Esthetic perception of facial profile after treatment with the Thurow appliance

Orthognathic Surgery and Relapse: A Systematic Review

BACKGROUND

This review aimed to analyze the relapse in orthognathic surgery.

METHODS

PubMed, Scopus, and Web of Science databases were used to find papers that matched our topic dating from 1 January 2012 up to November 2022. Inclusion criteria were (1) human studies, (2) open access studies, (3) studies concerning the correlation between orthognathic surgery and relapse. Exclusion criteria were: (1) in vitro or animal studies, (2) off-topic studies, (3) reviews, (4) other languages than English.

RESULTS

A total of 482 results were obtained resulting in 323 publications after duplicate removal (158). After screening and eligibility phases 247 records were excluded: 47 reviews, 5 in animals, 35 in vitro, 180 off-topic. The authors successfully retrieved the remaining 78 papers and evaluated their eligibility. A total of 14 studies from these were ultimately included in the review.

CONCLUSION

Using cephalometric examinations and digital study models, these studies reveal that the relapse after orthognathic surgery is an event that occurs in most of the cases. The limitation of our research is that most of the studies are retrospective and use small sample sizes. A future research goal should be to conduct long-term clinical trials with larger numbers of samples.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

PURPOSE

The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population.

METHODS

Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20 years), group II (20 to 39 years), group III (40 to 59 years), and group IV (over 60 years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ² test, and analysis of variance were used for statistical analysis according to age and gender.

RESULTS

The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P = .281) and female (P = .442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank.

CONCLUSIONS

An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

Attractiveness of the facial profile: comparison of Class II patients treated with Twin Force® or intermaxillary elastics

Objective:

To compare the facial profile attractiveness of Class II patients treated with Twin Force^® or intermaxillary elastics.

Methods:

Sample comprised 47 Class II patients divided into two groups: G1) TWIN FORCE - 25 patients treated with fixed appliances and Twin Force^® fixed functional appliance (mean initial age was 17.91 ± 7.13 years, mean final age was 20.45 ± 7.18 years, and mean treatment time was 2.53 ± 0.83 years); G2) ELASTICS - 22 patients treated with fixed appliances and Class II intermaxillary elastics (mean initial age was 15.87 ± 5.64 years, mean final age was 18.63 ± 5.79 years and mean treatment time was 2.75 ± 0.60 years). Lateral cephalograms from pretreatment and posttreatment were used. Cephalometric variables were measured and silhouettes of facial profile were constructed and evaluated by 48 laypeople and 63 orthodontists, rating the attractiveness from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with Mann-Whitney and independent t-tests.

Results:

At pretreatment, facial profile of the Twin Force^® group was less attractive than the Elastics group. Treatment with Twin Force^® or Class II elastics resulted in similar facial profile attractiveness, but the facial convexity was more reduced in the Twin Force^® group. Orthodontists were more critical than laypeople.

Conclusions:

Treatment with Twin Force^® or Class II elastics produced similar facial profile attractiveness at posttreatment. Profile attractiveness was reduced with treatment in the elastic group, and improved in the Twin Force^® group. Facial convexity was more reduced with treatment in the Twin Force^® group.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery

Objective

The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople.

Results

The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small.

Conclusion

The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Esthetic perception of facial profile changes in Class II patients treated with Herbst or Forsus appliances

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.

Orthodontic-surgical treatment for a patient with Class II malocclusion and inadequate maxillary incisor inclination

Dental health and patient satisfaction at the end of orthodontic treatment are needed if the treatment is to be considered successful. This case report highlights the importance of proper diagnosis for a patient initially treated with camouflage, despite the indications for surgery. A 16-year-old male patient sought treatment complaining about his appearance. He had been using an appliance for 6 years without improvement. He had a convex profile, an enlarged lower third of the face, reduced cervical-mandibular line, and Class II molar relationship. The maxillary incisors had excessive buccal root torque, throbbing pain, and dental mobility, with no visible bone coverage in the tomographic sections. The cephalometric analysis confirmed the skeletal Class II relationship (ANB, 11.6°; Wits appraisal, 14.2 mm) because of severe mandibular deficiency (SNB, 71.2°), aggravated by the vertical growth tendency (FMA, 27.3°). Changes in IMPA (108.1°) and U1-NA (0.9°; -2.9 mm) reflected the previous orthodontic attempt to compensate for the malocclusion. After periodontal and endodontic evaluation, a new treatment plan was developed. The incisors would be positioned in their bone bases, the mandibular first premolars would be extracted to create space for the second molars and increase the overjet, and the patient would be referred for orthognathic surgery. The patient was satisfied with the esthetic and functional results of this treatment.

Comparison of the facial profile attractiveness in Class III borderline patients after surgical or compensatory orthodontic treatment

Background

This study aimed to compare the facial profile attractiveness of Class III borderline patients after surgical or compensatory orthodontic treatment.

Material and Methods

The sample consisted of 60 borderline Class III malocclusion patients, divided into two groups: Group 1 (Surgical): 30 patients (16 male; 14 female) treated with orthodontic fixed appliances and bimaxillary orthognathic surgery. Mean initial age was 20.05 years (s.d.=2.40) and mean treatment time was 2.23 years (s.d.=0.82). Group 2 (Compensatory): 30 patients (13 male; 17 female) treated compensatorily with fixed appliances and Class III elastics. Mean initial age was 18.53 years (s.d.=4.35) and mean treatment time was 2.08 years (s.d.=0.67). Silhouettes of the facial profile were constructed obtained from the pretreatment and posttreatment lateral cephalograms and evaluated by orthodontists (N=41, 22 females and 19 males, mean age of 35.65 years), assigning scores from 1 (least attractive) to 10 (most attractive). Intergroup comparison of profile attractiveness was performed by Mann-Whitney test. For intragroup comparison of initial and final stages, the Wilcoxon test was used.

Results

At initial stage, the compensatory group presented a statistically significant greater attractiveness of the profile than the surgical group. With treatment, the surgical group presented significantly more improvement in facial profile than the compensatory group. At the final stage, profile attractiveness of surgical and compensatory groups was similar.

Conclusions

The facial profile attractiveness is similar in Class III patients after orthognathic surgery or compensatory orthodontic treatment. However, surgery provided more improvement in profile attractiveness than the compensatory treatment in Class III patients. Key words:Malocclusion, angle Class III, orthognathic surgery, corrective orthodontics.

Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment

This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.

Esthetic perceptions of facial silhouettes after treatment with a mandibular protraction appliance

INTRODUCTION

In this retrospective study, we aimed to evaluate the effects on the facial silhouettes produced by a mandibular protraction appliance associated with corrective treatment in Class II patients.

METHODS

The sample consisted of 54 (27 initial and 27 final) lateral radiographs from 27 patients. Of these patients, 14 were girls and 13 were boys, with a mean initial age of 12.27 years and a mean treatment period of 2.9 years. An album containing the silhouettes of the pretreatment and posttreatment profiles based on the lateral cephalograms of the patients was prepared. Then, 60 orthodontists and 60 laypeople chose the more esthetic facial silhouette (A or B) and the amount of alterations they perceived between the 2 silhouettes, according to a visual analog scale. A paired t test was used to compare the 2 groups of evaluators with a 5% significance level.

RESULTS

Differences between the preferences regarding the pretreatment and posttreatment facial silhouettes were statistically significant for both groups. The posttreatment silhouettes were preferred by most evaluators. The visual analog scale scores showed that the lay evaluators identified greater differences between the pretreatment and posttreatment silhouettes than did the orthodontists (P <0.001).

CONCLUSIONS

Based on the evaluators' judgments, treatment with the mandibular protraction appliance had a positive effect on the facial silhouette, and the laypeople better perceived this effect.