Facial profile changes /certified fixed orthodontic courses by Indian dental academy


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  • When we see a face in a profile it’s a soft tissue drape . What lies behind is skeleto of face .the profile of an individual gets influenced by soft tissue as well as hard tissue stru. Individualy to a significant extent.
  • Historical attempts to study profilr and changes due to the growth
    We have to be thorough with str of the face of a child
  • Aftr the advent of cephalometry it aws the major tool for study of profile changes
  • Forehead
  • Growth can be +ve / -ve /differential
  • Adenoid faces
  • Serial cephalometric tracings from bolton brush shows the chin position at
    Angle of convexity is also changes as the chin becomes more n more prominent
  • Primary- bone is displaced by its own growth
    Functional matrix- condyle has adaptive capacity- net result is translation of chin in space.
    Condyle attached to middle cranial fossa. Its growth affects position of chin
  • Convexity of the chin is the depository area where as the sub apical concavity is resorbtive
    Result is the contour of chin button increases
  • 30 subjects from bolton brush growth study
    12 retrusion- 12 constant 6 constant
  • Primary displacement – growth at sutural site max tuberosity area
    As max is attached ton anterior cranial fossa. Growth of A.C/F sec. affects maxill trans mitted downwards and forwards
  • Entire premaxillary and malar surface is resorbtive a,f,a. skeletal profile is concerned the prominence of cheek bones reduces progresively.
    Lower border of orbit
    Frontonasal suture are a is depository
  • Maxillary sinus
  • Prototype study – chaconas behrents mcnamara
  • Facial profile changes /certified fixed orthodontic courses by Indian dental academy

    1. 1. Facial profile changes from childhood to adulthood www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. Introduction Everyone is familiar with the facial appearance of babies. It is not a miniature of adult face. In a profile view the most striking feature is a lower jaw which is which is far retrusive than the face above.  The general tendency seems to be for the mandible to grow from the more retruded to a less retruded position. And This is usually true regardless of the individual facial type.  www.indiandentalacademy.com
    4. 4.  The maxillary jaw becoming less prominent relative to the rest of the skeletal profile indicates some disproportionality in facial growth. The maxilla tends to be positioned in a forward direction much more slowly than does the mandible, resulting in a decrease in the convexity of the facial profile. This differencial growth in an anterior direction determines the final facial type at the completion of growth. www.indiandentalacademy.com
    5. 5. PROFILE www.indiandentalacademy.com
    6. 6. Index A historical background 2. Face of child 3. Bases of profile changes 4. Hard tissue profile 5. Soft tissue profile 6. Profile Changes from 5-25 yr ( Bishara ) 7. Headform and profile 8. Sexual dimorphism 9. Prediction of profile change 10. Clinical implications 1. www.indiandentalacademy.com
    7. 7. Growth and profile change A historical background The physical anthropologists in earlier days worked with dry skull.  Keith and Campion (1922) studied human facial growth from childhood to the adulthood, using immature and mature skulls and 32 living individuals. www.indiandentalacademy.com
    8. 8.  Hellmann (1922) investigated facial growth on sample of 78 skulls of ancient American Indians. He classified the material on the stages of eruption, wear, and loss of teeth. He asserted that the mandible grew more rapidly in height and depth than did the upper face. www.indiandentalacademy.com
    9. 9. Hellmann (1935) studied 705 males and 988 females ranging from 3 to 22 years of age. A total of over 45,000 measurements of external dimensions of the face were made.  He concluded that, “the infant face is transformed into that of the adult not only by increases in size, but by changes in proportion and adjustment in position as well.  www.indiandentalacademy.com
    10. 10. Cephalometric studies Broadbent (1937) instrumented a Longitudinal study of over 4000 subjects from birth to adult hood.  Started in 1929 at case reserve university in Ohio this study is known as Bolton brush growth study.  The findings were presented in the form of superimposed tracings of serial cephalograms made at several stages from 1 month to adulthood.  www.indiandentalacademy.com
    11. 11. Child face  Whether a young child's headform is dolichocephalic or brachycephalic,the face itself appears more brachycephalic-like because it is still relatively wide and vertically short. www.indiandentalacademy.com
    12. 12. www.indiandentalacademy.com
    13. 13.  1. 2. 3. The face is vertically short because the Nasal part of the face is still small. The jaw bones are not yet grown. The primary and secondary dentition has not yet established. www.indiandentalacademy.com
    14. 14. It has a high intellectual-like forehead without coarse eyebrow ridges. The nose is short, the nasal bridge is low; the nasal profile is concave; The cheekbones are prominent. The eyes seem wide-set and large. The face is flat. www.indiandentalacademy.com
    15. 15. chin is usually quite receded while there appears to be a more or less pronounced protrusion of the maxillary aspect of the face. With growth there is a marked transformation of the face. Many features of the baby's face are destined to undergo marked changes as the face grows and develops through the years come.  www.indiandentalacademy.com
    16. 16. Why there is a change in profile? Differential growthhard tissue / soft tissue  Cephalo-caudal gradient of growth  Function  www.indiandentalacademy.com
    17. 17. Differential growth  Different organs in the body grow at different times to a different amount at different rates.  Scammon’s growth curve www.indiandentalacademy.com
    18. 18. Cephalo-caudal gradient of growth There is an axis of increased growth extending from head towards the feet.  This increased gradient of growth is evident even within face. The cranium is Proportionally larger than face during birth. Postnataly face grows more than cranium.  The Mandible grows more in amount and for longer duration than maxilla. www.indiandentalacademy.com
    19. 19. www.indiandentalacademy.com
    20. 20. Function In a child nasal part of the face is underdeveloped because of overall body and lung size is still small. Correspondingly, Respiratory function has low demands.  The nasal part of the face and the pharyngeal space has to enlarge in response to increased demands on respiratory function imparted by increasing overall body and lung size.  www.indiandentalacademy.com
    21. 21. For the Nasomaxillary space to enlarge Nasomaxillary complex has to grow out from beneath the anterior cranial base.  Then Both the jaws have to grow to accommodate erupting deciduous and subsequently a permanent dentition ,and enlarging muscles of mastication. These factors impart a vertical ht. and a depth to the face.  www.indiandentalacademy.com
    22. 22. Hard tissue profile changes www.indiandentalacademy.com
    23. 23.  A comprehensive knowledge of changes in the skeletal profile is necessary to provide a base line from which soft tissue profile changes can be assessed. Changes in the profile results from Soft tissue alteration and from modification of the underlying skeletal structures. www.indiandentalacademy.com
    24. 24. LOWER FACE The configuration and position of the following structures define the lower aspect of the facial profile.  CHIN  DENTO ALVEOLUS  PREMAXILLA www.indiandentalacademy.com
    25. 25. MIDDLE & UPPER FACE NASOMAXILLARY COMPLEX  ORBITS  FOREHEAD  www.indiandentalacademy.com
    26. 26. Chin The chin is incompletely formed in the infant. Indeed, it hardly exists at all.  The mandible of the young child is quite small and retrusively placed relative to the upper jaw.  www.indiandentalacademy.com
    27. 27.  The anterior cranial fossa is developmentally precocious. Hence the Nasomaxillary complex is carried to a more protrusive position. The mandible, which articulates on the middle cranial fossae is located more posteriorly. www.indiandentalacademy.com
    28. 28. Progressive forward positioning of chin www.indiandentalacademy.com
    29. 29. With continuing growth the chin tends to assume forward position relative to the superior aspects of the skeletal face.  The mandible to grow from the more retruded to a less retruded position regardless of the individual facial type at the onset and completion of growth.  www.indiandentalacademy.com
    30. 30. Displacement  Primary displacement  Secondary displacement www.indiandentalacademy.com
    31. 31. Surface Remodeling www.indiandentalacademy.com
    32. 32. Rotation of bases  Rotation of mandible characteristically result into a long face or short face.  Rotation of palatal plane auto rotates mandible accordingly making chin either prominent or retrusive. www.indiandentalacademy.com
    33. 33. Teeth and alveolar bone The uprighting and retrusion of the dento-alveolar structures were found to take place along with mandibular forward positioning.  It was noticed that, it exhibited some degree of constancy in its angular position relative to the profile of the skeletal jaws. i.e. The angle formed b/w mandibular incisors and A-Pog line remains more or less constant.  www.indiandentalacademy.com
    34. 34. Progressive retrusion www.indiandentalacademy.com
    35. 35. Progressive protrusion www.indiandentalacademy.com
    36. 36.    Changes comparable to basal bones have not been noted at pt A & pt.B. After approximately 7 to 9 years of age, point B, does not exhibit much forward change relative to point A. Angle b/w lower incisors and A-Pog plane increases until 9 years of age i.e. teeth tend to become progressively more procumbent. From 9 to 18 years, the average angular relationship between the lower incisor and this plane remains stable. www.indiandentalacademy.com
    37. 37.  Thus it can be generalized that the alveolar processes can be expected to exhibit some stability in their A-P relationship to each other after 9 years of age while their supporting skeletal bases continue to grow. www.indiandentalacademy.com
    38. 38.  With growth pogonion is going forward more rapidly than point A resulting in a straightening of the skeletal profile. The mandibular incisors are becoming more upright with growth permits it to maintain a somewhat constant angular relationship to the jaw profile. www.indiandentalacademy.com
    39. 39. Premaxilla  The anterior outline of the bony maxillary arch in the infant, has a vertically convex topography. This is in contrast to the characteristic concavity this region develops in the adulthood. The alveolar bone in this area of the adult face is noticeably protrusive. www.indiandentalacademy.com
    40. 40. www.indiandentalacademy.com
    41. 41.  Anterior contour of premaxilla is flat in infants , the differential remodeling process draws out this contour. www.indiandentalacademy.com
    42. 42. MIDDLE & UPPER FACE NASOMAXILLARY COMPLEX  ORBITS  FOREHEAD  www.indiandentalacademy.com
    43. 43. Nasomaxillary complex  Primary displacement  Secondary displacement www.indiandentalacademy.com
    44. 44. Surface remodeling www.indiandentalacademy.com
    45. 45. The cheek bones www.indiandentalacademy.com
    46. 46. www.indiandentalacademy.com
    47. 47. Nasal bone The young child has small rounded nose that protrudes very little and is vertically quite short.  The tip of the infant's nasal bone protrudes very little beyond the inferior orbital rim. The nasal bridge is quite low. The lateral bony wall of the nose is characteristically narrow and shallow.  www.indiandentalacademy.com
    48. 48. The whole nasal region of the infant is vertically shallow. Nasal floor lies close to the inferior orbital rim. Shape of Nasal bridge changes from concave to convex. The sagital depth increases. www.indiandentalacademy.com
    49. 49. Orbits  The eyes, which are precocious along with the brain can appear large in the young child. As facial growth continues, however, the nasal and jaw regions later develop disproportionately to the earliermaturing orbit and its soft tissues. As a result, the eyes of the adult appear smaller in proportion. www.indiandentalacademy.com
    50. 50.  The orbit grows by V principle. i.e. relocation by remodeling. The cone shaped orbital cavity moves towards its wide opening. www.indiandentalacademy.com
    51. 51. The superior and inferior orbital rims of the young child are in an approximately vertical line.  In the adult, Because of frontal sinus development and supraorbital protrusion, the upper orbital rim noticeably overhangs the lower. The orbital opening and lateral orbital rim become inclined obliquely forward.  www.indiandentalacademy.com
    52. 52. Clockwise rotation of profile www.indiandentalacademy.com
    53. 53. FOREHEAD  The neurocranium grows earlier faster and to a much greater extent that Facial complex. Cranial cavity completes 90% of its growth by 5 yrs of age. The young child's precocious forehead is upright and bulbous. This region seems very large and high because the face beneath it is still relatively small. But in following years the face enlarges much more, so that the proportionate size of the forehead becomes reduced. www.indiandentalacademy.com
    54. 54.   pnumatization of the frontal sinus is responsible for the supraorbital ridges becoming prominent. And forehead becoming much more sloping. The amount of slope is related to sex and head form. www.indiandentalacademy.com
    55. 55.  Protrusive modes of supraorbital and nasal remodeling and displacement cause the adult forehead and nose to appear progressively more prominent relative to the retrusively remodeling cheekbones and lateral orbital rims, thus drawing out the depth of the face due to regional developmental divergence. www.indiandentalacademy.com
    56. 56. The entire face of the adult is thus much deeper anteroposteriorly. it is much less "flat”.  The whole face is drawn out in many directions and it has much bolder topographic features than a child’s face.  www.indiandentalacademy.com
    57. 57. EVALUATION  The Angle of convexity by Down's frequently used to specify observations on the skeletal profile. This angle helps to evaluate the relative A-P position of the upper face to the rest of the craniofacial profile. In the longitudinal evaluation of the profile, an increase in the angle as it approaches 180 indicates a straighter skeletal profile or reduced convexity of the profile. www.indiandentalacademy.com
    58. 58.  Angle Ba-N-Pog At six month of age average degree of mandibular prognathism was found to be 54.0 for the male subjects and 57 for female subjects. By 3-4 years it increases by 58.4 for male and 60.4 for females. By 18 years it becomes 62 degrees. www.indiandentalacademy.com
    59. 59. Soft tissue profile www.indiandentalacademy.com
    60. 60. Soft tissue profile www.indiandentalacademy.com
    61. 61. Large fluctuations in the size of soft tissue measurements are to be anticipated. Any change posture and movement in the facial musculature can affect the length and thickness of tissues particularly at the lips and chin.  Hence though soft tissue measurements show consistency, the normal range is fairly wide.  www.indiandentalacademy.com
    62. 62. Components of soft tissue profile Soft tissue chin  Lips  Soft tissue nose  www.indiandentalacademy.com
    63. 63. Soft tissue chin  It has been demonstrated that the position of the integumental chin is very closely related to the position of the skeletal chin. And as the skeletal chin assumes a more forward relationship to the cranium with growth, so does the soft tissue chin.  Can we anticipated that the soft tissue profile of most individuals to become less retrognathic with progressive growth? www.indiandentalacademy.com
    64. 64.  Although the soft tissue chin has been found to follow closely the skeletal chin, the same close correlation can not be demonstrated in other areas of face. www.indiandentalacademy.com
    65. 65.  The soft tissue structures overlying other skeletal landmarks do not show the same pattern of change as that observed for the bony profile. The average hard tissue profile definitely tends to become straighter with age, Whereas the analogous soft tissue profile tends to remain comparatively stable in its convexity. www.indiandentalacademy.com
    66. 66. Is there a growth differential in the thickness of the soft tissue covering the hard tissue?  This possibility has been substantiated by the finding that there is a comparatively greater increase in the thickness of the soft tissue of maxillary jaw than that covering the mandibular symphysis and the forehead area.  www.indiandentalacademy.com
    67. 67.  Thus, considering the soft tissue covering alone, this would tend to swing the soft tissue profile toward the direction of a more convex rather than a less convex facial profile. www.indiandentalacademy.com
    68. 68. Lips The growth of the lips was found to follow the general growth curve for muscle and other connective tissue within the body.  The upper and lower lips gradually increase in length; the upper lip grows away from the level of the palate while the lower lip grows away from the chin.  A progressive increase in lip length was found to take place until approximately 15 years of age.  www.indiandentalacademy.com
    69. 69.  The lips attain a proportionately greater thickness in the vermillion regions than in the regions overlying skeletal points A and B. The upper lip increases in thickness at the vermillion level approximately the same amount as it increases in length. www.indiandentalacademy.com
    70. 70. In spite of progressive increase in length, both lips show a fairly constant vertical relationship to their respective alveolar processes. After the full eruption of the central incisors, there is little increase in the vertical distance between the crest of the alveolar process and the vermillion border of the lip.  The lips also maintain an equally constant relationship to the incisal edges of the anterior teeth.  www.indiandentalacademy.com
    71. 71. The A-P posture of the lips is also found to be closely related to their supporting hard tissue structures, that is, the teeth and alveolar processes.  The maxillary-mandibular dentitions progressively become more retruded relative to its supporting skeletal bone, and to the facial plane of the skeletal profile.  www.indiandentalacademy.com
    72. 72. www.indiandentalacademy.com
    73. 73. Nose  The soft tissue nose is short, rounded and pug-like the nasal bridge is low; the nasal profile is concave; the nares can be seen in a face on view. It protrudes very little and is vertically quite short. www.indiandentalacademy.com
    74. 74. When the nose is included in the profile appraisal, the soft tissue profile is seen to be increasing in convexity with progressive growth.  This happens because the nose grows in a forward direction to a proportionately greater degree than the other soft tissues of the facial profile.  With continuing growth, the nose increases in its projection relative to the total facial profile.  www.indiandentalacademy.com
    75. 75. www.indiandentalacademy.com
    76. 76. The human nose continues to grow in a downward and forward direction at least until early adulthood.  There does not seem to be an appreciable decrease in the rate of nasal growth which is typical for the skeletal structures.  Average yearly increase of 1-1.3mm in the overall length of the external nose is almost same for males and females.  www.indiandentalacademy.com
    77. 77. Shape changes in external nose The nose usually becomes more inclined in a forward direction and the tip of the nose, becomes more acute during the later stages of development.  In most instances the nose tends to grow longer vertically than it does horizontally.  www.indiandentalacademy.com
    78. 78.  Vertical dimension of the nose increases until 18 years of age. The upper nose height is found to increase 3 times more than the lower nose height, thereby maintaining a ratio of upper nose height to lower nose height of 3:1. www.indiandentalacademy.com
    79. 79.  In many males a growth spurt for the nose can be found to occur somewhere between 10 to 16years of age. sum total of the effect of the growth of nose on the configuration of the soft tissue profile is to make the facial profile more convex with age. www.indiandentalacademy.com
    80. 80. The apparent incongruity between the convexity of the skeletal and the soft tissue profiles indicates that the soft tissue of the upper face is not directly related to the hard tissue of the upper face. In contrast to this, the position of the soft tissue overlying the mandibular symphysis seems to be directly dependent on the position of the chin.  www.indiandentalacademy.com
    81. 81. Nasolabial angle  The Nasolabial angle decreases slightly from 7 to 18 years in both sexes. The mean at 7 years was 107.8±9.4 degrees for males and 114.7±9.5 degrees for the females. At 18 years the mean was slightly reduced to 105.8±9.0 and 110.7±10.9 degrees. www.indiandentalacademy.com
    82. 82. Mentolabial angle males 7 years 125.3±8.4 degrees  females, 7 years 136.1±11.6 and at  18 years 125.1±12.9 degrees 18 years. 127.1± 12.9 degrees www.indiandentalacademy.com
    83. 83. Profile Changes from 5-25 ( Bishara ) The purpose of this study is to quantify the changes which occur between the age of 5 years and adulthood. The total change between the ages of 5 and 25.5 years was arbitrarily divided into three periods of growth:  5 to 10 years (GP I),  10 to 15 years (GP II),  15 to 25.5 years (GP III). www.indiandentalacademy.com
    84. 84. www.indiandentalacademy.com
    85. 85. www.indiandentalacademy.com
    86. 86. Summary Significant changes take place in GP I & GP II which are significantly higher than the changes in GP III  Changes occur earlier in females than in males  Linear & angular changes do not occur at the same time and in same direction.  www.indiandentalacademy.com
    87. 87. There are significant changes in GP III in certain facial parameter like  face Ht.  ANB angle  Soft tissue convexity This indicates that most of the decrease in the convexity of profile occurred in late adolescence. www.indiandentalacademy.com
    88. 88. Headform  The facial complex is attached to the basicranium and early growing nasal floor is the template that establishes many of the angular, dimensional and topographic characteristics. www.indiandentalacademy.com
    89. 89. Leptoprosopic face  The dolichocephalic headform sets up a developing face that is long narrow and protrusive. www.indiandentalacademy.com
    90. 90. The nasal part of leptoprosopic face is more protrusive correspondingly the forehead is more sloping. Glabella and upper orbital rims are much more prominent.  This nature of nasal region gives cheek bones much less prominent appearance. Eyes appear deep set.  www.indiandentalacademy.com
    91. 91.  Open form of basicranial flexure and long midface relate to downward and backward rotation of mandible. This results into a tendency for retrusive lips and convex profile. www.indiandentalacademy.com
    92. 92. Euryprosopic face  The brachycephalic head form sets a face that is broader and less protrusive. www.indiandentalacademy.com
    93. 93. Sexual dimorphism The faces of prepubertal boys and girls are essentially comparable.  At about the time of puberty the sexrelated dimorphic facial features begin to manifested fully and this maturation process of the facial superstructures continues throughout the adolescent period and early adulthood.  www.indiandentalacademy.com
    94. 94. over the years males usually show a greater increase in mandibular prognathism.  In males a significant proportion of the total changes occurring in lower face prognathism gets expressed during and after puberty. In contrast to this, females usually show a proportionately smaller degree of mandibular development after puberty.  www.indiandentalacademy.com
    95. 95.  Females does not usually become as prognathic as males in the mandibular region. Therefore, they usually do not attain the same degree of straightness in the skeletal profile when compared with males. www.indiandentalacademy.com
    96. 96.  The male nose is proportionately larger than relatively thin and less protrusive female nose. The male nose usually ranges from a straight to a convex profile, whereas the female nose tends to range from a straight to a somewhat concave profile. www.indiandentalacademy.com
    97. 97. www.indiandentalacademy.com
    98. 98.  The tip of the male nose is often more pointed and has a greater tendency to turn downward, and the somewhat more rounded female nose often tips upward. www.indiandentalacademy.com
    99. 99. Because of protuberant nasal part the male forehead tends to be more sloping in contrast to a more bulbous, upright female forehead. Also The eyes appear deep set. Cheek bones appear less prominent.  In contrast to this female face is much flatter.  www.indiandentalacademy.com
    100. 100. Prediction of profile  Johnston’s grid www.indiandentalacademy.com
    101. 101. Template method  There are 2 types of templates :   Schematic template www.indiandentalacademy.com Anatomically complete template
    102. 102. Ricketts short range VTO  Nasion & Basion – 1 mm/yr   Condylar axis – 1 mm/yr Corpus axis – 2 mm/yr www.indiandentalacademy.com
    103. 103. Clinical implications  An intelligent anticipation of soft tissue modifications which may occur incident to normal growth and those which occur incident to treatment can be helpful in achieving esthetic harmony. www.indiandentalacademy.com
    104. 104. The rapid and disproportionate forward positioning of the nose and chin causes the lips to appear retrusive within the facial profile.  In such instances some procumbency of the lips and denture may be desirable. Any procedure which would retract the lips may be strongly undesirable since it may only result in exaggerating an already prominent nose.  www.indiandentalacademy.com
    105. 105.  On the other hand, in an individual with inherently small nose, it may be desirable to institute procedures which will cause the lips to retract. In this instance retraction of the lips and continued facial growth may dramatically improve facial appearance. www.indiandentalacademy.com
    106. 106. www.indiandentalacademy.com
    107. 107.  The soft tissue changes incident to treatment center around the lips, whereas soft tissue changes incident to growth encompass a greater aspect of the soft tissue profile — the nose and chin as well as the lips. The sum total of both growth and treatment determine the final facial configuration of any given individual. www.indiandentalacademy.com
    108. 108. www.indiandentalacademy.com
    109. 109. Conclusion  Majority of orthodontic treatment is directed towards preadolescent and adolescent patients who are still undergoing significant changes in there facial skeleton and profile.  Child face is not a miniature form of adult face. As the growth process unfolds the changes in the hard and soft tissues of the face brings about a significant change in structure and profile of the face. www.indiandentalacademy.com
    110. 110. The changes in hard tissue profile are mainly due to the change in the relationship of various skeletal components which affects the overlying soft tissue drape.  However changes in hard & soft tissue profiles are not identical. This observation reveals one important phenomenon i.e. differential growth of soft tissue.  www.indiandentalacademy.com
    111. 111. Nose is a major component of soft tissue profile. Its importance is enhanced by the fact that its forward growth continues even in early adult hood.  Changes in Chin and nose occur mainly as a function of growth and bares the potential to conceal or underscore mouth profile.  www.indiandentalacademy.com
    112. 112. Mouth profile is the area which most of the times orthodontist manipulates via orthodontic treatment. These changes should be planed in accordance with other components of facial profile to achive ultimate aim of structural balance, functional efficacy and esthetic harmony. That is where the wisdom and skill of our profession rests.  www.indiandentalacademy.com
    113. 113. www.indiandentalacademy.com