Age Related Soft Tissue Changes - Copy / orthodontic courses by Indian dental academy

AGE RELATED SOFT TISSUE CHANGES

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

ESTHETICS THE WORD ESTHETICS COMES

FROM THE GREEK WORD “AISTHETIKOS” MEANING ‘OF SENSE OF PERCEPTION’

WORD MEANING- a branch of philosophy dealing with beauty, especially with judgments of taste concerning them- Webster's dictionary


THE ESTHETIC HERITAGE Man, perhaps subconsciously, has

been aware of facial esthetics for a long time.

35,000 years ago the early man discovered the mental agility for survival & made life easier.

It was probably during this period that men found the time to develop his esthetic awareness & sensitivity.


PREHISTORIC ESTHETIC SENSE


THE EGYPTIANS

THE EGYPTIAN CULTURE DEVELOPED IN THE NILE VALLEY AROUND 5000 YEARS AGO & DURING THIS ERA A GREAT DEAL OF ESTHETIC ATTITUDES WERE RECORDED IN ART


EGYPTIAN SCLUPTURES



THE GREEKS The Greeks were the 1st to express

sensitivity to qualities of facial beauty through philosophy & sculpture.

While the philosophers formalized the study of beauty, the sculptors implemented the expression of beauty in their art.

Greek sculptures blossomed in 4th & 5th century B.C. often called as the “GOLDEN AGE OF GREECE”


GREEK SCULPTURES


THE ROMANS The Romans profusely documented beauty by

coping or reworking Greek sculptures & by carving original subjects.

Unfortunately, Roman sculptures was never formalized or idealized, no new concepts of facial esthetics are related in these works.

Faces of men were represented life so these works showed a range of facial features, harmony & proportions.


RENAISSANCE In his time

MICHELANGELO strongly influenced the direction & spirit of Italian Renaissance movement.

His sculptures identified with the classical traditions of Greece & Rome.www.indiandentalacademy.co

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IN 1865 AN OBJECTIVE STUDY OF HUMAN ESTHETICS WAS INTRODUCED BY A BRTISHER, WOOLNOTH. ACCORDING TO HIM PROFILES ARE SEEN IN 3 ORDERS –THE STRAIGHT, THE CONVEX & THE CONCAVE.


PROFILE CHANGES IN GROWING FACE The face of a child is vertically short

because1. Nasal part of the face is still small2. The primary & secondary dentition has

not fully established3. The jaw bones have not grown to the

vertical extent that would support the full dentition & the enlarging masticatory muscles & airway


THE BABY FACE LARGE APPEARING EYES DAINTY JAWS SMALL PUG NOSE PUFFY CHEEKS HIGH INTELECTUAL- LIKE

FOREHEAD NO COURSE EYE BROW

RIDGES LOW NASAL BRIDGE SMALL MOUTH & OVERALL WIDE & SHORT

PROPORTIONS


The baby’s face appears relatively smaller than the cranium. This is because the growth of the brain slows down considerably after about the 3rd or 4th year of child hood, but the facial bones continue to enlarge for many more years.



MALE V/S FEMALE The overall body size of the male

tends to be larger than that of the female & the male lungs correspondingly more sizable to provide for the relatively more massive muscles & body organs. This calls for a large airway beginning with the nose & the nasopharynx.




FACIAL TYPES MESOFACIAL

( IDEAL) TYPEMost often associated

with C I occlusions since these patients are characterised by relatively normal max. & mandi. relationship resulting in good facial balance. www.indiandentalacademy.co

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DOLICIFACIAL TYPEThese patients have

long & weak musculature because of the tendency for vertical growth. The molar occlusion is often C II div I variety


BRACHYFACIAL TYPEThey have short faces &

wide square mandibles of these patients are most often associated with C II div II malocclusions. These patients usually they exhibit excessive anterior overbites.


THE ROLE OF TONGUE The primary function of facial muscles is

expression These muscles are also important in

maintenance of posture of facial structures.

According to proffit the lip & buccinator muscles opposed by the tongue contribute to the postural equilibrium of the teeth


The tongue posture in the neonate is more forward. Many oral functions in the neonate are guided primarily by tactile stimuli from lips & tongue.


DENTAL CHANGES

FINAL OCCLUSION IN ADULT CLASS I- 59%

CLASSII- 39% CLASS III- 2%


The angulations of permanent incisors is less than deciduous teeth ie. The deciduous are more upright.

The reason for this decreased angulations of the permanent incisor is because the dental lamina of the permanent incisor is located lingual to the primary teeth


GROWTH CHANGES IN SOFT TISSUE PROFILE

ANGLE 1997 [ RAM .S. NANADA, SUNIL KAPILA & JOLANDE]

The relationship b/w nose, lips & chin can be altered by both growth & orthodontic treatment. It is imperative , therefore, that the orthodontist have an understanding not only of the changes incident to orthodontic treatment but also of the amount & direction of growth expected in facial structures

SAMPLE SIZE 17 M & 23 F B/W AGE GROUP 7 -18 YEARS


NOSE HEIGHTUpper nose height ( n’ – prn’)At 7 yrs same for both sexes. ^se in height b/w 7 -8 yrs.^se slowed down b/w 8 -11

yrs.Height again ^sed at 11yrs &

b/w 14 – 17 yrs.Lower nose height (prn’ – ans”)^sed more in males than

females F adult size- 15 yrs, M- still

growing at 18 yrsU/N : L/N = 3:1 www.indiandentalacademy.co

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INCLINATION OF THE NOSE

THE ANGLE ( prn’ – n’ – prn) IS SIMILAR IN BOTH SEXES B/W 8 – 16 YRS OF AGE

AT 18 YRS OF AGE THE MALE GROUP SHOWED 4.5 deg ^SE.


UPPER LIP HEIGHTMeasured from subnasale – upper

lip stomion – at 7 -8 yrs ^sed from 19.1 mm – 20.2 mm in females.

In males ^sed from 19.8 mm–22.5mm

A major part of this ^se occurred b/w 9 – 13 yrs –females & 9 – 15 yrs-

males www.indiandentalacademy.com

LOWER LIP HEIGHTLower lip stomion to soft

tissue pt B.^se of 4.2mm in males &

1.5 mm in females

Major ^se occurred b/w 10 – 11 yrs & 13 – 18 yrs.


UPPER LIP THICKNESSAt ( Pt A – A’) ^se of 4.7mm

in males & 3.5mm in females

At ( LS – LS’) labrale superiusMales -- ^sed 13.9mm –

17.1mmFemales -- ^sed 11.8mm –

12.5mm.www.indiandentalacademy.co

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LOWER LIP THICKNESSAT ( LI – LI’) ^SED 2.4mm

IN MALES. 1.4 mm IN FEMALES.

AT ( Pt B) AN INCREASE OF 2.8mm IN MALES & 1.6mm IN FEMALES


CHIN ( pg – pg’)MALES – 2.7mm ^SEFEMALES – 2mm


NASOLABIAL ANGLEB/w 7 – 18 yrs decreased in

both sexes

It was 107 sd 9.4 deg – males & 114.7 sd 9.5 deg – females

It reduced to 105.8 sd 9 deg-males & 110.7 sd 9 deg in females


MENTOLABIAL SULCUSMALES – AT 7 YRS 125.3 SD 8.4

deg. AT 18 YRS 125.1 SD 12.9 deg

FEMALES – 7 YRS 136.1 SD 11.6 deg . 18 YRS 127.1 SD 12.9 deg

The position of the lips is largely dependent upon incisor inclination.

Uprighting the max. & mand. incisors enlarges the nasolabial & mentolabial angles. www.indiandentalacademy.co

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A.J.O. 1978, PAUL LINES, RUSKIN LINES & CHRISTOPHER LINES.

In the past sexual differences were largely ignored, partly because no such differences had been demonstrated by a scientific study or validated statistical analysis.

Orthodontic treatment plans were based on primarily on the practitioner’s ability to move teeth within the alveolar bone.

PROFILOMETRICS & FACIAL ESTHETICS


The diagnostic tools necessary for facial profile management include

1. Knowledge of what constitutes esthetically pleasing facial profile.

2. Knowledge of the effects of hard tissue changes on the soft tissue profile.

3. Ability to accurately predict facial profile changes resulting from treatment.


The treatment capabilities at the disposal of the orthodontist include

1. Conventional orthodontic mechanotherapy

2. Orthopedic force therapy 3. Orthognathic surgery4. Rhinoplasty


INTERLABIAL PROMINENCE

Most female profile demonstrated 10 deg more prominence than the most popular male profile

Male 160-170 deg [mean 170 deg] Female 150deg [mean 160 deg]


CHIN PROMINENCE ANGLE

The general preference was 0 deg but +4 deg was also

preferred RANGE – 0 - +4 DEG


NASAL PROMINENCE IN RELATION TO CHIN

Most preferred male angle were – 30 deg & 35 deg. The opposite tendency was noted while selecting female profile 25 deg & 20 deg

PREFERRED RANGE- 20 deg– 35 deg


NASAL TIP ANGLE MORE ACUTE ANGLES

WERE PREFERRED FOR MALE PROFILES

PREFERRED RANGE- 60 – 80 deg


INFERIOR LABIAL SULCUS

ANGLEPreferred angles were 130 –

140 degMost pleasing angle was

130 deg or slightly greater.


NASO LABIAL ANGLE PREFERRED RANGE-

ACCORDING TO BROWN & Mc DOWELL-

90 – 110 deg


ARTICLES A.J.O. 1984, GROWTH OF LIPS IN 2-D: A SERIAL

CEPHALOMETRIC STUDY. Growth of lips measured b/w 8-18 yrs .largest

increment b/w 12-14 yrs with no significant change after16yrs.

Males had larger lips at 10,12, 14, 16 & 18 & larger lower lip at 18 yrs

Females showed larger lower at 12.


A.J.O. 1988, LINEAR CHANGES OF MAXILLARY AND MANDIBULAR LIPS

Sample size was 32 untreated male & female subjects from age 8-18 yrs of age. It was observed that the max. & mandi. lips, under the influence of growth increased in length & thickness.

The male lips exhibited greater increase than the female lips.


GROWTH CHANGES IN THE NASAL PROFILE FROM 7 – 18 YEARS , A.J.O. 1988

Increments in nose height, depth & inclination are complete in girls by 16 years of age while continuing to ^se in males even beyond 18 yrs of age.

Ratio b/w upper & lower nose heights were 3:1 Ratio b/w nose depth & sagittal depth of the

underlying skeleton changed from 1:2 at 7yrs to 1:1.5 in M & 1:1.6 in F

Upper nose inclination same for both sexs. lower nose inclination ^sed slightly in F after age 10. www.indiandentalacademy.co

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A.J.O. 1984, SOFT TISSUE PREFERENCE

Study showed that C I normal profiles were the favoured ones the C I deep profiles

Open profile types were the least appreciated.

This indicated that vertical profile characteristics could be more important than a/p features & lengthening of soft tissue profile were not desired in most cases.www.indiandentalacademy.co

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A.J.O. 1992, FACIAL GROWTH IN FEMALES BETWEEN 14 – 20 YEARS OF AGE

The objective of this study was to determine the magnitude & the direction of post pubertal mandi. & max. facial growth in females

The overall mandi. growth was approx. twice that of the overall max. growth.

Mandi. growth rate was found to be between 14-16 yrs of age.

Between 14-20 yrs the Mandibular Plane Angle decreased 1.1 deg showing a closing rotation of the mandible & the mandi. Incisors tipped labially with advancing age.


A.J.O. 1990, FACIAL GROWTH IN MALES 16-20 YRS OF AGE

MANDI. GROWTH WAS FOUND TO BE STATISTICALLY SIGNIFICANT FOR THE AGE PERIODS 16-18 YRS & 18-20 YRS

GROWTH FROM 16-18 YRS WAS GREATER THAN THAT 18-20YRS

OVERALL MANDI. GROWTH WAS APPROX. TWICE THAT OF MAX. GROWTH

MANDI. GROWTH WAS FOUND TO INVOLVE AN UPWARD & FORWARD ROTATION & INCISORSWERE FOUND TO TIP LINGUALLY WITH INCRESING AGEwww.indiandentalacademy.co

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A.J.O. 1994, LONGITUDINAL CHANGES IN ADULT FACIAL PROFILE

SUBJECTS WERE B/W THE AGES 18-42 YRS. Results showed that male profiles straightened with

age & became more retrusive. The males ^sed in all nose dimensions & in soft tissue

thickness at pogonion & decreased in upper lip thickness

The female profile did not become straighter with age & lips did not become more retrusive as with males

For males most changes in hard tissue measurements had been accomplished by age 25 yrs, whereas soft tissue changes occurred even after 25 yrs

For females both hard & soft tissue measurement had more changes after age 25www.indiandentalacademy.co

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ISRAEL ( 1973) reported data from women who were 1st examined at ages ranging from 24 – 48 yrs & were reexamined 14 – 28 yrs later.

He concluded that there was 4 – 5 % overall ^se in size, upper face ^sed by 6 %, frontal sinuses by 9- 14 % & mandible by 5 -7 %.

There was significant ^se in Se – Na, Se –Ba, Go – Gn, Co – Gn.


BEHERENTS ( 1985 ) found enlargement in all dimensions of cranial base & mandible after 30 yrs & growth ceased after 35 yre of age.


ANGLE 1988, LATE GROWTH CHANGES IN CRANIOFACIAL SKELETON

THIS STUDY SHOWED THAT ALL MEASUREMENTS REACHED PEAK AT 32 YRS EXCEPT FOR Go – Gn AT 40 YRS.

The age at which maxi. length occurs in an individual is regarded as the age at which growth has ceased.

There were small decreases in the cranial base & mandi. lengths after the maxi. Values were attained (mean decrease 0.62 – 1.33mm)

The decrease tended to be larger in men than in women.


^se in size of nose & ears

Nose- broader, longer & had downward tip.

Lower third of face showed ^sed dimension.

Lip prominence was lessened www.indiandentalacademy.co

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In both sexes most of the changes was expressed ant. ly. Thus the position of the nasion & tip of nasal bone were located in an anterior position with time.

The chin continues to get displaced ant .ly during all ages.

The mean ^se in total facial height was 2.8mm during adulthood

Because of the growth of the nose & the anterior movement of chin, teeth appear less prominent & lip area flattened www.indiandentalacademy.co

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Persons who had experienced the loss of many teeth also grew in adulthood.

But these individuals grew less in adulthood. They showed a vertical loss of dimension with time.

In a very old individual where the jaws are completely edentulous, the alveolar bone resorbs & vertical facial height is reduced. The lower face becomes concave.


CONCLUSION

ON THE BASIS OF THE FINDINGS PRESENTED HERE, IT MUST BE RECOGNISED THAT GROWTH & DEVELOPMENT OF THE CRANIOFACIAL SKELETON IS A CONTINUING LONGTERM PROCESS THAT APPARENTLY HAS ITS PERIODS OF EXUBERANCE & RELATIVE QUIESCENCE, BUT THE BIOLOGIC MECHANISMS THAT REGULATE THE CHANGES REMAIN INTACT & NEVER REALLY TERMINATE.


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Age Related Soft Tissue Changes - Copy / orthodontic courses by Indian dental academy

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