Soft tissue consideration in orthodontics

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  • 1. Soft tissue consideration In orthodontics INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Contents     Introduction Importance of soft tissue Classification of soft tissue Methods of examination :        Clinical Photographic’ Cephalometric Electromyographic Importance of soft tissue in diagnosis Importance of soft tissue in treatment planning conclusion www.indiandentalacademy.com
  • 3. Introduction  Need for orthodontic treatment esthetics www.indiandentalacademy.com ???
  • 4.  Increased esthetic demand ???  “ we know it when we see it “ www.indiandentalacademy.com
  • 5. History  Man subconciosly has been aware of facial esthetics for a long time  Cave paintings in southern france (35000 yrs ago ) provide ample evidence  Towards end of medivial times the idealized features shifted to narrower face and high brows and elaborate make ups www.indiandentalacademy.com
  • 6. Egyptian times www.indiandentalacademy.com
  • 7.  After Egyptians emerged GreeksAS THE 1ST to express their senstivity to qualities of facial expression www.indiandentalacademy.com
  • 8.  At the end of 4rth century Roman period had come to an end and the DARK AGE had begun  Almost all medivial descriptions of lower face valued a small inconspicious mouth with thin lips and even small teeth www.indiandentalacademy.com
  • 9.  Though idealistic features of the face changed over the yrs there was a denominator common to all esthetics marvels , physical beauty as well as constructed , that peristed consiously or subconciously www.indiandentalacademy.com
  • 10. Golden proportion  Euclid revealed a visually pleasing geometric proportion which has been regarded as formation of accepted beauty  It is a ratio between 2 dimensions of a plane figure or the 2 divisions of a line , such that smaller element is to larger as the larger is to whole  This proportion asserts a natural balance , a dynamic symmetery www.indiandentalacademy.com
  • 11. www.indiandentalacademy.com
  • 12.  Mathematically :    1.618 = Phi O.618 = phi Properties of Phi:    1-1.618 = 1 / 1.618 Sqt + 1/2 = Phi Sqt – 1 / 2 = phi www.indiandentalacademy.com
  • 13.  Features of logarithmic spiral can also be seen in nature as in nautilus as well as the HUMAN FACE as described By ROBERTS RICKETTS www.indiandentalacademy.com
  • 14. www.indiandentalacademy.com
  • 15. www.indiandentalacademy.com
  • 16. Role of an orthodontist  Chief problem - Malalligned teeth Malrelation of jaws Soft tissue of face Facial appearance www.indiandentalacademy.com
  • 17. Aim ?  Structural balance  Functional efficiency  Esthetic harmony www.indiandentalacademy.com
  • 18. Importance of soft tissue  Melvin moss - functional matrix theory  Soft tissue form and function has a vital role in overall form and shape of craniofacial skeleton www.indiandentalacademy.com
  • 19. Importance of soft tissue in diagnosis  Analysis of soft tissue gives valuable information       For e.g . – lip incompetance stenosis of nostrils Acute nasolabial angle Deep mento labial sulcus Dryness of lips Tension bridge gingivitis www.indiandentalacademy.com
  • 20.  E.g     Acute nasolabial angle Deep mentolabial sulcus Convex profile Incompetent lips www.indiandentalacademy.com
  • 21. Importance of soft tissue in treatment planning  Bear in mind the effect of treatment on soft tissue profile and relation whether    It worsens what is abnormal It maintains what is normal and desired It corrects what is abnormal www.indiandentalacademy.com
  • 22. Other important factors considered in treatment planning  Growth  Treatment procedures     – RETRACTION EXTRACTION EXPANSION SURGERY www.indiandentalacademy.com
  • 23. CLASSIFICATION OF SOFT TISSUE  Extraoral –     Forehead Nose Chin Lips  Intraoral     Gingiva Palatal mucosa Cheek Frenum tongue www.indiandentalacademy.com
  • 24. Methods of soft tissue examination     Clinical Photographic Radiographic Electromyographic www.indiandentalacademy.com
  • 25. Clinical examination    Natural head position Condylar position Lip posture www.indiandentalacademy.com
  • 26. Natural head position www.indiandentalacademy.com
  • 27. Centric relation www.indiandentalacademy.com
  • 28.  Methods to determine rest position :     Phonetic Command Non command Combined www.indiandentalacademy.com
  • 29. Significance www.indiandentalacademy.com
  • 30. www.indiandentalacademy.com
  • 31. www.indiandentalacademy.com
  • 32. Kinesiographic registration www.indiandentalacademy.com
  • 33. Examination of individual soft tissue  Forehead :    Genitically and ethinically determined Varies with age and sex Lateral contour www.indiandentalacademy.com
  • 34. www.indiandentalacademy.com
  • 35. Lateral contour www.indiandentalacademy.com
  • 36. Nose  Size  Shape  Position www.indiandentalacademy.com
  • 37. Size of nose www.indiandentalacademy.com
  • 38. Nasal contour www.indiandentalacademy.com
  • 39. Nostrils  Shape Deviation Width  Abnormality   www.indiandentalacademy.com
  • 40. Lips  Vertical lip relation ship www.indiandentalacademy.com
  • 41. Lip morphology www.indiandentalacademy.com
  • 42. Relation of upper lip to front teeth www.indiandentalacademy.com
  • 43. Horizontal lip profile www.indiandentalacademy.com
  • 44. Configuration of lips www.indiandentalacademy.com
  • 45. www.indiandentalacademy.com
  • 46. Lip texture and colour  Red and moist  Dry and scaly  Pale www.indiandentalacademy.com
  • 47. Lip tonicity  Hypertonic  Hypotonic www.indiandentalacademy.com
  • 48. Mentolabial sulcus www.indiandentalacademy.com
  • 49. Chin     Configuration Height Contour Assessing symmetery www.indiandentalacademy.com
  • 50. Relation of soft tissue chon to bony chin www.indiandentalacademy.com
  • 51. Overdevelopment of chin height www.indiandentalacademy.com
  • 52. Chin formation and profile contour www.indiandentalacademy.com
  • 53. Asymmetric chin position www.indiandentalacademy.com
  • 54. Intraoral soft tissue examination  Tongue :     Shape Colour Lingual frenum Type of swallowing pattern www.indiandentalacademy.com
  • 55. Tongue length and width www.indiandentalacademy.com
  • 56. Lingual frenum www.indiandentalacademy.com
  • 57. Type of swallowing pattern www.indiandentalacademy.com
  • 58. Infantile swallow www.indiandentalacademy.com
  • 59. Palatographic examination www.indiandentalacademy.com
  • 60. www.indiandentalacademy.com
  • 61. www.indiandentalacademy.com
  • 62. Frenum  Maxillary labial frenum Mandibular labial frenum  Diagnosis by :    Blanching test Radiographic evaluation www.indiandentalacademy.com
  • 63. www.indiandentalacademy.com
  • 64. Gingiva  Examination includes : • • • Gingival type Gingival inflammation Mucogingival lesions www.indiandentalacademy.com
  • 65. Healthy gingiva www.indiandentalacademy.com
  • 66. www.indiandentalacademy.com
  • 67. www.indiandentalacademy.com
  • 68. Palatal mucosa and palatal vault  Examined for : • • • • • Pathological swellings Mucosal ulceration and indentations Scar tissue Inflammation of tonsils Inspection of oropharangeal spaces www.indiandentalacademy.com
  • 69. www.indiandentalacademy.com
  • 70. Tonsils www.indiandentalacademy.com
  • 71. www.indiandentalacademy.com
  • 72. Cheek mucosa www.indiandentalacademy.com
  • 73. Photographic analysis  Advantage :      Absence of patient Accurate measurements Records of patient Assessment of prognosis Comparision www.indiandentalacademy.com
  • 74. Views taken are Profile view  Frontal view  Oblique view  www.indiandentalacademy.com
  • 75. Profile and frontal views can be achieved in various ways : • Frontal and profile views taken with a single camera with patient in 2 different positions (SIMON ) • 2 photographs taken with single camera obtaining different aspects by use of mirros ( A M SCHWARTZ ) • Frontal and lateral views are taken simaltaneosly using 2 cameras ( DAUSCH – NEWMAN 1987 ) www.indiandentalacademy.com
  • 76. PROFILE VIEW  Evaluation based on 3 reference planes • Eye – ear plane • Skin nasion perpendicular • Orbital perpendicular www.indiandentalacademy.com
  • 77. Depending on location of subnasale point  3 typical profile variations    : Average face Ante face Retro face www.indiandentalacademy.com
  • 78. www.indiandentalacademy.com
  • 79. www.indiandentalacademy.com
  • 80. www.indiandentalacademy.com
  • 81. Facial divergence www.indiandentalacademy.com
  • 82. Facial keys to orthodontic diagnosis and treatment planning  William Arnett and Robert T Bregman in 1993  19 FACIAL KEYS were selected 2 views of patient are selected for identification of problems in 3 planes of space : a ) anteropsterior b) transverse c) vertical  www.indiandentalacademy.com
  • 83.  FRONTAL • RELAXED LIP • FUNCTIONAL ANALYSIS - closed lip - smile PROFILE RELAXED LIP www.indiandentalacademy.com
  • 84. Frontal view      Outline form Facial level Midline alignments Facial one third Lower one third evaluation      : Upper and lower lip length Incisor to relaxed upper lip Interlabial gap Closed lip position Smile – lip level www.indiandentalacademy.com
  • 85. Profile view           Profile angle Nasolabial angle Maxillary sulcus contour Mandibular sulcus contour Orbital rim Cheek bone contour Nasal – base lip contour Nasal projection Throat length Subnasale pogonion line www.indiandentalacademy.com
  • 86. Outline form and symmetery     Bizygomatic width Bigonial width Height to width proportion is 1.3 :1 in females and 1.35 : 1 for males Height to width proportion is corrected in 2 ways :   Maxillary or mandibular surgery is used Augmentation or reduction of facial height or width www.indiandentalacademy.com
  • 87. www.indiandentalacademy.com
  • 88.  Correction of assemeteries is accomplished with :   Cant correction or midline movement of maxilla or mandible simeltaneous with occlusal correction Augmentation or reduction of skeletal surfaces www.indiandentalacademy.com
  • 89. Facial level  A reliable horizontal landmark is necessary www.indiandentalacademy.com
  • 90. Midline alignments www.indiandentalacademy.com
  • 91.  Dental midline shifts are due to various factors :       Spaces Tooth rotation Missing teeth Buccally or lingually positioned tooth Crowns / fillings Congenital tooth mass difference www.indiandentalacademy.com
  • 92. Facial one thirds www.indiandentalacademy.com
  • 93. Lower one third evaluation  Upper and lower lip length : • Normal length from subnasale to upper lip inferior is 19 -22 mm • Lower lip is 38 – 44 mm • normal ratio for u / l is 1:2 www.indiandentalacademy.com
  • 94. Upper tooth to lip relation   Distance from upper lip inferior to incisal edge is measured mnormal range is 1 – 1.5 mm www.indiandentalacademy.com
  • 95.  Conditions of disharmony are produced by 4 variables : • • • • Increased or decreased upper lip length Increased or decreased maxillary skeletal length Thickness of lips Angle of view www.indiandentalacademy.com
  • 96. Interlabial gap    With lips relaxed space of 1 – 5 mm exists Females show larger gap Dependant on • Lip length • Vertical dentoskeletal height www.indiandentalacademy.com
  • 97. Closed lip position  Adds support to diagnostic patterns  Reveals disharmony between skeletal and soft tissue lengths www.indiandentalacademy.com
  • 98. Smile position lip level  Different lip elevations are observed in normal and abnormal skeletal patterns  Variability in gingival exposure is related to     Lip length Vertical maxiilary length Maxillary anatomic crown length Magnitude of lip elevation with smile www.indiandentalacademy.com
  • 99. Profile view  Profile angle : • Class 1 :165 – 175 • Class II : less than 165 • Class III : greater than 175 www.indiandentalacademy.com
  • 100. Nasolabial angle  Range of 85 – 105 degrees Sex difference  Factors considered in treatment  planning ; • Existing angle • Tipping verses bodily movement of teeth • Anteroposterior lip thickness • Magnitude of mandibular retrusion • Movement of incisor teeth after extraction www.indiandentalacademy.com
  • 101. Maxillary and mandibular sulcus contour www.indiandentalacademy.com
  • 102. Orbital rim www.indiandentalacademy.com
  • 103. Cheek bone contour www.indiandentalacademy.com
  • 104. www.indiandentalacademy.com
  • 105. Nasal base – lip contour www.indiandentalacademy.com
  • 106. Nasal projection www.indiandentalacademy.com
  • 107. Throat length and contour www.indiandentalacademy.com
  • 108. Subnasle to pogonion line www.indiandentalacademy.com
  • 109.  Upper lip in front of sn-pog line by 3.5 sd 1.4 mm  Lower lip in front of sn pog line by 2.2 sd 1.6 mm www.indiandentalacademy.com
  • 110. www.indiandentalacademy.com
  • 111.  The relationship of lips to this line is affected by following factors :    Skeletal relation Incisor inclination Lip thickness www.indiandentalacademy.com
  • 112. Soft tissue characteristics of common skeletal deformities  With 19 facial keys 8 pure skeletal deformities with predictable soft tissue appearannce can be defined : • Class I facial and dental • Vertical maxillary excess • Vertical maxillary deficiency • Class II facial and dental • • • Maxillary protrusion Vertical maxillary excess Mandibular retrusion • Class III facial and dental • • • Maxillary retrusion Vertical maxillary deficiency Mandibular protrusion www.indiandentalacademy.com
  • 113. www.indiandentalacademy.com
  • 114. www.indiandentalacademy.com
  • 115. Cephalometric analysis  Advantages : • • • • • standardization Ease of measuring Ease of comparing Superimposition Comparision can be done www.indiandentalacademy.com
  • 116. Disadvantages         Number and values cannot always dictate aesthetics Soft tissue covering bone and teeth may vary Facial harmony may not have dentoskeletal harmony Cranial base as refrence – sometimes inaccurate Different analysis – different keys to diagnose Only anteroposterior assessment Posturing Relaxed lip profile norms not lncluded www.indiandentalacademy.com
  • 117. Various cephalometric analysis for facial profile  1) Downs analysis:   Facial angle Angle of convexity  2) Steiners soft tissue analysis  3) Ricketts – E line www.indiandentalacademy.com
  • 118. www.indiandentalacademy.com
  • 119. INTEGUMENTAL CONTOUR AND EXTENSION PATTERNS  BY BURSSTONE in 1959  This gives direct measure of soft tissue mass and difference in integumental contour and extension with respect to sex and maturation www.indiandentalacademy.com
  • 120. www.indiandentalacademy.com
  • 121. Subtenly’s analysis  Devised to make distinction between    Skeletal profile Soft tissue profile Full soft tissue profile www.indiandentalacademy.com
  • 122. www.indiandentalacademy.com
  • 123.  Subtenly further defined the thickness of soft tissue profile and established the following: • Thickness of soft tissue nasion was usually found to be constant • Thickness of sulcus labrale superiororis increased by 5 mm • Thickness of soft tissue chin increased by 2mm www.indiandentalacademy.com
  • 124. Subtenly’s analysis PROFILE CLASS I CLASS II Skeletal 174 178 181 Soft tissue 158 163 168 Total 133 133 139 www.indiandentalacademy.com CLASS III
  • 125. MERRIFIELD Z ANGLE  All 3 planes and all 3 analysis were utilized in this analysis  Profile line : www.indiandentalacademy.com
  • 126.  Total chin maesurement : • Mean 16. 07 mm • Range 12-20 mm  Horizontal thickness of upper lip • Mean 13. 74 mm • Range 9- 18 mm  Z angle – • Mean 81.4 degrees • Range 71 – 89  www.indiandentalacademy.com
  • 127. Merrifield nonorthodontic normals        FMA IMPA FMIA ANB Z-ANGLE TOTAL CHIN UPPER LIP - 24.37 86.81 68.82 1.92 81.4 16.07 13.74 www.indiandentalacademy.com
  • 128. HOLDWAY’S ANALYSIS  Reference lines used are : • • • • • • H line Soft tissue facial line Hard tissue facial line Sella nasion line FH plane A line running at righy angle to FH down tangent to vermillilon border of upper lip www.indiandentalacademy.com
  • 129. www.indiandentalacademy.com
  • 130. www.indiandentalacademy.com
  • 131.  Soft tissue facial angle: Mean – 91 degrees Range - 91 sd 7 www.indiandentalacademy.com
  • 132.  Nose prominence :  14 – 24 mm is the range www.indiandentalacademy.com
  • 133.  Upper lip curvature :  Range 1 – 4 mm www.indiandentalacademy.com
  • 134.  Soft tissue subnasale to H line :   MEAN 5 MM RANGE OF 3 – 7 MM www.indiandentalacademy.com
  • 135.  SKELETAL PROFILE CONVEXITY : • NORMAL VALUES TO – 2 MM +2 www.indiandentalacademy.com
  • 136.  Basic upper lip thickness : • Usually 15 mm  Upper lip thickness : • 13 – 14 mm www.indiandentalacademy.com
  • 137.  H ANGLE :  RANGE : 7- 15 DEGREES  IDEAL 10 DEGREES www.indiandentalacademy.com
  • 138.  LOWER LIP TO H LINE :  1 mm behind to 2 mm in front of H line www.indiandentalacademy.com
  • 139.  Inferior sulcus to H line :  Soft tissue chin thickness : www.indiandentalacademy.com
  • 140. Soft tissue esthetic triangle  POWELL N HUMPHARY  This technique utilizes angles and their relative propotions to compare the major soft tissue of face  The major angles used are : • • • • Nasofacial angle : Nasomental angle : Mentocervical : Nasofrontal : 30 – 40 120 – 132 80 – 95 115 - 130 www.indiandentalacademy.com
  • 141. www.indiandentalacademy.com
  • 142. www.indiandentalacademy.com
  • 143. Soft tissue cephalometric analysis used for orthognathic surgery  Cephalometric landmarks : www.indiandentalacademy.com
  • 144. www.indiandentalacademy.com
  • 145. www.indiandentalacademy.com
  • 146. Analysis of tongue position by cephalometric analysis  Preconditions of reference lines: • • • • • • Cover greatest possible area Independent of variation Positional change Tongue position Anatomical and functional properties of tongue simple www.indiandentalacademy.com
  • 147. www.indiandentalacademy.com
  • 148. www.indiandentalacademy.com
  • 149. Electromyographic examination  Helps in confirming clinical diagnosis of clinical activity  Evaluating activity of orofacial muscles  Using electrodes placed subcutaneously over muscles  Action potential from various motor units merge to produce electromyogram www.indiandentalacademy.com
  • 150. Perceptions of a balanced profile  CZARNECKI AND CURRIER AJO (1993) www.indiandentalacademy.com
  • 151. www.indiandentalacademy.com
  • 152. RESULTS www.indiandentalacademy.com
  • 153. www.indiandentalacademy.com
  • 154. GROWTH CHANGES IN SOFT TISSUE PROFILE  BY RAM NANDA AND SUNIL KAPILA (AJO 1990) www.indiandentalacademy.com
  • 155. RESULTS  NOSE HEIGHT : www.indiandentalacademy.com
  • 156.  upper and lower nose ratio was 3 : 1 www.indiandentalacademy.com
  • 157. NOSE DEPTH AND SAGITTAL DEPTH  from 7- 16 male and female graph runs parallel  diverge from 16- 18 yrs www.indiandentalacademy.com
  • 158.  At 7 yrs 85 percent of propotionate growth is completed in males and 90 % in females www.indiandentalacademy.com
  • 159. Inclination of nose www.indiandentalacademy.com
  • 160. Dorsum of nose  Between 8 – 16 yrs size of angle increased  At 18 male group showed 4.5 degree increase www.indiandentalacademy.com
  • 161. Base of nose www.indiandentalacademy.com
  • 162. Upper lip height  7-18 increased from 19.8 – 22. 5 mm in males  Females 19.1- 20.2 mm www.indiandentalacademy.com
  • 163. Lower lip height  Males : increased 4.2 mm ( 10 -11 and 13-18)  Females : 1.5 mm (11-13 yrs ) www.indiandentalacademy.com
  • 164. Thickness of lips  UPPER LIP THICKNESS AT POINT A  MALES - 4.7mm  Females – 3.5mm www.indiandentalacademy.com
  • 165. UPPER LIP THICKNESS AT LABRALE SUPERIUS  MALES- 13.9 TO 17.1mm  FEMALES – 11.8 TO 12.5mm www.indiandentalacademy.com
  • 166. LOWER LIP THICKNESS AT LABRALE INFERIUS www.indiandentalacademy.com
  • 167. UPPER LIP HEIGHT  MALES – 19.8 TO 22.5mm  FEMALES- 19.1 TO 20.2mm www.indiandentalacademy.com
  • 168. LOWER LIP HEIGHT  MALES - 4.2mm  FEMALES – 1.5mm www.indiandentalacademy.com
  • 169. www.indiandentalacademy.com
  • 170. Soft tissue changes from various surgical procedures  Soft tissue reactions caused by different surgical movements of the jaws :  Mandibular advancement : • Soft tissue pogonion advances in an almost 1:1(100%) ratio with hard tissue pogonion , acc to GARDNER • The inferior labial sulcus responds in a 69 : 1 (70 %) ratio with hard tissue B point • Labrale inferiororis advances in a 0.77 : 1 ( 75 %) ratio with lower incisor tip • The soft tissue chin advances in harmony with underlying bony chin .the thickness of lip also plays a role www.indiandentalacademy.com
  • 171. Mandibular setback  Soft tissue pogonion follows hard tissue pogonion at a 1:1 (100%) ratio (BETTS AND FONSECA )  the inferior labial sulcus responds in a 0.77:1(75 %) ratio with hard tissue B point  Labrale inferiororis responds to distal movement of the mandibular incisor in a 0.79 : 1 (75 %) ratio – DANCASTER  The lower lip shortens slightly and becomes more protrusive by curling out , labiomental fold becomes more accentuated  Minor effects occur on upper lip and nasolabial angle www.indiandentalacademy.com
  • 172. Genioplasty  According to gardners research on enhancement genioplasties , the soft tissue chin advances in a 1 : 1 ratio with hard tissue chin  In reduction genioplasties soft tissue chin also follows the bony countors in a 1 : 1 ratio www.indiandentalacademy.com
  • 173. Maxillary advancement  The nose tip responds to maxillary advancement measured at maxillary incisor anterius in a ratio of 0.26 : 1 (25 %) – DANCASTER  Subnasale advances in a 0.52 : 1 (50 %) ratio with maxillary incisor anterius and in a 0.56 : 1 (55 %) ratio with subspinale  The superior labial sulcus moves horizontally in a ratio of 69 : 1 (70 %) with maxillary incisor anterius  The labrale superius responds in a 0.55 : 1 (55 % )ratio with maxillary incisor anterius www.indiandentalacademy.com
  • 174.  CARLOTTI , ASCHAFFENBURG , AND SCHENDEL reported a ratio of 0.9 : 1 ( 90%) using vy soft tissue closure technique  Acc to FREIHOFER , leaving the anterior spine intact causes greater forward movement of upper lip and subnasale  Stomion superius was found to advance 25 % more  The v y technique also reduced the amount of lip shortening from 0. 26 : 1 to 0.1 : 1  The labrale superius and stomion superius move vertically in a 0.1 : 1 (10 % ) ratio www.indiandentalacademy.com
  • 175.  Thin lips advance 2.8 times more than thick lips  Nasal width is controlled by alar cinch suture technique ; only a 2.8 % increase was reported by GUYMON , CROSBY AND WOLFORD , as against 10 % increase when the technique was not performed  As the maxilla advances , the nose tip advances slightly , the alar base width widen marginally , subnasale advances , superior labial sulcus flattens , and labrale superius advances www.indiandentalacademy.com
  • 176. Maxillary impaction  Undesirable nasal tip elevation can occur as a result of maxillary superior repositioning  RADNEY AND JACOBSON found about 1 mm of elevation for every 6 mm of maxillary superior repositioning ( 15 % )  SCHENDEL AND WILLIAMSON in a sample of 10 cases that if maxilla is advanced in elevation process , the nasal tip will be further advanced and elevated www.indiandentalacademy.com
  • 177.  Alar bases widen with maxillary impaction , controlled by alar base cinch suture , which restricts such widening to 2.8 % ( GUYMON ,CROSBY AND WOLFORD )  Nasolabial angle decreases with maxillary impaction ( O’ RYAN)  MCFARLANE quantified nasal morphologic features that predispose patients having leforte 1 osteotomies to greater or lesser nasal tip deflection  The upper lip elevates superiorly with impacted maxilla by about 40 %(RADNEY AND JACOBSON )  SARVAR AND WEISMAN NOTED minimal shortening of upper lip , in a 5 year follow up study www.indiandentalacademy.com
  • 178.  ROSEN warned that upper lip will shorten more if maxilla is advanced as well as impacted  The amount of soft tissue change increased from nose tip to stomion superius  The v y surgical closure can prevent undesirable loss of vermilion exposure and reduce lip shortening  Sarvar and weissman nated little soft tissue thinning of upper lip in short term ., became mildly significant in long term www.indiandentalacademy.com
  • 179. Autorotation  The soft tissue chin follows autorotation of mandible in 1 : 1 ratio (RANNEY JACOBSON, BURSTONE AND LEGAN )  the lower lip becomes slightly recessive at labrale inferius , labiomental angle decreases www.indiandentalacademy.com
  • 180. www.indiandentalacademy.com
  • 181. Dentofacial and soft tissue changes in a class II div 1 treated cases with and without extraction  BISHARA AND CUMMINS ( AJO 1995 )  91 PATIENTS (44 +41 ) www.indiandentalacademy.com
  • 182. RESULTS www.indiandentalacademy.com
  • 183. CHNGES IN PROFILE DURING ORTHODONTIC TREATMENT WITH EXTRACTION OF 4 PREMOLARS  DROBOCKY AND SMITH ( AJO 1989 )  160 PATIENTS www.indiandentalacademy.com
  • 184. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com