Photographic Analysis of Soft Tissue Facial Profile in Patients With Class II Malocclusion
Condition: Class II Malocclusion
MeSH terms: Malocclusion; Malocclusion, Angle Class II; Overbite
Study type: Observational [Patient Registry]

Summary: 
      The present day social setup considers facial charisma as an important physical
      characteristic. The facial characteristics of an individual are measured through
      anthropometry, photogrammetry, computer imaging and cephalometric radiographs. Cephalometric
      radiographs offer significant diagnostic information regarding the association between the
      dental and skeletal structures. By means of photogrammetric measurements, a fresh diagnostic
      resource is accessible to the orthodontist which permits an intangible, radiation free
      attainment of measure points of soft tissue with no instrumental expense and radiation to the
      patient.

      Orthodontic patients range from adolescents to senior citizens and originate from an
      assortment of populations, thus an extensive series of representative norms will be ideal.
      Knowledge of the normal dentofacial outline of every group will make certain better success
      of treatment to set up the best possible facial agreement. Hence, it is extremely important
      to assess the soft tissue profile of a patient as it is one of the most vital components of
      orthodontic diagnosis and treatment planning.

      The purpose of the present study is to evaluate the photographic characteristics of soft
      tissue facial profile of patients with class II malocclusion as ethnic differences have been
      found to be reported in the literature. It is hypothesized that soft tissue facial
      characteristics on lateral profile photographs and lateral cephalometric radiographs in a
      sample of local population with class II malocclusion are closely related.
    

Detailed description: 
      The goal of orthodontic treatment planning is to achieve facial synchronization by an
      esthetically pleasing face.It was a common idea in orthodontic treatment planning that soft
      tissue enhancement would follow the hard tissues, but this did not always happen.The reaction
      of soft tissue to hard tissue movement is not found to be consistent.With the emergence of a
      new paradigm in orthodontic diagnosis and treatment planning, greater emphasis has been
      placed on the relationships of soft tissues and lesser emphasis on the treatment of
      malocclusion. During the last few years, diagnosis and treatment planning in orthodontics has
      been reallocated in the direction of facial planning. Formerly, a lot of consideration was
      placed on the dental and skeletal components but now greater thought is paid to the soft
      tissue components. The purpose of treatment in the new paradigm is to place the teeth in
      optimal position with reference to the lips, both vertically as well as antero-posteriorly.

      The facial characteristics of an individual are measured through anthropometry,
      photogrammetry, computer imaging and cephalometric radiographs. Cephalometric radiographs
      offer significant diagnostic information regarding the association between the dental and
      skeletal structures. Lateral cephalogram has been reported in the literature as an essential
      element of the diagnostic procedure in orthodontics. Frontal and lateral photographs of the
      patient correspond to another frequently used diagnostic method. Linear and angular soft
      tissue facial profile analysis on photographs is carried out corresponding to radiographic
      cephalometry.

      While taking a lateral cephalometric radiograph, the patient is exposed to radiations,
      moreover; the bony structures overlap each other that enhances the likelihood of misreading
      of the measured values. By means of photogrammetric measurements, a fresh diagnostic resource
      is accessible to the orthodontist which permits an intangible, radiation free attainment of
      measure points of soft tissue with no instrumental expense and radiation to the patient. It
      has also been reported that lip-tooth relationships during speech and while smiling are not
      documented by means of the cephalometric radiograph. Photographs of the face while smiling
      and at rest are essential to acquire lip-tooth relationships. By means of this, the
      orthodontist can evaluate anterior tooth as well as adjoining soft tissue relationships. Even
      though cephalometry is the standard for illustrating skeletal and dental morphology but it
      might not be appropriate for extensive epidemiologic studies because of the radiations that
      the patient is exposed to.

      Edward Angle, the father of modern orthodontics classified malocclusion based on the position
      of the maxillary first molar into three types; class I or neutrocclusion, class II or
      distocclusion and class III or mesiocclusion. Class II malocclusions are contemplated to be
      one of the most common among all the other forms of malocclusions. It has been reported in
      the literature that class II malocclusions present an assortment of dental and skeletal
      configurations. Skeletal class II patterns occur not merely from sagittal discrepancies but
      as well from vertical discrepancies.

      Dental class II is associated with distal relationship of lower teeth with their upper
      counterparts. It further has two subdivisions, class II division 1 and class II division 2.
      Class II division 2 malocclusion is less commonly come across as compared to class II
      division 1. The etiology behind class II malocclusion is multifactorial. An important
      etiological agent in this type of malocclusion is the soft tissue. For instance, class II
      division I malocclusion is commonly due to the result of a short or hypotonic upper lip while
      class II division II is due to the result of bimaxillary retroclination caused by active
      muscular lips. Prevalence of different occlusions vary with populations of diverse origin and
      comparable is the case with class II malocclusion. It has been reported in the international
      literature that class II malocclusion is the most prevalent form of malocclusion as compared
      to class I and class III malocclusions.

      The purpose of the present study is to evaluate the photographic characteristics of soft
      tissue facial profile of patients with class II malocclusion. The current study has also been
      planned to observe and compare the results of photographic and cephalometric variables. Soft
      tissue profile analysis of class II patients would assist us in planning the orthodontic
      treatment in such individuals. This would serve the purpose of establishing the diagnostic
      values that would aid the orthodontists in future while planning the treatment plan for class
      II patients. Planning soft tissue analysis on photographs would also save the patient from
      excessive radiographic exposure and would help in better planning of the soft tissues.
    

Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Study population comprises of subjects reporting to Dental department of Shaikh Zayed
        Medical Complex, Lahore and Department of Orthodontics at University College of Medicine
        and Dentistry, Lahore.
      
Keywords: Photographic analysis; Cephalometric analysis; Standardized photographs; Angular measurements; Linear measurements; Malocclusion; Facial Profile