tissue planning can help achieve adequate facial esthetics and patient satisfaction after orthognathic surgery. This study aimed to assess the Simplant O&amp;O software’s soft tissue prediction accuracy. Fourteen skeletal type III patients who underwent orthognathic surgery by the same surgeons were included in this prospective study, and they were separated into two groups: the one-jaw (n = 5) and two-jaw (n = 9) groups. The software was used to analyze the preoperative (T0) and 4-month postoperative computed tomography data (T1), as well as intraoral scans. Data from cone-beam computed tomography and stereolithography from a scanned dental cast were used to reconstruct a composite skull model. Based on the presurgical CT data, the program generated a predicted soft tissue image (TP), which was then superimposed on the T1. The distances between seven T1 and TP landmarks were measured and evaluated using a one-sample t-test. In the one-jaw group, the mean error for all linear measurements was 1.73 ± 1.14 mm, whereas the mean error of the two-jaw group was 1.03 ± 0.83 mm, and both measurements were within clinically acceptable limits. Pronasele had the best correlation (mean error of 0.63 ± 0.45 mm) while soft tissue pogonion and soft tissue point B had the worst correlations (mean error of 2.87 ± 2.22 mm and 1.31 ± 0.98 mm, respectively). Even though there were some limitations, it was possible to conclude that the ability to accurately predict soft tissue changes using Simplant O&amp;O for skeletal type III patients makes it adequate for use in clinical practice.

How Similar are the Dentoskeletal Characteristics of Class III Double-Jaw Surgery Patients with Ideal Post- Treatment Profiles and Class I Subjects?

To define the dental and skeletal characteristics of Class III surgery patients with ideal final soft-tissue profiles, and to compare them with those of Class I subjects. Also, to show how soft-tissues respond to surgical jaw movements and contribute to the outcome. This short-term, retrospective study was conducted using pre-treatment (T0), pre-surgery (T1), and post-treatment (T2) records of 50 double-jaw Class III surgery patients who presented with ideal cephalometric characteristics in sagittal (Holdaway and soft-tissue convexity angles) and vertical dimensions (GoGn. SN angle and upper-to-lower face harmony) at the end of treatment, and 50 control subjects. At T2, the horizontal distance between the vertical reference plane (a perpendicular plane to the horizontal reference plane that is angulated 7° clockwise to the SN plane) and hard-tissue A, B and Pog points, lower lip, soft-tissue B, and pogonion points were greater, Wits appraisal was more negative, U1.PP was higher, IMPA was lower, and soft-tissue chin (Pog-Pog') was thicker in Group 1 when compared to Group 2 (p<0.05). Moreover, upper lip and subnasal (A-A') thicknesses were decreased, and chin thickness (Pog-Pog') was increased significantly (p<0.05). Dentoskeletal characteristics of an ideally-treated Class III surgery patient differed from a Class I subject concerning a protrusive maxilla and soft-tissue pogonion, and incisors that were not fully-decompensated. Soft-tissues hindered the actual surgical correction to 66% and 73% in the mid- and lower-faces, respectively.

Dentoskeletal effects of clear aligner vs twin block-ashort-term study of functional appliances.

The twin block (TB) is one of the most widely used functional appliances for the correction of classII malocclusions. Align Technology (San Jose, CA, USA) developed the Invisalign® mandibular advancement (MA) that replicates the mechanism of action of afunctional appliance. The aim of this study was to compare the changes produced by the TB versus those by MA. The records of 56classII patients treated with the TB (TB group: n = 35) or the MA (MA group: n = 21) were compared to acontrol sample of 15 untreated classII subjects (UC2). The TB and MA groups showed asignificant reduction of the ANB angle, compared to the controls (TB group: -1.5°; MA group: -1.5°; UC2 group: +0.2°). For the Co-Gn values, the TB and MA groups showed significant differences when compared with the UC2 group with an increase of 8.4 mm in TB patients and of 8.3 mm in MA patients. The increase of the distance of Pg to the true vertical line (TVL) was the only measurement where significant differences between the three groups were found with agreater advancement of the soft tissue pogonion in the TB group compared with the MA group and the UC2 group (TB group: +3 mm; MA group: +0.9 mm; UC2 group: -1.6 mm). The angle between the palatal plane and mandibular plane revealed amore relevant reduction in the TB and MA groups. Both appliances were able to reduce overjet and vertical overbite values. Treatment with the MA and TB appliances produced asignificant elongation of the mandible with an improvement in sagittal relationship, overjet, and vertical overbite and with good control of the vertical relationship. TB subjects showed agreater advancement of the soft tissue chin.

Evaluation of Hard Tissue, Soft Tissue and Airway Changes Post Twin Block Therapy: An In-vitro Study

Introduction: Aesthetic improvement happens to be one of the main reasons for seeking orthodontic treatment in patients with Angle’s Class II malocclusion. Prognathic maxilla, retrognathic mandible or a combination of both are the main aetiological factors for this malocclusion. Growth modification treatment with different methods can be performed in order to correct skeletal class II malocclusion. Appliance therapy to correct similar malocclusions should immaculately be directed towards addressing the dentoskeletal discord, in order to gain a favourable facial aesthetic result. Aim: To assess the effects of twin block on mandibular length, soft tissue profile and Oropharyngeal Airway (OAW) dimensions in skeletal class II malocclusion patients. Materials and Methods: An in-vitro study was carried out in the Department of Paedodontics at Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow from June 2018 to March 2021. Study was done on lateral cephalograms of 15 growing children with Angle’s Class II Division 1 malocclusion in the age group of 9-12 years, who had undergone functional appliance therapy with twin block appliance. Standardised lateral cephalograms were evaluated at pretreatment (0 month) and postactive phase of twin-block therapy (9-12 months). Selected hard tissue, soft tissue and airway landmarks were marked and traced to evaluate hard tissue, soft tissue and airway changes. The data was analysed using statistical package for social sciences (SPSS) version 21. Results: There was a statistically significant increase in effective mandibular length (Condyle-Gnathion) and mandibular base length Gonion-Pogonion (Go-Pog) values (p&lt;0.001). Significant decrease in the facial convexity Glabella- Soft tissue Nasion (G-Sn) Soft tissue Nasion- Soft tissue Pogonion (Sn-Pog) was observed and airway dimensions showed significant increase after twin block therapy. Conclusion: Correction of Class II malocclusion by twin block appliance resulted in significant cephalometric changes in the hard tissue profile (increase in mandibular length), together with clinically favourable soft tissue changes and OAW dimensions.

Soft-Tissue Changes in Unilateral Cleft Lip and Palate Patients after Non-surgical Maxillary Advancement with Face Mask Therapy - A Prospective Cohort Study.

The aim of this study was to evaluate soft-tissue changes in Egyptian cleft lip/palate (CLP) patients after conservative non-surgical maxillary advancement using face mask therapy. This prospective cohort study included 20 Egyptian patients with unilateral CLP, six females and 14 males, ranging in age from 10 to 15 years and suffering from moderate maxillary deficiency. These patients had been chosen randomly from the Oro-dental Genetics Clinic at the National Research Centre, Egypt. For lateral cephalometry tracing and superimposition of pre-operative and post-treatment data, this study used Dolphin 11.0 software. Subnasal (Sn), pronasal (Pn), soft tissue pogonion (Pg), labial superior (Ls), stomion superioris (Ss), labiale inferior (Li), stomion inferioris (Si) and soft tissue Menton (Me) were the soft tissue points used in this analysis. All of the cases were successful and demonstrated a positive response to the orthodontic traction. All post-operative linear measurements of the measured soft-tissue points showed statistically significant advancement (P = 0.05) except for pronasal linear measurements, which did not show a significant difference post-treatment (P = 0.84). With the use of the face mask procedure, both upper and lower lip soft-tissue points improved significantly, but nasal points remained unchanged, requiring more management.

A quantitative analysis of facial changes after orthodontic treatment with vertical control in patients with idiopathic condylar resorption.

This study aimed to investigate temporomandibular joint (TMJ) stability and three-dimensional (3D) facial changes in class II hyperdivergent patients with stable idiopathic condylar resorption (ICR) after orthodontic camouflage treatment with vertical control by using temporary anchorage devises (TADs). Nineteen skeletal class II hyperdivergent patients who were diagnosed with stable ICR underwent bicuspid extraction orthodontic treatment with vertical control via TADs were enrolled. TMJ was evaluated with the cone beam computerized tomography (CBCT) and clinical records before and after treatment. Changes in dental and skeletal parameters were evaluated with cephalometric and dental cast measurements. The 3D morphable model (3DMM) method was performed with the MeshMonk toolbox for the 3D facial analysis. After the reposition and landmark setting process, 3D facial heatmaps were used to illustrate facial changes, and the 3D deviations of landmarks were calculated. Both the imaging evaluation and clinical examination proved that TMJs remained stable after treatment. The retrusion of the upper and lower incisors reached 6.63 ± 0.79 mm and 3.78 ± 1.49 mm. The intrusion of the upper first molar reached 2.65 ± 0.75 mm, with a 2.27 ± 0.82° counterclockwise rotation of the mandibular plane. An upward shift of the soft tissue pogonion (2.34 ± 2.03 mm) and protrusion of Po-NB (0.82 ± 0.70 mm) was gained. Larger intrusion was found in the lower lip (3.29 ± 0.80 mm) than in the upper lip (2.20 ± 0.69 mm). Camouflage orthodontic treatment with TAD for vertical control is acceptable for skeletal class II hyperdivergent patients with ICR, which can improve the facial profile.

Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease.

To compare two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease. A total of 47 patients were included in this study. Group anterior repositioning splint (ARS) was treated with temporomandibular joint (TMJ) disc surgery followed by an ARS and camouflage orthodontic treatment. Group stabilization splint (SS) was treated with an SS followed by orthodontic treatment combined with orthognathic surgery. Cephalometric analysis of lateral radiographs and measurements of condylar height were evaluated before and after splints. In group ARS, mandibular advancement was observed after treatment in 21 of 24 patients (87.5%). The SNB angle increased by an average of 1.40 ± 1.01°. The ANB angle, overjet, Wits, and convexity decreased. Facial angle and soft tissue N Vert to pogonion increased. Vertically, MP-FH, MP-SN, y-axis, and vertical ratio decreased and ANS-Me/N-Me and S-Go/N-Me increased, suggesting a counterclockwise rotation of the mandible. In group SS, 18 of 23 patients (78.3%) showed a backward change tendency. The SNB angle reduced by 0.90 ± 0.93°. The ANB angle, overjet, Wits, convexity, and y-axis increased. The facial angle and soft tissue N Vert to soft tissue pogonion (ST N Vert to ST pogonion) decreased. Magnetic resonance imaging showed condylar height increased by 1.45 ± 3.05 mm (P = .002) in group ARS. In group SS, condylar height change was not consistent. TMJ disc surgery followed by ARS promoted condylar bone remodeling and regeneration. The SNB angle increased, and the severity of skeletal Class II was improved. The SS enabled the mandible to withdraw backward and revealed a retrognathic but true mandible position.

Tissue Expander Followed by Autogenous Bone Graft Versus Autogenous Bone Graft Alone for Mandibular Reconstruction: Quantitative Assessment.

The use of a tissue expander in maxillofacial intraoral tissue reconstruction is a developing approach, which provide adequate tissue coverage and aesthetics. The purpose of this study was to quantitatively compare the use of a soft tissue expander in conjunction with autogenous bone graft with bone graft alone for the repair of the mandible's anterior region. The study comprised 24 patients with bone defects in the anterior mandibular region. Patients were divided into 2 groups at random. In group I, expander with bone graft was used, whereas in group II, bone graft was used alone. Volumetric measures of the grafted area was performed using CBCT, and cephalometric evaluations of the anteroposterior and vertical skeletal relationship, as well as the soft tissue profile were recoded. A comparison was made between the 2 groups 6 and 24 months after surgery with P ≤ 0.05 considered significant. The mean difference in grafted bone volume between the 2 groups was 1.95cm 3 , indicating a significant difference between the 2 groups ( P = 0.05) with superior group I results. The soft tissue profile of group I demonstrated a considerable improvement and stability of the lower lip, the labiomental sulcus, and the thickness of the soft tissue Pogonion compared with group II. The use of a tissue expander in conjunction with a bone graft resulted in a better soft tissue profile, making it a favored approach in maxillofacial reconstruction.

Establishment of soft tissue norms for sagittal discrepancy for maxilla and mandible in central Gujarat population

Objective: To establish the cephalometric norms of ‘Zero meridian line’ and ‘Mew line’ to assess the sagittal discrepancy in the maxilla and mandible of subjects in the Central Gujarat population Materials and methods: The sample was screened from the records from the hospital. 100 individuals (50 males, 50 females) of the age group between 18-50 years, native of Central Gujarat, with acceptable pleasing profile, no skeletal asymmetry, normal Class I occlusion having ideal anterior bite, less than 2 mm crowding and no history of previous orthodontic treatment were selected for the study. Lateral cephalograph were taken in natural head position. The linear measurements between points of soft tissue pogonion to the Zero Meridian line (vertical line dropped from soft tissue nasion) and distance of Mew line (the biting edge of the upper front teeth to the tip of the nose) was taken on cephalograms. Result: Mean value for soft tissue pogonion to the Zero meridian line on cephalograms was 0.2 mm for female and 0.8 mm for male and mean value for Mew line on cephalograms was 39 mm for female and 42 mm for male subjects. Conclusion: Normal value for soft tissue pogonion to the Zero meridian line is 0.8 + 1.8 mm for males and 0.2 + 1.7 mm for females, and normal value for Mew line is 41.2 + 3.2 mm for male and 39.4 + 2.2 mm for female in Central Gujarat population. Values other than normal suggests skeletal sagittal discrepancy of maxilla and/or mandible, which is helpful in diagnosis and treatment planning.

Long-term evaluation of soft tissue profile changes induced by Herbst appliance followed by fixed appliances

The present investigation aimed to evaluate, by cephalometric analysis, the soft tissue profile changes in adolescents with Class II Division 1 malocclusion, treated with Herbst appliance (Stage I) and fixed appliances (Stage II), followed-up for an average of 4 years (Stage III). The adolescents were divided into two groups: treated group (TG) - 33 adolescents with Class II malocclusions (17 boys and 16 girls) consecutively treated with Herbst appliance and fixed appliances; control group (CG) - 28 adolescents (13 boys and 15 girls) with untreated Class II malocclusions. Lateral cephalograms were obtained immediately before (T1) and after (T2) Herbst treatment, after fixed appliances (T3), and on average, 4 years after orthodontic treatment. Intergroup comparison was evaluated by t or Mann-Whitney tests. The TG was evaluated by analysis of variance followed by Tukey test or Friedman test followed by Dunn’s test. Compared to the CG, the TG showed significant favorable changes at Stage I: decrease in facial convexity, upper lip retrusion, lower lip protrusion, improvement of soft tissue pogonion and increase in mentolabial angle. The total posttreatment period (T2-T4) of the TG showed: increase in H line-Prn, and upper and lower lips retrusion, while the others variables remained stable. This study suggests that Herbst therapy improved features of soft tissue facial profile, which were maintained after fixed appliances and for an average of 4 years posttreatment, although the convex facial characteristic has prevailed.