Three-Dimensional Evaluation of Soft Tissue Changes after Functional Therapy

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Abstract
This study was aimed at proposing a three-dimensional (3D) evaluation method for the soft tissue effects of Twin Block (TB) functional appliance therapy by using cone beam computed tomography (CBCT) images. In this retrospective study, a total of 60 pre- and posttreatment (T0 and T1) CBCT images of Class II patients with mandibular retrognathia treated with a TB appliance were used. Volumetric and linear soft tissue changes were evaluated quantitatively with 3D measurements and qualitatively with color mapping visual. Linear (NV-A and NV-Pog) and angular (SNA, SNB, and ANB) skeletal changes were also measured on 3D images. The Wilcoxon signed-rank test was used to compare statistical differences, and the scores of male and female participant differences were observed with the Mann–Whitney test. In this study, a decrease was observed in SNA ( ), ANB ( ), and NV-Pog ( ) while an increase in SNB ( ) was found. However, decrease in NV-A distance was not statistically significant ( ). As a result of the evaluation of soft tissue changes, while the anterior reposition of the lower lip, soft tissue pogonion, and soft tissue gnathion was found to be significant ( , , and , respectively), the upper lip and subnasale repositions were not statistically significant ( ). 3D soft tissue changes after TB therapy can be evaluated quantitatively and qualitatively by using CBCT images. Anterior repositioning of the mandible with functional therapy also provides improvement in soft tissue profile, especially in the lower facial region.

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