Facial-profile attractiveness changes in adult patients treated with the Herbst appliance

The effect of low intensity pulsed ultrasound on mandibular condylar growth in young adult rats

There is a need for more effective methods to enhance mandibular growth in young adults with mandibular deficiency. Previous studies suggest that low intensity pulsed ultrasound (LIPUS) can enhance mandibular growth in growing individuals. This study aimed to evaluate the potential growth changes of the mandible following 4-week LIPUS application in young adult rats. Nineteen ≈120-day-old female rats were allocated to experimental (n = 10) and control (n = 9) groups. The animals in the experimental group were treated with LIPUS to their temporomandibular joints (TMJs) bilaterally, 20 min each day for 28 consecutive days. Animals were then euthanized; gross morphological evaluation was performed on 2D photographs and 3D virtual models of hemi-mandibles, and microstructural assessment was done for the mandibular condyle (MC). Evaluation of mineralization and microarchitecture properties of subchondral cancellous bone was performed by micro-computed tomography (μCT) scanning. Qualitative and histomorphometric analysis was done on condylar cartilage and subchondral bone following Alcian Blue/PAS and Goldner's Trichrome staining. Vital flourochrome (calcein green) labeling was also utilized to determine the amount of endochondral bone growth. Gross morphological evaluations showed a slight statistically non-significant increase especially in the main condylar growth direction in the LIPUS group. Moreover, 3D evaluation depicted an enhanced periosteal bone apposition at the site of LIPUS application. Microstructural analysis revealed that LIPUS stimulates both chondrogenesis and osteogenesis and enhances endochondral bone formation in young adult rat MC. Furthermore, the effect of LIPUS on osteogenic cells of subchondral cancellous bone was notable. To conclude, LIPUS can enhance young adult rats' MC residual growth potential.

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.

Patterns of Facial Profile Preference in a Large Sample of Dental Students: A Cross-Sectional Study

The objective of this study was to explore dental students’ facial profile preferences in a large sample of students. Nine hundred and nineteen dental students of four dental schools were involved. As part of a larger study on dentofacial esthetics, six photo series consisting of one unaltered and four altered variants of the same female profile were distributed among the students. The altered features were ones that are esthetically significant according to the literature. The students had to indicate the photo in each series that they preferred. The data were analyzed in a regression model in which preference in the given photo series was the dependent variable and gender, grade of studies, and dental school were the factors. Eight hundred and sixty-one students (93.7%) responded. Gender and dental school were not associated with the observed preferences, but the grade of studies was associated for three of the modified parameters: chin prominence, the sagittal position of the maxillary dental arch, and the simultaneous modification of the prominence of the chin and the nose. This study has confirmed several earlier observations, and new observations have also been made. We have demonstrated that the anteroposterior position of the maxillary incisors may be an important determinant of profile esthetics, even if this position does not influence the situation of the soft tissues and if the forehead cannot be used as a reference. We have also shown that the harmony between the nose and the chin overrides the importance of their individual dimensions.

Effect of Class II functional treatment on facial attractiveness, as perceived by professionals and laypeople

The literature offers different perspectives for and against two-phase treatment of skeletal Class II malocclusion. Facial attractiveness is an important aspect to take into account, given that children with skeletal Class II are often bullied by their peers and have low self-esteem and a lower social perception. The aim of the present study was to evaluate the aesthetic perception of facial profiles by a large number of observers, before and after treatment with a functional appliance, compared to untreated controls. The pre- and post-treatment cephalograms of 20 Class II subjects treated with Sander’s bite-jumping appliance and 20 untreated historical controls were collected and transformed into black and white silhouettes depicting only the lower third of the face. An online questionnaire comprising the silhouettes of the two groups, three “calibration” profiles and an “ideal” profile was submitted to dentists, orthodontists, undergraduates and laypeople, asking them to rate the profile’s attractiveness using a Visual Analogue Scale (VAS). The effect of treatment, and observers’ age, expertise and gender were analysed. The calibration images and the ideal profiles were used to evaluate the coherence of each observer’s judgement. The protocol was approved by the local Ethics Committee. Nine-hundred and ten questionnaires were collected. Treated subjects showed a larger improvement of facial attractiveness compared to controls. A significant effect of gender on the observer’s ratings was observed. Some observers showed incoherent judgement, which had a significant effect on the regression model. In conclusion, early treatment with functional appliances seems to improve patients’ facial aesthetics. This improvement is perceived equally by dental professionals and laypeople.

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.

Evaluation of Profile Changes in Class II Individuals Treated by Means of Herbst Miniscope Appliance

Background: To evaluate the profile changes following orthopedic/orthodontic treatment with the Herbst Miniscope^® appliance in subjects affected with Class II malocclusion with mandibular retrusion. Methods: A total of 44 patients presenting a skeletal Angle Class II malocclusion (ANB > 4°) due to mandibular retrusion and a cervical maturation stage between CS2 and CS3 were included in the study. Of these 44 patients, 22 (mean age 11.9 ± 1.3, HBT group) were treated using the Herbst appliance, while 22 (mean age 10.6 ± 1.3, CTR group) were followed for a 12-month observational period. A cephalometric tracing was performed at the beginning of treatment (T0) and after 12 months (T1). Results: In both groups there was a significant advancement of soft tissue pogonion (HBT = 3.5 ± 3.0 mm, p < 0.001; CTR = 2.2 ± 2.9 mm, p < 0.001), but the difference between the two groups was not significant (p = 0.172). On the contrary, both groups had a significant advancement of the mandibular sulcus (HBT = 3.7 ± 2.8 mm, p < 0.001; CTR = 1.2 ± 2.2 mm, p < 0.001) and a lower lip protrusion (HBT = 3.45 ± 2.51 mm, p < 0.001; CTR = 1.7 ± 2.7 mm, p = 0.008), but in both cases the HBT group showed a statistically significant greater increase in sulcus protrusion (p = 0.002) and lower lip protrusion (p = 0.029) than controls. There were no statistically significant effects on the upper jaw. Conclusions: The Herbst appliance advanced the lower jaw soft tissues.

Impact of functional orthodontic treatment on facial attractiveness of children with Class II division 1 malocclusion

Background/objectives

Whether orthodontic treatment with functional appliances improves facial aesthetics is still under debate. This study aimed to determine whether functional orthodontic treatment improves the facial attractiveness of patients with Class II division 1 malocclusion.

Materials/method

Extraoral lateral photographs of 20 children with Class I (CLI, 11.7 ± 0.8 years), and before (T1) and after treatment (T2) photographs of patients with Class II division 1 (CLII T1 and CLII T2; mean age ± SD = 11.1 ± 0.6 years) treated with functional appliances, were transformed into black silhouettes. Three panels of examiners including 30 orthodontists (39.0 ± 10.1 years), 30 dentists (40.0 ± 9.7) and 30 laypersons (39.0 ± 9.2) evaluated the attractiveness of patients’ silhouettes using a 100-mm visual analogue scale, and the sagittal position of patients’ upper lip, lower lip, and chin using a 3-point Likert scale. Two-way ANOVA and a chi-square test were used to test differences among groups. Statistically significance was set as P  &lt;  0.05.

Results

The silhouettes of CLII T2 individuals were more attractive than those of the other groups (all Ps &lt; 0.001). The upper lip, lower lip, and the chin of these individuals were judged to be normally positioned in 69.5 per cent, 74.9 per cent, and 72.3 per cent of the assessments, respectively (all Ps &lt; 0.05).

Limitations

This study did not account for the psychological profile of the examiners, which may have affected the ratings.

Conclusions/implications

Orthodontic treatment with functional appliances is associated with a superior facial profile attractiveness. Functional treatment should be considered as a treatment option to improve the facial appearance of children with Class II division 1 malocclusion.

Soft tissue effects of three different Class II/1-camouflage treatment strategies

OBJECTIVE

Aim of this retrospective study was to compare soft tissue effects of Class II treatments with the forsus fatigue resistant device (FRD), the pendulum appliance, and the extraction of two maxillary premolars, all of which were combined with pre-adjusted fixed appliances.

PATIENTS AND METHODS

The sample of 54 patients with Class II malocclusions was divided in three groups: group I patients (mean age = 15.91 years) were treated with the FRD concurrently used with fixed appliances; group II patients (mean age = 16.08 years) were treated with the pendulum appliance combined with a Nance and headgear followed by fixed appliances; and group III patients (mean age = 19.04 years) were treated with the extraction of two maxillary premolars with miniscrew anchorage. Soft tissue and dentoskeletal parameters were measured on pretreatment (T1) and posttreatment (T2) lateral cephalograms. The changes from T1 to T2 were compared between the groups using Kruskal-Wallis test, and treatment differences were evaluated with the Wilcoxon test at p < 0.05.

RESULT

Soft tissue measurement changes related to the upper and lower lips were significantly greater in group II than in group III (p < 0.05). Upper incisor measurement changes were significantly different between groups II and III. Lower incisor measurement changes were significantly different between groups I and III and groups II and III (p < 0.05).

CONCLUSIONS

Pendulum and extraction treatment groups showed significant differences in relation with the upper and lower lip positional changes, which were significantly greater in the pendulum group. Treatment time with the extraction treatment was statistically shorter than with the nonextraction protocols.