Soft TissuesMorphology & Behaviors

Dr. Maamar Al-Samet BDS, MDS Department of Orthodontics, Jazan University

Growth studying…Why?!!! A kid with

GHD

The best worldwide player

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Growth studying…Why?!!!

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Muscle balance Facial proportion The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Introduction Increased demand of

orthodontic Tx

Esthetic problems

Importance of facial soft tissues balance

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Esthetic?!!!Even ancient Egyptians did.

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Facial proportion Muscle balance The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Facial proportions

Facial height :

• Upper face• Middle face• Lower face

3 equal thirds

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lower face proportions

Upper lip length = 1/3

Lower lip length = 2/3

Facial proportions

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Facial proportions

Facial breadth:

“Rule of transverse fifths”

Between helix of outer ears.

Each fifth = width of 1 eye.

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Facial proportion Muscle balance The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Muscle balanceEffects of cheek and

lips are counteracted by the tongue.

Muscle balance

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Alteration of muscle balance:

Equilibrium theory

Tooth position changed in response to the exerted pressures (light and sustained)

Teeth

Lips

Cheeck

Tongue

Cheeck

Muscle balance

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Equilibrium theory

Lost left check by tropical infection

Buccal movement of teeth Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Large tongue + thyroid deficiency

Mandibular prognathism

Equilibrium theory

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Muscle balance The lips

Competent lips Incompetent lips Lip seal

The tongue Oral seal swallowing

Mouth breathing Other oral tissues

Fraenum Periodontal and effect of other tissues

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lips

In lower third face Importance:

1. Lip seal (mouth breathing, swallow).2. Phonation, facial esthetic.Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lips

COMPETENT LIPS INCOMPETENT LIPS

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Competent lips

Features: Lips in contact at rest and function with

minimal contraction of circum-oral muscles lip separation at rest should be not more

than 4 mm.Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Incompetent lips

Features:

Wide gap between upper and lower lip in relaxed state (without minimal muscle activity)

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lip strain Excessive muscular activity to close the

lips is indicated by puckering of the chin due to mentalis contraction.

“ Potentially competent lip”

Incompetent lips

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Incompetent lipsCauses:1- Morphological

Short upper lip. “primary

incompetent lips”.

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Incompetent lips

Causes:2-Antero-posterior

discrepancy “ class II division 1”

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Incompetent lips

Causes:3- Vertical

discrepency:Increased lower face height

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Incompetent lips

Causes:4- Maxillary dental

protrusion:lower lip falls between upper and lower incisors

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lip seal (Normal oral seal)

Importance of lip seal: (swallow, breathing…)

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Lip seal (Normal oral seal)

Normal oral seal: Lip contact No muscular activity Jaws in rest position

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Muscle balance Facial proportion The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

To Be Continued ……..

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

The tongue  muscular

structure that forms part of the floor of the oral cavity.

Plays a major role in Oral seal Swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Oral seal

In case of incompetency of lips

Called “Adoptive oral seal”

Important in swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Oral seal

NORMAL LIP SEAL ADOPTIVE ORAL SEAL

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Adoptive oral seal

1- LIP-TRAP LIKE

Contact “tongue – lower lip”

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Adoptive oral seal

Seen in open bite

2- Lip-palate contact

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Adoptive oral seal

Seen in class III

3- Tongue-upper lip

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Muscle balance Facial proportion The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Swallowing

Primary atypical swallowing: Inborn atypical

pattern of neuromuscular activity

Infantile more forward position of the tongue

Tongue in contact with lips during swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Swallowing Normal adult

swallowing: Mature swallow seen by

18 of age Teeth together Mandible stabilized by

muscle of mastication Tip of tongue behind

incisors Minimum contraction of

circumoral musclesDr. Maamar Al-Samet, Faculty of dentistry, Jazan University

STAGES OF MATURE SWALLOWING

1- Oral Phase. 2- Pharyngeal Phase . 3- Esophageal Phase.

Swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

1- ORAL PHASE

Soft palate moves upward and tongue drops backward and downward

Larynx and hyoid move upward

Bolus is pushed by tongue and liquid flows

Stabilization of mandible is done by muscle of mastication.

Stages of mature swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

2- PHARYNGEAL PHASE The bolus passes

through the fauces Nasopharynx is closed Tongue and hyoid

move upward.

Stages of mature swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

3- ESOPHAGEAL PHASE Food passes through

the esophagus to the stomach.

Stages of mature swallowing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Swallowing

Primary atypical swallowing: Increased over jet Decreased overbite Posterior cross bite

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Mature swallow vs. Atypical swallow

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Soft Tissues Morphology & Behavior

Introduction Muscle balance Facial proportion The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Mouth breathing

NASAL BREATHING MOUTH BREATHING

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Mouth breathing

Causes of mouth breathing:

• Adenoidism• Rhinitis • Pharyngitis …

etc Effect of mouth

breathing: Adenoid facies Abnormalities in all

planes of space Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

ET VOILA`

The End

Soft Tissues Morphology & Behavior

Introduction Muscle balance Facial proportion The lips

Competent lips Incompetent lips

The tongue Oral seal swallowing Mouth breathing

Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

C`est Fini

Thank you