Three-dimensional soft-tissue and hard-tissue changes in the treatment of bimaxillary protrusion

Facial convexity related to bimaxillary protrusion is prevalent in many populations. Underlying skeletal protrusion combined with increased dentoalveolar protrusion contributes to facial muscle imbalance and lip incompetence, which is undesirable for many patients. In this study, we evaluated the relationship between soft-tissue and hard-tissue changes in an orthodontically treated Asian population.

Twenty-four consecutive adult Asian patients (mean age, 24 years), diagnosed with severe bimaxillary dentoalveolar protrusion, were evaluated using pretreatment and posttreatment cone-beam computed tomography. The patients were treated with 4 first premolar extractions followed by anterior retraction with either skeletal or intraoral anchorage. Serial cone-beam computed tomography radiographs were registered on the entire cranial base and fossa. Soft-tissue and hard-tissue changes were determined through landmark displacement and color mapping.

Upper lip retraction was concentrated between the nasolabial folds and commissures. Lower lip retraction was accompanied by significant redistribution of soft tissues at pogonion. Soft-tissue changes correlated well with regional facial muscle activity. Significant retractions (2-4 mm) of the soft tissues occurred beyond the midsagittal region. Use of skeletal anchorage resulted in 1.5 mm greater lower lip retraction than intraoral anchorage, with greater retraction of the maxillary and mandibular incisor root apices.

Profound soft-tissue changes accompanied retraction of the anterior dentition with both treatment modalities.