Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

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Cephalometric evaluation of preoperative incisor inclination in patients with class ii dentofacial deformities treated with mandibular advancement

Brazilian Dental Science ◽

10.14295/bds.2015.v18i1.1080 ◽

2015 ◽

Vol 18 (1) ◽

pp. 111

Author(s):

Gabriela Mayrink Gonçalves ◽

Roger William Fernandes Moreira ◽

Marcelo Marotta Araujo

Keyword(s):

Orthognathic Surgery ◽

Normal Values ◽

High Reliability ◽

Intraclass Correlation ◽

Class Ii ◽

Mandibular Advancement ◽

Dentofacial Deformities ◽

Lateral Cephalograms ◽

Incisor Inclination ◽

Lower Incisors

ABSTRACTObjective: To evaluate cephalometrically the preoperative incisor inclination of 30 patients with Class II malocclusion, who were treated with mandibular advancement. Materials and Methods: Thirty immediate preoperative lateral cephalograms were photographed to be used in Dolphin Imaging Software. Linear and angular measurements were traced and analyzed. Each tracing was repeated twice with 1-week interval by the same operator. The measures were tabulated at Microsoft Excel and submitted to Student’s-t test and mean measures were compared with the normal values. The intraclass correlator coefficient was used to test the intraexaminer reliability. Results: The intraclass correlation coefficient was >0.9 and it featured a high reliability. Mean values of lower incisors differed from normal values, presenting labial inclination compared to normal values. Conclusion: In this study, the results showed that Class II patients that will be submitted a mandibular advancement (orthognathic surgery) had dental compensations and the lower incisors are more proclined comparing to the standard values. Keywords: Orthognathic surgery; Orthodontics; Cephalometry.

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The Prediction Capacity 3-D Software, on a 2-D Analysis, in Planning the Positioning of the Upper Lip After Maxillary Advancement

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520906670 ◽

2020 ◽

Vol 13 (2) ◽

pp. 93-98

Author(s):

Letícia Liana Chihara ◽

Jéssica de Fátima Segantin ◽

Paulo Esteves Pinto Faria ◽

Eduardo Sant’Ana ◽

Eduardo Dias-Ribeiro ◽

...

Keyword(s):

Statistical Significance ◽

Cone Beam ◽

Mandibular Movement ◽

Upper Lip ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Maxillary Advancement ◽

Nasolabial Angle ◽

Error Index ◽

Le Fort I

Purpose: The maxillary advancement using Le Fort I osteotomy directly affects in the positioning of the upper lip (UL) and the nasolabial angle (NLA), which plays an important role in facial expression and aesthetics, because of this, the aim of this study was to evaluate the ability of Dolphin Imaging 11.8 software in predicting changes to the UL position and NLA in patients undergoing maxillary advancement. Materials and Methods: It was a retrospective cohort study. Predictive and final tracings using pre- and postoperative Cone beam computed tomography (CBCT) of 24 patients undergoing maxillary advancement, regardless of mandibular movement, were compared. Whether the amount of advancement changes this predictability was also analyzed. The predictive and the 12-month postoperative data were evaluated using Dolphin Imaging 11.8 software and compared. Student t test was used to get the results. Results: The vertical analysis of the incisal tip and cementoenamel junction of the upper central incisor (UCI) and of the UL were statistically significant ( P = .001 for all). The horizontal measurements of the same variables ( P = .238, P = .516, P = .930, respectively) and the NLA ( P = .060) showed no statistical significance. The amount of advancement did not interfere with the variables analyzed, except for the exposure ( P = .009) and inclination of the UCI ( P = .010). Conclusion: It was concluded that the amount of maxillary advancement does not interfere with the UL prediction; the prediction capacity of the software was good for the horizontal measurements, but had a significant error index for vertical measurements.

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Facial Profile Changes in Early Class II Correction with Cervical Headgear

The Angle Orthodontist ◽

10.2319/092106-384 ◽

2007 ◽

Vol 77 (6) ◽

pp. 960-967 ◽

Cited By ~ 11

Author(s):

Mirja Kirjavainen ◽

Kirsti Hurmerinta ◽

Turkka Kirjavainen

Keyword(s):

Treatment Time ◽

Class Ii ◽

Upper Lip ◽

Facial Profile ◽

Nasolabial Angle ◽

Lateral Cephalograms ◽

Division 1 ◽

Before And After ◽

Profile Changes ◽

Class Ii Division 1

Abstract Objective: To characterize the effects of early cervical headgear treatment on the facial profile of children in Class II division 1 malocclusion. Materials and Methods: Forty children aged 9.1 (7.2–11.5) years with Class II division 1 malocclusion were treated using a cervical headgear appliance. The headgear consisted of a long outer bow bent upward 15° and a large expanded inner bow. Lateral cephalograms were taken before and after treatment, and the facial profile was estimated from the cephalograms. The results were compared to an age- and sex-matched normal cohort of 644 Finnish children. Results: Class I molar relationship was achieved in all treated children. The treatment time was 1.6 (0.3–3.1) years on average. Compared to the controls, the treatment restricted the forward growth of maxillary A-point, and the SNA angle decreased 1.4° ± 1.2° per year (P < .00001). Decreased maxillary prognathism was associated with decreased facial convexity, g-sn-pg (P = .02), and the ANB (P < .00001) angles decreased compared to the controls. Upper lip protrusion (distance ls to sn-pg; P < .00001) was decreased, and the nasolabial angle (cm-sn-ls) widened despite the increased facial inclination of the upper incisors (P = .0005). The treatment significantly decreased the gap between the lips (P = .0009) in their relaxed position. Conclusion: Cervical headgear treatment in Class II correction is associated with a decreased facial convexity caused by the restriction of forward growth of the maxillary A-point, while the rest of the facial profile, including the mandible, continue to grow forward at a normal rate.

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Controversies in the Satisfaction of Surgeons and Orthodontists on Facial Aesthetics after Orthognathic Surgery

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0032-1332209 ◽

2013 ◽

Vol 6 (1) ◽

pp. 43-48

Author(s):

Leonardo Faverani ◽

Gabriel Ramalho-Ferreira ◽

Ellen Jardim ◽

Marcelo Goiato ◽

Flavia Pereira ◽

...

Keyword(s):

Postoperative Period ◽

Orthognathic Surgery ◽

Facial Asymmetry ◽

Facial Morphology ◽

Frontal Analysis ◽

Facial Aesthetics ◽

Facial Analysis ◽

Nasolabial Angle ◽

Dentofacial Deformities ◽

Morphology Characteristics

Aim Acceptable facial aesthetics is a common desire among patients presenting with dentofacial deformities planning to undergo orthognathic surgeries. Thus, professionals must be alert to their patients’ complaints as well as their desires regarding facial morphology, because this is quite subjective and personal. This research aimed at evaluating the different views of orthodontists and oral maxillofacial surgeons regarding the facial analysis of patients who undergo orthognathic surgery. Methods Thirty individuals were selected with a minimum postoperative period of 6 months and photographed in the frontal and profile norm. Facial morphology characteristics were recorded to observe the agreement of the assessments of four professionals (two orthodontists and two surgeons). Results A significant agreement was seen between the orthodontists regarding the nasolabial angle (80%). In the frontal analysis, the agreement percentage (60%) between orthodontists and surgeons was considerable regarding facial asymmetry assessment. Conclusions Professionals must keep alert to facial analysis, especially in terms of tegumental harmony, for the orthognathic surgery to reestablish, satisfactorily, the facial aesthetics in all parameters set.

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Soft Tissue Response to Orthognathic Surgery in Persons with Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1993_030_0320_strtos_2.3.co_2 ◽

1993 ◽

Vol 30 (3) ◽

pp. 320-327 ◽

Cited By ~ 7

Author(s):

Mark Ewing ◽

R. Bruce Ross

Keyword(s):

Soft Tissue ◽

Orthognathic Surgery ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Tissue Response ◽

Appreciable Effect ◽

Upper Lip ◽

Anterior Maxilla ◽

Maxillary Advancement ◽

Soft Tissue Response

Individuals with cleft lip and palate often require Orthognathic surgery to establish facial harmony and optimal occlusal function. Surgery to the skeletal components of the face can accomplish predictable alterations in jaw relations. The soft tissue response to those skeletal movements, however, is difficult to predict, as it is also for the noncIeft individual. In addition there is the variability of the repaired cleft lip. The study included 30 persons with complete unilateral cleft lip and palate, operated for midface deficiency using a Le Fort I maxillary advancement at a mean age of 18.0 years. Some relapse occurred in the immediate postoperative period, but after 1 year the mean advancement of the maxilla was 4.9 mm (best fit of anterior maxilla) and 5.6 mm (incisai edge). Both skeletal and soft tissue changes were negligible after that time. The ratio of upper lip advancement to underlying incisor advancement was 0.65 to 1. Although the lip response was highly correlated to the underlying bony movement, the variation was sufficient to preclude accurate prediction. The upper lip thinned with maxillary advancement, but this was not related to the original lip thickness. Coincident mandibular surgery had no appreciable effect on upper lip movement.

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Comparison of Botulinum Toxin and Orthognathic Surgery for Gummy Smile Correction

The Open Dentistry Journal ◽

10.2174/1874210602014010416 ◽

2020 ◽

Vol 14 (1) ◽

pp. 416-420

Author(s):

Carlos Roberto Dutra ◽

Paula Patricia Primo ◽

Daniel Salvatore de Freitas ◽

Renata Cristina Oliveira ◽

Ricardo Cesar Gobbi de Oliveira ◽

...

Keyword(s):

Botulinum Toxin ◽

Orthognathic Surgery ◽

Central Incisor ◽

Upper Lip ◽

Maxillary Central Incisor ◽

Incisal Edge ◽

Intergroup Comparison ◽

Before And After ◽

The Difference ◽

Gummy Smile

Objective: This study aimed to compare the changes in the gummy smile in cases treated with botulinum toxin (BTX) application or orthognathic surgery. Methods: The retrospective sample comprised 61 subjects with gummy smile divided into 2 groups according to treatment received for gummy smile correction: 1-38 patients (6 male; 32 female), at a mean age of 28.60 years (s.d.=6.09), treated with BTX application; 2- 23 patients (7 males and 16 females) at a mean age of 29.59 years (s.d.=5.72) treated with orthognathic surgery. Patients from the BTX group refused to undergo orthognathic surgery. The measurement of the gingival exposure was performed in extraoral photographs of the posed smile, before and after treatment, and it was defined as the difference between the stomion of the upper lip and the incisal edge of the maxillary central incisor minus the height of maxillary central incisor obtained in the patient's dental casts. The data were obtained before (T1) and after treatment (T2) and change of gingival exposure with treatment (T2-T1). Intergroup comparison of gummy smile was performed with independent t-tests. Results: The surgical group presented significantly greater correction of the gummy smile with treatment than the BTX group. Conclusion: Gummy smile presented a greater improvement in patients treated with orthognathic surgery than with botulinum toxin application.

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Conservative treatment of a Class I malocclusion with 12 mm overjet, overbite and severe mandibular crowding

Dental Press Journal of Orthodontics ◽

10.1590/s2176-94512012000500007 ◽

2012 ◽

Vol 17 (5) ◽

pp. 43-52

Author(s):

Marcos Alan Vieira Bittencourt ◽

Arthur Costa Rodrigues Farias ◽

Marcelo de Castellucci e Barbosa

Keyword(s):

Class I ◽

Facial Features ◽

Conservative Approach ◽

Upper Lip ◽

Facial Aesthetics ◽

Lower Lip ◽

Angle Class ◽

Nasolabial Angle ◽

Lower Arch ◽

Lower Incisors

INTRODUCTION: A female patient aged 12 years and 2 months had molars and canines in Class II relationship, severe overjet (12 mm), deep overbite (100%), excessive retroclination and extrusion of the lower incisors, upper incisor proclination, with mild midline diastema. Both dental arches appeared constricted and a lower arch discrepancy of less than -6.5 mm. Facially, she had a significant upper incisors display at rest, interposition and eversion of the lower lip, acute nasolabial angle and convex profile. OBJECTIVE: To report a clinical case consisting of Angle Class I malocclusion with deep overbite and overjet in addition to severe crowding treated with a conservative approach. METHODS: Treatment consisted of slight retraction of the upper incisors and intrusion and protrusion of the lower incisors until all crowding was eliminated. RESULTS: Adequate overbite and overjet were achieved while maintaining the Angle Class I canine and molar relationships and coincident midlines. The facial features were improved, with the emergence of a slightly convex profile and lip competence, achieved through a slight retraction of the upper lip and protrusion of the lower lip, while improving the nasolabial and mentolabial sulcus. CONCLUSIONS: This conservative approach with no extractions proved effective and resulted in a significant improvement of the occlusal relationship as well as in the patient's dental and facial aesthetics.

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Management of Large Periapical Cystic Lesion by Aspiration and Nonsurgical Endodontic Therapy using Calcium Hydroxide Paste

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1249 ◽

2012 ◽

Vol 13 (6) ◽

pp. 897-901 ◽

Cited By ~ 6

Author(s):

Kunjamma Thomas ◽

T Prasanth Dhanapal ◽

Elsy P Simon

Keyword(s):

Calcium Hydroxide ◽

Cystic Lesion ◽

Additional Treatment ◽

Radiographic Evaluation ◽

Treatment Protocols ◽

Maxillary Central Incisor ◽

Periapical Lesions ◽

Nonsurgical Management ◽

Complications Of Surgery ◽

Periapical Cyst

ABSTRACT Aim To report a case of conservative nonsurgical management of periapical lesions. Background Small periapical lesions of endodontic origin usually heal by conventional endodontic therapy alone. Larger periapical lesions presumed to be cystic may require additional treatment protocols to aid in regression. Conservative nonsurgical management of such lesions eliminates the possible complications of surgery and has wider patient compliance and acceptance. Case description A periapical cystic lesion associated with maxillary central incisor and lateral incisor was treated conservatively using buccal aspiration decompression followed by conventional endodontic therapy employing calcium hydroxide iodoform paste as intracanal medicament is reported. Clinical significance The treatment was successful as evidenced by relief of symptoms and radiographic evaluation. Conclusion Large periapical cyst-like lesions can resolve by nonsurgical endodontic therapy employing calcium hydroxide intracanal interappointment medicament. How to cite this article Thomas K, Dhanapal PT, Simon EP. Management of Large Periapical Cystic Lesion by Aspiration and Nonsurgical Endodontic Therapy using Calcium Hydroxide Paste. J Contemp Dent Pract 2012;13(6):897-901.

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Orthognathic surgery: A clinical update

International Journal of Orofacial Myology ◽

10.52010/ijom.1985.11.1.2 ◽

1985 ◽

Vol 11 (1) ◽

pp. 7-11

Author(s):

Edward Dolan ◽

◽

John Riski ◽

Robert Mason

Keyword(s):

Family Physician ◽

Orthognathic Surgery ◽

Surgical Correction ◽

Working Relationship ◽

Dentofacial Deformities ◽

Functional Patterns ◽

Operative Evaluation ◽

Oral And Maxillofacial Surgeon ◽

General Dentist

Summary: Surgical correction of dentofacial deformities may produce dramatic results. It is essential that a thorough pre-operative evaluation be performed. Therefore a close working relationship between the oral and maxillofacial surgeon and the orthodontist is essential, however consultation with other professionals is mandatory. Among these are the general dentist, family physician, psychologist, speech clinician and myofunctional therapist. An overview of orthognathic surgery has been presented in order to familiarize the myofunctional clinician with these procedures, so that functional patterns both prior to and after surgical repositioning can be properly evaluated and treated.

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