Profile changes after Orthodontic treatment

1. 1 Profile changes after orthodontic treatment Profile changes after orthodontic treatment Prepared by: Prepared by: Dr Mohammed Al Dr Mohammed Alr ruby uby P Profile rofile changes after Orthodontic treatment changes after Orthodontic treatment Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 Factors considered in profile changes Effect of functional appliances on profile Effect of fixed appliances Factors affect soft tissue profile changes For orthognathic surgery P Profile rofile changes after Orthodontic treatment changes after Orthodontic treatment Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 The effect of orthodontic treatment on the face is one of orthodontic major concern, orthodontist study the soft tissue profile in patients treated orthodontically, there is facial harmony depend on the dental position. Profile means: skeletal foundation, dental support, soft tissue component; nose, lip and chin Factors considered in profile changes 1-Age of patient 2-Gender differences 3-Skeletal factors 4-Dental inclination 5-Size of mandibular plane angle 6-Type of treatment, fixed, removable or orthognathic surgery, extraction or non-extraction Change in profile by age; = greatest change – 10 to 15 years --- in fenales = greatest change-- 15 to 25 years in males = angle of convexity changes little from 5 to 45 years = upper and lower lip more retruded in relation to esthetic line 15 to 45 years of age. Preferred profile: In males: straight In females; convex Worse profile with recessive chin and convex profile. Land mark for facial profile Pro-nasal: Pr: most anterior point on the contour of the nose Subnasal: Sn: point at junction of collumella and upper lip Labral superior; Ls: the most anterior point on convexity of upper lip Labral inferior: Li: the most anterior point on convexity of lower lip Sulcus superior; Ss: point of greatest convexity in the middle between labral superior and subnasal Sulcus inferior: Si: point of greatest convexity in the midline between labral inferior and soft tissue pogonion Soft tissue pogonion; Pog: most anterior point of soft tissue chin Reference lines: = E line: esthetic line by Ricketts between Pog and pronasal = Sn---Pog plane: by Burston to measure lip protrusion = Line tangent to labral superior and perpendicular to FH by Holdaway and measure depth of sulcus superior = H line by Holdway: from labral superior and to Pog soft tissue Measurements: 1-Ss to E line 2-Ls to E line 3-Li to E line 4-Si to E line 5-Nasolabial angle 6-Ls to Sn—Pog 7-Li to Sn—Pog P Profile rofile changes after Orthodontic treatment changes after Orthodontic treatment Dr. Mohammed Alruby Dr. Mohammed Alruby

4. 4 8-Labio- mental angle: formed by intersection between Li and Si and line drawn between Si and Pog 9-Si to H line 10-Ss to H line 11-Li to H line Effect of functional appliances on soft tissue profile Dento-alveolar effects: Functional appliances move the maxillary dentition against the mandibular dentition which very helpful in the correction of Class II and Class III providing excellent results to correct the facial profile of patients Skeletal effect: 1-Stimulate mandibular growth. 2-Rotation of the mandible 3-Backward translation of maxilla 4-Jacobson reported that ANS and A point prevented from moving forward William lange 1995 studied the effect of Bionator in patient profile in mixed dentition On dentition: decreased over jet by 4.7mm and reduction 13m over bite Facially: decrease facial convexity Decrease protrusion of upper lip Increase lower lip length 2,5mm and decrease thickness 2.6mm minimal effect on upper lip Skeletal: increase length of mandible 3.6mm or more Effect of fixed appliance on soft tissue profile = Erleen C and Donald R; studied the effect of fixed treatment on profile and longtime retention also. They found, that the facial profile continued to be flatten during both treatment and after long retention = Renata et al 2012 studied the effect of extraction treatment on facial profile and found high positive effect on facial profile esthetics (using Silhouette photograph before and after treatment) = Munizeh khan 2010, study the changes in profile with orthodontic extraction treatment, the premolar extraction group showing significant reduction in lip procumbancy which allow improved the patient profile There is a mild increase in IMPA and lower lip procumbancy at the end of active treatment, because horizontal reference line HRL constructed 7 degree inferior to sella nasion plane at the level of FHP = Sneh Lata et al 2013, straight arc of soft tissue convexity in extraction group more than non- extraction Upper and lower lip more retrusive in extraction more the non-extraction Both group have more pleasant profile and within normal range to E line Reduced inter-labial gap P Profile rofile changes after Orthodontic treatment changes after Orthodontic treatment Dr. Mohammed Alruby Dr. Mohammed Alruby

5. 5 = Naneed et al 2014; studied the change in profile by using Herbest appliance, they found: 1-Reduction in the relative surface of upper lip in both gender 2-Slight increase in relative surface of lower lip 3-Reduction of relative surface occupied by chin 4-Upper incisor retrusion and lower incisor protrusion 5-Forward movement of lower jaws = Gholameza et al 2014: studied soft tissue change after extraction and they found that, extraction of 1st premolars allow good position of lips relative to Holdaway and good esthetic profile, however amount of lips retraction from patient to patient = another authors in 2018 studied the effect of orthodontic treatment in profile changes and they found that, 1-Lip changes, obvious changes in lip position relative to skeletal, and lip thickness changed little 2-Posterior occlusal plane inclination is decreased after orthodontic treatment 3-Decrease distance of lower lip to esthetic plane 4-Change in naso-labial angle 5-Z angle decreased with increased inclination of posterior occlusal plane = Nits Roos 1977: studied profile changes in Class II treatment, and found, that 1-Changed position of upper incisors---- posterior located 2-Lesser degree of posterior located lower lip 3-Increase thickness of upper lip and decrease thickness of lower lip Factors affect soft tissue changes 1-Pre-treatment lip thickness 2-Vertical and anterior-posterior facial pattern 3-Individual variation in the growth of the nose and chin 4-Direction of overall facial growth 5-Final angulation of the upper and lower incisors 6-Treatment mechanics needed Effect of orthognathic surgery Chandan et al 2011: studied the changes in profile after orthognathic surgery, and they found: the upper lip respond variably to the direction and amount of maxillary positioning Change the profile to pleasant form within normal range but all of this depend on the type of treatment. P Profile rofile changes after Orthodontic treatment changes after Orthodontic treatment Dr. Mohammed Alruby Dr. Mohammed Alruby