• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.63-69
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• 2000

Le fort II osteotomy is much useful technique to correct the midfacial hypoplasia including nasomaxillary complex especilly in patient with dish face appearance. Not in simple orthognathic surgery but in Le Fort II osteotomy, the standardization of prognostic value is essential in treatment planning to achieve satisfactory postoperative results. According to pervious reports, the ratio of soft tissue change to hard tissue movements varies as to different surgical methods and different facial regions. But there are few report about the ratio of soft tissue change to hard tissue movement following Le Fort II osteotomy. So we tried to develop standarized soft tissue surgical treatment objective. We have followed up 16 patients, who had received Le Fort II osteotomy by one operator from 1990 to 1996, one year postoperatively. In cephalometrics, we used Frankfort line as horizontal reference line, and vertical reference line as one drawn from Sella to horizontal line perpendicularly. The landmarks are G to soft tissue G, N on reference line to soft tissue N, ANS to Pn and A to Sn. The results are as follows. 1. The value of soft tissue change to hard tissue movement showed positive correlation, having statistical significancy at G, N2, N3 point. 2. At G, N2, N3 point, the ratio of soft tissue change to hard tissue movement was 0.51, 0.98 and 0.80 respectively and showed statistical significancy, while at N1, ANS, A point, that was 0.72, 0.49 and 0.26 but didn't showed statistical significance. 3. This result shows much the same change of the soft tissue change to hard tissue movement on the upper nasomaxilla, and less the same change on the lower maxilla and so the Le Fort II osteotomy can be recommended as a reliable effective operation method for correction of nasomaxillary retrusion.

• The korean journal of orthodontics
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• v.35 no.3 s.110
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• pp.163-173
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• 2005

The purpose of this study was to compare the asymmetric degree between maxillofacial hard and soft tissues in individuals with facial asymmetry. Computerized tomographies (CT) of 34 adults (17 male, 17 female) who had facial asymmetry were taken. The CT images were transmitted to personal computers and then reconstructed into three-dimensional (3D) images through the use of computer software. In order to evaluate the degree of facial asymmetry, 6 measurements were constructed as the hard tissue measurements while 6 counterpart measurements were taken as the soft tissue measurements. The means and standard deviations were obtained for each measurement using 3D measure, then t-test was used to investigate the differences between each hard tissue measurement and the corresponding soft tissue measurement All measurements used in the present study showed statistically significant differences between the hard and soft tissues. The degree of soft tissue asymmetry was smaller than that of corresponding hard tissue asymmetry in case of chin deviation, frontal ramal inclination difference, and frontal corpus inclination difference. On the other hand, the degree of soft tissue asymmetry was greater than that of underlying hard tissue asymmetry in the measurement of lip canting and lip cheilion height difference The present study suggests that asymmetric differences of hard and soft tissue is observed nu facial asymmetric subjects and thus soft tissue analysis is needed in addition to hard tissue analysis when making an evaluation of facial asymmetry.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.3
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• pp.250-259
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• 1997

The purpose of this study was to evaluate the interrelationship of the soft and hard tissue changes after both maxillary and mandibular anterior segmental surgery in bimaxillary protrusion patients. 11 patients had received both maxillary and mandibular anterior segmental surgery and were investigated radiologically with lateral cephalogram. The results were as follows : 1. The correlation of maxillary hard and soft tissue horizontal changes were relative high. : Coefficient between UIE and Stms was 0.89 (p<0.001). 2. The correlation of mandibular hard and soft tissue horizontal changes were very high, especially at the chin. : Coefficients were over 0.90 (p<0.001) 3. All points were moved superiorly except SLS, LS, Stms. 4. Upper and lower lip convexity to the E-Line were decreased (p<0.001) and postsurgical facial profiles were changed very esthetically.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.3
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• pp.49-56
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• 1990

Facial balance is the primary detevminant of good facial esthetics and is expressed externally by the shape of facial soft tissues. Balance of the facial skeleton is most important in prediction of orthognathic surgery, however, it is not alwags coincided to soft tissue balance because the soft tissue drapes overlying hard tissue varies in thickness and tones from case to case. So, soft tissue facial balance and esthetics also should always be considered in prediction of hard tissue changes preoperatively. The chin has a paramount importance in the overall appearance of the face and facial profile because it may express individual charactor or image. Therefore positional change of the chin must be considered in any cases as the last and important option to give an overall soft tissue balance. Two cases were referred from orthodontists only for anterior segmental of teortomuy of the chin. Pre-operative evaluation showed poor soft tissue chin profiles which were not coincided to hard tissue chin balance. We altered surgical plans to fulfill balancing soft tissue profile and then could improve overall esthetics after surgery.

• The korean journal of orthodontics
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• v.23 no.4 s.43
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• pp.707-724
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• 1993

The purpose of the study is to estimate hard and soft tissue changes after orthognathic surgery for the correction of the mandibular prognathism and to describe interrelationship and ratios of soft and hard tissue changes. The presurgical and postsurgical lateral cephalograms of 31 treated patients(17 males and 14 females) was used ; these patients had received combined orthodontic-surgical treatment by means of a bilateral sagittal split ramus osteotomy. Their ages ranged from 16 to 31 years and mean age was 21.4 years. A computerized cephalometric appraisal was developed and used to analyse linear and angular changes of skeletal and soft tissue profile. The statistical elaboration of the data was made by means of $SPSS/PC^+$. The results of the study were as follows : 1. The correlations of soft and hard tissue horizontal changes were significantly high and the ratios were $97\%$ at LI, $107\%$ at ILS, and $93\%$ at Pog'. 2. The correlations of vertical changes at Stm, LI and horizontal changes at Pog were high$(26\%)$ and at the other areas were not statistically high. 3. The correlations of soft ad hard tissue vertical changes were not significantly high in all areas except Gn' $(30\%)$ and Me' $(56\%)$. 4. The soft tissue thickness was significantly decreased in upper lip and increased in lower lip, and the amount of changes after surgery was reversely correlated with initial thickness. 5. The facial convexity was increased and relative protrusion of upper lip was increased and that of lower lip was decreased. 6. The upper to lower facial height(Gl-Sn/Sn-Me') was increased and upper to lower jaw height(Sn-Stms/Stmi-Me') was increased.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.6
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• pp.509-514
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• 2005

Purpose: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. Patients and Methods: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up roentgenograms and clinical observation. Results: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1: 0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. Conclusions: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.

• The korean journal of orthodontics
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• v.38 no.4
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• pp.252-264
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• 2008

Objective: To aid the development of a frontal image simulating program, we evaluated the soft tissue frontal changes in relationship to movement of hard tissue with orthognathic surgery of facial asymmetry patients. Methods: Preoperative and postoperative frontal cephalograms and frontal view photographs of 45 mandibular surgery patients with facial asymmetry were obtained in a standardized manner. Vertical and horizontal changes of hard tissue and soft tissue were measured from cephalograms and photographs, respectively. Soft tissue change in result to hard tissue change was then analyzed. Results: Both vertical and horizontal correlation analysis showed a weak relationship between the changes. Hard tissue points that were picked for 1 : 1 mean ratio with soft tissue points did not show any significant relevance. For each soft tissue change, regressive equation was formulated by stepwise multiple regression analysis, and the equation for soft tissue Menton was most reliable in predicting changes. Both vertical and horizontal hard tissue changes were used together in prediction of vertical or horizontal soft tissue change. Conclusions: The results suggest that computerized image simulation using regression analysis may be of help for prediction of soft tissue change, while 1:1 mean ratio method is not useful.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.413-420
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• 2012

Purpose: The purpose of this setback genioplasty study is to develop a prediction method for the calculated osteotomy angle using horizontal and vertical changes as well as to evaluate the proportion of hard and soft tissue changes. Methods: Twelve patients who had received setback genioplasty with other maxillofacial surgery were examined. Three lateral cephalograms were taken just before surgery, immediately after surgery, and 3 months later surgery. A reference line was established to the reference point of the inner most point of the lingual symphysis cortex, incisor tip, and 2nd molar cusp tip. Measuring was conducted from pogonion (Pg), menton (Me), labrale inferius (Li), Mentolabial fold, soft tissue pogonion (Pg'), and soft tissue menton (Me') to the reference lines. Results: In setback genioplasty, the skeletal Pg moved posteriorly 5.07 mm. The ratios of soft tissue to hard tissue movement were 36% posteriorly and 62% inferiorly at Pg', 67% posteriorly and 104% inferiorly at Me', and 34% anteriorly and 164% posteriorly at Li. In reduction & setback genioplasty, skeletal Pg moved posteriorly 4.63 mm and skeletal Me moved superiorly 3.63 mm. The ratios of soft tissue to hard tissue movement were 76% posteriorly and 18% superiorly at Pg', 68% posteriorly and 42% superiorly at Me', and 44% anteriorly, 124% posteriorly at Li. The calculated mean slope angle, based on ${\Delta}H/{\Delta}V$ ratio, was 61.25 and the measured mean slope angle was 60.17. Thus, the calculated and measured slope angles have a similarity. Conclusion: In setback genioplasty, soft tissue moves posteriorly and inferiorly. In particular, at the Me' and Pg', the inferior movement of the soft tissue is greater than the posterior movement. Also, the predictable results (measured slope angle) after operation can be achieved by the calculated slope angle. Thus, the relationship of soft and hard tissue changes must be considered as the results are predictable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.447-452
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• 2006

Purpose: In order to clarify the correlation of mandibular setback using bilateral intraoral vertical ramus osteotomy (BIVRO) and post-surgical transverse mandibular width (TMW), this study examined the pre- and postsurgical changes in hard and soft tissues of TMW and the relationship of TMW and the amount of mandibular setback. Patients and Methods: One-hundred seven patients who had undergone BIVRO were evaluated radiographically and clinically. A comparison study of the changes in hard and soft tissue after surgery in all 107 patients was performed with preoperative, 1 month, 3 month, 6 month and 1 year postoperative posteroanterio cephalograms and clinical photographs by tracing. And this changes were evaluated in parts to amounts of mandibular setback. Results: Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue from 1 month to 1 year postopertive were gradually decreased. TMW in soft tissue was not changed uniformly but almost equal to pre-operative width. And there was no significant correlation between TMW and amount of mandibular setback. Conclusions: The results show that mandibular setback using BIVRO did not significantly influence increasing of TMW in soft tissue.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.24 no.1
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• pp.13-24
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• 2015

With the development of treatment of hard and soft tissue around the implants, the implant restoration is increasingly used in the maxillary anterior region which is very important aesthetically. However, the aesthetic reconstruction of the maxillary anterior region is still challenged. Three following conditions should be fully satisfied for aesthetic prosthesis restoration; reconstruction of hard tissue, soft tissue and harmonic prosthesis. In this case report, hard and soft tissue augmentations were performed at atrophied maxillary incisor. Additionally, customized impression coping and provisional restoration were used to make the final restoration.