The Analysis Of Soft Tissue:before And After Treatment Changes In Protrusive Class Ⅱmalocclusion Case

Objective: This study was designed to observe and analyze the effect of class Ⅱdivision 1 malocclosion, with protrusive face by using fixed appliance, as well as the cephalometric change of soft tissue.Methods: A patient with classⅡdivision 2 malocclusion and protrusive profile was selected from the Dental Division of The First Affiliated Hospital of Dalian Medical University as the object. The analysis of the model shows that the left molar relationship is normal the right molar relationship is class Ⅱ cusp to cusp. She is in permanent teeth stage.Anterior teeth was deep overbite Ⅱ°,deep over jet Ⅱ°.Both arch are mild crowding; the curve of Spee left is 3mm right is 3.5.Upper middle line is good,lower one is 2mm right.When lips are relax,anterior teeth could be seen.Her lower 1/3 facial height is big with mouth breathing and gummy smile.Maxillary protrusion and mandible retrusion lead to profile protrusion.Nose,lips and pogonion are not harmony.Cephalometric analysis shows that class Ⅱ skeletal pattern,high angle case 。 Maxillary development is good,mandible is retrusive and short.Upper incisor lingual tilts,lower incisor labial tilt.Full facial height and upper facial height are higher than the normal value.ODI implys deep bite tendency,APDI implys class Ⅱ tendency,EI implys teeth extraction.FCA shows soft tissue profile is convex.Both lips are over the E-line.Z angle shows upper lip is too protrusive.NLA is above the normal.H angle shows soft tissue pogonion is too retrusive,upper lis is too protrusive.She is a chronic nasitis patient without effective treatment.TWEED analysis shows C.F.Difficulty Total:140.51,Total Dntition Space Analysis:34.3,Total =C.F.+Space Analysis :174.86.This is a difficult case.Results:The course of orthodontic treatment requires 24 months.The changes of pre-and post-treatment:EL-UP from 4.5mm to 0mm,EL-LL from 7mm to 1.5mm,implyboth lip retraction to E-line.ULP from 8mm to 3.5,LLP from 9mm to 4mm,imply profile becomes straight.Z angle from 53°to 66°to the average level implies good lip pattern.H angle from 23°to 17°,nosepoint-H from 7mm to 0mm,nose lip sulcuse-H from10 mm to 7mm,LL-H from 4mm to 2mm,pogonion lip sulcus-H from 1mm to2 mm,imply that nose,lip,pogonion relationship becomes harmony.This effect is related to teeth extraction and soft tissue development.FCA from 21.5°to 19°implys that soft tissue profile conves is decreasing.ANB from 8.5°to7°,Wits from 4mm to 1mm,imply the anterior and posterior position of the maxillary and mandible becomes relatively better.Lower incisor position changes for good.Upper and lower facial height ratio changes to normal value.Chronic nasitis is not healed so mourth breathing still exist.We highly recommend the patient to treat nasitis. Both side molar relationship are slightly to distal.Upper and lower midline is perfect.Over bite and overjet is alomost perfect.Patient is satised with the change of the soft tissue profile.Conclusions:Proper teeth extraction could result in better soft tissue facial profile changes for growing class Ⅱ skeleton pattern high angle protrusion patient.