Efficacy of the combination of myofunctional therapy (lip exercises) and activator high-pull headgear in the closure of interlabial gap in long-face skeletal class II patients with lip incompetence: A 6-8-month longitudinal randomized clinical trial.

Background: Lip incompetence is an important issue in orthodontics. No study has evaluated the effects of the combination of headgear + lip exercises on lip incompetence. Therefore, this study was conducted. Materials and Methods: This was a longitudinal randomized clinical trial on 29 subjects (16 controls and 13 experimental subjects). Both groups were treated with standardized activator high-pull headgear (and followed up monthly) for 6-8 months. In the experimental group, patients were also instructed to practice certain lip exercises 3 sessions a day, 5 times per session. Pre-/post-treatment interlabial gap, upper lip length and vermilion height, lower lip length and vermilion height, nasolabial angle, and profile convexity angle were measured clinically and photographically, immediately before treatment and after it. Data were analyzed using paired/unpaired t-tests (α = 0.025) and partial correlation coefficient controlling for the intervention type (α = 0.05). Results: Lip exercise plus activator headgear significantly changed/improved all parameters (P ≤ 0.006) over the 6-8-month course of treatment. Activator headgear alone changed/improved only 4 parameters: interlabial gap, upper and lower lip lengths, the lower lip vermilion height, and profile convexity (P ≤ 0.008). Compared to the control (activator headgear alone), in the experimental group, the changes observed in the interlabial gap closure (P = 0.011), upper lip lengthening (P = 0.002), and upper lip vermilion lengthening (P = 0.017) were significantly greater. Convexity angle corrections were more successful in cooperative patients (R = 0.469, P = 0.012). Cases with smaller pretreatment nasolabial angles may experience more changes in this angle after treatment (R = 0.581, P = 0.001). Conclusion: The addition of lip exercises to activator high-pull headgear can boost activator headgear's efficacy in treating lip incompetence.

Associations among the occurrence or types of maxillary canine impaction, labial frenum attachment types, lateral incisor anomalies, and midline diastema in patients with and without impaction: A case-control study.

INTRODUCTION: We tested whether the labial frenum attachment types may affect the occurrence or type of maxillary canine impaction. METHODS: This case-control study was performed on 96 subjects (48 with maxillary canine impaction [20.50±4.99 years, 32 females], 48 controls [21.94±3.79, 31 females]). Types of canine impaction (buccal/palatal, bilateral/unilateral, left/right), types of upper lip middle frenums (mucosal, gingival, papillary), the anatomy of lateral incisors (impacted, peg shaped, small, normal), and the midline diastema were evaluated clinically and radiographically. Associations were examined using multiple binary logistic regression, 3-way repeated-measures ANCOVA, and Fisher tests (α=0.05, ß=0.2). RESULTS: The numbers of mucosal, gingival, and papillary frenums in the case group were '29, 14, and 5', respectively; in the control group, they were '25, 21, and 2' (Fisher, P=0.248). The numbers of mucosal, gingival, and papillary frenums were respectively '25, 11, and 1' in the palatally impacted canine subgroup; they were '4, 3, and 4' in the buccally impacted subgroup (Fisher, P=0.010). Abnormal laterals were present in 12 cases and 4 controls; normal laterals were observed in 36 cases and 44 controls (Fisher, P=0.053). Abnormal laterals were seen in 10 cases with palatally impacted canines and 2 cases with buccally impacted canines; normal laterals existed in 27 cases with palatally impacted canines and 9 cases with buccally impacted canines (Fisher, P=0.705). Lateral anatomy was not associated with frenum attachment (Fisher, P=0.827). Greater midline diastemas were seen in cases with maxillary canine impaction, papillary frenums, and abnormal laterals (ANCOVA, P≤0.016). CONCLUSIONS: Buccal type of canine impaction is positively associated with papillary labial frenums. Canine impaction is 3.6 folds more prevalent in cases with lateral abnormality. Midline diastema is positively and independently associated with canine impaction, papillary frenums, and abnormal laterals.

The Perception of the Severity of Facial Asymmetry among Laypersons, General Practitioners, Orthodontists, and Maxillofacial Surgeons.

STATEMENT OF THE PROBLEM: The degree of asymmetry perception of dental and medical practitioners is influenced by several factors. The perceived asymmetry affect the treatment plan design. PURPOSE: The aim of the present study was to investigate the consistency of facial asymmetry and identify the amounts of transverse asymmetry that can be regarded as normal and might need correction. MATERIALS AND METHOD: In this cross-sectional descriptive study, three-dimensional (3D) images of a man and a women volunteer were obtained. Then transverse changes were applied by ZBrush software so that for each volunteer, seven 3D images of their face with varying degrees of facial transverse asymmetry were created. Then, the images were displayed to four groups of observers including layperson, general dentists, orthodontists, and maxillofacial surgeons. Finally, the consistency of the perception of these four groups of observers with the different degrees of facial asymmetry was compared. RESULTS: Fourteen photographic samples were evaluated and ranked by 80 observers in four groups. The consistency of the perception of the facial transverse asymmetry was equal to 33%, which indicated a lack of consistency. CONCLUSION: According to the findings of this study, there was no consistency between the groups. The perception of dental professionals and ordinary people regarding the severity of transverse facial asymmetry seems to be inconsistent.