Alterations in Integumental Facial Dimensions after Orthodontic Treatment.

BACKGROUND: It is documented that the facial profile changes, morphology changes, and continued facial growth in early adults and late adolescents. AIMS: The present trial was aimed to quantitatively assess the changes in facial growth from adolescents to adults.
MATERIALS AND METHODS: In the present study, 16 facial distances (transverse) and craniocaudal facial distances were measured, and growth changes were assessed. The collected data were subjected to statistical evaluation, and the results were formulated.
RESULTS: Upper face width was statistically significantly increased in males than females from posttreatment to recall with the P < 0.0001. The decrease in outer canthus was seen in females as compared to males, which was statistically significant with the P < 0.0001. An increase in mouth width was seen in both males and females with higher in females.
CONCLUSION: The present study showed an increase in facial dimensions in both genders with age where transverse changes were higher than the craniocaudal alterations. Copyright:

INTRODUCTION

Facial changes are observed in humans throughout their lives to some extent or other. About the later phases of growth and development in adults are described in detail with the anthropometric data available which shows the continuous growth and development throughout life.[1] The growth and alteration in the facial dimensions in adolescents are well documented in the literature. However, the data regarding the alterations in the facial dimensions in adults are scarce in the existing literature. This can be due to the lack of available data to assess these changes in adult humans.[2] Few studies in the literature, however, document the facial profile changes, morphology changes, and continued facial growth in early adults and late adolescents.[3]

Controversy exists to date, concerning changes in soft tissues following orthodontic treatment of retraction for cases with bimaxillary protrusion. Majorly the studies done on facial growth seen in the adult subjects rely on the cross-section studies.[4] Cross-section studies show that alteration noticed in subjects of different ages is the reflection of how an individual grows. However, in cross-section studies, the subjects are evaluated only once, hence, no information can be extracted regarding growth. Longitudinal studies are required to assess actual changes in growth rate which are relatively very few in this area.[5]

Before, during, and after orthodontic treatment, various data in terms of the radiograph, dental casts, and photographs are recorded for the information purpose. These can serve as important data to evaluate the changes in growth observed over a while.[6] These photographs taken for the orthodontic purpose mainly help to evaluate growth changes in adolescents as orthodontic treatment is mainly taken in adolescents. The availability of the photographs from frontal view for a long recall period can provide a unique opportunity to assess the long-term changes in facial growth in adults, especially in soft-tissue profiles.[7] Hence, the present trial was aimed to quantitatively assess the changes in facial growth from adolescents to adults.

MATERIALS AND METHODS

One hundred and twenty participants were screened who had frontal facial photographs to assess the soft-tissue transitions from adolescent to adult age. The photographs were taken from the department of orthodontics from posttreatment to the long-term follow-up period for at least 5 years following orthodontic treatment. The participants were 14 years–18 years treated with edgewise technique irrespective of the malocclusion. The inclusion criterion for the study was the availability of frontal facial photographs from the period of orthodontic posttreatment phase to the final recall of a minimum of 5 years. The final participants were 86 participants including both genders.

In the present study 16, facial distances (transverse) were assessed and calculated including face width (upper, midface, and lower). Upper face width was measured from left zygion to right, midface width from left Otobasion to the right, and lower face width from left to right Gonion. Outer and inner canthus width was measured from left exocanthion to right (ExL to ExR) and from left endocanthion to right (EnL to EnR), respectively. Alar width was measured from left alare to right, mouth width from left chelion to right.

Craniocaudal facial distances measured were upper face height, lower face height, and total face height were, respectively, measured as the distance from ExL to ExR with subnasale (Ex to Sn), Sn to menton (Sn toMe), and left exocanthiom to right with Me. Height of upper lip and lower lip were, respectively, measured as the distance from Sn to Labrale Superius (Sn to Ls) and from stomion (St) to Me. St height was a distance from Sn to St. Exposure of lower lip and upper lip was measured, respectively, as the distance from St to Labrale Inferius (St to Li) and from Ls to St. The chin height was measured from Li to Me from Li to Me. Collected data were subjected to the statistical evaluation, and the results were formulated.

RESULTS

The age distribution of the study samples at posttreatment and recall is summarized in Table 1. It was seen that in males the mean age at the time of treatment completion was 15.33 ± 1.64 which at last recall was 23.23 ± 4.59 with an average posttreatment to recall-duration of 7.10 ± 3.86. Concerning females, these values at posttreatment and recall, respectively, were 15.22 ± 2.43 and 23.14 ± 4.32 with a mean posttreatment to recall value of 7.23 ± 4.16 years.

Table 1

Age distribution in males and female study participants

Parameter	End of the treatment	At recall	From end treatment to recall
Males (n=32)	15.33±1.64	23.23±4.59	7.10±3.86
Females (n=54)	15.22±2.43	23.14±4.32	7.23±4.16
Total (n=86)	15.56±1.78	23.23±4.42	7.44±3.82

Facial ratios and their descriptive analysis are described in Tables 2 and 3 concerning all the assessed 16 parameters and facial dimensions. Upper face width was significantly increased in males than females from posttreatment to recall with the P < 0.0001. Outer canthus which was measured from ExL to ExR showed a decrease with the age with the inner canthus width which was measured from the EnL to EnR with more decrease in inner canthus width. The decrease in outer canthus was seen in females as compared to males, which was statistically significant with the P < 0.0001. Inner canthus width decrease was greater in males with a P = 0.0942 and 0.0229 in females and males showing statistically nonsignificant results. Alar width did not show changes in males and females at two evaluated periods within the total change of 0.000 ± 0.028 and P = 0.8584.

Table 2

Description of facial dimensions in study participants

Dimension	Facial Dimensions at posttreatment			Facial dimensions at recall			Changes from posttreatment to recall
	Females (n=54)	Males (n=32)	Combined (n=86)	Females (n=54)	Males (n=32)	Combined (n=86)	Females (n=54)	Males (n=32)	Combined (n=86)
Upper face width	2.12±0.11	2.12±0.12	2.12±0.11	2.13±0.13	2.18±0.14	2.15±0.13	0.008±0.012	0.054±0.106	0.026±0.099
Mid face width	1.97±0.11	2.01±0.14	2.00±0.11	1.99±0.13	2.13±0.18	2.06±0.16	0.020±0.099	0.121±0.126	0.061±0.121
Lower face width	1.81±0.12	1.84±0.15	1.82±0.14	1.88±0.15	2.02±0.19	1.94±0.17	0.071±0.120	0.179±0.157	0.115±0.147
Alare width	0.56±0.05	0.57±0.04	0.56±0.05	0.55±0.05	0.58±0.05	0.56±0.05	−0.001±0.027	0.003±0.029	0.000±0.028
Outer canthus width	1.47±0.05	1.46±0.05	1.46±0.05	1.46±0.06	1.44±0.06	1.45±0.06	−0.007±0.045	−0.020±0.047	−0.012±0.046
Inner canthous width	0.54±0.05	0.53±0.04	0.54±0.05	0.54±0.05	0.52±0.04	0.53±0.05	−0.007±0.029	−0.011±0.027	−0.008±0.028
Mouth width	0.69±0.07	0.72±0.07	0.70±0.07	0.72±0.07	0.74±0.07	0.73±0.07	0.032±0.059	0.018±0.062	0.026±0.060
Upper Face height	0.68±0.09	0.69±0.08	0.69±0.09	0.66±0.09	0.68±0.08	0.67±0.09	−0.023±0.063	−0.011±0.070	−0.018±0.066
Lower face height	1.09±0.11	1.15±0.10	1.11±0.11	1.10±0.11	1.20±0.12	1.14±0.13	0.012±0.070	0.058±0.095	0.031±0.083
Total face height	1.76±0.12	1.83±0.12	1.79±0.13	1.75±0.13	1.88±0.15	1.80±0.15	−0.012±0.060	0.048±0.091	0.013±0.080
Stomion height	0.36±0.05	0.39±0.05	0.37±0.05	0.37±0.06	0.40±0.06	0.38±0.06	0.011±0.037	0.007±0.039	0.009±0.038
Chin height	0.58±0.08	0.60±0.07	0.59±0.08	0.60±0.08	0.68±0.08	0.63±0.09	0.021±0.061	0.083±0.081	0.046±0.076
Lower lip height	0.74±0.08	0.76±0.07	0.75±0.08	0.74±0.08	0.81±0.09	0.77±0.09	0.002±0.053	0.052±0.076	0.022±0.068
Upper lip height	0.28±0.05	0.31±0.04	0.29±0.05	0.29±0.05	0.33±0.05	0.31±0.05	0.016±0.034	0.016±0.032	0.016±0.033
Upper lip exposure	0.09±0.03	0.09±0.04	0.09±0.03	0.08±0.03	0.08±0.03	0.08±0.03	−0.005±0.018	−0.011±0.028	−0.007±0.023
Lower lip exposure	0.17±0.04	0.17±0.04	0.17±0.04	0.15±0.04	0.14±0.04	0.15±0.04	−0.020±0.032	−0.031±0.030	−0.025±0.032

Table 3

Description of posttreatment alterations in study subjects

Dimension	Females (n=54)	P	Males (n=32)	P	Combined (n=86)	P
Upper face width	0.008±0.090	0.4546	0.054±0.106	0.0016	0.026±0.099	0.0057
Mid face width	0.020±0.099	0.0996	0.121±0.126	<0.0001	0.061±0.121	<0.0001
Lower face width	0.071±0.122	?0.0001	0.179±0.157	<0.0001	0.115±0.147	<0.0001
Alare width	−0.001±0.027	0.5645	0.003±0.029	0.3624	0.000±0.028	0.8584
Outer canthus width	−0.007±0.045	0.1634	−0.020±0.045	0.0064	−0.012±0.046	0.0040
Inner canthus width	−0.007±0.029	0.0942	−0.011±0.027	0.0229	−0.008±0.028	0.0062
Mouth width	0.032±0.059	0.0001	0.018±0.062	0.0728	0.026±0.060	<0.0001
Upper face height	−0.023±0.063	0.0078	−0.011±0.070	0.3474	−0.018±0.066	0.00897
Lower face height	0.012±0.070	0.2132	0.058±0.095	0.0004	0.031±0.083	0.0005
Total face height	−0.012±0.060	0.1549	0.048±0.091	0.0020	0.013±0.080	0.1133
Stomion height	0.011±0.037	0.0309	0.007±0.039	0.3357	0.009±0.038	0.0226
Chin height	0.021±0.061	<0.0001	0.083±0.081	<0.0001	0.046±0.076	<0.0001
Lower lip height	0.002±0.053	0.09060	0.052±0.076	?0.0001	0.022±0.068	0.0019
Upper lip height	0.016±0.034	0.0001	0.016±0.032	0.0034	0.016±0.033	<0.0001
Upper lip exposure	−0.005±0.018	0.0639	−0.011±0.028	0.0278	−0.007±0.023	0.0039
Lower lip exposure	0.012	<0.0001	0.024	<0.0001	0.016	<0.0001

However, the difference in mouth width was statistically nonsignificant with a respective P = 0.0001 and 0.0728 in females and males, respectively. The chin height increased in both males and females from posttreatment to recall period with statistically significant P < 0.0001. Lower lip exposure changes in both males and females showed statistically significant results at all the time intervals with the P < 0.0001. Lower lip height values showed a statistically significant increase in males with respective values of 0.076 ± 0.07 and 0.081 ± 0.009 at posttreatment and recall with the P < 0.0001. Upper lip height showed statistically significant changes with a value of 0.016 ± 0.033.

DISCUSSION

Larger changes were seen in male subjects with the facial width in the mid-face and lower face region. It was also seen that greater changes were seen in males than females and early aging than older. Upper face width was significantly increased in males than females from posttreatment to recall with the P < 0.0001. These findings were in agreement with the study of Farkas et al.[8] in 2004 where the authors reported a significant change in upper face width in both genders with age. This can be attributed to an increase in masseter thickness.

The decrease in outer canthus was seen in females compared to males, which was statistically significant with the P < 0.0001. Inner canthus width decrease was greater in males with a P = 0.0942 and 0.0229 in females and males showing statistically nonsignificant results. Alar width did not show changes in males and females at two evaluated periods within the total change of 0.000 ± 0.028 and P = 0.8584. These findings were consistent with the findings of Ferrario et al.[9] in 2001 where authors reported age-related effect on eye inclination showing medial and down movement in outer canthus.

Difference was statistically nonsignificant in mouth width with a respective P = 0.0001 and 0.0728 in females and males, respectively. A similar increase was shown by the study of Ferrario et al.[10] in 2000; however, they showed significant results. Chin height increased in both males and females from posttreatment to recall period with statistically significant P < 0.0001. Chin height increase was also reported by Bradshaw[11] in 2002 where authors mentioned an increase in vertical distance from skeletal to soft tissue Me.

Lower lip exposure changes in both males and females showed statistically significant results at all the time intervals with the P < 0.0001. Lower lip height values showed a statistically significant increase in males with respective values of 0.076 ± 0.07 and 0.081 ± 0.009 at posttreatment and recall with the P < 0.0001. Upper lip height showed statistically significant changes with a value of 0.016 ± 0.033. These findings were in agreement with studies of Ferrario et al.[10] in 2000 and Bradshaw[11] in 2002. in 2004 where the author reported tall and narrow lips in youths.

CONCLUSION

Within its limitations, the present study showed an increase in facial dimensions in both genders with age where transverse changes were higher than the craniocaudal alterations. Furthermore, the difference was seen in the lower facial height, lip exposures, and chin height. The magnitude and growth timings differ in both genders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.