Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients

Abstract

Objectives: To assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances. Subjects and methods: The study sample consisted of 36 pairs of pre-and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed. Results: The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (F = 0.91; P = 0.526; Wilks lambda = 0.93), raters (F = 1.68; P = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results (F = 0.72; P = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length. Limitations: Retrospective study design. Conclusions: The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient's facial appearance when this treatment option is used.

Valid 3D surface superimposition references to assess facial changes during growth

“…A small rectangular area on the forehead plus an area including the middle part of the nose and the lower wall of the orbital foramen (Area 4) was found to show morphological stability, adequate reproducibility, and comparable results to the golden standard technique. Though close to the facial center, this area is located towards the upper third of the face, allowing for proper assessment of the middle and lower parts of the face which are primarily affected by treatment and growth 39 , 40 , and show the highest variation in the human face 41 . This superimposition reference is similar to that recommended by the 3dMD camera manufacturer, consisting of an analogous forehead area and the nasal bridge 12 , 42 .…”

Valid 3D Surface Superimposition References to Assess Facial Changes During Growth

“…A small rectangular area on the forehead plus an area including the middle part of the nose and the lower wall of the orbital foramen (Area 4) was found to show morphological stability, adequate reproducibility, and comparable results to the golden standard technique. Though close to the facial center, this area is located towards the upper third of the face, allowing for proper assessment of the middle and lower parts of the face which are primarily affected by treatment and growth 37,38 , and show the highest variation in the human face 39 . This superimposition reference is similar to that recommended by the 3dMD camera manufacturer, consisting of an analogous forehead area and the nasal bridge 16,40 .…”

A non-cephalometric two-dimensional appraisal of soft tissue changes by functional therapy in Class II patients: a systematic review and meta-analysis

“…A total of 313 patients were treated with FA. Two studies did not report the male to female ratio (10,11), two studies used perfectly balanced treatment groups (12,13) and two had an abundance of respectively male and female patients (14,15). All studies used a Class II molar relation as inclusion criterion.…”

“…The different FA used can be retrieved in Table 1. Five of the included studies used control groups (10,12,13,15,16).…”