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Student Number : 9000040F - M Dentistry research report - Faculty of Health Sciences / This study assessed the sagittal soft-tissue changes of the lower lip and chin area in 22 patients subsequent to mandibular autorotation following surgical vertical impaction of the maxilla. A subgroup of six patients in addition had undergone advancement genioplasty procedures. Lateral cephalometric radiographs were taken immediately prior to surgery and on average 15 months following surgery. Sixteen cephalometric landmarks were identified on each radiograph and these were digitized using a Kontron Videoplan Image Analysis System to enable differences reflecting changes to be assessed. The comparison between those cases that had had maxillary elevation only and the six cases that had received additional advancement genioplasty procedures revealed statistically significant differences in relation to the proportional changes in the chin area. Therefore, when studying the soft-tissue chin changes following mandibular autorotation, these six patients were excluded from the sample. It was found that there was no significant difference in the lower lip response between the two groups and therefore when studying the lower lip changes, the two groups could be pooled. The soft-tissue changes in the chin area showed statistically and clinically significant correlations. In the horizontal plane, a ratio of 0.9:1 was found for the changes between sulcus inferior and point B, between soft-tissue pogonion and hard-tissue pogonion, and between soft-tissue gnathion and hard-tissue gnathion. In the vertical dimension, soft-tissue gnathion followed hard-tissue gnathion in a ratio of 0.9:1, whereas soft-tissue menton followed hardtissue menton in a ratio of 1:1. In the study of the lower lip response, a significant correlation with a ratio of 1:1 existed for the horizontal change in the lower lip as measured at labrale inferius relative to both lower incisor tip and lower incisor anterius. In the vertical dimension, stomion inferius followed lower incisor anterius in a ratio of 1.3:1, while labrale inferius followed lower incisor anterius in a ratio of 1.5:1. Multiple regression analyses revealed that presurgical tissue thickness exerted no influence upon the strength of the correlations between changes expressed at corresponding soft- and hard-tissue landmarks located in the lower lip and soft-tissue chin area. Based on the findings of this study, it is suggested that the soft-tissue to hard-tissue ratios may be applied to prediction tracings with enhanced confidence. As a result, the tracings will reflect a more accurate prediction of the lower lip and soft-tissue chin positions following autorotation of the mandible.

OBJECTIFS : L’objectif de cette étude était de déterminer les changements verticaux et horizontaux des tissus mous par rapport aux changements des tissus durs après une génioplastie fonctionnelle isolée, l'effet de l'âge sur ces changements et de revoir le remodelage des tissus durs au niveau de la symphyse. MÉTHODES : 75 patients ayant subi une génioplastie fonctionnelle comme seule intervention chirurgicale ont été suivis pendant un minimum de 2 ans avec une téléradiographie de profil pris avant la chirurgie (T1), immédiatement après la chirurgie (T2) et 2 ans après la génioplastie (T3). Ces patients ont été regroupés par groupe d'âge (gr 1 : <15 ans, gr 2 : 15-19 ans, gr 3 : >19 ans). RÉSULTATS : Le modèle prédictif a révélé que le changement horizontal des tissus mous peut être prédit avec plus de précision horizontalement que verticalement. Les changements verticaux des tissus mous ont présenté une prédictibilité moindre, comme le montre l'équation de prédiction du groupe 3 et un coefficient de détermination de 48 %. Le pogonion de tissu dur a montré un changement net horizontal de 6,39 mm (IC95% 5,68 ; 7,10) tandis que le tissu mou a montré un changement net de 6,72 mm (IC95% 5,89 ; 7,54). Verticalement, le changement net du tissu dur au niveau du menton pour les femmes qui ne grandissent pas a montré une réduction nette de 1,63 (IC95% -3,37 ; 0,11) tandis que les hommes ont montré une réduction nette de 3,89 mm (IC95% -5,83 ; -1,95). La réduction verticale des tissus mous était similaire pour les hommes et les femmes qui ne grandissent pas, soit 1,7 mm (IC95% -2,96 : -0,45). CONCLUSION : Pour les patients qui ne grandissent pas, le changement horizontal des tissus durs était stable, et le changement des tissus mous représentait 92% des changements des tissus durs. Verticalement, le changement des tissus mous était moins prévisible. Des équations de prédiction ont été calculées. Les variations d'épaisseur des tissus mous après une génioplastie dans les deux directions peuvent être expliquées par l'obtention d'une occlusion labiale non forcée. Ces résultats confirment le bénéfice fonctionnel et esthétique de cette chirurgie. / OBJECTIVES: The aim of this study was to determine the vertical and horizontal soft tissue change versus hard tissue change following isolated functional genioplasty and to examine hard tissue remodeling at the symphysis. METHODS: 75 patients who underwent a functional genioplasty as an isolated procedure were followed for a minimum of 2 years with cephalograms taken before surgery (T1), immediately after surgery (T2), and 2 years post-surgery (T3). These patients were grouped by age (Gp 1: <15 y.o., Gp 2: 15-19 y.o., Gp 3: >19 y.o.). RESULTS: The predictive model reveals that soft tissue change can be predicted with more precision horizontally than vertically. Hard tissue pogonion showed a net horizontal change of 6.39 mm (CI95% 5.68; 7.10) while soft tissue showed a net change of 6.72 mm (CI95% 5.89; 7.54). Vertically, the hard tissue net change at menton for nongrowing females showed a net reduction of 1.63 (CI95% -3.37; 0.11) while males showed a net reduction of 3,89 mm (CI95% -5.83; -1.95). Soft tissue vertical reduction was similar for non-growing males and females at 1,7 mm (CI95% -2,96: -0,45). CONCLUSION: For non-growing patients, the horizontal hard tissue change was stable, and the soft tissue change is 92% of the hard tissue changes. Vertically, the soft tissue change was less predictable. Prediction equations have been calculated. The soft tissue thickness variations after genioplasty in both directions can be explained by the achievement of an unforced labial occlusion. These results support the functional and aesthetic benefits of this surgery.