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Cairo Dental Journal (24)
Number (I), 85:97
January, 2008
Soft Tissue Profile Changes Associated
With Treatment of Anterior Open Bite
Amany Hassan Abdel Ghany1
1. Assistant Professor, Orthodontic Department, Faculty of Oral and Dental Medicine, Cairo University.
..
Abstract
I
n this study the soft tissue profile changes following treatment of anterior dentoalveolar open
bite were evaluated. Fifteen females with age ranging from 17-20 years were selected based
on clinical and cephalometric identification of dentoalveolar or mild skeletal anterior open
bite. Treatment was accomplished by a fixed appliance using a reverse counter arch wire together with
a head gear and a fixed tongue guard. Lateral cehphalograms were taken at the onset of treatment and
after an achievement of a positive overbite of 1 to 2 mm. The results of this study demonstrated a
significant increase in the soft tissue upper anterior facial height, while the soft tissue lower anterior
facial height was controlled leading to an improvement in the soft tissue upper to lower facial height
ratio. A significant decrease was evident in the interlabial gap. Moreover, a significant increase was
found in upper and lower lip lengths, upper lip thickness and nasolabial angle.
..
INTRODUCTION
because of interaction of many etiologic factors, both
Facial aesthetics are an important social concern in
current society.1 Orthodontic patients and their parents
believe that well-aligned teeth are important for overall
facial appearance.2 They expect that orthodontic
treatment will improve their dentofacial, esthetics3 and
consequently their social acceptance.4 Therefore, over
hereditary and environmental in nature.8-10 When there
is only dental and dentoalveolar involvement, there is
predominance of environmental causes such as thumb
or dummy sucking habits, mouth breathing, and tongue
or lip thrusting in addition to some local factors such as
tooth ankylosis and eruption disturbances. However, the
the last decades orthodontists focus their treatment plans
larger the skeletal involvement, the more the aetiology
more and more on improvement of facial esthetics.
is related to genetic factors, which are restricted to an
Facial disharmonies in the vertical plane, including the
unfavorable growth tendency.
anterior open bite, are great challenges to orthodontists5
To achieve a successful and stable result, however,
because of the remarkable difficulties of treatment and
it is essential to establish a correct diagnosis, identify
the instability of the correction.
the cause, locate the deformity and select an appropriate
6,7
Open bite develops
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C.D.J. Vol. 24. No. (I)
Amany Hassan Abdel Ghany
method of treatment. Various therapeutic modalities
crib associated with high-pull chin cup therapy in children
have been proposed for the treatment of anterior open
with an Angle Class I anterior open bite malocclusion
bite malocclusion. These treatment modalities may start
and found that hard tissue changes did not imply any
from self-correction, removable, functional and fixed
soft tissue changes. Vertical lip changes resulting from
appliances to surgical intervention in severe skeletal cases.
maxillary incisor retraction by orthodontic treatment were
Conventional orthodontic treatment has been directed at
evaluated by Jacobs38 who found no correlation between
11
inhibiting the vertical maxillary growth with headgear,
the amount of maxillary incisor retraction and the vertical
retarding the mandibular growth with chincups,12 or
closure of the interlabial gap. Nor did he find a significant
extruding anterior teeth with vertical elastics.13-15
correlation between the vertical decrease in the distance
Among the methods available for the treatment of
open bite also is with fixed appliance using multilooped
between labrale superius and labrale inferius and the
relative upper-incisor extrusion or intrusion occurring
arches16-19 (MEAW therapy) or extrusion arch wires.20,21
during incisor retraction. Abdel Kader39 assessed changes
The goals of these techniques include proper vertical
in vertical lip height relative to changes in dental height,
positioning of maxillary incisors, compatible cant of
overjet, and overbite and noted insignificant increase
the upper and lower occlusal planes, and uprighting
in Vertical lip height, although overjet
of posterior teeth. And since oral habits are frequently
measurements showed significant reductions during the
involved in the development of or the maintenance of
treatment. There appear to be conflicting reports on the
anterior open bite during growth.20-24 Tongue cribs has
response of the soft-tissue to changes in the hard tissues.
been advocated to allow normal development of the
The issue draws the attention of orthodontists as the
anterior dentoalveolar region, since it prevents thumb or
effect of orthodontic treatment on the face continues to
dummy sucking and avoids tongue thrusting.
be debated. Therefore it was the purpose of this study
25-29
When developing an orthodontic treatment plan,
both the hard and soft tissues should be considered.
Successful treatment means that objective treatment
to assess the soft tissue profile changes secondary to
treatment of anterior dentoalveolar open bite with a fixed
appliance using upper reverse curve of spee arch arch
goals and subjective patient desires were met.
wire in a group of adult Egyptian females.
Therefore, improvement in facial appearance should be
..
30
considered in the treatment plan.31 Soft tissue changes
and overbite
Subjects and Methods
following orthodontic treatment are usually regarded
The sample of the present study consisted of 15
as secondary to underlying hard tissues alterations.32-35
Egyptian adult females. With an age range from 18-20
Different opinions exist as to whether there is a definite
years. They were selected from the out patient clinic of
correlation between hard tissue change and soft tissue
change.30,36
Orthodontic Department, Faculty of Oral and Dental
Medicine, Cairo University. All of the cases presented
Soft tissue changes after treatment of skeletal open
with anterior open bite greater than 1.0 mm. Skeletal
bite was evaluated by Taher37 using maxillary removable
relationship in the sagittal direction was Class I, with
posterior bite plane combined with extraoral vertical pull
normal or slightly increased anterior vertical facial height.
chincup, a significant improvement in soft tissue profile
The molar relationship was Angle Class I. All patients
was observed, such improvement was demonstrated by
were having oral habits before treatment. Extraction
the significant change of the soft tissue upper to lower
cases were excluded from this study to eliminate any
facial height ratio, the soft tissue angle of convexity and
effects that may be caused by the extraction treatment.
lower lip length. However, Torres et al studied soft tissue
No history of other craniofacial anomalies, and had not
changes produced by a removable appliance with a palatal
undergone prior orthodontic treatment.
8
(87)
Soft Tissue Profile Changes Associated
Treatment Procedure
A preajusted edgewise appliance (0.022 inch slot size)
was used with a triple tube bands for the upper molars
stabilizing wire of size 0.016 × 0.022 inch stainless steel
was placed bilaterally, and the anterior segment was tied
by a ligature wire.
and with single tube for the lower molars. For every
Extrusion of the upper anterior segment proceeded
subject a headgear was adjusted and the patients were
with ready made reverse counter arch 0.016 × 0.022 inch
instructed to wear it at least 14 hours/day. The head gear
Nickel Titanium (Fig. 1 B). The legs of the wire was
was used to reinforce anchorage of the posterior segment
inserted in the auxiliary tubes of the maxillary molar
concurrently with a transpalatal bar. A fixed tongue guard
bands. The wire bypassed the premolars and was tied in the
was fabricated for each subject and soldered to upper
anterior bracket slots. After bite closure detailing of tooth
first molar band (fig. 1 A). Treatment was initiated with
position and the finishing procedures were accomplished.
alignment and leveling of the maxillary and mandibular
Average treatment time with fixed appliances was 16
teeth. After 3 months of initial alignment, extrusion of
months. Each subject was instructed to perform lip seal
upper anterior segment was done using a segmented
exercises by holding a wooden blade between upper and
technique, in the posterior anchorage segment a buccal
lower lips during different activities of the day.
Fig.1: A. Soldered transpalatal arch with tongue guard. B. Reverse curve of spee arch wire before insertion.
Cephalometric analysis
Measurements obtained
Cephalometric evaluation of the treatment changes
Five dentoalveolar and twelve soft tissue angular and
was conducted on lateral cephalograms taken at the
linear measurements were measured as follows (Figs. 3,4):
beginning and after an overbite of 1 to 2 mm was
obtained. The mean period between the initial and follow
1- Dentoalveolar measurements
up radiographs was 6.5 months. The lateral cephalograms
Upper incisor Inclination
were obtained in centric occlusion, with the lips in a
relaxed and passive position. The radiographs were taken
using the same cephalostat with standardized settings
and traced by one investigator using a 0.3-mm pointed
pencil. Different cephalometric landmarks are shown in
Fig. (2).
(U1/PP): maxillary
incisor long axis to palatal plane angle.
Lower incisor Inclination
(L1/MP): mandibular
incisor long axis to mandibular plane angle.
Interincisal angle (U1/L1): the angle formed by the
long axis of the upper and lower incisors.
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C.D.J. Vol. 24. No. (I)
Amany Hassan Abdel Ghany
Incisor overbite (OB): the distance between incisal
edges of maxillary and mandibular central incisors,
perpendicular to occlusal plane.
Incisor overjet (OJ): the distance between incisal
edges of maxillary and mandibular central incisors,
parallel to occlusal plane.
2- Soft Tissue measurements
Soft tissue upper anterior facial height (UAFH) : the
distance from soft tissue Nasion (N) to subnasale (Sn).
Soft tissue lower anterior facial height (LAFU): the
distance from (Sn) to soft tissue Menton (M).
Soft tissue upper anterior facial height / Soft tissue
lower anterior facial height ratio (UAFH/LAFH).
Upper lip length (ULL): the vertical distance between
subnasale (Sn) and stomion superious (Stms).
Lower lip length (LLL): the vertical distance between
stomion inferious (Stmi) and soft tissue gnathion(Gn).
Fig. (2) Dentoskeletal and soft tissue cephalometric
landmarks. S, sella turcica; N, nasion; ANS, anterior
nasal spine; A, subspinale; B, supramentale; Me,
menton; U1, maxillary central incisor edge; L1,
mandibular central incisor edge, N’ soft tissue
nasion; Sn, subnasale; Stms, Stomion Superious;
Ls, Labrale Superious; Stmi, Stomion Inferious; Li,
Labrale Inferious; Pg’ , Soft tissue Pogonion; Gn’,
soft tissue gnathion; Me’, soft tissue menton.
Upper lip thikness (ULT): the linear distance from
the most facial point of the maxillary incisor to the
laberale superious.
Lower lip thicknes (LLT)s: the linear distance from
the labial surface of the most protrusive mandibular
incisor to labrale inferius.
Position of the upper lip (UL-E Line): the distance
between labarale superious and the esthetic line (line
extended between Pronasale; tip of nose and soft tissue
pogonion).
Position of the lower lip (LL-E Line): the distance
between labarale inferius and the esthetic line.
Interlabial gap (ILG): the vertical distance between
stomion superious. and stomion inferious.
Fig. 3: Soft tissue profile measurements: 1, UAFH; 2, LAFH;
3 , ILG; 4, ULL; 5, LLL; 6, ULT; 7, LLT; 8, E-Line
Statistical Analysis
The collected data was statistically analyzed. The
mean values of different variables were calculated and
Nasolabial angle (NLA): the angle formed between
a tangent to the lower border of the nose and labrale
superius.
the significance of difference for treatment changes was
Mentolabial angle (MLA): the anterior angle formed
between labrale inferious (Li) and soft-tissue pogonion
(Pog)
difference/mean before treatment x 100. A correlation
computed using Wilcoxon signed rank test. Percentage
of treatment changes was calculated by dividing mean
analysis between each pair of variables used in this study
was also performed.
(89)
Soft Tissue Profile Changes Associated
..
RESULTS
Clinical observation:
Figs (5A & B) demonstrated the obvious closure of
open bite after the six months study period. Subsequently,
an improvement in soft tissue was observed as illustrated
in fig.(5B).
Fig. (4) Dentoalveolar and soft tissue Angular measurements:1,U1/PP; 2, L1/MP; 3, U1/L1; 4, NLA; 5, MLA
(A)
(B)
Fig. (5) A. Pretreatment photographs showing open bite
and subsequent facial appearance. B. Posttreatment
photographs showing closure of open bite and
subsequent facial appearance.
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C.D.J. Vol. 24. No. (I)
Amany Hassan Abdel Ghany
Statistical results:
Soft Tissue Changes: A significant increase (P<0.05)
Descriptive statistics; means and standard deviations
for the pretreatment and posttreatment parameters are
shown in table I. The significance of difference for
treatment changes over the six months observation period
is computed using Wilcoxon signed rank test (Table I).
Dental Changes: a significant improvement in anterior
was observed in upper facial height as shown by the 3mm
increase in UAFH. However, an insignificant increase
was observed in the lower anterior facial heights LAFH
(0.6mm) respectively. A significant improvement in the
interlabial gap was observed by the significant decrease
in ILG (4mm) (P<0.001). A significant increase in lengths
of both upper lip (2.07mm) and lower lip (3.87mm)
open bite was observed by the significant increase in the
(P<0.05) were found. The thickness of the upper lip was
overbite (5.13 mm) (P < .001), and the significant decrease
significantly increased (1.28) (P<0.001) however, no
of overjet (3.80mm) (P < .001). The Upper incisors were
significant differences were found in LLL, UL- E line
uprighted as shown by the decrease in U1/PP(-11.47°)
and LL- E line. The nasolabial angle was significantly
(P<.001). The inter-incisal angle was improved as shown
increased (9.20°) (P<0.01) while no significant increase
by the significant increase in U1/L1(15.4°) (P < .001).
was found in the mentolabial angle.
Table (I) Descriptive statistics and significance of dentoalveolar and soft tissue treatment changes.
Variables
Pretreatment
Mean
SD
Posttreatment
Mean
SD
Treatment
changes
P value
Dentoalveolar measurements
  U1/PP (º)
122.40
7.62
110.93
11.16
-11.47
0.001*
L1/MP (º)
95.67
5.26
94.13
5.35
-1.53
0.15
  U1/L1 (º)
108.33
11.34
123.80
10.6
15.4
0.001*
  Over bite (mm)
-3.00
2.10
2.13
0.63
5.13
0.001*
  Over jet (mm)
5.00
2.73
1.20
0.86
3.80
0.001*
Soft tissue measurements
  UAFH (mm)
55.00
5.90
58.00
6.76
3
0.05*
  LAFH (mm)
69.73
4.39
70.33
3.87
0.6
0.142
  UAFU/LAFH( %)
0.78
0.1
0.82
0.1
0.04
0.08
  ILG (mm)
-4.07
4.51
-0.07
1.03
4
0.002*
ULL (mm)
22.67
3.57
24.73
3.05
2.07
0.001*
LLL (mm)
44.67
4.16
48.53
4.68
3.87
0.037*
ULT (mm)
9.33
1.54
10.60
1.84
1.27
0.008*
LLT (mm)
15.33
1.44
14.73
1.03
-0.60
0.25
  UL- E Line (mm)
0.20
3.14
-0.40
2.87
-0.60
0.123
  LL- E Line (mm)
4.07
3.82
4.00
4.15
0.70
0.83
NLA (º)
95.13
13.71
104.33
11.99
9.20
0.009*
MLA (º)
124.47
18.67
130.87
17.64
6.40
0.083
(91)
Soft Tissue Profile Changes Associated
Table (II) Percentage of treatment change for soft tissue parameters.
Soft tissue measurements
Mean difference
SD
Percent changes %
UAFH
3
5.60
5.5
LAFH
0.6
1.62
0.9
UAFH/LAFH
0.04
8.97
6.1
ILG
ULL
4
5.07
-77.7
2.07
1.58
9.9
LLL
3.87
5.82
9.3
ULT
1.27
1.48
14.9
LLT
-0.60
1.68
-3.1
UL- E
-0.60
1.59
-19.7
LL- E
-0.70
2.18
-10.9
NLA
9.20
11.12
10.8
MLA
6.40
12.51
5.9
Table (III) Correlation between different dentoalveolar and soft tissue parameters.
Variables
U1/PP
L1/MP
U1/L1
Over bite
Over jet
r
p
r
p
r
p
r
p
R
p
  ILG
0.03
0.90
0.53
0.06
-0.62
0.01*
0.38
0.15
0.41
0.12
ULL
0.20
0.47
0.30
0.27
0.38
0.15
0.20
0.47
0.04
0.87
LLL
0.09
0.72
0.12
0.65
0.07
0.79
0.06
0.98
0.07
0.80
ULT
0.33
0.22
0.22
0.41
0.13
0.62
0.19
0.47
0.21
0.44
LLT
0.03
0.90
0.03
0.89
0.02
0.92
0.32
0.24
0.17
0.52
  UL- E Line
0.39
0.15
0.26
0.34
0.34
0.21
0.12
0.66
0.11
0.62
  LL- E Line
0.10
0.71
0.16
0.56
0.35
0.19
0.04
0.99
0.34
0.21
NLA
0.32
0.23
0.12
0.65
0.27
0.32
0.23
0.40
0.15
0.57
MLA
0.11
0.69
0.07
0.98
0.14
0.61
0.10
0.70
0.21
0.43
—
—
—
—
—
—
ULT
LLT
  UL- E
  LL- E
NLA
—
—
r
LLL
ULL
ILG
variables
ILG
—
—
—
—
—
—
—
—
-0.48
r
—
—
—
—
—
—
—
0.06
p
—
—
—
—
—
—
0.15
0.02
r
p
—
—
—
—
—
—
0.57
0.91
LLL
—
—
—
—
—
0.15
0.35
0.21
r
p
—
—
—
—
—
0.58
0.19
0.44
ULT
—
—
—
—
0.09
0.52
0.11
0.19
r
—
—
—
—
0.74
0.04*
0.69
0.48
p
LLT
—
—
—
0.07
0.29
0.07
0.43
0.12
r
—
—
—
0.79
0.29
0.79
0.10
0.64
p
UL- E 
—
—
0.26
0.42
0.16
0.42
0.30
0.07
r
p
—
—
0.34
0.11
0.54
0.11
0.16
0.80
LL- E
0.07
p
0.48
r
0.19
p
MLA
—
0.54
0.43
0.85
0.31
0.38
—
0.06
0.10
0.85
0.25
0.15
0.45
0.42
0.13
0.12
0.32
0.34
0.09
0.11
0.63
0.65
0.23
0.20
0.74 0.001* 0.56 0.02*
0.47
r
NLA
Amany Hassan Abdel Ghany
—
—
—
—
—
—
—
p
ULL
Table (V) Correlation between different soft tissue parameters.
(92)
C.D.J. Vol. 24. No. (I)
(93)
Soft Tissue Profile Changes Associated
Table II demonstrate the percentages of treatment
history of oral habits. The proposed treatment protocol
changes. The highest percentage of positive change
aimed to correct the anterior open bite and eliminate the
was fond for the upper lip thickness (14.9 %), while the
tongue thrusting habit.
least positive change was recorded for the lower anterior
using a fixed appliance with an extrusion upper arch wire,
facial height (0.9 %). The highest percentage of negative
together with a head gear and a transpalatal arch with a
change was fond for the interlabial gap (-77.7 %), while
tongue guard.
the least negative change was recorded for the lower lip
length (-3.1 %).
Treatment was accomplished
Dentoalveolar changes at the anterior region of the
dental arches are factors that usually lead to correction of
Correlation coefficients relating the movement of
the hard tissue and subsequent change of the soft tissue
are presented in table III. No correlations were found
except for the interlabial gap which was found to have
a significant correlation with the interincisal angle (r=
-0.62) (P<0.01).
Correlation coefficients relating different soft tissue
variables are presented in table V. The upper lip length was
anterior open bite malocclusions.8,42 In the present study,
almost all dentoalveolar variables showed statistically
significant changes after treatment. Assessment of the
results obtained demonstrated a mean closure of 5.13 mm
in the anterior open bite, resulting in a mean final overbite
of 2.13mm (Table I). The correction of anterior open bite
was possibly due to the extrusion and uprighting of the
maxillary incisors, as demonstrated by the U1/PP, U1/L1
and overbite variables (Table I). These variables showed
found to be significantly correlated to both the nasolabial
statistically significant changes during treatment; the
angle (r= 0.74) (P<0.001) and the mentolabial angle (r=
maxillary incisors showed statistically significant lingual
0.56) (P<0.05) , while the lower lip length was significantly
tipping (-11.47º), though not significant, the mandibular
correlated with lower lip thickness (r= 0.52) (P<0.05).
incisors were slightly uprighted (-1.53 º).
..
significant improvement was achieved in the interincisal
Discussion
angle (15.4º). These changes were also observed by
Considering the importance of providing not only
a pleasant smile but also a balanced profile, this study
involved cephalometric evaluation of the soft tissue
profile effects secondary to treatment of anterior open
bite in a group of adult Egyptian females. Adult females
were specifically chosen (17-20 years old with a mean
age of 18.3 years), to exclude the factor of growth since
most of the soft tissue measurements in females attain
their adult size at 15 years.
Because of the complex nature, etiology, and
dentofacial
pattern
Thus a
of
open
bite
malocclusion,
treatment strategies range from behavior modification
most other authors.5,14,43-46 These modifications may be
due to fixed appliance treatment mechanics together
with normalization of functions by elimination of tongue
thrusting habit encouraged by the tongue guard. The
effectiveness of tongue guard wear for anterior open-bite
closure was demonstrated by various cephalometric and
clinical investigations.19,27,29
As for the soft tissue, eleven variables were used in
an attempt to understand the possible changes in different
aspects of the face, such as upper and lower anterior
facial heights,
interlabial gap, upper and lower lip
lengths, upper and lower lip thickness, upper and lower
lip position in relation to E-line and finally naso- and
to orthodontic and orthopedic therapy. Pretreatment
mentolabial angles (Table I). Assessment of the results
cephalometric analysis revealed that all patients were
obtained demonstrated a significant increase (4mm) in
having dentoalveolar or mild skeletal anterior open bite
the soft tissue upper anterior facial height, this was in
greater than 1mm. Moreover, all subjects were having a
agreement with Taher.37 This improvement is probably
(94)
Amany Hassan Abdel Ghany
C.D.J. Vol. 24. No. (I)
due to treatment mechanics applied not due to growth
lower lips respectively, for girls between 7-18 years
factors since according to Nanda et al.40 and Andersen
old. Consequently, the significant changes observed
et al. the soft tissue vertical measurements had almost
in this study is probably due to treatment strategy and
reached their adult size.
lip training instead of being related to growth. This
41
Regarding the soft tissue lower anterior facial height,
an insignificant increase ( 0.6 mm ) was found. Also
this variable exhibited the least positive
percentage
of treatment change (0.9 % ) as shown in table II.
Consequently, though not statistically significant an
improvement was observed in the ratio between upper and
lower facial heights (UAFH/LAFH) which is expected
to worsen if no treatment was encountered as stated by
came in accordance with Taher37 who found statistically
significant increase in lower lip length after skeletal open
bite treatment and also with El-Sayed and El-bokle50
where a significant increase in upper lip length was found
to be correlated with reduction in inclination of upper
incisors. However, this came in disagreement with Torres
et al.8 this may be due to the difference in treatment
methodology and in the age of the sample.
Mizrahi.47 This may also be attributed to the effect of
Concerning lip thickness, a significant increase was
the head gear in controlling the extrusion of the upper
encountered in upper lip thickness 1.27mm, this increase
molars leading to redirecting of the mandible in a counter
of lip thickness could related to the lingual inclination of
clockwise direction. This was in accordance with Janson
the upper incisors as previous studies reported increase
et al. were they found a significant correlation between
in upper lip thickness after lingual inclination of upper
UAFH/LAFH ratio and both maxillary and mandibular
incisors.51,52 However, the lower lip thickness showed non
molar heights in open bite malocclusions.
significant decrease after treatment ( -0.60mm) this may be
48
Concerning the interlabial gap, a significant decrease
(-4mm) was observed following treatment. Moreover, the
interlabial gap showed the highest negative percentage
due insignificant change in the inclination of lower incisors.
A significant correlation was found between lower lip length
and lower lip thickness (r= 0.52) (Table V).
of treatment change (-77.7%) as displayed in table II.
Regarding the position of the upper and lower lips
This came in agreement with Gehring et al., however,
to the esthetic line, no significant change was observed
Torres et al. did not find any change in the interlabial
in these parameters. This was in agreement with Taher37
gap after open bite treatment. The interlabial gap was
and Torres et al.8 where similar results were obtained
also found to be correlated with the interincical angle (r
indicating that treatment of anterior open bite have no
=-0.62) (Table III). The improvement in the interlabial
significant effect on such soft tissue parameters.
15
8
gap encountered in this study may be partly due to the lip
seal training effect, as Ingervall and Eliasson49 previously
found a significant decrease in the interlabial gap after
lip training.
As for the nasiolabial angle, a significant increase
(9.20º) was observed after treatment (Table I). This
is almost attributed to improvement of upper incisors
inclination as shown by the significant decrease of U1/PP
Lip length and thickness are important elements of
angle. A significant correlation was observed between the
the facial profile. Lip position is affected by the position
nasolabial angle and the upper lip length (r= 0.74) (Table
and inclination of the maxillary and mandibular incisors
V). No significant change was observed in the mentolabial
and hence is responsive to orthodontic treatment. As
angle, this could be attributed to the insignificant change
for the lip lengths, the upper and lower lip lengths
in the inclination of the lower incisors. This came in
showed statistically significant increase 2.07mm and
accordance with Nanda et al.40 where they stated that
3.8mm respectively. Such increase was expressed by
uprighting the maxillary and mandibular incisors enlarges
Nanda et al.40 to be 1.1mm and 1.5mm in upper and
the nasolabial and mentolabial angles.
(95)
Soft Tissue Profile Changes Associated
..
Conclusion and Clinical
Implications
On the basis of the results drawn from this study, it
could be concluded that the upper extrusion arch wire
7.
diagnosis and some aspects of treatment. Angle Orthod;61:247260, 1991.
8.
Torres F, Almeida R, Almeida M R, Pedrin R, Pedrin F,
Henriques J. Anterior open bite treated with a palatal crib and
combined with fixed tongue guard in addition to lip
high-pull chin cup therapy. A prospective randomized study.
seal training exercises, showed clinical effectiveness in
Eur J Orthod. 28:610-617, 2006.
correcting the dental open bite and in improving the soft
tissue profile in dentoalveolar open bite malocclusion.
Nielsen H. Vertical malocclusions: etiology, development,
9.
Huang GJ, Justus R, Kennedy DB, Kokich VG. Stability of
Such improvement was demonstrated by the significant
anterior open bite treated with crib therapy. Angle Orthod.
changes of; interlabial gap, upper and lower lip lengths,
60:17-26, 1990.
upper lip thickness and nasolabial angle.
Since correlation coefficients showed no significant
correlation between hard- and soft tissue variables.
Therefore, it seems that lip response to orthodontic
tooth movement might depend on other factors such as
pretreatment lip strain or variation in lip structure and
thickness.
..
1.
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