3D Evaluation of Smile and Soft Tissue Changes in the Dental Esthetic Zone Following Upper Lip Dermal Fillers Injections of Skeletal Class 3 Orthodontically Treated Adult Females

Abstract

Skeletal class III malocclusion has always been a challenging form of malocclusion. Patients having besides their dental problems a retrusive concave soft tissue profile, that is usually their main issue of concern. Some studies discussed the effects of camouflage treatments on the soft tissue profile, and the soft tissue response to incisal repositioning that is controversial. Some have concluded that incisor retrusion correlates closely with lip retrusion while others state that even considerable tooth repositioning fails to improve soft tissue profiles. So, after exerting effort and time, patients’ disappointments and dissatisfaction about their smiles guided us to find an adjunctive aid to improve their smiles and soft tissue profiles after orthodontic camouflage treatment completion. Lip augmentation using hyaluronic acid dermal filler was the procedure of choice. Since it’s now widely used in dental clinics and known as a safe a temporary process with a reversible effect. A sample of fifteen adult female patients, all with skeletal class 3 malocclusion were recruited in this study after completion of camouflage orthodontic treatment. All patients showed mild to moderate retrusive profiles with midface deficiency that did not properly improve after the camouflage dento-alveolar orthodontic treatment. Though ideal occlusion was reached but complete satisfaction was not. The use of a dermal filler as an adjunctive aid to improve the smile and the soft tissue profile was suggested. Data were collected before lip augmentation via 3D face scans, 2D static photographs and conventional lateral cephalometric radiographs, that were already taken after orthodontic treatment completion. All patients received the same type of filler “Restylane Defyne” which is a hyaluronic acid-based filler material. Data collection was repeated 2 more times once after 2-3 weeks of injection and the other after 6 months to assess the changes in smiles and profile. Immediate improvement was recognized after injection and better results appeared in the second visit after complete disappearance of immediate post-operative redness or swelling that showed up with some patients. Besides, achievement of the maximum volume of the hydrophilic hyaluronic acid filler that needs 1 week to 10 days after absorbing water from the surrounding tissues.