Soft Tissue Changes Associated with Orthognathic Surgery ‘Norman J. Bets, DDS, MS, and Kieran F. Dowd, MD ‘The prinipsl gost of orthognathle surgery is the establishment of «balanced and stable Gentkelofacl complex One. ofthe ebjectives to this end i the Schivement of a8 esheteally pleasing focal soft tue envelope. This mandates That the surgeon be actly aware ofthe soft tsue response othe orthodontic and the face. Chowe alabors fon betveensungeon and orthodontist shoud allow forthe correction of destoske- letofacl deforms in order to prove function while optimising facial eset. “Singeal novement ofthe denfl-skelefal component GENERAL CONSIDERATIONS ‘Tere is a plethora of ertare on the subst of soft tssue changes associated swith orthognate surgery. Each investigation that has aempted to deny oF ‘quantify the soft Hams changes associated with orthognathic surgery has Is mers Sind ows. Berase no standardined quantitative or qualitative cera were used in these sti it» dificult to assent tet aifulnes in helping the surgeon identity fd understand the sof tase changes associated wih oscous surgery In at ‘tempt to make some objecive comparsons between methodologically diferent Studley «set of characteristics for the theoretically ideal stdy ofthe soft tissue ‘anges associtsd wth ovthognathle surgery were Menied (Table ). The evalu tion of individual investigations against these eters should help the reader 10 twos their useflnee and vals. This echnigue for assessing the previous itera ihre i lpi and shoolde considered for use in ther areas of sent invest gation” From apm of ey "a Ae, Magen IY, andthe Uneven Mine an Damsry New fre. Nena, 3“ CHANGES ABSOITED WT ORMHOGNATHG SURGERY 2 henge emp 5 Sc te eet twin sg & Bede pre th ace epee. dations) Ein conning te ed geropone cesar ech rove ‘Sie cea ne a pfloyane wt Boel ace-ajd ar meetin deareae SSthaie ce neoonare gen eo eames sm at aod by SHE a8 1 Seton ten poe st si a tan Sree 0 aa 18 xdonono suena epee 1b Sheed ccm rots {Nevers tee canny 03 eon oh sl 5) ‘cringe ame Spy nd Pag, Wes pcan Most of the studies dealing with this subject provide ralios of hard to soft tissue movement. Katie aro average, and only deserbe the relationship of 0 specie points I highly improbable that conastnty aecurte predictions of rk tlsue change can be sctoniplahed wilh ly simple coneatons The compen Ibhavior of the facial soft taaue drape ts ouch more relay desclbed by the ineroction of several factors This may explain some of the eateene Yarabty that ‘many investigators have countered"! Thorfore, al best alls serve to give 2 general appreciation of the expected outcome Some resarchers have tated that 15 aze mulliplesegresion and stepwise regres analysen™ This may be de © Several actos: lack of incon of inprtat variables such a method of st tssie ‘Sosur, and ossous contouring info toi database; a mised sample population ‘ace, age or gender); a sna umber of ptints; or nat to in he sample to specs wats of encour movement A Recent investigations have shown improved predictive ability when patients ‘were grouped by vesorspecie movements ofthe dec epments =" ‘SOFT TISSUE CONSIDERATIONS ‘The abit to predict the soft tssue changes prior 10 an orthognatic surgical procedure ie cote to the ueatment planning procs. With the refinement of Suspleal procedures and the advent of rigid baton tecigues the surgeon able to accurately rppontion and retain th ono components in 9 planned postion, ‘The soft tissues are another mater, cause the change in sof ssue morphology after combined dethodonie and surgical therapy” i dependent cn several factors Surgical procedurs70% methed of wound closure the new spt arrangement of the skeletal and dental element the adapuve qualites of the ‘oft teauen' growth; onhodomtc vectors of tooth movement lip thik ress” ip tomas ip area: ip contact (competence ip strength inte2p; amount of ore; amount of fatyGasve and muscular; and postoperative a Because of sweling,dssue reditibuton, and functional adaptation, ong term fotowap is naced 1 assess soft tae changes following surge procdure, Most reports suggest thatthe sft tess table after o month period.” ‘ners suggest that at lest 12 month ae reqled Strpal toque and method of woud cloaute have teen shown 10 affect soft tue latalpa For example, the horizontal incon in the “pper abla verte commonly used to gain acest the mail forthe LeFort 1 ‘Rtotoy causes shortening ofthe Up wh loss of veralion and a derese in ip Thickness However theese of etl inilons with a tunneling appronch forthe fine surgical proce shows minimal. postoperative ip changes" In a sty Investigating Ur molt tase response to Manila surgery it appeared that sot thoue Changes wee consistent aid may be more aeted by the type and positon ff te aot taauelncson and methods woed in csure than By the surgically Induced hard tawe change * it has boon shorn by many reeuchers hat thin ips move more predictably than thick pe? Ta theories have Den advanced Yo explain this doy fy. Fin, the actual bulk of «thick lip may have a tendency to absorb a lrge noun of bony advancement without » peeplisle change in sft wssue conto, SEcondy, “dead space” under the lp tay absorb the frst poron of = ony Svancement bere the soft sme fe aflted eg, severe Masilay retrogna: mannan "One of the mor cbtacles to quantification ofthe soft tie changes associated with othognatie surgery has been the inability of two-dimensional analyses such {Bcephalogrmn or photograph to accurately describe the three-dimensionl (-D) Stracres ofthe face However, cent studies ave used pre-and Postoperative Computed tomogaphy and computerized 3D laser scanning to more acartly fate the 2D ot tasuc change in exponse tothe bony movements" The sat {isu ofthe face relatively incompressible, andthe morphologic changes seen in the face ao.9 rent of surgery may be atibted to soft tssue redistotion™™ Scveal vestigate have Cockmerta minimal pontsughal change in the aren of |b inmging teceagues may be tac forthe evaluation anc quaiiicaion of his ‘oft sue et butin. ‘The general rend noted inthe Iteratrg is that the horizontal changes in the oft tious be ofan predictable, where he eral changes are les prediable ‘Ta may be dustostaller movements in the vera pane, and he use of soft and Tard tasue landmarks beter sited for horizontal assesment Ab, hard tisue ‘change es price snd less lable in he vertical censon.‘The cephalometric landmarks shown in Figure 1 will be used to describe the stony Htvon se ard changes Pn et of‘ORTHODONTIC INCISOR RETRACTION “The majority of studies investigating the eft of orthodontie teatment on the perioral soft dsus concern manilary and mandibular incisor retraction. ary stud. Fer in the orthocontic Meratre siesed tht the sof tieue profile was cowly elated to the seletal and dental structures" In a subsequent report, Subtelay” Indicated that not all pars ofthe soft tseue profile direc follow the underying ‘lea pro Burstone” agreed and suggested ata dct relationship between hard and soft tse changes may not alvays oust because of variation in the fhickness of the sft tacues covering the face The effects of growth and develop- ‘ment lange ApobitNakon-Bpoint (AND) differences, posional relationship of the ‘Upper incor onthe lovee ip foverite and vere) and adipoce sue ae other factors tha confue the Hamu an may’ conebute to the grat inaioiual varabty "The changes in the soft tasues astcated with orthodontic movement of the sncisor are coe Table 2 “ibe. SOFT TGGUE CHANGES ASSOCATED WITH ORTHODONTIC ‘Toor MOVEMENT ire sto 09 Tnonanichange eee Upertesornscus Buon 697 SEE nese Upper -07509:1 perpen than (7 enn 053, te prc teres 3! SEES sewer cor eae 05:1 Mey cer on Poa E10) otic dagen Ueno 008 tpn Sm ous et nn mine oe LESSER Review of tse Merature indies that with inckor retraction, the upper ip rotates poserory around the Subnasale* with am associated reduction in the prominence of he lpr relative to ther adjacent sulci" Also, upper lp thickness Increses with maxillary icisor retraction (Iman with 3 mm of Insor retraction =| {mm with 15 mm of incaor retraction). Conlation analysis discloses that upper lp response is sot only elated to the upper incisor retaction, ul also to lower ‘ncsor movemen, mandiula rotation, an the position of the lover lip “The lower ip moves les predictably with retraction of the incisors than does the upper lp? Several theories have been advanced to explain this phenomenon Hershey has theorized that this i because the lower lip is much more sell supporting and aot at dependent on underving incisor support. Other investiga {or blieve tha both the upper and lower Incors have elects on the lower ippesioning (ote the ~1:1 effet of upper incisor retrtion to lower lip retraction {They feel that the upper tech, not the lower, establish the Curve of the lower Ip. ‘Therefore, ifthe upper inane retract more than the Lower se, the Lower lip may splice more posteoly than the lower incisor (156: 1 ~122"7%, 129-18). Another theory is that many factors contbute to the fal positon of ‘he lower lp. This theory supported by correlation analysis, which indates that ‘mandibular rotation has a greater infvence on lover lip response than incisor ‘ovement Spi regression analyse lends farther support 19 ths theory by revealing that there a complex eration between dental movement, mancibul fotation andthe perioral soft asus, a8 well ab complex relationship within the oft tases themecves MAXILLARY SURGICAL PROCEDURES ‘The mort of the soft Usa change afer LeFot [surgery is manifested inthe asl and labial srctures"™" Nasal Structures Movement of the mila does affect the lower aspect of the nasal dor- sum. The genera tend is sedening oF the lar basen all pints regardless ofthe vector of maslary movement’ An amsoiated shortening of the ‘clumelia height, als height and nasal Up proton an boen observed, and the ‘slab angle Gorenes or remain constant in most cases! Fp 2). oe aan eiboumacs Eaieacteobes Eeecum eens Barcsanmanses EE Pan eee See eee eee Spe ‘rg auc of hema Tea ‘rs ton apres ‘Sn ine poe)“le 2 NAGAL EFFECTS OF MANLLARY SURGERY cy suoatp agi vnc Aurtaee Nawal Tip rpanion Donat Wump__ Ane a SARE Sa eT AR To Sp Diterent movements ofthe mavila have ditnct effects on the ns and labia morphology (Tale 3). Superior repositioning of the maxilla causes elevation of the faa ipa wiering of the alr bass?" and a decrease inthe nasolabial angle? Incrion maxillary reposting, prodoces loss of has p supp, downward movement of the solumell and aay Bases, ening of the lip, ad an increase in {he nasolabial ange. Anterior repositioning ofthe maxlla has 3 profound efiect on the nose and upper lip, realing im advancement ofthe upper lp, subrasale, and pron; thinnng of the ip widening ofthe alar bases and an neease in tho Eiprtip break if the aneror nasal spine elf intace® = The asa ip edvances fpproximetely one hal! the distance of the subasale The explanation fr this may te Widening at the ala bae,shich reduces nasal Up protrusion” "The preoperative lar bse width of the nose important in proicting fal postural eater, Narrow noses have been cbserved to widen shore at the alar Ese than brood nose" Inpertant nasal changes sto ave been documented 2s 2 reul of rotation a he asl” An increase ithe oclusal plane ass the nasal tip and a decrsse ofthe nce plane decreas the supzror movement ofthe cal tp" bit Structures Masilry surgery has a significant impact on upper lip morphology and pos tion. The upper ip is attached 4 the nose, and this prevents a 1:1 sof tsi ‘huge The upper lip widens and lengthen tthe pil cols afer manly Surgery.” Shortening 6 the upper ip an lose of exposed vermin can ceca If ‘Va ocure technique not eda he ime of Surgery ™ 19Antrior Segmental Posterior Repositioning ‘The soft tisve changes associated with the maxllay segmental setback ote tomy ince an increase in the nasolabial angle because of psterior ip oun und the submaale=”* lengthening of the upper lip: decrease in Intra fap" and uncuring and retraction ofthe lower ip with toc deren he Afepeh of the infrce abal sulcus" Table. ‘hole SOFT TISSUE CHANGES ASSOCIATED WITH ANTERIOR SEGMENTAL SETBACK OSTEOTOMY Deere) CORRS ere) ass ue we 74 ero 09 oer eri os Prt an er 50) er 60) oe Nestle waa Le anton 0)SOFT TISSUE CHANGES ASSOCIATED WITH ORTHOGNATING SURGERY 21 Anterior Repositioning Masilary anterior repositioning as the greatest elect on the nose and upper lip. This movement precpittes advancement of the upper ip, subnasl, ard owe®=3 aight shortening ofthe wpper lip thinning ofthe ip (~2 mm" tridening of the sit baxo?™"; and a deopering of the supatip depresion i the hterior nasal spine i let ntact" A. progresive increase inthe horizontal oft tee displacements sen fom the tp ofthe nose to the fre end ofthe upper Tipe" A concomlant decease in nasolabial angle Is cbserved with only shght ‘anges in the lover lip” Leaving the antor nasal spine intact has favorable ‘et on the fonvana diuplacement of the upper ip and especially on the base of the nose (eubnase) The tale derived from previous investigations are given In ‘Tabs ‘le SOFT TSEUE CHANGES ASSOCIATED WITH MAXILLARY ADVANCEMENT Geni esr ero 0 os tree a Niscminge 1 depwe:t sale one sabe ot me Saat aon ost Nica on oat er oss at ays Seoe a Upper imitadom o) 8:3 ert 00 verte eer, Newey sto Tega ens Ure) Poi Den ne Foneca (57) BoB Frater) sean BA Blem pe Frat (87) Pra eer 60) me ry a ses 88) sean San 18) te co 88) ge primey Seheineio fe Some ie ten 38 mors, SeAtomees engin the ook)A sigan cifrence noted Between the rato of the hort change the upper incr tothe vernon border of the upper ip in previous sae (Gs:1)254 compared with the ratio reported by Carats eta (19:0 This ier fence is due t te use ofthe air cinch suture and VY closure daring the sung Procedure. The ratio yeduces with larger advancements because of sof tse ‘Stretching ® If the antenor nasal spine is let ntact the nasolabial angle may remain Feltvly unchanged. This ts hechawe 36 the nal penises lightly the subnasle Iniraes forward slong withthe upper ip™ ‘Superior Repositioning Superior repositioning of the mani canes cevation of the nasal tp - ‘widening ofthe lar bases 2-4 m= anda decrease nthe nasolabial angle {Table 61°"= These nasal changes cccur without change in angulation ofthe pet lips The upper ip closely fellows the movement of the maxilary incisor in the Ihoriontl plane The lip follows superiorly approxiately 0% of he veri mae lary change. Thi lp shortening ms secenuated wih combined anterior and supe ‘ior mally movements The amount of vertical soft tina change Sncresses Dropresvely fom the nasal ip tothe stomonsuperive with loss of vermion i VV csi i noe seed“ However, Philips fund tht the vention border of (he upper and lower lips docensed sigh in the lateral portion of he ip, even ‘with a comure. Interestingly, when superimpesition i done om esiay Ide ‘marks, the soft tssues ofthe ip migrate downward in relation #9 the mail. This ‘ay be det the conection ofthe upper Upto the nose “Tino SOFT TISSUE CHANGES ASSOCIATED WITH MAXILLARY IMPACTION rere Upper i dou nse nos Teer we Theres) Seber 07) PE ANS mene any 80) Soe trou (86) g prezee ezrin eerie i ‘sin 867) te, ay 866) ra 86 cane 195) ok 985)Interior Repostioning Maxillary inion sepostoning produces loss of mas ip support posibly leading to "polbesk” detormity,downseard reposting ofthe columella and flats thinning of help nd an increase in the nasolabial angle Lenten ing and thowing 3 the upper ip als abserved.™ Posterior Repositioning Masiary setback procedures result in Joss of nasal tip support because of posterior movenet of ihe anterior nas spine andthe bony support area around {he palm aperare Cable)" The lip rottes postersorly and special about the brava with easing soll angle” ae thicken igh “tle 7.SOFT TISSUE CHANGES ASSOCIATED WIT MAXILLARY SETBACK T= pp “amt hora seve 1978 ero osrt te er asa 0) Souit ‘he Nove 0 ee Nee = ay 06)Py ‘Mutcireetional Maxilary Movements Most maxillary movements are mulidiectional (i anterior and superior, anterior and infrioe, posterior an sperog, posterior ahd nferion, The expected Sit tasue changes ould bea combination of the expected changes frm the pure wetors of movement (Figs. 3-3), ne Ten ae Soee ere ae See ieee ace cetera? SieSOFT Tssue HuNGES ASSOCIATED WT ORTHOGAATIC SURGERY oar 4 The tage hs So ue cares Toe charcome Surg gun net ee iprow Sopet ey reson Sean ara ‘Sorge) Ref te rau tp eva sig bt ‘tenis aaane poe ey soc he feel ip paces hm Bee Cate (he alan ilo ee eg ap ang ote mat Mg Meus oto Maa Feet of on hrSoret — eosten —— gee & On fae ad er Se args ot Sent fares a er et an Stn od aan ‘Desotel Sep fae fa samme meen he dc ‘Shans fn pa So tas er ge ra ‘ge Unworty ot Mian 1350 wh permsMANDIBULAR SURGICAL PROCEDURES Generally the sot tissues of the mandible follow the hard tissues coely. The exception is the Tower lip. Because ofits contact withthe Upper inésor and Upper lip ts movements often varable and unpredictable Anterior Segmental Posterior Repositioning ‘The upper i fllows the lower inior posteriorly, which causes a Mating of ‘he inbiomental eld (Table. Thre i lens ponterio doplacement ofthe sft estes {5 the chin is approached. No effective change is observed atthe cin “hls SOFT ISS 6 CHANGES ASSOCIATED WITH MANDIBULAR ANTERIOR ‘SEGMENTAL OsTEOTOMY Teme 0 a ma Taos 70) serie 0) cons emer Eocny Prot an per 909 mr sons us Le neh 1985)[Anterior Repositioning ‘The soft sue change asacatd with mandibular advancement surgory are limited tothe structures below the superior labial sulcus CTable 9. There is ie Conge in the upper Iph®= and none above the subnasle” The lower lp ‘Advancement is‘vanabl and the ip often lengthens. The lower labial suas and ‘he adhere tothe bony structure 6 the mandible. Consegunly, day follow the trying too Hares close, advancing more thon the lover ip. Ts leads 10 tm opening of the lablomestal fol As with masilory and_ genial surgeries the ‘etal changes ae vaable Fig 8) Fare & Overy of eign tas ae ote Ee Pinna tdi ecu ar ns thyA coreatior between the vertical change in Menton and tho angle and dep ‘of the itiomen fold hae been elucdatsd As the menton moves caidally, the fale opens and he depth decrees ical height is ls feted by mandibular advancement. [a low-angl dass I cases, there fe ile ines in fal eh with advancement Dut in highangle ‘Sas I cases, ge inereve i fas eighe ocurs with advancement, ‘les SOFT TISSUE CHANGES ASSOCIATED WITH MANDIBULAR ADVANCEMENT ‘rst nt Fae ‘sna ‘ee aoete oat ee eed a roan we 574 {eters Islan Sine Poe rs en 05) oer oi Prt en e180) er ue (er ese 09 ten Sal meee eat Stee uma 180) elon i = rare 080) rote oma 8) S scans oaest ‘Ter 009 Leta ati) om oa 08) oat ‘The position ofthe lower lip is affected. by the upper inctor at well asthe lower indoor The anterosuperior postion ofthe upper hal of the lower lip touches {he upper inceor In angle cass Tl (non-open tte cases) and 6 usually Toded forwatd. As the mandible & advanced, the chin and lower labial sulcus come forward, but the superior portion ofthe lower ip does aot, because twas are folded forward sy ie conte with the upper inor. This cases an opening of he Isbiomental fld-and may explain why the rato of advancement st the Labrale Infriu to the Incr Inferius is reduced" Consaquenly, during tweatent Planning the lover lp mist be uprighted to a relatively normal position before ts [hdvancad inorder to approximate fs postage positon.Posterior Repesttioning Mandibular setback surgery has no effect on Subnasle ofthe ues superior to Sutmasle, A slight posterior dapiacement of the upper lp with lenge Ing" and 9 sigh increase inthe nasolabial angle is observed The sft ess follow the mandible posteriry wath the chin following mst clsdy, Flot by ‘he inferior Ibial sulcus and the lower ip. The lower lip shorts and becomes more prorusive by curling out, and the ibiomenal fold deepens and becomes fore acute™="> (Fg. 7. see 7. Ont of erage at ts a mar ‘ase an earVertical changes of the soft ssues of the ips are related fo the hard issue vertical changes (lable 10) Duing superior mandibular epostcning, the lower Up ‘comes shorter, prota and smaller in are. In contrast, with inferior mandibe- Lar reposionng the lower lip becomes longer with incensed area” The vertical soft tesve chang coneate poorly with he hard sue movements {le 18, SOFT TISSUE CHANGES ASSOCIATED WITH MANDIBULAR SETBACK. Sit ain 1972) ero te eon we 576 aay) i Pre an per (60) SBS necaee ise) ep oe Po ona 00) ‘Autortation During sutevation of the mandible, the soft issues follow the otseous Ind smarts Sppreimately 21:1 sis" except for te lower ip, Wich fas sgh Tengu tothe are of roaion Table 11) A light increase Inthe lablomental tingle is fen cheered’ ae ight thickaning of the ip asthe vor aca aight decreas ‘ble 11. SOFT TISSUE CHANGES ASSOCIATED WITH MANDIOULAR AUTOROTATION Savor MMNTUTTT INN eaEETINNTTINISeATUTT TeT rae 98) rea 00) Sie see 687) "Mey apes png ey aan ihGENIAL SEGMENT SURGICAL PROCEDURES ‘The symphysis has been exposed both intoorally and extaoraly fr steotomy ofthe inferior border ofthe mandible to advance retract, wien, narrow, legen, tr shorten the chin? The majorly of change seen after geiopiasty isin The sof "Sous of the chin ad les effect Son inthe labial sulcus and Tower lip." Eany studies dasabing the soft issue changes asoclated with gona surgery had several problems. They included few cases rated nly short-term rel, and superim- Pose the cephalograms on the canis base. Superimposition ofthe cephalograns ‘Should occur om the ares ofthe mandible not changed with surgery" because foncorane mally and mandibular surgery may lalate hin measurements Calelated from superimpostons on the cal ase = [Anterior Repositioning: Bony Enny attempts at advancement genoplsty used nonpedided free grafts or ‘onlay hone grafts. However, these procures were later abandoned de Yo exces Sive resorption and poor predictably. Consequently the surgical emphases shifted to the horizontal osteotomy ofthe anterior mandible[AX fat 4 deoing incon was ed to expose the amerir mandible However seer invetgatos demons that mma so fae SUN ge ‘or predicate hard and tf mae response reine fs bone rp of the vanced epment™50 No bony Ranoling of Gniion or Menton ws ‘Sicrel Boa foorpon could be demonsated tat the astm) (he trot fever and pose tpt ofthe advanced genase)" Bony ppontion scuned at 8 pat and the ineror toner cotony "These same ‘files denned ht when the hie of minal so Sawing was Sed he so tues flowed the had ues dandy wiht chin doops ‘Tove wo ako 1 small but nelle elle on the bom scs™ a i- Comedie length an improved neeriptooth restore” Tes 0 {sue tining*and an improved eck-chin angle i 8.‘The sot se changes following horizontal alvancement genioplsty depend on the magnitude end diction ofthe postonal change ofthe genial seinen the ‘design of the mucosal and osseous incisions, the amount of soft Ussve sipping, nd eter concomitant jae movements (Table 12)" anno eee ae ante cits petyenmelementing tomar one ows rove) at ht ee ny a Sees. Bile SEY RIA et nee Smt peymamtanenten® Sumo ates Si tek ea a Gees Get mpi be ante cons neem cette Eakooo cee|| s2n|) pons me ont amt pe monenas cece nts Goes cbnondontnmtin tan om i ren omer cnn oa nen mn Onis tis Pepin onto Pata ‘The advantages of osseous genial sungery include preservation of the normal hin contour improved prediabty ofthe sf dass response’ sabi ver ‘aul and preservation Gf Hood supply to estctomiaed segment." ‘Those patents who had both Yertea! reduction and advancement enlopasties| showed sighily lager soft tissue advancement than those who had advancement sgrsoplanty’ ony (83:1. OS). Thin may be explained by bunching ofthe sok fisues. When the sof tious are bunched (verel raucson more than advance: ‘mand, the sot Ussues advance more than whan the sft tssues are sted (ad vancerent only)™ Texause Pogonion remodels postsurgery (owing to its close proximity to the ‘osteotomy et), those measures based on i ay be less accurate This s Why some ‘ovearhers resort #9 ing the Gnathion and sft Hesse Gnathion ftir vest ‘ators. “Tulasne™ suggested that the overiapping bone Nap geniopaty gives & more ‘natural contour to the lower face and a Bete bulsnce between the Tower Kp, chin, 8nd sabmentl region than does the sliding genioplasy asocatd with a wedge ‘vtec. Ts associated with a Inge amount of Bony sorption, Nowever «Spe ‘lly in adolescent patientaly aterots at advancement genoplsty inladed the we of allopastie - plints Unfortintely, longterm fllow-sp reveled. Several unforesean comple Hons. Fortis rason advancement geniopisy with alloplastic implants has fallen ‘somewhat out ¢ favor. The disadvantages of alloplastic materials cde resorption fr deformation af the underlying symphyseal bone with possible dvitaizaton of the mandibule anterior teh" migration ofthe Impl’: exrasion of the implant ifecion (especially Proplas a less predcabe soft sue to hard tise rato ant the face tat they do noe adres excessive of seduced chin height (able 13)? Newer materials have been develope hat reduce the incidence ofthese ‘complications, therefore making alloplastic augmentation a mere viable option. ‘le 18. SOFT TSSUE CHANGES ASSOCIATED WITH ALLOPLASTIC CHIN HMPLANTS inoy Gt Bar Fa Stare (ecttnrnapion Bland Sen (9 ae fe Boe Ph emacaSepaecwopson) Gam wag 1 allplatis implans are wed, they should be placed subperiosteal, lw on the inferior border below the mentalis muscle, and Over dense coral bone. Allo plaicimplnts ould not be sed during the coretion of severe deformities, But xn be used in pallens with a mK! to moderate deformity A periie rior {giphic eannation ofthe implant for monitoring of bany resorption is recom ‘anda Posterior Repositioning Ely attanpts at reduction of horizontal exces of the genial segment of the smandibe by bony reconouring cured lite iprvernet of the soft sue prfle (able 1 Ava result this eh hasbeen abandaned. The sol tissue changes sssocated with setback genioplsty are not as well corelated as the hard tissue rovements dering advancement genoplasty. ‘ible 4. SOFT TSSUE CHANGES ASGOGIATED WITH SETBACK GENIOPLASTY Smt) 9ST Easier preva Ee ne 371 essa 8 Geel) TRE Baeegheraona aim bees peace Be Sink haot ieee Fane 98 Reduction genioplasty is containdicated in patient with minimal or no i bomental fol. Fatenng ofthe cin and elimination ofthe Iabiomental fold il eau! It ale important to reais that stick geioplsty wal make undeseale ‘anges In the neck-chin proportion. In a patent with « poor nck-chin propor ‘on, this procedures contzsindictdVertical Repositioning: Supeior and Inferior ‘The soft asus follow the hand Kasuce very closely in vertical augmentation senloplaty. Ths ot the cae for the vertical ection Gnfroe bord ots frsandwvih ostetomy) genoplsty Cable 15, “wie 16 SOFT TSSUE CHANGES ASSOCIATED WITH VERTICAL AUGMENTATION OF REDUCTION GeMIOPLASTY “ein et aapoatonal Weedon (1980) = eet jae Seer ae peeerek lect ae ay = poke ay £ ai mane Se ana wee | ge ee See | ae eas oe 2 Anderson JP, Joondeph DR. Tuyptn DL: A Eur | Orthod 821, 1986 a ee set ey “ee eet ‘tem cocoret wake cchodort tet) Fenopy] Or Sug he, oT tent Ia | Orthod 249, 160 as GREWAL Rettdcndang PL Stet iy rune Whe Je Lang om SAF ter sued hp agama are Oa Fey i sth Sha Gen Sap 1 at can 5A wat, came fran ree" Seb mi Ps Rs Sa Tea. Gon Rng, el St te EET Brmmer ty Made Kee at Re" cng acy aya hamlet Collies Geltcl Gal Saztme 7 a 1 Om Sas 7 bal'WH. 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