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Member, Royal College of Dentists of Canada; Professor, Department of Orthodontics, Bauru Dental School, University of So Paulo, Bauru, Brazil
Orthodontic Graduate Student, Department of Orthodontics, Bauru Dental School, University of So Paulo, Bauru, Brazil
Associate Professor, Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, Bauru, Brazil; Bauru Dental School, University of
So Paulo, Bauru, Brazil
d
Orthodontic Graduate Student, Department of Orthodontics, Bauru Dental School, University of So Paulo, Bauru, Brazil
e
Private Practice, So Paulo, Brazil
f
Associate Professor, Department of Orthodontics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
b
c
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 7 July 2013
Received in revised form
25 September 2013
Accepted 2 November 2013
Available online 2 December 2013
Background: The purpose of this study was to evaluate the long-term behavior of the interlabial gap in
patients with Class I and Class II malocclusion after orthodontic treatment and to investigate whether
interlabial gap behavior is related to treatment with or without extraction.
Methods: Lateral head-lms at the pre- and post-treatment and long-term follow-up stages were
obtained from 61 patients who initially had Class I or Class II malocclusion and with pre- and posttreatment lip incompetence, who were treated with or without extraction. Dependent and independent Students t tests were used for the intra- and intergroup comparisons.
Results: There were signicant interlabial gap reductions of 1.64 and 1.72 mm in Class I and II, respectively, but there was no signicant intergroup difference. Nonextraction patients had signicantly greater
interlabial gap reduction (2.7 mm) than did extraction patients (1.3 mm) in the long-term.
Conclusions: It was concluded that the interlabial gap decreases signicantly and similarly in treated Class
I and Class II malocclusion patients and that nonextraction treatment has greater interlabial gap
reduction than does extraction treatment in the long-term post-treatment period.
2013 World Federation of Orthodontists.
Keywords:
Cephalometry
Lip
Tooth extraction
1. Introduction
During the past decade, great concern has been drawn toward
facial esthetics as one of the major goals of orthodontic treatment
[1,2]. Consequently, evaluation of lip posture features is a requirement for achieving pleasant facial harmony [3e5]. Before orthodontic treatment, clinical assessment should always include
evaluation of the soft tissue at rest and during function because
morphology of the soft tissues is a major factor in determining the
overall facial prole [6].
In normal occlusion or at the end of treatment, a normal
vertical-lips relationship should consist of a mean gap of 2 mm
(2 mm), with the mandible in centric occlusion [7]. Therefore, a
small amount of lip incompetence is considered to be normal. A
number of studies have described the relationship between lip
e176
Fig. 1. Linear measurements. 1, upper lip length; 2, interlabial gap; 3, lower lip length.
All statistical analyses were performed with Statistica for Windows 7.0 (Statsoft, Tulsa, OK).
3. Results and discussion
Table 1
Post-treatment and long-term post-treatment ages, and long-term post-treatment
times
Parameter
Class I (n 30)
Class II (n 31)
P*
Post-treatment age
Long-term post-treatment age
Long-term post-treatment time
15.21 (1.86)
21.87 (2.79)
6.66 (2.77)
15.88 (1.75)
22.67 (3.53)
6.79 (2.83)
0.154
0.332
0.854
e177
Table 2
Interlabial gap behavior with time in Class I and II malocclusions
Table 3
Relationship between the lip length, facial pattern, and extraction and interlabial gap
behavior*
Parameter
Class I
(n 30)
Class II
(n 31)
P between
classes*
3.13 (1.53)
1.40 (1.98)
<0.001
1.72 (2.12)
0.246
0.183
e
0.894
Variable
0.546
0.958
0.472
0.028y
0.785
*
y
e178
Table 4
Comparison of interlabial gap changes between nonextraction and extraction
treatment
Variable
Nonextraction (n 16)
Extraction (n 45)
2.73 (1.53)
1.31 (2.42)
0.024*
are no reports that have assessed the relationship between interlabial gap behavior with time and nonextraction and extraction
treatment. However, several studies have reported the relationship
between interlabial gap behavior during orthodontic treatment
[30,36,39e42]. Extraction treatment causes greater interlabial gap
reduction during treatment than does nonextraction treatment
[36]. This is probably consequent to the incisor retraction that
usually occurs during extraction mechanics. As the incisors retract,
the lips usually follow and consequently approximate to each other,
decreasing the interlabial gap. This mechanism is absent in Class I
nonextraction treatment and is partially present in Class II nonextraction treatment during correction of the anteroposterior
discrepancy. During the long-term post-treatment period, the
amount of interlabial gap decrease is greater in nonextraction
treatment due to the natural changes with growth and development. It seems that the interlabial gap behaves similarly to other
variables when submitted to orthodontic treatment [39e41]. The
greater the changes during treatment, the smaller post-treatment
changes will be [42].
3.8. Clinical implications
Several studies have assessed the relationship between interlabial gap and malocclusion. Among the occlusal conditions most
associated to lip incompetence are over jet, mandibular incisor
inclination, and anteroposterior discrepancies [10e12]. This means
that different occlusal conditions for different types of malocclusion
can be related to interlabial gap. However, no research has assessed
the relationship between malocclusion and interlabial gap behavior
with time, after orthodontic treatment. Consequently, any comparison to other research is fairly limited. In this study, patients
who initially had Class I and Class II malocclusions and pretreatment lip incompetence were included. At the end of orthodontic
treatment, these patients still had lip incompetence and showed
the same interlabial gap behavior with time, regardless of the initial
malocclusion (Table 2). Therefore, independently of the initial
malocclusion, one can expect the same changes in interlabial gap
after orthodontic treatment, with time. In fact, this would be expected because at the end of treatment, both groups nished with a
normal occlusion and consequently the changes should be similar if
there were no signicant relapses in the groups. Primarily, it would
be over jet relapse in the Class II malocclusion group that could be
accounted for some intergroup difference. However, because there
were no intergroup differences in interlabial gap behavior with
time, this indirectly suggests that there were no signicant relapses
in over jet in the Class II group. Therefore, the initial occlusal factors
of the different malocclusions no longer have an effect.
4. Conclusions
References
The interlabial gap decreased signicantly more in the nonextraction than in the extraction patients, with time (Table 4). There
Acknowledgment
The authors would like to acknowledge FAPESP (So Paulo State
Research Foundation) for its Support. Process #09/06927-3 So
Paulo, Brazil.
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