Quantitative investigation of the esthetic impact of lip prominence in relation to the esthetic line

INTRODUCTION

The purpose of this quantitative investigation was to assess the influence of lip prominence in relation to the esthetic line (E-line) on perceived attractiveness and threshold values of desire for treatment.

METHODS

The lip prominence of an idealized silhouette male white profile image was altered incrementally between -16 mm to 4 mm from the E-line. The images were rated on a Likert scale by pretreatment orthognathic patients (n = 75), laypeople (n = 75), and clinicians (n = 35).

RESULTS

In terms of perceived attractiveness, lips to E-line distance within the ranges of -12 mm to -16 mm and 0-4 mm in relation to the E-line was associated with a reduction in median attractiveness scores to below 4 in the patient and clinician groups of observers; for the lay group, the corresponding ranges were -14 mm to -16 mm and 2-4 mm. Relative lip prominence appears to be viewed as more attractive than lip retrusion. Clinicians were generally least likely to suggest treatment for varying levels of bilabial position. For a number of the images, there was reasonable agreement among clinicians and laypeople regarding whether treatment is required. For the clinician group, the only categories for desire for treatment were at a lip to E-line distance within the ranges of -14 mm to -16 mm and 2-4 mm.

CONCLUSIONS

It is recommended that the range of normal variability of the prominence of the lips and threshold values of the desire for treatment be considered in planning.

What is the best soft-tissue reference plane to quantify lip change in bimaxillary protrusion cases? A retrospective cohort study

Objectives:

The objective of the study was to evaluate the validity of five soft-tissue profile planes to actual horizontal lower lip changes following treatment of severe bimaxillary protrusion patients with vertical maxillary excess using extra-alveolar miniscrews. The null hypothesis was no differences in the incremental changes of horizontal lower lip changes from pre-treatment to post-treatment of the five methods compared to actual changes.

Materials and Methods:

Seventy adults were treated orthodontically with extractions for bimaxillary protrusion and “gummy” smile using extra-alveolar miniscrews. Lower lip horizontal position was assessed with pre- and post-treatment lateral cephalograms and five commonly used soft-tissue reference lines were used to measure horizontal lower lip treatment change.

Results:

Compared to actual therapeutic lower lip horizontal retraction (4.38 mm), soft-tissue references Ricketts’ E-line (3.89 mm) and Steiner’s S-line (3.88 mm) demonstrated no statistical difference (P > 0.05) from actual change. The five profile plane measures showed moderately high to high intercorrelations among themselves, but none of them were related to the actual amount of anteroposterior lip change that occurred. None of the five soft-tissue measurements showed a statistically significant difference (P > 0.05) between subgroups with least and greatest lower lip retraction.

Conclusion:

Under conditions of maximum lower lip retraction, Rickett’s E-line and Steiner’s S-line were fair measures of horizontal lower lip change. Although actual lower lip change and soft-tissue reference plane changes were correlated poorly, intercorrelations among the five soft-tissue references planes were moderately high. None of the five soft-tissue measurements was able to discriminate (P > 0.05) between treatments with least and greatest lower lip retraction. It may be concluded that Rickett’s E-line and Steiner’s S-line soft-tissue profile references are valid when there is considerable therapeutic retraction (4+ mm) of the lower lip.

Surgically Facilitated Orthodontic Therapy (SFOT): Diagnosis and Indications in Interdisciplinary Dentofacial Therapy Involving Tooth Movement

FOCUSED CLINICAL QUESTION

What are the key considerations for the interdisciplinary dentofacial therapy (IDT) team in the diagnostic process to evaluate a patient for surgically facilitated orthodontic therapy (SFOT)?

SUMMARY

SFOT creates a demineralized bone matrix and augments dentoalveolar deficiencies in the management of dentofacial disharmony malocclusion. Numerous indications and contraindications exist which are essential to the periodontal surgeon for proper case selection. A collaboratively focused workup by an IDT team is equally essential. Cone beam computed tomography (CBCT) and orthodontic simulation software which identifies changes in the dentoalveolar complex influenced by tooth movement are critical in providing transparency to the patient and IDT team during the treatment planning process. Such transparency can aid the team in assessing goals and outcomes that consider and respect foundational dentoalveolar parameters while contributing to sustainable outcomes.

CONCLUSIONS

The SFOT IDT decision making process is complex, yet full of opportunities. Embracing SFOT IDT with innovative and novel 3D technology can optimize conditions leading to long-term outcomes that align with periodontal stability as well as patient goals and preferences which permeate beyond the achievement of "straightening teeth". Transparency of complex IDT through 3D CBCT and orthodontic simulation software engenders "collaborative accountability" and can improve patient communication which is critical to developing meaningful and essential treatment plans.

Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon's perspective

Objective aesthetic criteria are important for patient evaluation and analysis during aesthetic surgeries, while successful aesthetic surgeries must take into account the underlying ethnic differences. The aim of this study is to help surgeons and scientists better plan facial aesthetic surgeries and understand the aesthetic needs according to different patients by reviewing and comparing the current aesthetic principles and preferences in Caucasian and East Asian populations. PubMed and The Cochrane Library were searched using keywords regarding anthropometric measurements. Only original clinical studies and reviews written in English and Chinese and those that focused on the objective assessment of facial aesthetics in Caucasian and East Asian female populations were retained for review. Reference lists of the selected articles were also reviewed for eligible studies. Sixty-five articles that described objective aesthetic criteria in Caucasian and East Asian female populations were found through PubMed, among which 47 included Caucasian populations and 18 included East Asian populations. Compared with White women, East Asian women prefer a small, delicate, and less robust face, lower position of double eyelid, more obtuse nasofrontal angle, rounder nose tip, smaller tip projection, and slightly more retruded mandibular profile. Various differences exist between objective facial aesthetic criteria in Caucasian and East Asian populations. Further studies that focus on the objective aesthetic criteria of facial attractiveness in different ethnicities need to be conducted, especially in Asian countries. Level V: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Can extraction sites affect the profile?

Tooth extractions, apart from the third molars, which it seems is normal to extract today, have always given rise to controversy among orthodontists with both supporters and opponents. It is legitimate to raise the question regarding the need for extractions in our treatment plan and to opt for the first or second premolars as the extraction site, or even the first molars when the latter are decayed and the germs of the third molars are in place. Facial esthetic guides us in our treatment decisions but we must free ourselves from the so-called esthetic lines drawn up many years ago and, for the most part, on the basis of lateral headfilms and small study samples. Particular ethnic features are another major factor to be borne in mind, given that the vast majority of cephalometric standards were based on Caucasian populations. In this article, we will draw on clinical studies to illustrate the thinking behind the need for extractions and the choice of extraction sites.