INDIAN DENTAL ACADEMY: AGE RELATED SOFT TISSUE CHANGES

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AGE RELATED SOFT
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TISSUE

CHANGES


ESTHETICS
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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

THE ESTHETIC HERITAGE
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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.

PREHISTORIC ESTHETIC SENSE


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

EGYPTIAN SCLUPTURES


THE GREEKS
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The Greeks were the 1st 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 4th & 5th
century B.C. often called as the “GOLDEN
AGE OF GREECE”

GREEK SCULPTURES


THE ROMANS
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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.


RENAISSANCE
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In his time
MICHELANGELO
strongly influenced the
direction & spirit of Italian
Renaissance
movement.
His sculptures identified
with the classical
traditions of Greece &
Rome.




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.

PROFILE CHANGES IN GROWING
FACE
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1.
2.

3.

The face of a child is vertically short
because
Nasal part of the face is still small
The primary & secondary dentition has not
fully established
The jaw bones have not grown to the
vertical extent that would support the full
dentition & the enlarging masticatory
muscles & airway

THE BABY FACE
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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




The baby’s face appears relatively
smaller than the cranium. This is
because the growth of the brain slows
down considerably after about the 3 rd or
4th year of child hood, but the facial
bones continue to enlarge for many
more years.

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.

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.



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



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.



THE ROLE OF TONGUE
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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




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


DENTAL CHANGES


FINAL OCCLUSION IN
ADULT
CLASS I- 59%
CLASSII- 39%
CLASS III- 2%


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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

GROWTH CHANGES IN SOFT TISSUE
PROFILE
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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

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
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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.


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 yrsmales

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.


UPPER LIP THICKNESS
At ( Pt A – A’) ^se of 4.7mm in
males & 3.5mm in females
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At ( LS – LS’) labrale superius
Males -- ^sed 13.9mm –
17.1mm
Females -- ^sed 11.8mm –
12.5mm.

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


CHIN ( pg – pg’)
MALES – 2.7mm ^SE
FEMALES – 2mm
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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 degmales & 110.7 sd 9 deg in
females

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.

PROFILOMETRICS & FACIAL
ESTHETICS
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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 practitioner’s ability to move teeth within the
alveolar bone.

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1.

2.

3.

The diagnostic tools necessary for facial profile
management include
Knowledge of what constitutes esthetically pleasing
facial profile.
Knowledge of the effects of hard tissue changes on
the soft tissue profile.
Ability to accurately predict facial profile changes
resulting from treatment.


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1.
2.
3.
4.

The treatment capabilities at the disposal of
the orthodontist include
Conventional orthodontic mechanotherapy
Orthopedic force therapy
Orthognathic surgery
Rhinoplasty


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]



CHIN PROMINENCE
ANGLE
The general preference was
0 deg but +4 deg was also
preferred
RANGE – 0 - +4 DEG
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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
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PREFERRED RANGE- 20 deg– 35
deg




NASAL TIP ANGLE
MORE ACUTE ANGLES
WERE PREFERRED FOR
MALE PROFILES

PREFERRED RANGE- 60 – 80
deg




INFERIOR LABIAL SULCUS

ANGLE
Preferred angles were 130 –
140 deg
Most pleasing angle was 130
deg or slightly greater.


NASO LABIAL ANGLE
PREFERRED RANGEACCORDING TO BROWN & Mc
DOWELL90 – 110 deg

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ARTICLES
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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.


A.J.O. 1988, LINEAR CHANGES OF
MAXILLARY
AND MANDIBULAR LIPS
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

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.

GROWTH CHANGES IN THE NASAL
PROFILE
FROM 7 – 18 YEARS , A.J.O. 1988
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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.

A.J.O. 1984, SOFT TISSUE
PREFERENCE
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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.

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.

A.J.O. 1990, FACIAL GROWTH IN MALES
16-20 YRS OF AGE
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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

A.J.O. 1994, LONGITUDINAL CHANGES IN
ADULT FACIAL PROFILE
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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

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ISRAEL ( 1973) reported data from women who
were 1st 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 914 % & mandible by 5 -7 %.
There was significant ^se in Se – Na, Se –Ba, Go –
Gn, Co – Gn.

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


ANGLE 1988, LATE GROWTH
CHANGES
IN CRANIOFACIAL SKELETON
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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.


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^se in size of nose & ears
Nose- broader, longer &
had downward tip.
Lower third of face
showed ^sed dimension.
Lip prominence was
lessened

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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

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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.

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.


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