Management of an orthognathic surgery treatment in a skeletal class III patient: case report.

Introduction: The treatment established as the gold standard for skeletal deformities of the craniofacial complex is orthodontic treatment combined with orthognathic surgery, to achieve occlusal stability, facial harmony, improved mastication, phonation and breathing. The conventional orthognathic surgery protocol consists of 3 phases: pre-surgical orthodontic treatment, orthognathic surgery and post-surgical orthodontics. Case Report: 18 year old female patient with skeletal class III. She presents occasional pain, crepitation and luxation of the temporomandibular joint, laterognathia. Treatment: Conventional orthognathic surgery of both jaws with unilateral sagittal osteotomy. Results: The objectives of the treatment plan were achieved 1 year and 9 months after starting orthodontic treatment. Conclusion: With a good diagnosis and treatment planning orthodontic - maxillofacial surgery ensures excellent results, as well as bone stability and occlusal harmony post-surgery.

Determination of the Occlusal Plane in Complete Denture: About the Paterson Technic

The rehabilitation by complete removable denture is commonly used for edentulous patients. The respect of operating procedures represents the main condition for therapeutic success.Among these procedures, the determination and the orientation of occlusal plane remain an important step to respect minutelyIndeed, it is one of the most stages for obtaining an optimal smile esthetic, a facial harmony and improve the oral functions.Various technics were reported by many authors: anatomical, radiographic, and physiologic methods such as piezography and Paterson technic.This later consists on the determination of the individualized occlusal plane according to the registration of physiological movements.In this context, we will describe Paterson method via a case report and discuss its feasibility, clinical effectiveness as well as its advantages compared to others technics.

Determination of Mandibular Symphysis Width in Skeletal Class I Patients with Different Vertical Patterns

Symphysis is an anatomical part of mandible that includes lower incisors and anterior chin. Mandibular symphysis is a contributing factor of facial harmony for esthetics and is a determinant for lower incisor position in orthodontic treatment planning for border line cases. This cross-sectional study was carried out in Orthodontics department, Fatima Memorial Hospital College of Medicine and Dentistry Lahore on a sample size of 90 cases using 95% confidence level. Non probability consecutive sampling technique was used. Symphyseal dimensions were measured on lateral cephalogram. Data collected was entered and analyzed in computer program SPSS version 20. Quantitative outcomes like symphysis dimensions, symphysis width, vertical pattern, and ANB were subjected to ANOVA of significance. Independent T-test was used to make the comparison between males and females on the basis of variables. Results of this study suggested thatC-C’ varies significantly between males and females, whereas the differences in symphysis width LA, and LP between males & females are statistically insignificant (P>0.05). Bone anterior to lower incisor apex varies significantly among various facial profiles with hypo divergent males exhibiting wider chin than normo divergent and hyper divergent subjects. Sexual dimorphism in symphysis width was seen among genders. Keywords: Facial harmony, lower incisor position

Chin and Malar Augmentation

Facial attractiveness relies on a balance between the nose, cheekbones, and chin. An increasingly visual world with social media, teleconferencing, and online interactions heighten the demand for procedures that deliver facial harmony. Aesthetic facial augmentation changes the facial shape, establishes a more youthful appearance, and de-emphasizes unpleasant facial prominences, ultimately elevating one’s confidence. Facial implants provide a long-term solution to creating facial harmony and can be combined with other facial rejuvenation procedures at low morbidity. After studying this article, the participant should be able to understand the principles and practice of facial implant surgery, with particular attention to implants of the chin and midface. This review contains 9 figures, 6 tables and 32 references Keywords: aesthetic surgery, aging face, biomaterial, chin, facial analysis, facial augmentation, facial implant, facial rejuvenation, injectable filler, midface

Facial Analysis

Facial analysis is a critical skill in the pre- as well as post-operative assessment of patients undergoing facial surgery. A successful approach is based on familiarity of normal anatomy, its clinical variance, and developing a systematic approach. In an an effort to develop a comprehensive and methodical approach, we have segregated out nasal elements from facial analysis. Progressive skill refinement requires a combination of foundational anatomy, a critical eye for facial harmony, and routine practice. This review contains 8 figures and 9 references Keywords: nasal analysis, facial analysis, Fitzpatrick, dental occlusion, cephalometrics, MRD-1, MRD-2, chin position, nasal tip projection

Correlation of Angle SNA to Angle NSAR in Normal Occlusion, Class II Division I and Class III Malocclusion in Vidarbha Region - A Cephalometric Study

BACKGROUND Facial prognathism may be because of prognathic maxilla, prognathic mandible or aggregate of both. Numerous studies performed to diagnose a single morphological feature commonly producing protrusive relationship, revealed that ‘a single morphological feature does not ordinarily produce a protrusive relationship. Existence of structural imbalance in one area also affects the nature of balance in other areas. A number of separate but inter-related cause and effect factors tend to augment each other in a cumulative and composite manner. Effect of marked discrepancy of an individual’s facial part could be cancelled or nullified by deviation of another part in opposite direction, ultimately resulting in good facial harmony. In this study by means of cephalometric roentgenography, the relation between Angle SNA and Angle NSAr was assessed in Vidharbhites, having normal occlusion, Class II division I and class III malocclusion. METHODS 40 individuals of normal occlusion, Class II division I and Class III Malocclusion, each between 16 and 25 years were analysed. These subjects were selected from patients reporting the outpatient department of Government Dental College, Nagpur. Statistically correlation between angles SNA and NSAr at level of significance 5 % was assessed. RESULTS After data collection a thorough observation & analysis was done and co-relation coefficient between SNA angle & NSAr (F--1.054 M--0.7981), also standard deviation of angular cephalometric measurement between males & females was found out in the population, leading to discussion on topic ‘Facial prognathism is due to maxillary prognathism, mandibular prognathism or combination of both’. In Females SNA was found to be 81 - 800 1.91310 and in males SNA was 82.1660 4. 380 respectively. CONCLUSIONS The results inferred that “Marked part of variation in Angle SNA can be explained by variation in Angle NSAr. KEY WORDS Angle SNA, Angle NSAr, Correlation

Personalized Orthodontics: From the Sagittal Position of Lower Incisors to the Facial Profile Esthetics

Background: One of the goals of orthodontic treatment is to obtain maximum facial harmony. The sagittal position of the lower incisors plays a significant role in the planning of orthodontic treatment. The aim of the study was to evaluate the relationship between the sagittal position of lower incisors and facial profile esthetics with reference to the skeletal vertical dimension. Methods: There were 200 patients included in the study. Patients were allocated into three groups, depending on the vertical growth pattern: normal-angle, low-angle, and high-angle cases. Tweed–Merrifield cephalometric analysis was used to assess the sagittal and vertical position of the mandible, as well as to assess the sagittal position of the lower incisors. Results: Z-angle and Frankfort mandibular incisor plane angle (FMIA) decreased significantly (p < 0.001) with the increase of the skeletal vertical dimension. Incisor mandibular plane angle (IMPA) was significantly higher (p < 0.001) in low-angle patients compared to the high-angle ones. Z-angle appeared to be the most accurate parameter (area under curve, AUC = 0.957) describing patients with a convex profile. The cutoff value of Z-angle 68.0° was characterized by the sensitivity of 94.1% and the specificity of 84.3%. Conclusions: The sagittal position of the lower incisors significantly affects the facial profile convexity. The Z-angle is the parameter which most accurately describes the patients with a convex profile.

Perubahan harmoni wajah pasca perawatan kelas II skeletal dengan pencabutan dua premolar satu atas menurut analisis Arnett dan BergmanChanges in facial harmony after skeletal class II treatment with extraction of two maxillary first premolars based on Arnett and Bergman analysis

Pendahuluan: Arnett dan Bergman (1999) membuktikan bahwa perawatan ortodonti, analisis jaringan lunak wajah, diagnosis dan rencana perawatan memiliki parameter nilai harmoni sebagai kunci penetapan estetika wajah. Perawatan maloklusi klas II skeletal disertai proganotisme maksilaris umumnya dilakukan dengan pencabutan dua premolar satu atas untuk mengkoreksi profil wajah pasien. Tujuan penelitian untuk menganalisis perubahan nilai harmoni wajah pasca perawatan maloklusi kelas II dengan pencabutan premolar satu atas menurut analisa Arnett dan Bergman. Metode: Jenis penelitian analitik observasional dengan teknik pengambilan sampel purposive sampling. Sampel penelitian 72 foto sefalometri lateral maloklusi kelas II skeletal sebelum dan setelah perawatan ortodonti. Penilaian harmoni jaringan lunak dibagi menjadi 4, yaitu harmoni intramandibular, harmoni antar rahang, orbita ke rahang dan keseimbangan wajah. Data menggunakan Shapiro Wilk menunjukkan tidak berdistribusi normal. Uji yang digunakan Shapiro Wilk dan analisis Spearman. Hasil: Terdapat perubahan harmoni intramandibular dan keseimbangan wajah pada maloklusi kelas II skeletal dengan pencabutan premolar satu atas sebelum dan setelah perawatan (p=0,025;p=0,032). Tidak terdapat perubahan nilai harmoni antar rahang dan orbita ke rahang pada maloklusi kelas II skeletal dengan pencabutan premolar satu atas sebelum dan setelah perawatan. Ada pengaruh besar retraksi gigi insisivus terhadap nilai harmoni wajah sebelum dan setelah perawatan pada perawatan kelas II dengan pencabutan dua premolar atas (p= 0.001). Simpulan: Perawatan maloklusi kelas II skeletal dengan pencabutan dua premolar satu atas memiliki hubungan antara besar retraksi dengan perubahan nilai harmoni wajah berdasarkan analisa Arnett dan Bergmann. Kata kunci: Maloklusi kelas II skeletal, pencabutan dua premolar pertama atas, nilai harmoni wajah. ABSTRACT Introduction: Arnett and Bergman (1999) have proved that orthodontic treatment, facial soft tissue analysis, diagnosis, and treatment plan have parameters of harmony values as the key to determining facial aesthetics. Treatment of skeletal class II malocclusion with maxillary prognathism is generally performed by extracting two maxillary first premolars to correct the patient’s facial profile. This study was aimed to analyse changes in the facial harmony values after class II malocclusion treatment with the extraction of the maxillary first premolar following Arnett and Bergman’s analysis. Methods: This research was observational analytic with a purposive sampling technique. The study sample was 72 images of skeletal class II malocclusion lateral cephalometry before and after orthodontic treatment. Assessment of soft tissue harmony was divided into four, namely intramandibular harmony, intermaxillary harmony, orbital to jaw harmony, and facial balance. Data was not normally distributed, as resulted from Shapiro Wilk analysis. The analysis in this study was conducted using Shapiro Wilk and Spearman’s analysis. Results: There were changes in intramandibular harmony and facial balance in skeletal class II malocclusion with the maxillary first premolar extraction before and after treatment (p=0.025 and p=0.032, respectively ). There was no change found in the value of intermaxillary harmony and the orbital to the jaw harmony in skeletal class II malocclusion with extraction of the maxillary first premolar before and after treatment. There was a high effect of incisor retraction on the facial harmony values before and after treatment in class II treatment with extraction of two maxillary premolars (p=0.001). Conclusion: Treatment of skeletal class II malocclusion with extraction of two maxillary first premolars has a relationship between the magnitude of retraction and changes in facial harmony values based on Arnett and Bergmann’s analysis.Keywords: Class II skeletal malocclusion, extraction of two maxillary first premolar, facial harmony.

Técnica nariz perfeito: uma nova abordagem em rinomodelação

Less invasive approaches, performed ooffice, with reduced cost, have gained notority in recent years and it needs studies, with the objective of presenting new techniques that are safer and reproducible.This work aims to present a set of procedures, organized in levels of complexity (Nariz Perfeito Technique), whose adaptations were made based on techniques already described. Results: four cases performed using the “Perfect Nose” technique showed satisfactory results, after two years of follow up. Conclusion: the “Nariz Perfeito” technique proved to be an alternative, less invasive, that can be successfully applied in small aesthetic corrections of the nose, favoring all facial harmony, being effective and reproducible.

Therapeutic application of hyaluronic acid for buco-facial harmony. A clinical case

Aim: To show a clinical case where hyaluronic acid was used to improve bucco-facial zone. Methods: We present a case of a patient, a 46 years oldwoman. Hyaluronic acid (RestylaneKisse) was injected in upper and lower overall (that had lost its outline), in upper philtral columns and marionette lines. Results: Hyaluronic acid treatment showed clinicalchanges. This changes were, uniform contour lip, increased volume in the philtral columns andhydrated skin. Conclusion: The clinical case showed that the hyaluronic acid improved the lips, the skin, and the marionette lines. This treatment produced clinical changes that were maintained in time without alterations in the tissues.