Sie sind auf Seite 1von 60

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
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
PREHISTORIC ESTHETIC SENSE
www.indiandentalacademy.com
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
www.indiandentalacademy.com
EGYPTIAN SCLUPTURES
www.indiandentalacademy.com
www.indiandentalacademy.com
THE GREEKS
The Greeks were the 1
st
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 4
th
& 5
th

century B.C. often called as the GOLDEN
AGE OF GREECE
www.indiandentalacademy.com
GREEK SCULPTURES

www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.com
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.
www.indiandentalacademy.com
PROFILE CHANGES IN GROWING FACE
The face of a child is vertically short
because
1. Nasal part of the face is still small
2. The primary & secondary dentition has not
fully established
3. The jaw bones have not grown to the
vertical extent that would support the full
dentition & the enlarging masticatory
muscles & airway
www.indiandentalacademy.com
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
www.indiandentalacademy.com
The babys face appears relatively
smaller than the cranium. This is
because the growth of the brain slows
down considerably after about the 3
rd
or
4
th
year of child hood, but the facial
bones continue to enlarge for many
more years.
www.indiandentalacademy.com
www.indiandentalacademy.com
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.
www.indiandentalacademy.com

www.indiandentalacademy.com

www.indiandentalacademy.com
FACIAL TYPES
MESOFACIAL ( IDEAL)
TYPE
Most often associated with
C I occlusions since these
patients are characterised
by relatively normal max.
& mandi. relationship
resulting in good facial
balance.

www.indiandentalacademy.com

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

www.indiandentalacademy.com
BRACHYFACIAL TYPE
They 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.

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


FINAL OCCLUSION IN
ADULT

CLASS I- 59%

CLASSII- 39%

CLASS III- 2%
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
NOSE HEIGHT
Upper 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 yrs
U/N : L/N = 3:1
www.indiandentalacademy.com

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.
www.indiandentalacademy.com

UPPER LIP HEIGHT
Measured 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 HEIGHT
Lower 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.
www.indiandentalacademy.com


UPPER LIP THICKNESS
At ( Pt A A) ^se of 4.7mm in
males & 3.5mm in females

At ( LS LS) labrale superius
Males -- ^sed 13.9mm
17.1mm
Females -- ^sed 11.8mm
12.5mm.
www.indiandentalacademy.com


LOWER LIP THICKNESS
AT ( 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
www.indiandentalacademy.com



CHIN ( pg pg)
MALES 2.7mm ^SE
FEMALES 2mm
www.indiandentalacademy.com

NASOLABIAL ANGLE
B/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
www.indiandentalacademy.com
MENTOLABIAL SULCUS
MALES 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.com
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 practitioners ability to move teeth within the
alveolar bone.
PROFILOMETRICS & FACIAL ESTHETICS
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
The treatment capabilities at the disposal of
the orthodontist include
1. Conventional orthodontic mechanotherapy
2. Orthopedic force therapy
3. Orthognathic surgery
4. Rhinoplasty
www.indiandentalacademy.com
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]
www.indiandentalacademy.com
CHIN PROMINENCE ANGLE
The general preference was
0 deg but +4 deg was also
preferred
RANGE 0 - +4 DEG
www.indiandentalacademy.com

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
www.indiandentalacademy.com

NASAL TIP ANGLE
MORE ACUTE ANGLES WERE
PREFERRED FOR MALE
PROFILES

PREFERRED RANGE- 60 80 deg
www.indiandentalacademy.com
INFERIOR LABIAL SULCUS
ANGLE
Preferred angles were 130
140 deg
Most pleasing angle was 130
deg or slightly greater.
www.indiandentalacademy.com



NASO LABIAL ANGLE
PREFERRED RANGE- ACCORDING
TO BROWN & Mc DOWELL-
90 110 deg
www.indiandentalacademy.com
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.

www.indiandentalacademy.com
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.

www.indiandentalacademy.com
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.com
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.com
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.


www.indiandentalacademy.com
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 AGE
www.indiandentalacademy.com
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 25
www.indiandentalacademy.com
ISRAEL ( 1973) reported data from women who
were 1
st
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.
www.indiandentalacademy.com


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

www.indiandentalacademy.com

^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.com
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.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com

Thank you

For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com

Das könnte Ihnen auch gefallen