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Cephalometric landmarks used on lateral tracings-1: N′, soft tissue nasion; 2: Prn, pronasal; 3: Cl, columella; 4: Sn, subnasale; 5: A′, soft tissue A point; 6: UL, upper lip (most anterior point of upper lip); 7: LL, lower lip (most anterior point of lower lip); 8: B′, soft tissue B point; 9: Pog′, soft tissue pogonion; 10: Me′, soft tissue menton; 11: N, nasion; 12: Or, orbitale; 13: S, sella turcica; 14: Po, porion; 15: Ptm, pterigomaxillary fissure; 16: ANS, anterior nasal spine; 17: PNS, posterior nasal spine; 18: A, A point; 19: B, B point; 20: Pg, pogonion; 21: Gn, gnathion; 22: Me, menton; 23: D, D point; 24: Go, gonion; 25: Co, condylion; 26: Mx1MAP, most anterior point of maxillary central incisor; 27: Mx1IE, maxillary central incisor edge; 28: Mx1IA, maxillary central incisor apex; 29: Md1MAP, most anterior point of mandibular central incisor; 30: Md1IE, mandibular central incisor edge; 31: Md1IA, mandibular central incisor apex; 32: Mx6MAP, most anterior point of maxillary first molar; 33: Mx6OP, occlusal point of maxillary first molar; 34: Mx6MDP, most distal point of maxillary first molar; 35: Md6MAP, most anterior point of mandibular first molar; 36: Md6OP, occlusal point of mandibular first molar; 37: Md6MDP, most distal point of mandibular first molar.

Cephalometric landmarks used on lateral tracings-1: N′, soft tissue nasion; 2: Prn, pronasal; 3: Cl, columella; 4: Sn, subnasale; 5: A′, soft tissue A point; 6: UL, upper lip (most anterior point of upper lip); 7: LL, lower lip (most anterior point of lower lip); 8: B′, soft tissue B point; 9: Pog′, soft tissue pogonion; 10: Me′, soft tissue menton; 11: N, nasion; 12: Or, orbitale; 13: S, sella turcica; 14: Po, porion; 15: Ptm, pterigomaxillary fissure; 16: ANS, anterior nasal spine; 17: PNS, posterior nasal spine; 18: A, A point; 19: B, B point; 20: Pg, pogonion; 21: Gn, gnathion; 22: Me, menton; 23: D, D point; 24: Go, gonion; 25: Co, condylion; 26: Mx1MAP, most anterior point of maxillary central incisor; 27: Mx1IE, maxillary central incisor edge; 28: Mx1IA, maxillary central incisor apex; 29: Md1MAP, most anterior point of mandibular central incisor; 30: Md1IE, mandibular central incisor edge; 31: Md1IA, mandibular central incisor apex; 32: Mx6MAP, most anterior point of maxillary first molar; 33: Mx6OP, occlusal point of maxillary first molar; 34: Mx6MDP, most distal point of maxillary first molar; 35: Md6MAP, most anterior point of mandibular first molar; 36: Md6OP, occlusal point of mandibular first molar; 37: Md6MDP, most distal point of mandibular first molar.

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Objective: The aim of this study was to compare the soft tissue changes and post-treatment status after complete fixed functional appliance non-extraction and maxillary premolar extraction treatment in patients with Class II division 1 malocclusion. Materials/methods: The sample consisted of 96 lateral cephalograms of 48 patients, divided into t...

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... software also corrected the mag- nification factors of the radiographic images that were between 6% and 9.8%. A total of 37 landmarks were defined on each cephalo- gram; 9 skeletal, 13 dental, and 10 soft tissue variables were meas- ured ( Figure 1 and Table 1). Skeletal maturity was assessed by using the cervical vertebral maturation (CVM) method (23). ...

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... The complaints they reported were related to morphological deficiencies observed in patients with chin deficiency, lip projection, mentolabial sulcus, profile convexity and reduced chin-neck line (Capelozza 2004, Brandäo 1997. Janson et al. (2018) reported that malocclusions such as Class II directly alter the facial profile of the patients involved and the correct diagnosis of these malocclusions added to the advances that have emerged over time in Dentistry serve as a basis to this day for orthodontic treatment and also for new procedures including facial harmonization. ...
Article
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Objective: The present study aimed to evaluate and compare the profile attractiveness after compensatory filler in different regions of the face of individuals with chin deficiency. Materials and Methods: The sample consisted of 24 patients with chin deficiency treated compensatorily with facial fillers. The patients were divided into 3 groups: Group C- Chin: 11 patients (1 man, 10 women), with a mean age of 31.27 years (s.d.=9.72), who received chin filler with iPRF. Group CN- Chin and Nose: 9 patients (2 men, 7 women), with a mean age of 32.33 years (s.d.=8.17), who, in addition to filler the chin with iPRF, also received rhinomodeling. Group CNL- Chin, Nose and Lips: 4 patients (4 women), with a mean age of 29.00 years (s.d.=4.24), who received, in addition to filler the chin with iPRF and rhinoplasty, filler of the lips with iPRF. The attractiveness of the profile before and after the filler was evaluated in profile photographs with scores from 1 to 10, with 1 being less attractive and 10 the most attractive. The evaluation was performed by 82 individuals, 45 specialists in Orthodontics or Orofacial Harmonization (27 female, 18 male, mean age 39.11 years, s.d.=9.06) and 37 laypeople (27 female, 10 male, mean age of 39.88 years, s.d.=15.97). The comparison between groups C, CN and CNL was performed by the one-way ANOVA and Tukey tests and for the comparison between specialists and laypeople, the independent t-test was used. Results: There was a statistically significant difference in the profile attractiveness among the different types of compensatory facial filler. After filler, the CNL group became the most attractive, followed by the CN group and lastly and the least attractive was the profile of the C group. The amount of improvement with the compensatory filler was greater in the CNL group, followed by the CN group and lesser in the C group. In the evaluation performed by laypeople, the improvement and attractiveness of the profile after filler were significantly greater than in the specialists’ assessment. Conclusion: The filler of the chin, nose and lips resulted in a greater attractiveness of the facial profile, followed by the filler of the chin and nose, and lastly, the filler of the chin only.
... The Published studies showed results as substantial soft tissue changes in orthodontic treatments performed with premolar extractions, obtaining results with predictable aesthetic improvements in patients with initial diagnosis of protrusion ( [16][17][18][19] ). However, a 2018 study aimed to determine soft tissue changes following orthodontic treatment with and without premolar extractions had similar results in both groups ( 20 ). ...
Article
Objective: To determine the changes in the position and inclination of the upper incisor and upper lip after orthodontic treatment in a series of 3 clinical cases. Materials and Methods: The three reported clinical cases correspond to adult patients who were treated with fixed orthodontics and premolar extractions. Measurements of upper incisor position (UIP), upper incisor inclination (UII), upper lip position (ULP), and upper lip inclination (ULI) were performed on pre-treatment and post-treatment cephalometric radiographs for assessment of changes. Results: In the first case a variation of -1 mm was found for both the UIP and the ULP, as well as a variation of the UII and the ULI, although in different magnitude. Case 2 presented a 2 mm variation in the UII with minimal changes in the upper lip (Δ ULP = 0 mm and Δ ULI =-0.5 mm) and in case 3 a 2 mm variation was obtained for both IIS and ILS. Conclusions: The results obtained in this case reports show us a wide variability, so it is impossible to accurately predict changes in soft tissues as a response to tooth movement. Clinical significance: Predicting tooth movement changes in soft tissues is critical during the initial planning phase of orthodontic treatment.
... According to a systematic review fixed functional appliances in Class II div I patients produce significant soft tissue changes in profile, but these are not clinically significant. It was also found that Class II div I patients in late pubertal age treated with a fixed functional along with fixed orthodontic treatment, and those with two maxillary premolar teeth extracted have similar soft-tissue outcomes (Janson et al., 2017). ...
... In Group PE, overall change of overjet and overbite was -4.23mm and -2.64mm, respectively; whereas Group FF demonstrated reduction of -4.73mm and -3.27mm, respectively. Similar changes were reported by Janson et al. 23 Optimization of overjet in both groups was mainly due to dentoalveolar changes. ...
... gies. Group FF had significant distal displacement of maxillary molar, whereas Group PE demonstrated mild mesial displacement, which is in agreement with the findings of Kizinger et al.29 However, the findings of the present study were not in consonance to those of Janson et al,23 who reported a mean anchorage loss of 4.10mm in extraction cases. Better maintenance of molar position in extraction group in the present study was attributable to the use of implant-anchored space closure.Effect on maxillary molar along the vertical plane was not significantly different between the groups. ...
Article
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Objective The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment. Methods Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis. Results Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog’: -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog’: -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N’-Sn-Pog’: 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases. Conclusions Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship. Keywords: Extraction; Fixed functional appliance therapy; Randomized controlled trial
... Uno de los procedimientos que se muestra como efectivo para tratar la maloclusión Clase II subdivisión 1 son las extracciones de los primeros premolares superiores, el mismo que puede provocar cambios en el perfil facial; lo cual la convierte en uno de los temas más estudiados en la ortodoncia contemporánea por su complejidad e incidencia (Trecenti et al., 2018). Se discute sobre la necesidad de pronosticar los cambios de los tejidos blandos del rostro resultante de los distintos tratamientos aplicados en ortodoncia, en lo que respecta a las diferencias entre los protocolos (Janson et al., 2018). Existe la suposición de que los tratamientos de maloclusiones clase II subdivisión 1 con extracciones de los primeros premolares superiores pueden causar retrusión del labio superior e inferior en relación con el mentón y la nariz dando como resultado perfiles faciales más aplanados. ...
... Existe la suposición de que los tratamientos de maloclusiones clase II subdivisión 1 con extracciones de los primeros premolares superiores pueden causar retrusión del labio superior e inferior en relación con el mentón y la nariz dando como resultado perfiles faciales más aplanados. (Janson et al., 2016;Janson et al., 2018;Zierhut et al., 2000). Luego de realizar las extracciones de los primeros premolares superiores se necesita la retracción de los incisivos superiores, implicando a que los labios acompañen este desplazamiento provocando cambios en el perfil facial sobre todo de manera sagital; es por eso que corresponde al ortodoncista dictaminar el tratamiento que brindará los mejores resultados funcionales y estéticos para el paciente (Trecenti et al., 2018). ...
... En la revisión de la literatura en los tratamientos de la maloclusión Clase II subdivisión 1 en donde se realizaron extracciones de los primeros premolares superiores, se han encontrado cambios como: la disminución del resalte, con valores iniciales de 7,5 mm con cambios en el post tratamiento de 2,53 mm (Janson et al., 2018) Tabla 1. ...
Article
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La maloclusión clase II subdivisión 1 se puede corregir con diferentes tipos de tratamiento como: ortopedia, ortodoncia correctiva con extracciones, sin extracciones, y cirugía ortognática. Uno de los tratamientos son las extracciones de primeros premolares maxilares; este tratamiento consiste en corregir la maloclusión a través de movimientos dentoalveolares. El objetivo de esta revisión narrativa es analizar la evidencia científica disponible sobre los cambios del perfil facial por exodoncias de primeros premolares maxilares en la maloclusión Clase II subdivisión 1 tratados con ortodoncia. Se realizó una revisión narrativa por vía electrónica a través de los buscadores: PubMed, Google académico, Springer y Cochrane Library, con términos como: maloclusión Clase II subdivisión 1, tratamiento, extracción primer premolar, rostro. Cuando se realizan extracciones, ambos labios se retraen, presentado más disminución en la protrusión del labio superior, lo que da lugar a cambios en el perfil facial.
... These errors were considered within clinically acceptable limits. [24][25][26] Four variables (Mx1.NA, Mx6-PP, molar relation, UL-E plane) presented significant systematic errors. ...
Article
Introduction The objective of this study was to compare the cephalometric changes in Class II Division 1 malocclusion patients treated with the Twin-block (TB) and the mandibular anterior repositioning appliance (MARA). Methods This retrospective study was performed with 132 lateral cephalograms of patients with Class II malocclusion divided into 3 groups: a TB group comprised 21 patients with mean initial and final ages of 10.59 and 11.97 years, respectively, treated for a mean period of 1.38 years; a MARA group comprised 21 patients with mean initial and final ages of 11.98 and 13.20 years, respectively, treated for a mean period of 1.22 years; and a control group included 24 subjects with untreated Class II malocclusion with mean initial and final ages of 10.55 and 12.01 years, respectively, observed for a mean period of 1.46 years. Cephalometric intergroup comparisons regarding the treatment changes (T2 − T1) were performed with the analysis of covariance, followed by Tukey tests. Results Both appliances demonstrated significant restriction of the maxilla and improvement of the maxillomandibular relationship. The MARA produced a significantly greater amount of labial tipping and protrusion of the mandibular incisors than the other groups. The TB showed significant extrusion of the mandibular incisors and molars compared with MARA and control, respectively. Both treated groups reduced the overjet and overbite. The MARA presented a significantly greater reduction in the molar relationship than the other groups. Conclusions The appliances showed a headgear effect on the maxilla and effectively changed Class II cephalometric parameters through a combination of skeletal and dentoalveolar effects. TB showed a greater increase in LAFH. MARA promoted greater labial tipping and protrusion of the mandibular incisors.
... According to a systematic review fixed functional appliances in Class II div I patients produce significant soft tissue changes in profile, but these are not clinically significant. It was also found that Class II div I patients in late pubertal age treated with a fixed functional along with fixed orthodontic treatment, and those with two maxillary premolar teeth extracted have similar soft-tissue outcomes (Janson et al., 2017). ...
... In the Class II treatment with intermaxillary elastics or fixed functional appliances, all skeletal and dentoalveolar changes produce effects on the soft tissue profile. [1][2][3][4][5][6] Therefore, it is extremely important for the orthodontists to understand these effects to better perform the treatment planning and fulfill the esthetic expectation of each patient. ...
... [20][21][22] Mendes et al. 23 found similar attractiveness for nonextraction Class II treatment when compared to 2-and 4-premolar extraction. Janson et al. 1 found similar soft tissue changes between Class II treatment with fixed functional appliances or maxillary premolars extraction. ...
Article
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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.
... Subjects of both the groups demonstrated no difference in distribution in terms of age, gender, and cephalometric parameters investigated (P > 0.05). The mean age of the subjects of Group CG and Group SG at the start of study was 21 Table 8 ...
... They are considered as a source of absolute anchorage. 20 Implant supported en-masse retraction in Group CG resulted in statistically significant reduction in incisor inclination (U1 -ANS-PNS, À4.09 AE 0.75), which is in concurrence with the findings of Upadhyay et al. 20 In Group CG, overall change of overjet and overbite was À3.95 and À3.23 mm, respectively, which was similar to the findings of Janson et al, 21 whereas Group SG demonstrated statistically significant reduction of À5.05 mm (P ¼ 0.004) and À4.86 mm (P ¼ 0.002), respectively, which is similar to previous published studies 22 (Supplementary Digital Content, Table 7, http:// links.lww.com/SCS/D2). The mean overjet reduction of 5.05 mm in surgical cases has been found to be highly stable on 2 years follow-up. ...
Article
No randomized controlled trial has compared the treatment outcome between surgical mandibular advancement and premolar extractions in class II malocclusion. This 2-arm parallel randomized controlled trial evaluated the treatment effects and lip profile changes in skeletal class II adult patients subjected to bilateral sagittal split ramus osteotomy for mandibular advancement and those treated with premolar extractions. Seventy skeletal class II patients were accessed and forty-six subjects who fulfilled inclusion criteria were distributed randomly into Group CG (patients: 23, mean age: 21.28 ± 2.69 years) and Group SG (patients: 23, mean age: 21.15 ± 2.64 years). Group CG was subjected to extraction of maxillary first premolars and mandibular second premolars followed by implant supported space closure and Group SG was managed by surgical mandibular advancement. Skeletal, dental, and soft-tissue changes were analyzed. The study was single-blinded (statistical analyzer). Groups were closely matched for baseline parameters. In the present trial there was no loss to follow-up. Though overjet and overbite were optimized in both the groups but significant improvement was seen in surgical cases. Group CG demonstrated statistically significant point "A" remodeling, dentoalveolar changes, and increase in nasolabial angle. Group SG exhibited significant sagittal and vertical skeletal improvement and lip position change. Surgical mandibular advancement was found to be a better treatment modality compared to premolars extraction for managing skeletal class II div 1 malocclusion as it permits greater improvement of the profile and skeletal relationship.
... The main conclusions obtained refer to an improvement of the facial profile [2,17,19,20,24,34] with reduction in facial convexity [3,7,8,12,17,24,26,28,32]. This is achieved by the dental and skeletal changes promoted by the appliance leading to anterior displacement of the chin and lower lip [2,4,18,22,23,25,26,28,32,34], as well as some retrusion of the upper lip [3,4,7,8,10,12,13,18,19,22,24,26]. ...
... There was a significant retrusion of the upper lip in the Twin Force group (Table 2). This result has been widely reported in previous studies with fixed functional appliances [3,4,7,8,10,12,13,18,19,22,24]. This was probably due to increased nose projection by normal growth bringing the upper lip into a retruded position in relation to the E-line [3,24]. ...
... Similar results have been previously reported [8,22,24]. However, other studies have reported protrusion of the lower lip with other fixed functional appliances [3,4,13,18,19,30,32]. One possible explanation is the retrusion of the maxillary incisors combined with the protrusion of the mandibular incisors. ...
Article
PropositionThis study aimed to compare soft tissue profile changes in Angle class II malocclusion patients treated with a Twin Force appliance (Ortho Organizers, Inc., Carlsbad, CA, USA) or class II elastics.Methods The sample comprised 47 class II malocclusion patients treated orthodontically without extractions, divided into two groups. Group 1 (Twin Force): 25 patients were treated with the Twin Force, with initial and final mean ages of 17.91 and 20.45 years, respectively, and mean treatment time of 2.53 years. Group 2 (elastics): 22 patients were treated with class II elastics, with initial and final mean age of 15.87 and 18.63 years, respectively, and mean treatment time of 2.75 years. The lateral cephalograms were evaluated at the initial and final stages. Intragroup comparisons were performed with dependent t-tests and intergroup comparisons were performed with independent t-tests.ResultsTreatment-related changes in the Twin Force group included reduction of facial convexity, retrusion of the upper lip, increase of the H‑Nose distance, and decrease in Sn‑H distance, indicating improvement in facial profile. In the elastics group, treatment resulted in an increase in nasolabial angle, retrusion of the upper lip, increase of the H‑Nose distance, and decrease in Sn‑H distance, indicating improvement in facial profile. The Twin Force group showed a greater reduction of the facial convexity with treatment than the elastics group.Conclusions Class II patients treated with the Twin Force appliance showed greater reduction in facial convexity than patients treated with class II elastics. The other soft tissue changes were similar for both groups.