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Final DR Manish
Final DR Manish
To begin with, I thank the most merciful and compassionate, the ALL MIGHTY GOD.
An enterprise such as this can only be accomplished with proper guidance, assistance
and encouragement which I received by my guide Dr.P.P.BISWAS, Associate Professor,
Department of Orthodontics and Dentofacial Orthopaedics, Bapuji Dental College and
Hospital, Davangere. His valuable suggestions not only during this dissertation but entire my
post-graduation brought me to this stage.
It is with utmost sincerity and deep sense of appreciation that I thank my beloved
teacher Dr.K.SADASHIVA SHETTY, Principal, Professor and Head, Department of
Orthodontics and Dentofacial Orthopaedics, Bapuji Dental College and Hospital, Davangere.
A mere word of thanks is not sufficient to express his unflinching support, keen
surveillance, inestimable aid, and continued inspiration during the preparation of this
dissertation. He has enlightened me about the absorbing and stimulating world of
orthodontics with his truly encyclopedic knowledge and experience. During these three
years of post graduation his demands for perfection set a strong foundation on learning the
basics, logical thinking and working systematically in every aspects of my life. As his
postgraduate student, I have not only gained knowledge but also other humane qualities of
life.
His discipline, principles and scientific approach to his art of orthodontics shall always
be my guiding start to follow his trodden path in the quest for perfection. I am indeed
fortunate to be among the few who have had the honour of being his disciple, for which I will
be ever grateful. Last, but not the least, I require his blessings forever, before I venture out
into this competitive world.
I am indebted to Dr.RAMANJULU T., Dr.DIVAKAR K., Associate Professors for their
efficacious guidance and altruistic co-operation and support throughout my post-graduation
course.
I am very grateful to Dr.ALIREZA JAFARI NAIMI, Dr.JEBBY JACOB,
Dr.KRISHNAKANTH REDDY, Dr.ASHUTOSH SHETTY, Dr.PRASHANTH C.S., Dr.SUNIL
SUNNY, Assistant Professors who were very helpful, cheerful and encouraging in the
preparation of this dissertation.
I am thankful to Mr.SANGAM B.K., Bio-Statistician, J.J.M. Medical College,
Davangere for his service in carrying out the statistical analysis.
I also thank Mr.Surendra of M/s.DYNA COMPUTERS and Mr.Vamshi of M/s.
PACE COMPUTERS for organization and neat typing of this manuscript.
My special thanks to my friend Dr.AMIT SHAIKH, who has helped me in and out in
the preparation of this dissertation. I am thankful to Dr.ASHISH GUPTA, for helping me to
present this dissertation in a neat form.
A lot of thanks and appreciation to all my colleagues and non-teaching staff for being
with me and helping me directly or indirectly throughout the course.
Finally words are not suffice to express my gratitude to my PARENTS, My brother
Mr.AMARISH GOYAL and my wife Dr. NEELAM GOYAL It is their love, prayers and
sacrifices that made my education possible. Thank you all for being there.
Dr.MANISH GOYAL
1
CONTENTS
PAGE NO.
1. INTRODUCTION 01
2. AIMS AND OBJECTIVES 03
3. REVIEW OF LITERATURE 04
4. MATERIALS AND METHODS 16
5. RESULTS 28
6. DISCUSSION 52
7. SUMMARY AND CONCLUSION 55
8. BIBLIOGRAPHY 56
2
LIST OF ILLUSTRATIONS
PHOTOGRAPHS :
Armamentarium used in this study.
FIGURES :
1. Hard-Tissue Analysis (Angular parameters)
2. Hard-Tissue Analysis (Linear Parameters)
3. Soft-Tissue Analysis (Angular Parameters)
4. Soft-Tissue Analysis (Linear Parameters)
5. Dental Analysis (Angular and Linear parameters)
TABLES :
TABLE 1 Skeletal Measurements (Angular)
TABLE 2 Skeletal Measurements (Linear)
TABLE 3 Soft Tissue Measurements (Angular)
TABLE 4 Soft Tissue Measurements (Linear)
TABLE 5 Dental Measurements
TABLE 6 Linear Sagittal Changes of Soft Tissue Landmarks after movements of skeletal
landmarks (Expressed in percentage)
SUPERIMPOSITIONS OF INDIVIDUAL SUBJECTS :
Basion-Nasion Line registered at CC point.
Superimposition :I
Superimposition : II
Superimposition : III
Superimposition : IV
Superimposition :V
Superimposition : VI
Superimposition : VII
Superimposition : VIII
BARGRAPHS :
Graph I : Angles : SNB, ANB, N-A/Pg-A
Graph II : Angles : MP-HP, N-Pg/FH
Graph III : Linear : N-B (11 HP), N-Pg (11 HP), N-Pg (11FH)
Graph IV : Linear : ANS – Mn, Go to Pg
Graph V : Angles : G-Sn-Pg’, Sn-Gn-C, Cm-Sn-Ls
Graph VI : Angles : Ns-Pg’/FH, Ns-Pg’/Pg’-Ls, Li-Ils/FH, Sn-Ls/FH
3
Graph VII : Linear : G-Pg’, G-Sn and Sn-Mn (⊥HP), Sn-Gn and Gn-C
Graph VIII : Linear : Li to (Sn-Pg’), Ils to (Li-Pg’), E-line
Graph IX : Linear : Pg-Pg’, Ls-U1/Sls-A, Sls-Ls
Graph X : Isi-Isa/Iii-Iia, Iii/Isi (Hor), Iii/Isi (vert)
Graph XI : Iii-Iia/MP, Iii/A-Pg
1
INTRODUCTION
The facial deformity caused by mandibular prognathism has long been of great mutual
interest to the orthodontist and the oral surgeon. The deformity of the lower jaw is readily
expressed as a profile disfigurement, since the soft tissues of the face depend on the lower
jaw for much of their contour. The dental literature is replete with various surgical techniques
for the correction of mandibular prognathism.
The selection of the proper type and site of osteotomies in orthognathic surgery is
based on the extent of the dentofacial deformity, the degree of the desirable jaw movement,
and the anticipated soft-tissue changes following surgical intervention. Improvement of the
stomatognathic function is a major reason for seeking combined orthodontic surgical therapy,
but the consequences of surgery on facial appearance are of great importance, even for the
patient whose chief complaint is not dominated by the cosmetic rationale.
Therefore an accurate prediction of the postoperative facial profile comprises an
essential and integral part of the diagnostic and treatment planning procedures of the
combined surgical orthodontic therapy.
Surgical correction of Class III dentofacial deformities may be accomplished by
maxillary advancement, mandibular setback, or bimaxillary procedures. In some instances,
the choice between these procedures is not straight forward. While any of these approaches
are usually equally effective in correcting the dental malocclusion, each procedure affects the
patient’s appearance differently, with only 1 resulting in the most esthetically pleasing profile.
During the last 20 years, several cephalometric investigations have reported on the
alterations of the soft tissue profile that accompany mandibular setback, thus enlightening
our understanding of the interplay between dentoosseous and soft tissues and providing data
for predicting postsurgical soft tissue response.
However, soft tissue response after mandibular set back osteotomies is in many
instances subject to individual variation, and the predictability of soft tissue changes is not a
precise science.
Alterations of the soft tissue profile that accompany mandibular setback surgery have
been addressed by several studies. While there is general agreement on the anticipated
average impact of surgery, little is known about the influence of factors such as gender,
presurgical facial morphology, soft tissue tonicity, magnitude of surgical repositioning and
skeletal relapse on soft tissue response. Knowledge of possible effects of these variables
could improve the accuracy of presurgical predictions.
2
The aims of the present cephalometric study were (1) to describe the
interrelationships of the soft tissue and dentoskeletal profiles following total mandibular set
back osteotomies and (2) to detect whether there were cephalometric variables that could
contribute to an accurate prediction of the surgical effect on the soft tissue profile.
3
Pg’:Pg = 1.06:1 for the females and they concluded that the changes in soft tissue
were closely correlated with the hard tissue movement after surgical setback of mandible.
The average ratios of soft tissue to hard tissue change in horizontal direction appear to show
a gender difference, which suggests the need for different ratios when predicting the results
of orthognathic surgery.
Mobarak K.A. et al (2001)26 assessed long term changes in the soft tissue profile
following mandibular setback surgery and investigated the presence of factors that may
influence the soft tissue response to skeletal repositioning. The subjects enrolled were 80
consecutive mandibular prognathism patients operated with bilateral sagittal split osteotomy
and rigid fixation. Lateral cephalograms were taken at 6 occasions; immediate presurgical,
immediate postsurgical, 2 and 6 months postsurgical, and 1 and 3 year post surgical.
Females generally demonstrated greater ratios than males with a statistically significant
difference for the upper lip and chin (P<.05). Postsurgical alterations in the profiles were
more predictable in patients with larger setbacks compared to patients with smaller ones.
16
MATERIALS AND METHODS
1. DATA COLLECTION :
Pre-treatment, Pre-surgical and post-surgical lateral cephalograms of 8 adult patients
who had been treated successfully at Department of Orthodontics and Dentofacial
Orthopedics, Bapuji Dental College and Hospital, Davangere were obtained. The age group
of these patients ranged from 17 to 25 years, with a mean age of 21 years. Post-surgical
cephalograms were taken two months following surgery. All the patients used in the study
were treated by Pre-adjusted Edgewise appliance for pre-surgical decompensation with or
without extractions. Bilateral sagittal split osteotomy for mandibular set back procedure was
carried out under the supervision of a single surgeon.
2. MATERIALS USED IN THE STUDY :
1. Standardized pre-treatment, pre-surgical and post-surgical cephalograms.
2. 0.3 mm acetate tracing paper
3. 0.3 mm lead pencil.
4. Geometry Box (Scale, Protractor, Setsqures, Eraser, Sharpener).
5. Scotch tapes
6. Tracing board
7. Black, green and red pilot pens
8. Scissors and calculator
3. CRITERIA FOR SELECTION OF PATIENTS :
The primary selection criterion were :
1. Patient was a non-growing adult.
2. Patient had a natural dentition supporting the lips.
3. Patient demonstrated a severe class III skeletal malocclusion with an ANB of -1 to -5 and
prognathic mandible for which surgical intervention was necessary.
4. Mandibular setback procedure was carried out by bilateral sagittal split technique and in
two of the cases genioplasty was also performed.
The technique employed in taking the cephalograms was as follows :
1. All radiographs of each subject were taken using the same machine.
2. Each cephalogram was taken with the patients teeth in habitual occlusion and lips at rest
position.
17
4. ANALYSIS OF LATERAL CEPHALOGRAMS :
Profile cephalograms were taken in occlusion under standardized conditions with a
cephalostat. Among the various surgical cephalometric analysis for estimating the amount of
hard and soft tissue changes, the Legan Burstone, Steiner’s, McNamara, Rickett’s,
Holdaway and Rokosi Jarabak analysis were employed in this study. These analysis include
certain angular and linear measurements for both hard and soft tissues, which were easily
applicable for the study.
The various hard tissue landmarks include :
1. Sella (S) : The point representing the geometric center of the pituitary fossa (Sella
turcica).
2. Nasion (N) : the most anterior point of the frontonasal suture in the mid sagittal plane.
3. Subspinale (A) : The deepest point in the mid sagittal plane between the anterior nasal
spine and prosthion, usually around the level of and anterior to the apex of the maxillary
central incisors.
4. Pogonion (Pg) : The most anterior point in the midsagittal plane of the contour of the chin.
5. Supramentale (B) : The deepest point in the mid sagittal plane between infradentale and
pogonion, usually anterior to and slightly below the apices of the mandibular incisors.
6. Anterior nasal spine (ANS) : the most anterior point of the nasal floor, the tip of the pre-
maxilla in the mid sagittal plane.
7. Menton (Mn) : The lowest point on the contour of the mandibular symphysis.
8. Gnathion (Gn) : The midpoint between pogonion and menton located by bisecting the
facial line N-Pg and the mandibular plane.
9. Mandibular plane (MP) : A plane constructed from menton to the gonion of the mandible.
10. Gonion (Go) : Located by bisecting the posterior ramal plane and the mandibular plane
angle.
11. Horizontal plane (HP) : A plane constructed by drawing a line at 7o from sella nasion
plane. It is a surrogate of Frankfort horizontal plane.
12. Fronkfort horizontal plane (FH Plane) : A plane constructed by drawing a line from porion
to orbital.
13. Sella nasion plane (SN Plane) : A plane constructed by drawing a line from sella to
nasion.
18
The soft tissue landmarks include :
1. Glabella (G) : The most prominent point in the mid sagittal plane of the forehead.
2. Columella point (Cm) : The most anterior point on the columella of the nose.
3. Subnasale (Sn) : The point at which the nasal septum merges with the upper cutaneous
lip in the mid sagittal plane.
4. Labrale Superius (Ls) : A point indicating the mucocutaneous border of the upper lip.
5. Labrale Inferius (Li) : A point indicating the mucocutaneous border of the lower lip.
6. Mentolabial sulcus (Ils) : The point of greatest concavity in the midline between the lower
lip and chin.
7. Soft tissue pogonion (Pg’) : The most anterior point on soft tissue chin.
8. Soft tissue Gnathion (Gn) : The constructed midpoint between soft tissue pogonion and
soft tissue menton.
9. Soft tissue menton (Mn') : Lowest point on the contour of the soft tissue chin.
10. Cervical point (C) : The innermost point between the submental area and the neck
located at the intersection of lines drawn tangent to the neck and submental area.
11. Superiorlabial Sulcus (Sls) : The point of greatest concavity in the midline of the upper lip
between subnasale and labrale superius.
12. Nasion soft tissue (Ns) : The point of deepest concavity of the soft tissue contour of the
root of the nose.
13. Pronasale (Pn) : The most prominent point of the nose.
5) Iii/A-Pg : The linear distance between the line from A to Pg and Iii. It evaluates the lower
incisor inclination in relation to maxilla and mandible.
22
Paired t-test
P<.05, P<.01 Significant (S)
P<.001 Highly Significant (HS)
P>0.05 Not significant (NS)
34
SKELETAL MEASUREMENTS
Linear (mm)
Ls Li Ils Pg’
Pre-Treatment
Pre-Surgical
Post-Surgical
Pre-Treatment
Pre-Surgical
Post-Surgical
Pre-Treatment
Pre-Surgical
Post-Surgical
Pre-Treatment
Pre-Surgical
Post-Surgical
CASE : 5
Pre-Treatment
Pre-Surgical
Post-Surgical
CASE : 6
Pre-Treatment
Pre-Surgical
Post-Surgical
CASE : 7
Pre-Treatment
Pre-Surgical
Post-Surgical
Pre-treatment
Pre-Surgical
Post-Surgical
GRAPH - I
SNB ANB N-A/Pg-A
4.75 4.625
5
4 3.25
2.50
3
1 0.25 0.125
-0.75
-1
-2
-3
-4
-4.38 -4.63
-5
GR APH - II
MP-HP N-Pg/FH
0.75 0.75
1
0
-0.50
-1
-2
-3
-4
-4.13
-4.63
-5
GRAPH - III
N-B(||HP) N-Pg(||HP) N-Pg(||FH)
0.75
1.00
0.00
-0.63 -0.50
-1.00
-2.00
-3.00
-3.50
-4.00 -3.88
-4.13
-4.38 -4.38
-5.00 -5.13
-6.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
GRAPH - IV
ANS-Mn Go to Pg
0.38
0.50 0.00
0.00
-0.25
-0.50 -0.63
-1.00
-1.50
-2.00
-2.50
-3.00
-3.50
-4.00
-5.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1
49
GRAPH - V
G-Sn-Pg' Sn-Gn-C Cm-Sn-Ls
5.00
4.75
5.00
4.25 4.25
3.63
4.00
3.38
3.00
2.00
1.00 0.50
0.00
-0.25
-0.75
-1.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
GRAPH - VI
Ns-Pg'/FH Ns-Pg'/Pg'-Ls Li-Ils/FH Sn-Ls/FH
4.00 3.50
3.00
3.00
2.00
1.13
1.00 0.25
0.00
-0.50
-1.00
-1.25
-2.00 -1.88
-3.00
-3.25 -3.13
-4.00 -3.88
-4.13
-4.38
-5.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
50
GRAPH - VII
G-Pg' G-Sn & Sn-Mn(|_HP) Sn-Gn & Gn-C
0.50 0.13
0.00 0.01 0.00 0.07 0.07
0.00 0.00
-0.50
-1.00
-1.50
-2.00
-2.50
-3.00
-3.50
-4.00 -4.00 -4.13
-4.50
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
GRAPH - VIII
Li to(Sn-Pg') Ils to (Li-Pg') E-Line
2.00
1.50
0.88
1.00 0.74
0.50
0.00 0.00
0.00
-0.11
-0.50
-0.88 -0.85
-1.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
GRAPH - IX
Pg-Pg' Ls-U1/Sls-A Sls-Ls
1.00
0.50
0.04 0.13
0.00 0.05
0.00 -0.01
-0.50
-1.00
-1.25
-1.38
-1.50
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
51
GRAPH - X
Isi-Isa/Iii-Iia Iii/Isi(Hor) Iii/Isi(VerT)
5.00 5.00
5.00
4.25
4.00 3.50
3.00
2.00
1.00
0.75
1.00 0.38
0.00
-0.63
-1.00
-1.50
-2.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1 T1-T T2-T T2-T1
GRAPH - XI
Iii-Iia/MP Iii/A-Pg
6.38
7.00
5.38
6.00
5.00
4.00
2.38
3.00
2.00 1.00
0.25
1.00
0.00
-1.00
-2.00 -2.13
-3.00
T1-T T2-T T2-T1 T1-T T2-T T2-T1
52
DISCUSSION
The untreated mandibular prognathism patient presents with a discrepancy in jaw size
or position between the maxilla and the mandible. Commonly, the teeth are partially
compensating for the discrepancy. The mandible is relatively too far anterior and
consequently the lower incisors are usually tipped posteriorly. The maxillary incisors are
more variable but most often are anteriorly inclined in varying degrees.
Orthodontic correction alone of such a problem must be designed to push these
dental compensations to even greater amounts. Clearly, this is often an unstable and
esthetic compromise when gross discrepancies in jaw size or position exist. In the
orthodontic surgical approach the presurgical orthodontic objectives are just the opposite. All
dental compensations are removed. When the teeth are appropriately related to their
respective jaws, the jaw to jaw discrepancy will appear clinically more severe. This is not only
desirable but beneficial to treatment. The interdigitation requirements of the dentition
determine the positioning of the jaws at surgery. Surgery done in the presence of abnormal
tooth positions will result in jaw positioning dictated by these same tooth positions. Usually
this will mean only a partial correction of the mandibular prognathism. If the discrepancy has
been temporarily worsened by removing dental compensations, the surgery can fully correct
the jaw imbalance.
Class III patients typically have a concave profile characterized by an upper lip with a
turned up contour that is too far behind the esthetic line, small nasolabial angle, a protrusive
lower lip, and a poorly defined mentolabial fold.
The first report of a surgical procedure used in the correction of a mandibular
deformity was by Hullihen in 1849.1 He described an osteotomy procedure which effectively
lengthened the body of the mandible. In 1898 Blair,1 who pioneered the surgical correction
of mandibular prognathism, presented a report on a resection of the mandible in the bicuspid
area, a procedure which severed the nerve and blood supply of the mandible.
In early 1960’s surgical procedures for mandibular prognathism became common after
intraoral approach to orthognathic surgery was popularized by European surgeons,
particularly Trauner and Obwegeser.33 Modifications in osteotomy design, the evolution of
special instrumentation for stabilization and the versatility of the procedure for fixation
allowed for corrections in three planes of space making the sagittal split osteotomy, the
mandibular procedure most often performed today.
The basic osteotomy pattern includes horizontal cuts through the mandibular cortical
bone first on the medial side above the lingula, down the anterior ramus on to the superior
aspect of body of the mandible and then curving inferiorly through the cortical plate including
53
the inferior border. These cuts may be made with a rotary instrument or with the
reciprocating saw and should extend only through the cortex and slightly into the medullary
bone. Following these basic principles, bony parts were reduced into the desired position,
stabilized and then fixed by rigid internal fixation. The main advantages of this form of fixation
compared to intermaxillary one are;
1. Shorter period of intermaxillary immobilization and
2. Primary bone healing is attained by the use of compression allowing the union of bony
fragments to take place much earlier.
When properly managed, rigid fixation techniques are exacting and leave little room
for error in planning or performance of the surgical procedures.
In general, posterior repositioning of the mandible by bilateral sagittal split osteotomy
yields a significant change at the chin, labiomental fold and the lower lip selective to the
antero-posterior bone change and in contrast a mild posterior movement of the upper lip.
The upper lip retruded and lengthened after mandibular setback surgery as shown by
other studies (Lines and Steinhauser, 20%; Hershey and Smith, 20%; Kajikawa, 15% to
25%; Gjorup and Athanasiou, 16%; Bengt Ingerwal, 23% ; Karim Mobarak, 25%).
In the present study the upper lip, retruded an average of 20% and 14% of the
setback of point-B and Pogonion respectively.
Assessment of the results of the present study demonstrated that considerable facial
changes and improvement took place following the mandibular setback. The skeletal and soft
tissue facial profiles were straightened and posture of lips was improved. The normal incisal
relationship that was achieved became influential on the soft tissues overlying both incisors
and led to better lip competence and posture.
The upper part of the lower lip generally does not follow the setback of the hard tissue
as closely as the labial fold or the soft tissue chin follows the hard tissues. In other studies
the net effect for the lower lip has been found to vary between 66% and 105% (Bjork et al
92% to 105%, Lines and Steinhauser, 75%, Hershey and Smith 98%, Suckiel and Kohn
83%, Kajikawa, 66% to 75%, Group and Athanasiou, 93%, Bengt Ingervall, 88%; Karim
Mobarak, 100%).
In the present study the lower lip followed the point-B and pogonion by 83% and 69%
respectively.
An additional factor was the relative deeping of mentolabial fold in relation to hard
tissue structures as reported by several authors (Kojikawa, 92% to 112% ; Gjorup and
Athanasiou, 103%; Bengt Ingerval, 106%; Karim Mobarak 100%). The soft tissue chin and
mentolabial fold generally follow their corresponding bony structures in about 1:1 ratio.
54
The present study showed that posterior movements at point-B and pogonion was
accompanied by deepening of mentolabial sulcus by 96% and 82% respectively.
The effects on the soft tissue chin due to hard tissue changes as described in other
studies are Bjork et al 88% - 97%, Liner and Steinhauser, 100%; Messley and Smith, 90%;
Suckiel and Kohn, 95%; Kojikawa,80% - 104%; Gjroup and Athanasiou 91%; Bengt
Ingervall,107%; Karim Mobarak 94%.
In the present study the posterior movement of soft tissue chin following point-B and
pogonion was 97% and 87% respectively. While there was increase in the soft tissue chin
thickness.
A study of this kind may contain a certain amount of inherent error in the form of
radiograph tracing error, differences in muscular tonus on radiographs of the same patient,
and error in locating the rather vaguely defined soft tissue landmarks. This type of error may
mask or exaggerate the relatively small changes in soft tissue.
It appears reasonable to assume that, with further cephalometric investigation of all
the various aspects of the surgical correction of mandibular prognathism, a more objective
diagnosis and prognosis could be made.
55
SUMMARY AND CONCLUSION
A sample of 8 patients were evaluated retrospectively after an average of 2 months of
surgical setback of the mandible. The age group of these patients was from 17 to 25 years
with a mean age of 21 years. The purpose of this study was to see how closely the soft
tissues are related to the underlying skeleton after mandibular setback osteotomy. Pre-
treatment, Pre-surgical and post-surgical lateral cephalograms were taken in habitual
occlusion with lips at rest position. The surgical technique performed was bilateral sagittal
split osteotomy for mandibular setback with rigid internal fixation. Various hard and soft
tissue, angular and linear parameters from Legan-Burstone, McNamara’s, Steiner’s,
Rickett’s, Holdaway and Rokosi’ Jarabak analysis were employed in this study to compare
the pre-treatment, pre-surgical and post-surgical lateral cephalograms of the patients treated
with mandibular setback osteotomy.
The conclusions indicated from this study were as follows :
1. The facial concavity, in regard to the relationship of the hard and soft tissue chin to the
upper face, was decreased by this surgical procedure; facial esthetics was improved.
2. The mandible was repositioned posteriorly in all cases and the lower denture base
assumed a more normal relationship to the upper denture base.
3. The changes in angulation of the skeletal analysis measurements showed varying
degrees of correlation to the posterior displacement of the chin (pogonion).
4. The soft tissue contour of the upper lip, the maxillary sulcus of the upper lip, the lower lip,
the mandibular sulcus of the lower lip, and the soft tissue chin were altered by the
surgical procedure.
5. The least amount of change of the soft tissue profile was exhibited by the upper lip and
maxillary sulcus of the upper lip. There was a tendency for the upper lip to be slightly
posteriorly displaced, and the maxillary sulcus contour of the upper lip to become more
obtusely angulated after the surgical procedure.
6. The greatest amount of change of the soft tissue profile was exhibited by the lower lip, the
mandibular sulcus of the lower lip, and the soft tissue chin. The lower lip and the soft
tissue chin were posteriorly displaced in all cases with a tendency for a downward
displacement. There was also a tendency for the mandibular sulcus contour of the lower
lip to become more acutely angulated.
7. The lower lip and the soft tissue chin, being posteriorly repositioned in all cases, assumed
a better esthetic relationship to the rest of the soft tissue profile.
BIBLIOGRAPHY
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3. Athanasiou A.E., Melsen B., Mavreas D. and Kimmel F.P. : Stomatognathic function of
patients who seek orthognathic surgery to correct dentofacial deformities. The
International Journal of Adult Orthodontics and Orthognathic Surgery. 1989 ; 4 (4) : 239-
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