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Background: The purpose of this study was to compare the frontal lip cant changes in common facial asymmetry (FA) cases after simultaneous maxillomandibular distraction osteogenesis (DO) and mandibular DO with maxillary orthognathic surgery. Materials and Methods: Retrospective analysis of FA cases at tertiary craniofacial referral was performed. Patients of either gender with all medical imaging records and pre- and post-operative (1 year) facial photographs in natural head position were included in the study. The lip cant change was assessed by the ratio of the linear dimension between affected and unaffected side labial commissures and the bi-pupillary reference line. Difference between the pre- and post-operative ratio was analyzed. Statistical analysis was performed for the outcome. P ≤0.05 was taken as significant. Results: The mean preoperative measured value of the affected side was 0.845 ± 0.036 while the postoperative value was 0.95 ± 0.032. The effective change was 0.11 ± 0.044. The postoperative ratio compared with simultaneous DO case was 0.98 ± 0.06 while that of mandibular distraction with orthognathic surgery was 0.92 ± 0.08 (P = 0.048). The mean change of the simultaneous DO case was measured as 0.114 ± 0.041 while the same for the mandibular distraction with orthognathic surgery was 0.069 ± 0.035 (P = 0.013). Discussion and Conclusion: The results indicate that the simultaneous DO yields more better frontal lip cant change between both halves than the mono-DO with orthognathic surgery. The mean change is much higher in the simultaneous DO cases indicating a more effective correction and desired result. The biological reason and lip musculature mechanism behind the response in both conditions are discussed.

Recently, CT scans of the head are increasingly being used for a variety of forensic reasons, regardless of the head position in which the scans were taken. The study is aimed at monitoring differences in facial shape in vertical and horizontal positions caused by gravity. The first aim was to analyze variations in facial morphology due to gravity between sexes, looking into which regions are most affected. The second aim was to understand changes in the facial soft tissue position due to gravity with advancing age. The final objective was to investigate how variations in body fat percentage influence facial changes due to gravity. The study uses 3D facial scans of 132 Czech and Slovak adults (85 females, 47 males), aged 20–72, captured in vertical and horizontal positions. Differences between both facial polygon networks representing the influence of gravity were analyzed by geometric morphometric methods (CPD-DCA, color-coded maps) and the Morphome3cs II software. Both sexes showed a similar but otherwise intense shift of facial soft tissues in horizontal position. Males exhibited a stronger supero-lateral shift from the upper cheek to parotid-masseteric regions, whereas females showed greater buccal retrusion. Intensities of soft tissue displacement in these areas increase with increasing age. Almost the same trend can be observed when comparing soft tissue displacement with normal and increased body fat percentage. Positional correction factors should be implemented in craniofacial identification for increased efficiency of facial reconstruction software towards creating realistic approximations. •3D facial morphology and averages were compared between vertical and horizontal postures using Morphome3cs II software.•Males showed superolateral cheek shift when lying down; females had sunken buccal areas—trend increased with age and body fat•Extensive changes were observed in the lateral facial regions, while positional changes along the midsagittal plane remain minimal or neutral.•Postural differences affect soft tissue positioning, indicating the need to account for body orientation in morphological assessments.

Enhancement of facial profile represents one of the primary objectives of orthodontic treatment, particularly in the light of the growing aesthetic concerns among patients. This randomized controlled trial (RCT) aimed to evaluate and compare the effects of aesthetic (ATB) and conventional (CTB) Twin Block appliances on the facial soft tissues of patients with skeletal Class II Division 1 malocclusion. 52 pubertal patients were randomly assigned to two groups: 26 received ATB, and 26 received CTB. Pre- and post-treatment lateral cephalometric radiographs were used to assess 16 soft tissue variables. The data were analyzed via paired and independent t tests, with the significance level set at p  < 0.05. Both ATB and CTB significantly improved facial convexity and mentolabial angles, with no significant difference between the groups ( p  < 0.05). The CTB group presented significant upper and lower lip retraction relative to the Ricketts’ E-line, whereas the ATB group did not, with no significant difference between the groups ( p  < 0.05). Holdaway analysis indicated significant soft tissue improvement in both groups. Notably, the ATB group demonstrated greater advancement in the lower lip sulcus ( p  = 0.02) and less nasal prominence ( p  = 0.03) than did the CTB group. No serious harm was reported. Functional treatment with both appliances caused favorable soft tissue changes. However, The ATB appliance demonstrated more advantageous outcomes in enhancing the concavity of the lower labial sulcus. Trial Registration: NCT05418413 (14/06/2022).

Artificial intelligence (AI) has been utilized in soft-tissue analysis and prediction in orthodontic treatment planning, although its reliability has not been systematically assessed. This scoping review was conducted to outline the development of AI in terms of predicting soft-tissue changes after orthodontic treatment, as well as to comprehensively evaluate its prediction accuracy. Six electronic databases (PubMed, EBSCO host , Web of Science, Embase, Cochrane Library, and Scopus) were searched up to March 14, 2023. Clinical studies investigating the performance of AI-based systems in predicting post-orthodontic soft-tissue alterations were included. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Joanna Briggs Institute (JBI) appraisal checklist for diagnostic test accuracy studies were applied to assess risk of bias, while the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was conducted to evaluate the certainty of outcomes. After screening 2500 studies, four non-randomized clinical trials were finally included for full-text evaluation. We found a low level of evidence indicating an estimated high overall accuracy of AI-generated prediction, whereas the lower lip and chin seemed to be the least predictable regions. Furthermore, the facial morphology simulated by AI via the fusion of multimodality images was considered to be reasonably true. Since all of the included studies that were not randomized clinical trials (non-RCTs) showed a moderate to high risk of bias, more well-designed clinical trials with sufficient sample size are needed in future work.

This review evaluated literature on soft tissue changes in patients following bilateral sagittal split osteotomy (BSSO) for mandibular advancement or setback. Twenty published articles were identified for further analysis. The included articles related to patient cohorts ranging between 12 and 109 participants, the age range of 14–68 years, with a majority of female patients, and follow-up periods in the range of 6–114 months. The primary outcomes were soft tissue changes in the cephalometric soft tissue points; pogonion (Pg'); menton (Me'); labrale inferius (Li); and mentolabial fold (B'). Soft-to-hard tissue ratios varied widely across both conventional and alternative mandibular procedures, with higher ratios observed for advancement in the conventional group. For example, at pogonion (Pg’) in advancement cases, ratios ranged from 80 – 133%. This study highlights the complexity of soft tissue changes following bilateral sagittal split osteotomy (BSSO). The variability seen in outcomes underscores the need for longer follow-up periods and surgery after skeletal growth has waned. Despite the valuable insights gained from the literature, considerable variability underscores the influence of skeletal relapse, age, and fixation type. Standardized long-term 3D studies are warranted to refine predictive models when isolated BSSO is performed.

Background Increased interest in intraoral devices like Bionator III, reverse twin block, and removable mandibular retractor (RMR), which modify tissues beneficially. The emerging Orthodontic Removable Traction Appliance (ORTA™) or the lower-clear-plate-based intermaxillary traction (LCP-IMT) has shown promising results, especially in stimulating maxillary growth and inhibiting mandibular growth in Class III malocclusion. Objectives To evaluate the effectiveness of the LCP-IMT against the RMR during the early correction of Class III deformities in growing patients regarding skeletal, dental, and soft tissue variables. Methods A two-arm randomized controlled clinical trial was conducted from July 8, 2023, to June 15, 2024, at the Department of Orthodontics, University of Damascus. It enrolled patients aged 9 to 13 with mild to moderate skeletal Class III malocclusion (ANB + 1 to -3 degrees), an anterior crossbite involving two or more teeth, or an edge-to-edge relationship. Participants had normal or horizontal growth patterns (MM ≤ 35; SN.ManP ≤ 40) and lower incisor inclination (IMPA 85–100 degrees). Patients were randomly assigned to receive orthodontic treatment with either the LCP-IMT or the RMR appliance. Standardized lateral cephalometric images were collected before treatment (T1) and after active treatment (T2), using specialized orthodontic software (Viewbox). Soft- and hard-tissue changes in both groups were evaluated. Blinding was limited to data analysis due to feasibility constraints. Results The sample consisted of 30 patients (12 males and 18 females) ( n  = 15 for each group). All 30 patients were included in the analysis. Skeletal cephalometric analysis revealed no statistically significant differences between the LCP-IMT and RMR groups across all variables ( P  > 0.05), despite slightly greater SNA and ANB changes in the LCP-IMT group. Dentally, both groups showed favorable outcomes; however, the RMR group exhibited significantly greater lower incisor lingual inclination (L1.ManP: − 7.66° vs. − 5.05°, P  = 0.016). Differences between the two groups in overjet, overbite, and soft tissue parameters—including upper lip protrusion and nasolabial angle did not reach statistical significance. Conclusions Both appliances produced comparable short-term dental and soft-tissue improvements; a between-group difference in lower-incisor inclination favored LCP-IMT. These preliminary results require confirmation in larger and longer-term trials. Trial registration This study was retrospectively retrospectively registered in the Clinical Trials database (ID: NCT06596239) on the 11/09/2024. URL: https://clinicaltrials.gov/study/NCT06596239 .

Aim. To investigate the effect of changes in incisor tip, apex movement, and inclination on skeletal points A and B and characterize changes in skeletal points A and B to the soft tissue points A and B after incisor retraction in Angle Class I bimaxillary dentoalveolar protrusion. Methods. Twenty-two patients with Angle Class I bimaxillary dentoalveolar protrusion treated with four first premolar extractions were included in this study. The displacement of skeletal and soft tissue points A and B was measured using cone-beam computed tomography (CBCT) using a three-dimensional coordinate system. The movement of the upper and lower incisors was also measured using CBCT-synthesized lateral cephalograms. Results. Changes in the incisal tip, apex, and inclination after retraction did not significantly affect the position of points A and B in any direction (x, y, z). Linear regression analysis showed a statistically significant relationship between skeletal point A and soft tissue point A on the anteroposterior axis (z). Skeletal point A moved forward by 0.07 mm, and soft tissue point A moved forward by 0.38 mm, establishing a ratio of 0.18: 1 (r = 0.554, p < 0.01). Conclusion. The positional complexion of the skeletal points A and B was not directly influenced by changes in the incisor tip, apex, and inclination. Although the results suggest that soft tissue point A follows the anteroposterior position of skeletal point A, its clinical significance is suspected. Thus, hard and soft tissue analysis should be considered in treatment planning.

ObjectivesThis study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy.Materials and methodsPatients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect.ResultsA total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0–T1 (p = 0.02), T0–T2 (p = 0.03), and T0–T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group.ConclusionsWe found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback.Clinical relevanceIt is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism.

Background The increased resistance of midpalatal, zygomaticomaxillary, and pterygopalatine sutures over time reduces the dentofacial orthopedic effect of conventional expanders. To address this, mini-screw-assisted rapid palatal expanders have been developed. The aim of this study was to investigate the mid-facial soft tissue changes along with rotational movements of zygomaticomaxillary complex after maxillary skeletal expander 2 (MSE 2) application. Methods Pre- and post-expansion CBCT images of 17 patients (10 female, 7 male) with transversal maxillary deficiency and treated with MSE 2, were enrolled in this retrospective study. Eight skeletal angular measurements were performed in the coronal and axial zygomatic sections. Besides, nineteen linear and three angular soft tissue measurements were investigated in the midsagittal plane. All the measurements were performed using OnDemand3D software. Paired t-test was used to compare the pre- and post-expansion outcomes. Results In the coronal zygomatic section, the decrease in frontoethmoidal angle (-2.39°, p  = 0.006) and increases in frontozygomatic (R:3.04° ( p  = 0.001); L:3.01° ( p  = 0.001)) and zygomaticomaxillary (R:1.36° ( p  = 0.001); L:1.22° ( p  = 0.05)) angles revealed the outward rotation of the zygomaticomaxillary complex. The increase in maxillary inclination (R:2.75° ( p  = 0.001); L:2.76° ( p  = 0.003)) showed the downward rotation of zygomaticomaxillary complex. The increases in frontozygomatic, frontoalveolar (R:2.77° ( p  = 0.001); L:2.64° ( p  = 0.001)) and frontodental (R:2.49° ( p  = 0.001); L:2.07° ( p  = 0.001)) angles represented greater skeletal expansion and minimal alveolar bone bending and dental tipping. Soft tissue measurements revealed significant increase in upper (1.47 mm ( p  = 0.002)) and lower (1.56 mm ( p  = 0.009)) face heights, alar nasal width (R: 0.67 mm ( p  = 0.001); L: 0.95 mm ( p  = 0.002)), nasal tip protrusion (0.83 mm ( p  = 0.03)), vertical philtrum height (0.25 mm ( p  = 0.037)), and nasal width angle (4.60° ( p  = 0.001)), and a decrease in the facial profile angle (2.49° ( p  = 0.037)). Conclusion Downward and outward rotation of the zygomaticomaxillary complex around the fulcrum area above the superior aspect of the frontozygomatic suture resulted in significant soft tissue changes in the paranasal and nasal regions.

Background: Immediate implant placement in the esthetic zone, particularly in Class II extraction sockets with partial facial bone loss, presents challenges in achieving soft and hard tissue stability. Customized computer-aided design/computer-aided manufacturing (CAD/CAM) titanium abutments may offer advantages over prefabricated stock abutments. This study compared the clinical, radiographic, and patient-reported outcomes of customized CAD/CAM titanium abutments versus stock Laser-Lok stock abutments. Materials and methods: In a single-center, double-blind randomized clinical trial, 48 patients received immediate maxillary anterior implants restored with either customized CAD/CAM titanium abutments (n = 24) or stock titanium abutments (n = 24). Primary outcomes included peri-implant probing depth (PD), mucosal height, Pink Esthetic Score (PES), crestal bone level changes, and patient satisfaction assessed at baseline, 6, and 12 months post-loading. Statistical analysis included effect sizes and 95% confidence intervals. Results: At 12 months, the customized abutment group showed significantly shallower PD (mean difference: −0.54 mm; 95% CI: −0.72 to −0.35; p < 0.001), higher PES (12.21 ± 0.35 vs. 10.41 ± 1.17; p < 0.0001; Cohen’s d = 2.08), and less crestal bone loss (1.75 ± 0.36 mm vs. 2.33 ± 0.52 mm; p < 0.0001). Patient satisfaction scores were also higher in the customized group (p = 0.003). Within-group improvements were observed in both groups over time. No implant failures occurred. Conclusions: At 1-year follow-up, customized CAD/CAM titanium abutments demonstrated improved peri-implant soft tissue parameters, esthetics, and patient satisfaction compared to stock abutments. While these findings support their use in esthetically demanding immediate implant cases, the short-term duration and single-center design warrant further long-term multicenter studies to confirm durability. Trial registration: Registered at ClinicalTrials.gov on 19/01/2025 (NCT06791655).