Tissue Profile Changes Research Articles

Retrospective Analysis of Nasal Soft Tissue Profile Changes With Maxillary Surgery

The aim of this study was to analyze the changes in the position of the nasal and labial soft tissue profile of patients undergoing bimaxillary orthognathic surgery, with special emphasis on the effect on the nasal tip projection. The lateral cephalometric radiographs of 27 consecutive patients (16 female and 11 male patients; mean age, 22 years) who had undergone maxillary advancement and mandibular setback were studied. The pretreatment and end-of-treatment lateral cephalometric radiographs were selected. The pretreatment and end-of-treatment radiographs were superimposed on the sella-nasion plane, and the case was only included if there had been no change in sella-nasion length (ie, no growth). Analyses of Pearson correlation coefficient and stepwise linear regression tests were used to compare the cephalometric measurements at the beginning and at the end of treatment. Paired-sample t tests were also performed to analyze changes in nasolabial angle (NLA) and columella-lobular angle (CLA). The correlations between vertical movement of nasal tip, A-point, and maxillary incisal tip were important. Although there was an important correlation between nasal and incisal tip, interestingly, there was no correlation between nasal tip and A-point in horizontal movement. According to stepwise linear regression analysis, the best model for horizontal movement of nasal tip was as follows: Nasal anteroposterior movement = 0.241 + 0.188 × Incisal tip anteroposterior movement + 0.153 × Incisal tip superoinferior movement. For vertical movement of nasal tip, the best model was as follows: Nasal superoinferior movement= -1.117 + 0.399 × Incisal tip superoinferior movement + 0.323 × A-point anteroposterior movement. There was no significant relation in angular measurements of NLA and CLA before and after treatment. The results of our study suggest that both horizontal and vertical movements of nasal tip were related to incisal tip and A-point movements; however, angular changes in CLA and NLA did not affect the nasal tip.

Hard and soft tissue profile changes before and after treatment in severe maxillary protrusion —Comparison of surgical orthodontic treatment using maxillary anterior alveolar osteotomy and orthodontic treatment alone with extraction of maxillary molars

"Hard and soft tissue profile changes before and after treatment in severe maxillary protrusion —Comparison of surgical orthodontic treatment using maxillary anterior alveolar osteotomy and orthodontic treatment alone with extraction of maxillary molars." Orthodontic Waves, 70(1), p. 48

Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Setback: A Systematic Review

To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation. A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion. The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long term. The upper lip showed mainly protrusion, but the amount was highly variable. This systematic review shows that evidence-based conclusions on soft tissue changes are difficult to draw. This is mostly because of inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measurements. Well-designed prospective studies with sufficient samples and excluding additional surgery, ie, genioplasty or maxillary surgery, are needed.

Effects of the functional regulator III on profile changes in subjects with maxillary deficiency

The aim of this study was to determine the hard and soft tissue profile changes in Class III malocclusion subjects following functional regulator III (FR-3) treatment. The material comprised the cephalometric films of 15 patients (11 males and four females; mean ages 10.22 and 10.44 years, respectively) with a Class III malocclusion and a concave profile treated with the FR-3, and a control group of 15 subjects (11 males and four females; mean ages 10.39 and 10.27 years, respectively) with a Class I malocclusion matched for chronological age and observation period with the study group. Fourteen linear and seven angular measurements were measured on the cephalometric films taken before (T1) and after (T2) treatment/observation. The results of the Student's t-test showed that the treatment group had a concave facial profile when compared with the controls. At the end of treatment, the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001 and P < 0.01, respectively), whereas mandibular growth was restricted. The vertical dimensions increased, the upper incisors proclined, and the lower incisors retroclined significantly (P < 0.001). The FR-3 appliance produced significant improvements in the hard and soft tissues of Class III subjects with a concave profile.

Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Advancement: A Systematic Review

The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5 years for WF. The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were 50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the soft tissue pogonion to pogonion in BSSO with RIF; they tended to be greater than a 1:1 ratio. The upper lip mainly showed retrusion but with high variability. Despite a large number of studies on the short- and long-term effects of mandibular advancement by BSSO, the results of the present systematic review have shown that evidence-based conclusions on soft tissue changes are still unknown. This is mostly because of the inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measures. Well-designed prospective studies with sufficient sample sizes that have excluded patients undergoing additional surgery (ie, genioplasty or maxillary surgery) are needed.

Soft tissue profile changes following maxillary protraction in Class III subjects

The dentoskeletal effects of maxillary protraction (MP) therapy have been extensively investigated, while those relating to soft tissue profile changes are limited. Thus, the aim of this study was to determine the degree of soft tissue profile changes following MP therapy. The material consisted of the cephalometric films of 24 female subjects (12.69 +/- 1.08 years) with a Class III malocclusion who underwent MP therapy; these were compared with a control group of 15 females (12.13 +/- 0.63 years) with a Class I occlusion and matched for chronological age and observation period. Cephalometric films were available for all subjects before (T1) and after (T2) treatment/observation. The initial measurements and treatment/control changes were compared between the groups by means of a Student's t-test. The subjects in the MP group had a concave facial profile when compared with the controls. Comparison of the changes induced by MP therapy showed that the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001), whereas the mandible and surrounding soft tissues showed a backward and downward rotation. The improvement in facial profile predominantly resulted from maxillary soft tissue changes and mandibular hard tissue changes. The concave soft tissue profiles of the Class III subjects were corrected by anterior movement of the maxilla and a concomitant increase in the fullness of the upper lip. The concave skeletal profiles were, however, corrected mainly by backward and downward rotation of the mandible.

Camouflage treatment in adult skeletal Class III cases by extraction of two lower premolars

Objective: The purpose of this study was to evaluate the dentoskeletal and soft tissue profile changes after extraction of two lower first or second premolars in “borderline” adult skeletal Class III cases. Methods: Twenty-eight patients with “borderline” skeletal Class III malocclusion were studied. All of them were treated by extraction of two lower first or second premolars. Lateral cephalometric radiographs taken at the start and end of treatment were analysed. Twenty-five cephalometric variables were calculated and paired t-tests were performed. Results: After treatment, no significant changes were noted in the skeletal parameters (p ≥ 0.05). Regarding the dental parameters, the L1-MP angle decreased by 8.1˚, the U1-L1 angle increased by 7.7˚ (p ＜ 0.01), the overjet distance increased by 5.7 mm (p ＜ 0.01), the L1-NB angle decreased by 7.3˚ and the L1-NB distance decreased by 4.8 mm (p ＜ 0.01). The soft tissue parameters of Li-E, Li-H and Li-RL2 distance decreased by 3.2 mm, 3.4 mm and 4.1 mm respectively (p ＜ 0.01). Conclusions: Orthodontic camouflage treatment by extraction of two lower first or second premolars provides a viable treatment alternative for “borderline” skeletal Class III cases to achieve a good occlusal relationship. (Korean J Orthod 2010;40(5):349-357)

Effects of Flapless Implant Surgery on Soft Tissue Profiles: A Prospective Clinical Study

Flapless implant surgery has been suggested as a suitable treatment modality for the preservation of soft tissue after implant placement. The purpose of this study was to determine the extent of soft tissue profile changes around implants after flapless implant surgery. A total of 44 patients received 76 implants using a flapless implant procedure. The marginal level of the peri-implant soft tissue was evaluated using dental casts 1 week, 1 month, and 4 months after implant placement. The mean soft tissue levels around implants showed 0.7 ± 0.3 mm of coronal growth 1 week after surgery. At 1 month, the levels were 0.2 ± 0.2 mm coronal growth and at 4 months, the values were 0.0 ± 0.3 mm. Soft tissue profiles assessed 4 months after flapless implant placement were similar to profiles assessed immediately before implant placement. Flapless implant surgery is advantageous for preserving mucosal form surrounding dental implants.

The Soft Tissue Profile, Growth And Treatment Changes

Abstract No Abstract Available. *The author gratefully acknowledges the kindness of Dr. B. Holly Broadbent in making available serial cephalometric films from the files of the Bolton Fund, Western Reserve University.

Accuracy of combined maxillary and mandibular repositioning and of soft tissue prediction in relation to maxillary antero-superior repositioning combined with mandibular set back: A computerized cephalometric evaluation of the immediate postsurgical outcome using the TIOPS planning system

The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary antero-superior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic surgical planning system (TIOPS). Out of 100 prospectively and consecutively treated patients, 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and so were included. All patients were managed with rigid internal fixation (RIF) and without intermaxillary fixation (IMF). Preoperative cephalograms were analyzed and treatment plans and prediction tracings produced by computerized surgical interactive simulation. The planned horizontal and vertical hard tissue positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. The mean accuracy of the planned and predicted hard and soft tissue outcome was relatively high varying from 0.0mm to 0.5mm from one cephalometric reference point to another. At the cephalometric reference points where significant differences between planned/predicted, and actually obtained hard and soft tissue positional changes were demonstrated, these significant inaccuracies were, except for the predicted horizontal position of the lower lip, relatively small, varying from 0.2mm to 1.1mm. However, the variability of the predicted hard and soft tissue individual outcome was relatively high. The current study demonstrates from a mean point of view relatively high predictability of the immediate postsurgical hard and soft tissue outcome. However, as the variability of the predicted individual outcome seems to be relatively high, caution should be taken when presenting the planned and predicted hard and soft tissue positional changes to the individual patient, preoperatively.

Soft tissue profile analysis using Ioi’s method for dentoalveolar bimaxillary protrusion cases before and after treatment with extractions of four first premolars

The purpose of this study is to measure the soft tissue profile changes before and after treatment of dento-alveolar bimaxillary protrusion cases which had orthodontic treatment including extraction of upper and lower first premolars. Iori's soft tissue analysis used in this study and cephalometric analysis on 14 patients wich fulfilled sample criteria was performed. Four angular and two linear measurements were done manually utilizing protractor. Statistical analysis was paired t-test. The result showed significant changes in soft tissue after the treatment.

Changes in facial profile during orthodontic treatment with extraction of four first premolars

The present study was designed to evaluate soft tissue profile changes after the orthodontic treatment of class I bimaxillary dentoalveolar protrusion in adult cases. Pre- and post-treatment cephalograms of 20 Caucasian female class I bimaxillary dentoalveolar protrusion patients were selected from private practice. All of them were treated by extraction of four first premolars, and banded and bonded by 022 × 028 standard edgewise technique. t-Test was used to analyze pre- and post-treatment cephalograms. This study showed that upper and lower lip protrusions were decreased respectively 2.7 ± 2.9 mm ( p < 0.001) and 2.8 ± 2.8 mm ( p < 0.001). The mean changes of upper and lower lip thickness and length, as well as nasolabial and labiomental angles were not significant. Significant positive correlation was found between changes of maxillary and mandibular incisors with changes in upper lip ( r UI = 0.70, p < 0.001, r LI = 0.59, p < 0.006) and the lower lip positions ( r UI = 0.64, p < 0.002, r LI = 0.72, p < 0.001). By using stepwise regression it was found that a ratio of 0.63:1 was obtained between upper lip retraction and maxillary incisor retraction and a ratio of 0.62:1 was obtained between lower lip retraction and mandibular incisor changes. This study concluded that, a strong correlation exists between anterior tooth retraction and the position of both lips.

Soft tissue profile changes after vertical ramus osteotomy

Patients with mandibular prognathism have, for a number of years, been treated by orthognathic surgery and post-surgical changes in the facial profile have been widely reported. However, little is known about the influence of gender and age on the soft tissues. The aim of this study was to investigate changes in the soft tissue profile following orthognathic surgery and to evaluate gender and age differences in the ratios of soft-to-hard tissue change. Forty-two Caucasian adults (18 males and 24 females) aged from 17 to 46 years with mandibular prognathism who underwent vertical ramus osteotomy were included. Lateral cephalograms were taken 2-8 months pre- (T1) and 12-19 months post- (T2) surgically. Five skeletal, two dental, and seven soft tissue parameters were hand traced. Paired and unpaired Student's t-tests, Pearson's correlation coefficients, and multiple regression analyses were used to evaluate the data. Due to the setback of the mandible, soft and hard tissues changed in a 1:1 ratio at the mentolabial fold and chin in females and 1:1,1 in males. Significant differences of soft-to-hard tissue ratios were found at points Pg (P < 0.05) and Gn (P < 0.01). Age effects on the ratios were not significant. Other effects of the mandibular setback on the soft tissue profile were a significant increase in facial convexity, a deepening of the mentolabial fold, an increase in lower lip thickness, and a decrease in upper lip thickness, which increased the nasolabial angle. These findings indicate that use of gender-specific ratios in treatment planning might improve the accuracy of predicting treatment results.

Comparison of the effects of Twin Block and activator treatment on the soft tissue profile

The aim of this study was to evaluate and compare the effects of activator and Twin Block (TB) appliances on the soft tissue profile. The study included 50 skeletal Class II patients (25 girls and 25 boys, mean age: 11.9 +/- 0.16 years) who were randomly allocated to one of two functional appliance treatment groups. The control group included 25 untreated skeletal Class II patients (13 boys and 12 girls, mean age: 10.11 +/- 0.91 years). Data were obtained from standardized lateral cephalograms taken at the beginning (T0) and end (T1) of appliance wear. The mean treatment time was 9 months for the activator group and 8 months for the TB group. The observation period of the control group was 8 months. Soft tissue profile changes were evaluated by means of 12 linear and five angular measurements. The groups were compared at T0 and T1 using analysis of variance, and treatment/observation differences (T1-T0) were evaluated with the Kruskal-Wallis test. Treatment changes in both appliance groups differed significantly (P < or = 0.001) from those in the control group, except for Ss-y, Ls-y, Li-E, and A-y measurements in the TB group and Ls-y, Li-E, nasolabial angle, and A-y measurements in the activator group. When the effects of the two appliances were compared, significant differences were observed only for SS-y (P < or = 0.05), Ss-E (P < or = 0.05), Si-E (P < or = 0.05), and nasolabial angle (P < or = 0.01). The effects of the activator and TB appliances on the soft tissue profile were similar; both significantly changed the soft tissue profile.

Cephalometric evaluation of soft tissue profile changes following mandibular setback in Egyptian adults

Cephalometric evaluation of soft tissue profile changes following mandibular setback in Egyptian adults

Soft Tissue Profile Changes Following Mandibular Advancement and Setback Surgery an Average of 12 Years Postoperatively

The aim of this study was to assess long-term changes in position of soft tissue landmarks following mandibular advancement and setback surgery. Twenty-seven patients (14 women, 13 men; mean age, 36 years) who had undergone either mandibular advancement (15 patients) or setback surgery (12 patients), were available for a long-term follow-up an average of 12 years postoperatively. In all of these cases, lateral cephalometric radiographs taken immediately before operation, at 1 week, 14 months, and 12 years postoperatively, were studied. During the 14 months postoperatively, soft tissue chin and mentolabial fold followed its underlying hard tissue in all patients. A continuous skeletal relapse was observable 12 years after mandibular advancement, but soft tissue chin moved more in an anterior direction. After mandibular setback, soft and hard tissue landmarks remained almost unchanged. Over the entire observation period, a thickening of soft tissue at pogonion was generally seen, and particularly a thickening of the whole chin in the setback group. All patients showed a significant lengthening and thinning of the upper lip. In all except 2 males, the patient's body weight increased markedly. In contrast to the immediate postoperative stage, soft tissue changes observed an average of 12 years after the primary operation do not directly follow the movements of the underlying skeletal structure. The soft tissue profile changes observed over such a long term seem to be influenced not only by the underlying skeletal structure but also by other factors such as weight gain and aging process.

Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes

The aim of this study was to evaluate skeletal, dentoalveolar, and soft tissue profile changes with activator and high-pull headgear combination therapy in patients with Class II malocclusions caused by maxillary prognathism and mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 28 patients were treated with an incisor double capping activator and a high-pull headgear combination appliance (13 girls, 15 boys mean chronological age 11.7 +/- 1.2 years, skeletal age 12.1 +/- 1.4 years) and an untreated group of 28 subjects (14 girls, 14 boys mean chronological mean age 11.9 +/- 1.1 years, skeletal age 12.3 +/- 1.3 years). The skeletal, dentoalveolar, and soft tissue profile changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 1.1 +/- 0.3 years when the combination appliance was removed (T1). In the control group, the radiographs were obtained at the start (T0) and after an observation period 1.2 +/- 0.4 years (T1). Statistical analysis was undertaken with Wilcoxon's ranked-sum test for intra-group comparisons and differences between groups with t-test and Bonferroni's test at a level of significance of P < 0.05. Activator and high-pull headgear combination treatment in these growing patients resulted in a correction of the skeletal Class II relationship (ANB -3.4 degrees), a restriction of maxillary growth (SNA -2.0 degrees, OLp-A -2.3 mm), an advancement of the mandibular structures (SNB +2.6 degrees, FH-NPg +2.3 degrees, OLp-B +2.7 mm, OLp-Pg +2.2 mm), an increase in lower face height (ANS-Me +3.9 mm), a correction of the overjet (-5.4 mm), an improvement in overbite (-2.2 mm), uprighting of the maxillary incisors (U1-FH -5.3 degrees, OLp-U1 -2.5 mm), protrusion of the mandibular incisors (IMPA +2.0 degrees, OLp-L1 +2.7 mm), and a correction of the dental Class II malocclusion (OLp-L6 +3.5 mm). The soft tissue profile changes were a correction of facial convexity (G'-Sn-Pg' angle 2.3 degrees, Mlf-Li-x-axis angle 9.1 degrees), and an increase in lower antero-posterior (Mlf-y-axis 5.6 mm, Pg'-y-axis 5.3 mm), and lower vertical (Sls-x-axis 3.8 mm, Pg'-x-axis 3.8 mm, Me'-x-axis 5.1 mm) soft tissue dimensions. The mentolabial fold depth (Mlf-E line) also significantly decreased, -0.8 mm in the treated group. The activator and high-pull headgear combination appliance was effective in treating growing patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of skeletal and dentoalveolar changes and improvement in the soft tissue facial profile.

Prediction of Soft Tissue Profile following Two-Jaw Surgery

The purposes of this study were to investigate the facial changes by two-jaw surgery for mandibular prognathism accompanying maxillary hypoplasia and skeletal open bite, and to design a regression model that predicts the soft tissue profile changes after two-jaw surgery. Fourteen cases diagnosed as mandibular prognathism accompanying maxillary hypoplasia and skeletal open bite at the Nihon University Hospital, School of Dentistry at Matsudo were studied. The surgical methods used were Le Fort type I osteotomy for the maxilla and sagittal split ramus osteotomy for the mandible. Angle measurements showed significant differences in SNA, ANB, FA, FD and MPA (p<0.01), and significant difference in SNB (p<0.05). In horizontal distances, PTV-L1, PTV-Id, PTV-B, PTV-Pog and PTV-Me changed significantly (p<0.01). In vertical distances, a significant change in N-Me was observed (p<0.05). In horizontal distances, significant changes were observed in PTV-Li and PTV-Spog (p<0.01), and in PTV-St (p<0.05). In vertical distances, significant changes in PTV-St and PTV-Li were observed (p<0.05). No significant changes in cheek line were observed. For the horizontal lip and chin position, the multiple correlation coefficients R ranged from 0.89 to 0.95, and for the horizontal position of the cheek line, the multiple correlation coefficients R ranged from 0.65 to 0.84, indicating a high precision of the prediction equations obtained in this study. In conclusion, the result of this study indicates that the prediction equation for lips and chin has a high precision and can be applied to predict soft tissue profile in two-jaw surgery.

Soft tissue profile changes in patients with Angle Class II division 1 malocclusion treated using a functional regulator

Soft tissue profile changes in patients with Angle Class II division 1 malocclusion treated using a functional regulator

O.052 Soft tissue profile changes following mandibular advancement and setback 12 years post-operatively

Advances in diagnostic technologies, surgical management, and perioperative care have increased survival for neonates with complex congenital heart disease (CCHD). The success of these advances exposed a heightened risk of brain injury and developmental disabilities. The General Movements Assessment, a non-invasive method, may detect early neurodevelopmental impairments in high-risk infants.To examine whether infants with CCHD undergoing neonatal surgery have higher prevalence of atypical general movements (GMs) than a reference group, and whether single ventricle physiology with systemic oxygen saturations <90% increases risk for atypical GMs.Serial General Movements Assessment (GMA) in a cohort of infants with CCHD (n = 74) at writhing (term-6 weeks) and fidgety (7–17 weeks) GM-age. GMA focused on the presence of definitely abnormal GM-complexity and absent fidgety movements. Single GMAs at 3 months were available from a reference sample of Dutch infants (n = 300). Regression analyses examined relationships between cardiac characteristics and definitely abnormal GM-complexity.Higher prevalence of definitely abnormal GM-complexity in infants with CCHD compared to reference infants (adjusted OR 5.938, 95% CI 2.423–14.355), single ventricle CCHD increased the risk. Occurrence of absent fidgety movements was similar in infants with CCHD and reference infants (adjusted OR 0.475, 95% CI 0.058–3.876). Systemic postoperative oxygen saturations <90% was associated with higher risk of definitely abnormal GM-complexity at fidgety (adjusted OR 16.445 95% CI 1.149–235.281), not at writhing age.Infants with CCHD, especially those with single ventricle CCHD, are at increased risk of definitely abnormal GM-complexity. GMA at fidgety age is recommended.