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This study assessed whether pre-operative class III patients could recreate their facial difference based on a profile photograph. Twenty class III pre-surgery bimaxillary orthognathic patients used CASSOS (SoftEnable Technology Ltd.) to manipulate a distorted soft tissue image of them until they felt it resembled their current soft tissue profile. Patients were able to move their upper lip and lower chin backward and forwards, as well as the lower chin up and down. Differences in the mean absolute distance between the patient-perceived position of the upper lip (Labrale superious) and chin (Pogonion) and the actual position of their upper lip and chin were measured on two occasions. Intra-patient reproducibility was found to be excellent (ICC 0.93 to 0.98). All differences were statistically significantly greater than 3mm, and would be clinically significant. Patients were better at re-creating their AP chin position rather than their AP upper lip and vertical chin positions. Approximately half of patients undergoing surgical correction of their class III skeletal pattern were unable to correctly identify their pre-surgical facial profile. Given the lack of awareness of their profile, this questions the validity of using profile planning for informed consent.

Introduction This study was conducted to investigate and compare esthetic perceptions of different facial profiles among Hong Kong Chinese laypersons and patients scheduled for orthognathic treatment. Methods Two sets of 3-dimensional facial photographs (1 male and 1 female) each comprised 7 images that showed different dentoskeletal relations (ie, Class I, bimaxillary protrusion, bimaxillary retrusion, maxillary protrusion, maxillary retrusion, mandibular protrusion, and mandibular retrusion). The sets of photographs were shown to 101 laypersons (age, 28.87 ± 6.22 years) and 60 patients seeking orthognathic treatment (age, 27.12 ± 6.07 years). They rated their esthetic perceptions of the photographs on the basis of a 100 mm visual analog scale (VAS) from 0 (very unattractive) to 100 (very attractive). Results The dentoskeletal Class I facial profile was ranked as the most attractive profile. Female orthognathic judges selected the retrusive maxilla while male orthognathic judges and male and female laypersons ranked the mandibular protrusion profile as the least attractive profile for both females and males. A bimaxillary protrusive female profile was viewed as more attractive by the orthognathic male (P = 0.006) and female (P = 0.006) judges, compared with female layperson judges. After adjustment for age, no statistically significant interaction between sex and judges (P >0.10) for all VAS scores were detected. For the female bimaxillary protrusive profile, orthognathic patient judges assigned a mean VAS score of 9.174 points higher than layperson judges (95% confidence interval, 3.11-15.24; P = 0.003). Conclusion Dentoskeletal Class I facial profile was generally considered the most attractive profile in both sexes; male and female orthognathic patients preferred a bimaxillary protrusive female profile. A concave facial profile was perceived as least attractive in both sexes.

Objectives: The objective of this study was to find the cephalometric measurements that correlate with the visual perception. Materials and Methods: A total of 250 lateral cephalograms of patients from the year 2016 to 2018 were hand traced and analyzed. Thirty-six hard- and soft-tissue measurements were obtained from the lateral cephalometric analysis. Silhouettes obtained from cephalometric films were rated by 10 orthodontists based on their level of convexity. For each sample, the rating of visual perception was correlated with all the cephalometric (hard and soft) measurements. Results: ANB, AF-BF, L1-NB (mm), overjet, anterior maxillary alveolar height, posterior maxillary alveolar height, lower lip to E plane, and H angle were positively correlated with the visual perception. On the contrary, Pg. to N perpendicular and Pg. to NB (mm) were negatively correlated with the visual perception. However, the measurements in the vertical dimensions did not have any significant correlations with visual perception. H angle showed a higher correlation with visual perception than the nasolabial angle, facial contour angle, and lower lip to E plane. Conclusion: The agreement between objective cephalometric measurements and subjective visual perception was less than expected. In general, only 27% of the cephalometric measurements had a significant correlation with visual perception. Therefore, orthodontic treatment planning based solely on cephalometric analysis can result in unsatisfactory treatment outcomes. An inclusion of subjective measures such as visual perception in orthodontic diagnosis and treatment planning is necessary.

The treatment of anterior open bite represents a challenge for orthodontist due the difficulty and instability of correction. This article presents the case of a 16-year-old male patient who attended the Dental Center of the San Martin de Porres University School of Dentistry - Specialty of Orthodontics, who presented class 1 malocclusion with anterior open bite . The patient received corrective treatment for the atypical swallowing habit, for which a palatal grid was used. Extractions of the upper and lower first premolars were also performed. At the end of the treatment, facial and dental changes were observed. The closure of the open bite was achieved, adequate alignment of the teeth, excessive protrusion of the upper and lower incisors and a correct occlusion were reduced. In the facial aspect, a notable improvement in the facial profile was observed, as well as a decrease in labial incopetence and the retraction of the upper and lower lip.

To evaluate the influence of sagittal and vertical skeletal patterns (skeletal classes and facial profiles), and sex on the distance between upper central incisors roots and incisive canal.Cone-beam computed tomography exams of 172 patients were classified into skeletal classes I, II, and III and according to the facial profile into mesofacial, brachyfacial, and dolichofacial. In sagittal reconstructions, linear measurements were done between central incisors roots and incisive canal at three levels: incisive foramen opening, intermediate region, and the region close to the apex of upper central incisors. In axial reconstructions, measurements of incisive canal width and distance between the roots were obtained. Analysis of Variance (three-way ANOVA) was used to evaluate measurement differences in relation to skeletal classes, facial profiles, and sex.The distance between upper central incisors roots and incisive canal anterior region was little influenced by sagittal and vertical skeletal patterns and sex. Men had significantly greater incisive canal (mean=2.85mm; SD=1.18) width compared to women (mean=2.40mm; SD=1.04), regardless of skeletal class and facial profile (P0.05). In general, inter-root distance between medial points of central incisors roots and incisive canal opening was greater in the region close to upper central incisors apex (mean=3.84mm; SD=1.44) than in incisive foramen opening (2.44mm; SD=1.04), (P0.05).The distance between upper central incisors roots and incisive canal is little influenced by sagittal and vertical skeletal patterns and sex.

Objectives To develop and validate a nomogram based on fetal nuchal translucency thickness (NT) and ultrasonographic facial markers for screening for trisomy 21 in the first trimester of pregnancy. Methods This was a retrospective case–control study using stored two‐dimensional midsagittal fetal profile images captured at 11 + 0 to 13 + 6 weeks' gestation in singleton pregnancies. We included images from 302 trisomy‐21 pregnancies and 322 euploid pregnancies. Cases were divided into a training set (200 euploid + 200 with trisomy 21) and a validation set (122 euploid + 102 with trisomy 21) at a ratio of approximately 2:1. For each, the maternal age, gestational age, fetal NT and karyotype were noted, and 12 ultrasonographic fetal facial markers were measured. The least absolute shrinkage and selection operator (LASSO) method and multivariable analysis were used to select automatically the discriminative markers. Logistic regression was used to develop a LASSO model, based on the selected markers, to screen for trisomy 21 in the first trimester of pregnancy. Furthermore, 60 of the 624 images were selected randomly as a retest set to evaluate the model's robustness. The predictive performance of screening for trisomy 21 of a model based on fetal NT and maternal age and of the LASSO model was assessed using the area under the receiver‐operating‐characteristics curve (AUC). A nomogram was developed as an individualized tool to predict patient‐specific probability for trisomy 21, which is a more visual presentation of the LASSO model. The performance of the nomogram was assessed using the C‐index and calibration curve. Results Into the LASSO model were incorporated eight markers, including fetal NT, prenasal‐thickness‐to‐nasal‐bone‐length ratio, facial profile line, frontomaxillary facial angle, frontonasal facial angle, mandibulomaxillary facial angle, maxilla‐nasion‐mandible angle and d2 (distance between the anterior edge of the prefrontal skin and the mandibulomaxillary line) (all P

Background: The general tendency of facial soft tissue response toward incisors retraction could be expected in various malocclusions. However, different initial malocclusion no doubt leads to differences in this response. Material and method: This retrospective study consisted of thirty-seven pre- and posttreatment lateral cephalographs belongs to adolescent female with mean age of 15.03 years. The twenty-four landmarks (skeletal, dental, soft tissue) were located and horizontal and vertical reference planes were used. Sixteen linear and six angular measurements were evaluated statistically. The pretreatment and posttreatment lateral cephalograms were superimposed on best fit cribriform plate of the ethmoid to analyze soft tissue facial profile changes after orthodontic treatment. Results: The three methods of error indicated that measurements were valid and reliable. The Labrale superius retraction exhibited the best predictability among upper lip components (Sn, Ss), whereas the lower lip showed better predictability and correlation than the upper lip. The upper and the lower lips revealed relatively similar mean retraction value (2.92 mm) and (2.6 mm) although the upper incisors retracted more (5.25 mm) than the lower incisors (2.86 mm). Conclusion: The upper incisors to Labrale superius ratio (1.99:1, UIP:Ls) exhibited the highest correlation (r=0.55**) among the other established ratios. The lower incisors to Labrale inferius ratio was (1.13:1, LIP: Is) with significant correlation (r=0.44**), whereas no significant correlation was observed with Labrale superius (r=0.27).

Advancement genioplasty is performed to aesthetically improve the lower third of the facial profile. Excessive chin advancement alone may lead to deepened labiomental sulcus and deformed aesthetic results. The purpose of this study was to assess the efficacy of silicone prosthesis placement as an alternative method for effacing an excessively deepened labiomental groove after advancement genioplasty. Three hundred and seventy-six patients underwent genioplasty between January 2014 and October 2017. Among these were 216 cases of advancement genioplasty, of which 79 (62 females and 17 males) underwent advancement procedures using silicone implants. Inserting the silicone implant at the sulcus easily removes the deepened groove. This procedure could be an easy and reliable method for attaining an aesthetically pleasing result in excessive advancement genioplasty.

Background Fillers have been widely used to improve facial profile, and a better result is obtained if the entire profile is treated at the same time. Objective To compare the outcomes of 2 groups of patients: the former undergoing a treatment in a single area to improve the facial profile, and the latter undergoing a total profiloplasty reharmonization in 1 session. Materials and methods The outcomes of this study have been evaluated using both the angle of convexity and the Global Aesthetic Improvement Scale method. Results This study demonstrates that the approval rating increases by 56.3% for patients, 81.3% for the practitioner, and 76.3% for an independent practitioner when a synchronous treatment is used to improve the facial profile as compared with a single treatment of 1 profile area. Conclusion The profiloplasty treatment in 1 session allows the achievement of a more harmonic facial profile and increases the patient's approval as compared with treatments of a single facial area.

Esthetics has been an ever-evolving concept and has gained considerable importance in the field of orthodontics in the last few decades. The re-emergence of the soft tissue paradigm has further catapulted the interest of the orthodontist. So much so that achieving a harmonious profile and an esthetically pleasing smile has become the ideal goal of treatment and is no longer secondary to achieving a functional dental occlusion and/or a rigid adherence to skeletal and dental norms. Esthetics in the orthodontic sense can be divided into three categories: macroesthetics, miniesthetics, and microesthetics. Macroesthetics includes the evaluation of the face and involves frontal assessment and profile analysis. The frontal assessment involves assessment of facial proportions, while the profile analysis involves evaluation of anterior–posterior position of jaws, mandibular plane, and incisor prominence and lip posture. Miniesthetics involves study of the smile framework involving the vertical tooth–lip relationship, smile type, transverse dimensions of smile, smile arc, and midline. Microesthetics involves the assessment of tooth proportions, height-width relationships, connectors and embrasures, gingival contours and heights, and tooth shade and color. The harmony between these factors enables an orthodontist to achieve the idealized esthetic result and hence these parameters deserve due consideration. The importance placed on a pleasing profile cannot be undermined and the orthodontist should aim for a harmonious facial profile over rigid adherence to standard average cephalometric norms. This article aims to give an overview of the macro, mini, and microesthetic considerations in relation to orthodontic diagnosis and treatment planning.

The nose is the most prominent structure of the face, influencing facial appearance and profile. Orthodontists have an awareness of facial structures, including nasal morphology, when diagnosing and treatment planning. Maxillofacial surgeons influence facial profile by bimaxillary surgery, improving facial aesthetics and harmony. The aim of this review was to summarize the available methods of analysing nasal morphology and profile, and to assess their complexity. A literature search was conducted in PubMed, Scopus, Web of Science, and Embase using the following search terms: “nasal profile analysis”, “nasolabial angle”, and “nasal profile cephalometric” in order to select studies providing knowledge on correlations between occlusion and nasal development, differences between skeletal classes, ethnic variability, and differences between the sexes. Studies concerning genetic disorders were excluded. Finally, 17 full-text papers were analysed, which pertained to nasolabial angle, or facial profile including the nose. Data concerning methods, ethnic group, reference landmarks used, and measurements made were extracted and placed in tables. Numerous methods of nasal profile analysis can be found in the literature. These methods describe various numbers of parameters, which have influence on facial aesthetic. Nasal parameters are correlated to skeletal class and nasolabial angle, positions of upper incisors, and maxillary inclination.

Introduction The purpose of this study was to determine the esthetic preferences of people at different levels of society and also to determine whether this preference is affected by sex, age, education level, social status, geographic region, and individual profile factors. Methods Facial profile photographs of 1 man and 1 woman, each having a profile designated as ideal (the ideal profile), were digitized. The sagittal and vertical dimensions of these photographs were modified, and 9 variations of each profile picture were obtained using different combinations of alterations. The photographs were scored by 373 participants. For the analysis, Mann-Whitney U and Kruskal Wallis-H tests were used in the comparison of the scores. Results The ideal profile was the most preferred in both sexes, whereas the least preferred was a severe Class III malocclusion with a reduced vertical dimension of 8 mm. In general, esthetics decreased as it moved away from the ideal profile in a sagittal or vertical direction. Conclusions Some factors from among those sampled (sex, age, education, social status, geographic region, and personal profile) affected esthetic preference, whereas others did not.

Objective: To assess the effects of deviations in the nose and chin prominence on facial attractiveness. Methods: In this study, a reference digital photograph was taken from the facial profile view of an adult female model. Some changes were made in the nose and chin prominence in Photoshop software using the Crumley’s analysis. Changes made in the nose prominence yielded a prominent nose (2:11 ratio), a normal nose (3:53 ratio) and a small nose (4:61 ratio). Changes made in the chin prominence were protrusion by +2 and 0 mm and retrusion by −2, −4 and −6 mm (distance from the pogonion to the vertical reference line). In total, 18 orthodontists, 18 oral and maxillofacial surgeons, 18 art students and 18 laypeople evaluated the photographs (n = 15) and expressed their opinion regarding the facial profile attractiveness using a visual analogue scale (0−100). Data were analysed using SPSS version 18. Results: A significant difference was noted in the ratings of photographs (Greenhouse-Geisser, P < 0.001). Orthodontists gave a significantly higher score than laypeople to photographs with a small nose and deviations of the chin prominence ( P = 0.015). Art students gave a significantly higher score than laypeople to photographs with a prominent chin and deviations in the nose prominence ( P = 0.012). Conclusions: Facial profile with a normal (3:53 ratio) or small (4:61 ratio) nose and chin protrusion/retrusion by 2 mm (pogonion-vertical line) is considered attractive.

Purpose To compare the reliability of measurements of five fetal facial profile parameters by operators with different levels of experience, at 15 to 23 weeks of gestation in Thai fetuses. Methods An observational study was conducted. The inferior facial angle, anteroposterior mandibular diameter, mandible width, maxilla width, and mandible length were measured in 123 normal fetuses, using 2D ultrasonography, by three operators with different levels of experience. Each participant was examined by two operators. Each operator performed three independent measurements for each parameter and was blinded to the results of the other. Reliability of measurement was evaluated using intraclass correlation coefficient. Bland-Altman analysis was used to evaluate agreement. Results The ability to obtain a mandible length measurement was highest (100%) among the five parameters. Intraobserver variabilities of anteroposterior mandibular diameter, mandible width, maxilla width, and mandible length measurements were excellent for all operators (ICC 0.958-0.986), while those of inferior facial angle measurements were moderate to excellent (ICC 0.560-0.923), depending on the operators' experience. Interobserver variabilities varied between pairs of operators; only two parameters, anteroposterior mandibular diameter and mandible length, showed excellent interobserver variabilities (ICC >0.9), with good agreement. Conclusions The mandible length measurement was the best parameter in terms of feasibility and reliability.

Summary Background Class III patients are characterized by a deficiency of the maxilla and/or a prognathism of the mandible and require early treatment. Diagnosis This case report describes the treatment of a 5-year-old patient with a skeletal class III relationship, a significant mandibular symphysis deviation towards the right side and a different height of the mandibular angles. Management and outcome The patient was treated with rapid maxillary expander combined with miniscrew, facemask and aligners. A functional and aesthetic occlusion in an improved facial profile was established at the end of the orthodontic treatment. Pre-treatment, post-treatment and one year retention records for the patient are presented. Discussion Class III patients require early treatment in order to optimize the traditional expander effects; subsequently hybrid anchorage allowed to maximize skeletal advancement. In addition, loss of space for the erupting teeth and dento-alveolar tipping were avoided. The good results of the phase I treatment and of the active retainer meant that a complex case would become relatively simple at the phase II treatment.

Summary This case report presents an 18-year-old female patient who had skeletal Class II relationship due to a mandibular retrognathia, decreased lower anterior facial height and proclined incisors with increased overjet and overbite. Her main complaints were protruding upper incisors and decreased distance between the tip of the nose and chin. A modified surgery-first approach was performed with two months of presurgical orthodontics to achieve 8 mm mandibular advancement. The total treatment time was 11 months. Improved aesthetics, a balanced facial profile and a stable and functional occlusion were obtained in less treatment time due to accelerated tooth movement.

This case report describes the orthodontic and surgical treatment of an adult patient aged 25 years 10 months, who had a skeletal Class I and Angle Class III subdivision malocclusion, with mild mandibular crowding and facial asymmetry. The chief complaint was a deviated chin to the left. Treatment was performed using a surgery- first approach that included maxillo-mandibular advancement, followed by orthodontic fixed appliances. After 12 months, the treatment has addressed the chief complaint of facial asymmetry and resulted in an attractive smile, functional occlusion, passive lip seal, balanced facial profile, and esthetic improvement. After 2 years 5 months of follow-up, the patient showed a stable surgical-orthodontic outcome with increased airway space.

Introduction: Orthognathic surgery has become a more acceptable treatment modality in conjunction with orthodontic treatment as esthetic awareness has been increased. The criteria for success of an orthognathic surgical procedure are not only centred on the correction of the skeletal and dental abnormalities, but also on an esthetic improvement as judged by both patients and practitioners. Using computer softwares for prediction of orthognathic surgical outcome is gaining more popularity. It was the purpose of the present study to examine the efficacy of prediction of soft tissue changes after performing orthognathic surgeries using the cephalometric software program FACAD. Aims and Objectives: The aim of the study is to assess the perception of facial profile attractiveness and soft tissue outcome in predicted profile images in patients undergoing orthognathic surgery. Materials and Methods: Total of 50 samples aged 20 to 25 years (35 females and 15 males) 20 skeletal class I bimaxillary protrusion cases, 20 skeletal class II cases and 10 skeletal class III cases. Cephalometric radiographs were scanned using Epson V 700 film scanner. The radiographic images were analysed using cephalometric software (FACAD 3.6 )and traced by identifying and placing a series of cephalometric points, both bony and soft tissue. Result: The study suggested that the predicted profile images of all the patients were attractive and rankings were decreasing from class I bimaxillary class III and then class II. The least score of attractiveness were given to class II patients. The predicted profile images of class I bimaxillary patients were more attractive. Conclusion: this study showed that the predicted profile images were attractive as suggested by three raters with class I bimaxillary most attractive and class II least attractive. In overall, laypersons and dental students ratings were somehow similar in the assessment of facial profile attractiveness in the predicted profile images.

A 13 year old female patient came to our department with chief complain of excessive gum show. On Clinical examination patient presented with convex facial profile, obtuse nasolabial angle, mesocephalic, mesoprosopic, incompetent lips and increased interlabial gap. Intraorally she had class II canine and molar relation bilaterally with crowding irt 31, 32, 33, 41, 42, 43. Patient was really concerned about her facial profile. So we decided to manage the same with triplet approach i.e the combination of orthopedic, myofunctional and fixed mechanotherapy. The total treatment time was 28 months which include 13 month phase I therapy and 15 months phase II therapy and the results were exuberant.

Background: Patients with anterior open bite appear both dentoalveolar component and with increased skeletal vertical dimension. Objectives: The main objective was to treat open bite with an ideal overbite and overjet relationships and to maintain proper intercuspstion with midline correction. Results: The goal of the treatment has been achieved according to patients' desire and satisfactory interdigitation. In further follow up no relapse has been seen. Conclusion: The treatment resulted in an aesthetic, functional, and stable occlusion, along with an improved facial profile.

The aim of this study was to report the case of a Class III prepuberal patient treated by a maxillary protraction using four miniscrews. The screws were installed between maxillary first molars and second premolars and between mandibular canines and first premolars. A 1/4˝ intermaxillary elastics were used in both sides, ligating the upper-lower screws to perform a maxillary protraction and correction of the Class III malocclusion. A bite plate made by resin flow was made on lingual surfaces of the mandibular incisors to eliminate occlusal interference. After 16 months of treatment, it was possible to see a significant improvement of patient’s facial profile, with overcorrection in overjet and preservation of the tissues and integrity of dental roots.

To carry out both an objective and subjective assessment of the facial esthetics, clinical outcome, and quality of life evaluation in 25 OSAS patients treated with telegnathic surgery. Patients wer...

Severe mandibular deficiency caused by temporomandibular joint (TMJ) ankyloses produces functional and aesthetic problems that require complicated long-term treatment. In this case report, we describe the benefits of using microimplant mechanics for controlling the direction of distraction during distraction osteogenesis and for performing the movement of teeth. We also present its remarkable results and long-term stability. A 20-year-old girl presented with a convex profile due to severe mandibular retrognathia after a history of several TMJ surgeries for bilateral TMJ ankyloses. Mandibular distraction osteogenesis (MDO) was performed, and elastics were placed between the microimplants to control the direction of distraction. Subsequently, after retraction of the maxillary anterior teeth and distalisation of the whole mandibular dentition, the facial profile was markedly improved, and good interdigitation was obtained. The six-year follow-up retention and overall stability were satisfactory with good interdigitation and jaw function.

Objective: The present study aimed to analyze the accuracy of the Dolphin Imaging 11.9® computer program in the surgical prediction of the soft tissue facial profile. Methods: The investigators designed and implemented a retrospective study. It was used a sample of 55 patients, being 14 males and 41 females, aged from 19 to 55 years old. All patients were subjected to surgery orthognathic bimaxillary combined with mentoplasty, in Class II facial profile – Angle. Patients’ actual results were compared to the obtained up to a year and a half after the surgery procedure. The study was delineated in three phases. In the first phase, cephalometric preoperative radiographs were performed; in the second phase the postoperative cephalometries were made; in the third phase, the measurements of the soft profile of the virtual analysis were compared with the real post-surgical profile. The data was collected and subjected to statistical analysis in the “R” program, using the t test and ANOVA. Results: The results demonstrated that measures A’ and Eis were underestimated in -0.15 ± 0. 52 mm and -0.47 ± 1.05 mm, respectively, while measures Pg’ and ANL were overestimated at 0.76 ± 1.98 mm and 3.31 ± 3.60° respectively. There was no evidence of measures, Ls, Li and B’, being different between real and virtual. Conclusions: The results of this study suggest that Dolphin 11.9® computer program complies with the function of preserving with reliability virtual surgical planning. RESUMO Objetivo: O presente estudo teve como objetivo analisar a precisão do programa de computador Dolphin Imaging 11.9® na predição cirúrgica do perfil facial dos tecidos moles. Métodos: Os pesquisadores projetaram e implementaram um estudo retrospectivo. Utilizou-se uma amostra de 55 pacientes, sendo 14 do sexo masculino e 41 do sexo feminino, com idades entre 19 e 55 anos. Todos os pacientes foram submetidos à cirurgia ortognática bimaxilar combinada com mentoplastia, no perfil facial Classe II de Angle. Os resultados reais dos pacientes foram comparados com os obtidos até um ano e meio após o procedimento cirúrgico. O estudo foi delineado em três fases. Na primeira fase, foram realizadas radiografias cefalométricas pré-operatórias; na segunda fase, foram realizadas cefalometrias pós-operatórias; na terceira fase, as medidas do perfil mole da análise virtual foram comparadas com o perfil pós-cirúrgico real. Os dados foram coletados e submetidos à análise estatística no programa “R”, utilizando o teste t e ANOVA. Resultados: Os resultados demonstraram que as medidas A ‘e Eis foram subestimadas em -0,15 ± 0, 52 mm e -0,47 ± 1,05 mm, respectivamente; enquanto as medidas Pg’ e ANL foram superestimadas em 0,76 ± 1,98 mm e 3,31 ± 3,60°, respectivamente. Não houve evidência de medidas, Ls, Li e B’, sendo diferentes entre real e virtual. Conclusão: Os resultados deste estudo sugerem que o programa de computador Dolphin 11.9® cumpre a função de preservar com confiabilidade o planejamento cirúrgico virtual.

Orthognathic surgery and orthodontic treatment are required for patients with dentofacial deformities to obtain an ideal facial esthetic with good functioning. Recently, characterized by the surgery-first approach, an integrated orthodontic–surgical treatment has been introduced as an emerging solution to dentofacial deformity treatment. The surgery-first approach is regarded to have less treatment time and quicker enhancement of a facial profile than the conventional orthodontic–surgical treatment. Moreover, the recent advances in computing and imaging have allowed the adoption of 3-dimensional (3D) virtual planning protocols in orthognathic surgery as well as digital orthodontic treatment, which enables a paradigm shift when realizing virtual planning properly. These techniques then allow the surgeon and orthodontist to collaborate, plan, and simulate the dentofacial deformity treatment before performing the whole procedure. Along this line, in this research article, we present an integrated treatment method for the realization of an effective deformity treatment. Specifically, we implemented the integrated 3D technique by combining it with the surgery-first orthognathic approach (SFOA) as a novel treatment method for the patients. The outcomes from the combined treatments of the patients with dentofacial deformity, in practice, have demonstrated that our proposed 3D technique in orthognathics and orthodontics using clear aligner therapy (e.g., Invisalign) can enhance the satisfactory level of the patient since the start of treatment then improve their quality of life. As a result, the combined techniques realize the novel integrated treatment method using 3D technology with the use of 3D imaging and modeling as a promising development trend of dentistry, which fits into the context of Dentistry 4.0 as a key enabler to the concept of sustainable dentistry development.

The best-studied examples of genetically defined developmental disorders, such as Down syndrome (trisomy 21) and velocardiofacial syndrome (del22q11), have been known since before the genomic era and were initially recognized as distinct syndromes based on their own unique constellation of dysmorphic and multisystem features. For example, Down syndrome is characterized by the co-occurrence of several dysmorphic features, including a flattened facial profile, slanted palpebral fissures, protruding tongue, and transverse palmar crease, with accompanying hypotonia, cardiac issues, and developmental delay.1 None of these features in isolation is specific to Down syndrome, and all features are not present in all cases, but the co-occurrence of multiple features from this set is a specific and sensitive marker for the presence of trisomy 21. To what extent might similar principles apply to the patterning of cognitive and behavioral features across different neurogenetic syndromes?

Objective To evaluate the esthetic perceptions of orthodontists and laypersons for facial profile changes after orthodontic treatment using Herbst or Forsus appliances. Materials and Methods Pre- and posttreatment facial profile contour images of 20 Class II patients treated with Herbst (group H; n = 10) and Forsus (group F; n = 10) appliances were analyzed by 30 orthodontists and 30 laypersons, who graded them from 1 (unattractive) to 10 (very attractive) using a visual analog scale. Two assessments were carried out with a 15 day-interval. In the first evaluation, 40 images were presented in a random sequence. In the second evaluation, initial and final facial profile images of each patient were randomly presented side by side. To compare groups in relation to treatment method, Mann-Whitney tests were used. To evaluate differences between time points, Wilcoxon tests were used. Results In the first evaluation, there was a significant difference between initial and final images only for group H, for both laypersons (P = .017) and orthodontists (P = .037). There was also a significant difference between laypersons and orthodontists in their ratings of posttreatment Herbst appliance profiles (P = .028). There was no significant difference between initial and final facial profile images for group F and no significant differences between or within evaluator groups in their ratings of initial or final Forsus appliance profiles. In the second evaluation, there was a significant difference between appliance groups only for laypersons, who considered cases treated with the Herbst appliance more attractive than those treated with the Forsus (P = .031). Laypersons also considered Herbst profiles more attractive than did orthodontists (P = .047). Conclusions Class II malocclusion treatment using the Herbst appliance may produce a more esthetically improved facial profile silhouette compared with Forsus appliances. The magnitude of perceived changes may not be considered clinically relevant.

Aim Achieving a satisfactory facial esthetics is of utmost importance in the practice of orthodontics. Cl II div 1 patients often suffer from numerous adverse facial characteristics which may impair their social well-being. The objective of the current study was to evaluate the esthetic changes in such patients by using a modified twin block appliance. Materials and methods Seventy adolescent patients with mandibular deficiency consecutively underwent treatment with a modified twin block appliance for a mean period of 13 months. Soft tissue analyzes of Burstone and Mcnamara were applied to evaluate the changes before and after the treatment. The esthetic changes before and after the therapy were compared using parametric paired t tests analysis. p values less than 0.05 were considered significant. Results Facial convexity, lip incompetence, upper lip protrusion, and columellar inclination significantly decreased (p < 0.05) while Merrifield's Z-angle nasolabial angle, lower lip length, and mentolabial angle significantly increased (p < 0.05). Vertical facial height ratio, lower lip protrusion, upper lip length as well as nasal projection and inclination, did not change significantly (p > 0.05) Conclusion Our findings indicated that a modified form of the twin block appliance can be substantially effective in the improvement of several aspects of patients’ facial balance with minimum untoward effects. Clinical significance Adolescents suffering from mandibular deficiency can gain substantial facial balance with the twin block appliance. The whole face attractiveness, however, is another subject and should not be conflicted with the facial balance. How to cite this article Shahamfar M, Atashi MHA, Azima N. Soft Tissue Esthetic Changes Following a Modified Twin Block Appliance Therapy: A Prospective Study. Int J Clin Pediatr Dent 2020;13(3):255–260.

Background The patient’s needs should guide the orthodontist in choosing the most appropriate therapy. The purpose of the present survey was to compare the esthetic perception of the facial profile by orthodontists (O), dentistry students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP) and to evaluate the influence of gender, age and level of study. Material and Methods A facial profile photograph of a young female was taken and twelve modified images were made, altering the position of the jaws in protrusion and in retrusion. Two hundred caucasian examiners, divided into four groups (O, DS, OP, SOP), were selected. Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. An ordinary least square OLS model was applied. Significant levels were set at P ≤ 0.05. Results All examiners considered a straight profile or a slight retrusion of the maxilla as the most attractive profile. Slight discrepancies (up to 2 mm) in jaw protrusion were barely perceived by patients. Mandibular retrusion (2 and 4 mm) was one of the least appreciated condition by all examiners. Surgical-orthodontic patients assigned lower ratings compared to orthodontic patients. Female subjects assigned lower ratings than males. Patients with secondary school education assigned higher statistically significant values compared to other levels of study. The lowest values were attributed by the sample of age > = 17 years. Conclusions The choice of the most appropriate therapy is based not only on a correct diagnosis, but on the evaluation of esthetic and psychological aspects. Key words:Estethic, profile, orthodontic, surgical orthodontic patients.

A ortodontia e a harmonização facial podem contribuir juntas, para a evolução na mudança das queixas em relação ao perfil facial. Portanto, este estudo possui o objetivo de realizar, por meios de artigos científicos, uma revisão de literatura sobre a relevância do tratamento ortodôntico e da harmonização facial na correção do perfil facial. Buscou-se nas bases de dados do BIREME, Medline, Pubmed, LILACS e BBO, além da biblioteca virtual Scielo, artigos científicos que foram publicados no período de 2014 a 2019, exceto um artigo clássico de 1999. Foram excluídos da revisão: teses, dissertações, trabalhos de conclusão de curso e artigos em revistas não indexadas com os resultados referentes ao tema abordado. Observou que a terapêutica ortodôntica é um tratamento definitivo quando se pensa em mudança de perfil, aconselha-se, portanto, o tratamento da correção da mau oclusão quando este for a causa de um perfil indesejado. A harmonização facial é uma forte colaboradora para a busca dos melhores resultados mas não substitui a correção da mal oclusão.

Objective: This study aimed at determining variation of Tweed’s norms in male and female of West Bengal population. Materials and Methods: The study sample consisted of Standardized lateral cephalograms obtained from 50 subjects (25 males and 25 females) from West Bengal of 12-18 years age group with normal occlusion and pleasing facial profile. Tweed’s cephalometric analysis was performed and difference between male and female samples was recorded. Any association between the three parameters of tweeds analysis and gender of the subjects was also calculated. Results: Mean FMA value for females was found to be significantly higher than that of males (t48 = 2.97; p48 = 2.45; p Conclusion: The result of the study indicated difference in the norms of diagnostic facial triangle in males and females of West Bengal population. Keywords: Tweeds analysis, Diagnostics facial triangle, Bengali ethnicity, Cephalometric study.

Application of elastics in orthodontics has various outcomes in relation to maxillary arch, mandibular arch, facial pattern and occlusal plane. All these factors can be modified depending upon the response of the individual towards the treatment procedure. Elastics being a dependable mode of changing such parameters have been employed in orthodontics from time to time. In the present case report class II elastics were incorporated with a motive to stimulate growth and change or improve the facial profile as the individual was in a growing phase. With continuous application of elastics and patient cooperation satisfactory occlusion and facial profile was achieved for the patient. Keywords: Class II malocclusion, Class II elastics, Growth, Profile.

Class II skeletal relation present with mandibular retrusion as a common etiological problem. Myofunctional appliances remain the main treatment methodology for growing patients with such problems. But when the patient reports at the penultimate end of growth curve or is non compliant, fixed functional appliances for mandibular advancement become the treatment method of choice. The present case is of a 14 year male with the chief compliant of irregular and forwardly placed teeth. On examination a skeletal and dental Class II relation with crowded anteriors was observed. Extraction of all 1st premolars to relieve crowding along with 0.022 MBT prescription was used initially, followed by application of Powerscope Appliance for mandibular advancement. Significant improvemrnt of facial profile was seen due to forward displacement of mandible with the Powerscope Appliance. Thus it can be concluded that Powerscope Appliance is a useful novel innovation in the field of fixed functional appliances which can be successfully used to treat Class II patients. Keywords: Class II malocclusion, Fixed functional appliance, Powerscope.

Objective the aim of this study was to test the hypothesis that sagittal anomalies have an effect on the perception of mandibular asymmetry. Secondly, it aimed to determine the asymmetry perception threshold of orthodontist and laypeople. Setting and Sample Population A total of 90 individuals were included in the study from different professions (Orthodontist: n:45, layperson: n:45). Materials & Methods the reference image was obtained with 3dMD device and selected from among the individuals with class I soft tissue relationship. in the sagittal direction, the chin area has been moved as to produce 5 and 10 degrees of change in facial convexity angle. Similarly, 0, 2, 4, 6, 8 and 10 mm changes were made and recorded in video format. Manipulated images were scored by participants with VAS method. Results When differences between the groups were evaluated, the reference image was scored similarly by orthodontists and layperson (P: .017). No statistically significant difference was observed between the groups in other parameters (P > .05). Asymmetry in 0-2 mm range was evaluated by orthodontist and layperson and statistically insignificant (P > .05). Similarly, the change between 8 mm and 10 mm was different in both groups and statistically insignificant (P > .05). Also, when there was no asymmetry, the sagittal direction was differently scored by the participants in both groups and statistically insignificant (P > .05). Conclusions It was observed that the effect of sagittal direction changes on asymmetry perception was not statistically significant.

The facial profile is an essential part of facial analysis and significantly impacts surgical decision making. Knowledge of the underlying anatomy, which creates the facial profile, and the anatomic sources of the common abnormalities in the profile can help to ensure adequate surgical correction of the abnormality.

This case report introduces a treatment in mandibular prognathism correction by combining the surgery-first (SF) approach and clear aligners. An intraoral scanner (TRIOS 3, 3Shape, Copenhagen, Denmark) and a virtual setup program (OrthoAnalyzer, 3Shape) were used for treatment simulation. All clear aligners were fabricated using a 3-dimensional printer. The total treatment was completed within 3 months after surgery. An immediate improvement of the facial profile was obtained using the SF approach, and rapid and esthetic tooth movement was achieved using clear aligners. This case report demonstrated that the combination of the SF approach and clear aligners could be a patient-oriented surgical-orthodontic treatment method.

Purpose Decreased upper airway dimensions due to adenoid enlargement may have unfavorable aesthetic and/or functional effects on the soft or hard tissue profile development. The aim of this study was to investigate the associations between adenoid sizes to upper airway size ratio (airway ratio) in the midsagittal plane and various types of soft and hard tissue facial profile convexity. Materials and methods 251 lateral cephalometric images of pre-orthodontic healthy subjects with age group of 6•12, 13•18, 19•25 and 26•29 years, were collected. They were classified into four subgroups based on the airway ratio (grade 1: 3/4 i 100). The radiographs were characterized as convex, normal and concave soft tissue facial profile according to the facial convexity angle. Cephalometric analyses were done using Dolphin imaging computer software 11.95. Kruskal Wallis test was used to evaluate differences between airway ratio and facial morphologies; the mandibular plane angle was compared between airway ratio subgroups by Chi square. Results Airway ratio was not significantly different (P = 0.241) between soft tissue facial convexity subgroups and within age subgroups. Mandibular plane angle was in a significant relation within airway ratio (p = 0.028). Conclusion There was not any significant relation between decreased upper airway ratios and types of the soft or hard tissue facial profile convexity, however there was a significant relation between upper airway ratios and age subgroups. A significant revers correlation was seen between the mandibular plane angle and nasopharyngeal dimensions.

Introduction The position of the incisors is considered as a key landmark in treatment planning to provide the patient with the most attractive and well-balanced smile. It is important to quantify the relationship between anteroposterior position of incisors to overlying soft tissue structures. Aim The purpose of this study was to evaluate cephalometric changes on the soft tissue profile of the adult patients after first premolar extraction. Materials and Methods The study included pretreatment and posttreatment lateral cephalograms of 24 adult patients (Class II div 1 malocclusion and Class I bimaxillary protrusion) treated with preadjusted edgewise appliance following first premolar extractions. Seven angular and twelve linear soft tissue parameters were evaluated. Six hard tissue parameters were evaluated. Results All the linear and angular measurements pertaining to soft tissue and hard tissue showed significant changes. When posttreatment values were compared with pretreatment values, certain parameters (nasolabial angle, Z angle, UL and LL length, and UL strain) were found to be increased, whereas other parameters showed decrease in their posttreatment values. The tissue alteration showed statistically significant increase in nasolabial angle, Z angle, and decrease in soft tissue profile and interlabial gap. Conclusion Facial profile improvement can be enhanced by dentoalveolar and soft tissue retraction following premolar extraction.

Due to errors introduced during the production process, Tables were published incorrectly in the original publication of this article. The correct tables are given here.