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The Art Pastor's Guide to Sabbath | Steve Thomason
Prediction of maxillary repositioning in lefort 1 surgery /certified fixed orthodontic courses by Indian dental academy
1. “PREDICTABILITY OF MAXILLARY
REPOSITIONING AND THE UPPER LIP
RESPONSE IN MAXILLARY LEFORT I
OSTEOTOMIES.”
-A CEPHALOMETRIC STUDY.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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3. • For
more
than
three
decades, orthognathic surgery has
proved to be a significant tool in
correcting severe dentofacial skeletal
discrepancies.
• The success of surgical orthodontic
therapy, is determined by factors such
as function, stability and esthetics.
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4. • Defining ideal esthetic results is very
subjective and may be viewed differently by
the clinician and the patient.
• Patients who have viewed prediction
outcomes prior to treatment are more likely to
be satisfied with the outcome than those who
did not, also patients feel grateful for being
empowered and involved in planning their
treatment
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5. • It is important to achieve an optimal profile
change which requires a correct balance of
midfacial dentoskeletal structures and soft
tissue contour.
• It would be necessary to be able to
predict, reliably and accurately, the changes
in the skeletal and soft tissues, which would
occur by a maxillary surgery.
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6. • The final soft tissue profile of the lips is
of particular importance because when
asked to evaluate esthetics of life-sized
lateral photographs, laymen place more
emphasis on postoperative changes in
the lips than on the nose or the chin.
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7. • Therefore an attempt is made here to
study the reliability of the predictions of
hard tissues in Maxillary LeFort I
Osteotomies, and assessing the
changes in the upper lip related to
these surgeries.
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9. 1.
To compare the pre-surgical predictions and the
actual
changes
in
the
midface
dentoskeletal
structure, after a Maxillary Le-Fort I osteotomy.
2.
To predict the upper lip response to a Maxillary LeFort I osteotomy.
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11. • Pre-surgical and post-surgical (two months
following surgery) lateral cephalograms of
11 adult patients
• The age group of these patients ranged from
14 to 23 years.
• Treated by a Pre-adjusted Edgewise
appliance for pre-surgical decompensation.
• Maxillary Le-Fort I osteotomy was carried out
under the supervision of a single surgeon.
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12. • 0.003 inch acetate tracing paper.
• 0.3 mm lead pencil.
• Geometry box (scale, protractor, set
squares, eraser).
• Scotch tapes.
• Tracing board.
• Scissors and calculator.
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14. Primary Criterions For
Selection Of Patients
1.Patients who were treated by Maxillary
Le-fort
I
advancement/impaction
osteotomy with rigid fixation.
2.Patients had completed their growth
phase of maximum growth.
3.No concomitant or previous nasal
surgery.
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15. 4. No history of oral clefting.
5. No previous trauma to the midface.
6. Presurgical
and
cephalograms
were
standardized technique.
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postsurgical
taken
by
16. HARD TISSUE VERTICAL
CHANGES (Fig. 2)
Na
S
S-Na + 7
PNS
A
ANS
UM
Is
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S-Na + 7 To
PNS
Upper Molar
Point A
Point Is
Point ANS
17. HARD TISSUE HORIZONTAL
CHANGES (Fig. 3)
Na
S
S-Na + 7
PNS
A
ANS
UM
Is
Perpendicular of S-Na + 7 To
PNS
Upper Molar
Point A
Point Is
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Point ANS
18. HARD TISSUE ANGULAR
CHANGES (Fig. 4)
Na
S
PNS
ANS
A
Sella Nasion to Nasion Point A
Sella Nasion to Palatal Plane
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19. UPPER LIP RESPONSE (Fig. 5)
ANS
10
UL
UL
0
A
75
Sn
SLS
Pro
UL
Ia
50
UL 25
STO
ANS-SN
A-SLS
Pr-LS
Ia-LS
Sn-STO
LIPLT
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LS
0
UL
20. CEPHALOMETRIC PREDICTION TRACING FOR
SUPERIOR REPOSITIONING OF MAXILLA AS
PER FISH AND EPKER
STEP – 1
STEP – 2
STEP – 3
STEP – 5
STEP
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STEP – 4
33. RELIABILITY OF
PREDICTION
• This part of the study comprised of two
angular, five vertical and five horizontal
measurements.
• For these measurements “Wilcoxons
signed rank test” was done and the P
value was determined to find if the
prediction was significantly accurate.
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34. Graph 2
Sn +7 TO PALATAL PLANE ANGLE (Degrees)
3.5
3.5
Graph 1
82
ANGLE SNA (Degrees)
81.3
81.2
81
2.5
Pre
Surgical
Predicted
80
2
79
78
2.7
3
1.6
Post
Treatment
1.5
Post
Treatment
77.6
1
77
0.5
76
0
Pre Surgical
Predicted
Post Treatment
75
Pre Surgical
Predicted
Post Treatment
Graph 2
Sn +7 TO PALATAL PLANE ANGLE (Degrees)
3.5
3.5
Parameters
2.7
3
2.5
2
1.6
SNA
1.5
1
0.5
Sn+7 to Palatal
Plane
0
Pre Surgical
Predicted
P
Significance
0.82
NS
0.11
NS
Pre
Surgical
Predicted
Post
Treatment
Post Treatment
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Pre
Surgical
Predicted
35. Graph 4
Graph 3
70
POINT A HORIZONTAL (mm)
69.9
69.4
72.5
72
Pre
Surgical
Predicted
71.5
69
Pre
Surgical
Predicted
68
71
70.5
67
66
POINT ANS HORIZONTAL (mm)
72.2
72.1
70
65.7
Post
Treatment
Post
Treatment
69.5
69.5
69
65
68.5
64
68
Pre Surgical
Predicted
Post Treatment
63
Pre Surgical
Predicted
Post Treatment
Graph 4
72.5
POINT ANS HORIZONTAL (mm)
72.2
72.1
72
71.5
Parameters
71
70.5
70
69.5
69.5
Point A
ANS
69
Pre
Surgical
Predicted
P
Significance
Post
Treatment
0.21
NS
0.86
NS
68.5
68
Pre Surgical
Predicted
Post Treatment
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36. Graph 6
Graph 5
20
POINT PNS HORIZONTAL (mm)
19.9
19.7
19.5
UPPER INCISOR HORIZONTAL (mm)
73.2
72.9
73
Pre
Surgical
Predicted
19
18.5
74
Pre
Surgical
Predicted
72
71
Post
Treatment
69.7
70
Post
Treatment 69
18
18
68
17.5
67
Pre Surgical
Predicted
Post Treatment
17
Pre Surgical
Predicted
Post Treatment
Graph 6
74
UPPER INCISOR HORIZONTAL (mm)
73.2
72.9
73
72
70
69
68
Significance
NS
0.41
NS
Post
Treatment
69.7
PNS
UPPER INCISOR
67
Pre Surgical
P
0.77
Parameters
71
Pre
Surgical
Predicted
Predicted
Post Treatment www.indiandentalacademy.com
37. Graph 7
UPPER FIRST MOLAR HORIZONTAL (mm)
48
47.4
46.4
47
Pre
Surgical
Predicted
46
45
43.1
44
Post
Treatment
43
42
41
40
Pre Surgical
Predicted
Post Treatment
Parameters
P
Significance
UPPER 1ST MOLAR
0.25
NS
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38. Graph 9
Graph 8
50
POINT A VERTICAL (mm)
49.5
45.5
POINT ANS VERTICAL (mm)
45.2
45
Pre
Surgical
Predicted
44.5
49
Pre
Surgical
Predicted
48
46.3
47
45.8
Post
Treatment
46
44
43.5
42.9
43
Post
Treatment
42.1
42.5
42
41.5
45
41
44
40.5
Pre Surgical
Predicted
Post Treatment
43
Pre Surgical
Predicted
Post Treatment
Graph 9
45.5
POINT ANS VERTICAL (mm)
45.2
45
44.5
44
42.5
42.9
Point A
42.1
42
41.5
ANS
P
Significance
0.09
NS
0.04
Parameters
43.5
43
Pre
Surgical
Predicted
S
Post
Treatment
41
40.5
Pre Surgical
Predicted
Post Treatment
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39. Graph 11
Graph 10
42.5
POINT PNS VERTICAL (mm)
42.2
76
UPPER INCISOR VERTICAL (mm)
75.3
75
Pre
Surgical
Predicted
42
Pre
Surgical
Predicted
41.5
41
40.1
40.5
73
72
Post
Treatment
39.5
40
74
71.3
71.2
71
39.5
70
39
69
38.5
Pre Surgical
Predicted
Post Treatment
38
Pre Surgical
Predicted
Post Treatment
Graph 11
76
75
UPPER INCISOR VERTICAL (mm)
75.3
Parameters
Pre
Surgical
Predicted
74
73
PNS
72
71
71.2
71.3
UPPER INCISOR
Post
Treatment
P
Significance
0.1
NS
1
NS
70
69
Pre Surgical
Predicted
Post Treatmentwww.indiandentalacademy.com
Post
Treatment
40. Graph 12
69
UPPER FIRST MOLAR VERTICAL (mm)
68.5
68
67
66.2
Pre
Surgical
Predicted
66
64.7
65
Post
Treatment
64
63
62
Pre Surgical
Predicted
Post Treatment
P
Parameters
UPPER 1ST MOLAR
Significance
0.003
S
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41. UPPER LIP
RESPONSE
• The change in the upper lip morphology was
correlated using the soft tissue measurements of
pre and post surgical tracings.
• Pearson’s correlation coefficient was calculated to
assess the nature and degree of the relation.
Linear regression analysis was then carried out to
predict the changes in the soft tissue
measurements for the changes carried out in the
hard tissue measurements.
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42. • There were a total of twelve
correlations of the thickness of the lip to
the various hard tissue measurements
and six correlations of the length of the
lip to the various hard tissue
measurements.
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43. Y
Pt. A
Predicted Y
LIP THICKNESS CHANGE
Graph 14
Graph 13
PREDICTION OF A-SLS FROM POINT A
PREDICTION OF ANS-Sn FROM POINT A
8.0
12
10
6.0
8
6
4.0
A-SLS
2
0
0
1
2
3
4
5
6
7
8
9
2.0
0.0
-2
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
-2.0
-4
-6
-4.0
-8
-10
-6.0
Y
Pt. A
Y
Pt. A
Predicted Y
Predicted Y
Graph 14
PREDICTION OF A-SLS FROM POINT A
Ratio
Parameters
8.0
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
-0.55
-0.92
6.0
Point A
4.0
A-SLS
ANS-Sn
4
2.0
2.3:1
ANS-Sn
0.0
0.0
-2.0
-4.0
1.0
2.0
Point3.0
A
A-SLS
4.0
5.0
6.0
7.0
8.0
9.0
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02:01
-0.48
-0.06
44. Graph 15
PREDICTION OF Ia-Ls FROM POINT A
4.0
3.0
2.0
1.0
La- Ls
0.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
-1.0
-2.0
-3.0
-4.0
-5.0
Y
-6.0
Parameters
Point A
Pro-LS
Predicted Y
Pt.A
Ratio
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
3.6:1
-0.04
NS
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45. Graph 16
Graph 17
PREDICTION OF ANS-Sn FROM POINT ANS
PREDICTION OF A-SLS FROM POINT ANS
12.0
8.0
10.0
8.0
6.0
6.0
4.0
2.0
0.0
-4.0
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
-2.0
-4.0
-4.0
2.0
A-SLS
ANS-Sn
4.0
0.0
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
-2.0
-6.0
-4.0
-8.0
-10.0
ANS
Y
-6.0
Y
Predicted Y
ANS
Predicted Y
Linear (Predicted Y)
Graph 17
Ratio
PREDICTION OF A-SLS FROM POINT ANS
Parameters
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
-0.64
-0.53
-0.59
-0.36
8.0
ANS
6.0
4.0
ANS-Sn
2.0
A-SLS
-4.0
1.6:1
ANS
0.0
-2.0
0.0
-2.0
2.0
4.0
6.0
A-SLS
1.4:1
8.0
10.0
12.0
14.0
-4.0
Y
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-6.0
ANS
Predicted Y
Linear (Predicted Y)
46. Graph 18
Graph 19
PREDICTION OF Pro-SLS FROM POINT ANS
PREDICTION OF Ia-LS FROM POINT ANS
8.0
7.0
4.0
6.0
3.0
5.0
2.0
3.0
Pro-SLS
4.0
1.0
2.0
0.0
La-LS
1.0
0.0
-4.0
-2.0
-1.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
-4.0
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
-1.0
14.0
-2.0
-2.0
-3.0
-3.0
-4.0
ANS
-5.0
Y
Y
-6.0
Predicted Y
Predicted Y
ANS
Graph 19
PREDICTION OF Ia-LS FROMRatio ANS
POINT
Parameters
Change
Regression
Coefficient
0.01
NS
0.36
4.0
Pearson correlation
Coefficient (r-value)
0.19
3.0
ANS
2.0
1.0
Pro-LS
La-LS
0.0
-4.0
-2.0
0.0
-1.0
2.6:1
2.0
4.0
6.0
ANS
10.0
12.0
14.0
4.3:1(-)
-2.0
-3.0
8.0
Ia-Ls
-4.0
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-5.0
Y
-6.0
ANS
Predicted Y
47. Graph 21
PREDICTION OF A-SLS FROM POINT UI
Graph 20
PREDICTION OF ANS-Sn FROM POINT UI
8.00
12.0
6.00
10.0
8.0
4.00
6.0
A-SLS
ANS-Sn
4.0
2.0
0.0
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
-2.0
-2.00
2.00
0.00
0.00
2.00
4.00
6.00
8.00
10.00
-2.00
-4.0
-6.0
-4.00
-8.0
Y
Y
-10.0
Predicted Y
UI
-6.00
UI
Predicted Y
Graph 21
PREDICTION OF A-SLS FROM POINT UI
Ratio
Parameters
Change
Regression
Coefficient
0.03
NS
0.17
8.00
Pearson correlation
Coefficient (r-value)
0.23
6.00
A-SLS
4.00
-2.00
2.00
0.00
0.00
-2.00
-4.00
-6.00
UPPER
INCISOR
2.2:1
ANS-Sn
UPPER
INCISOR
2.00
4.00
6.00
8.00
10.00
1.9:1
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A-SLS
Y
UI
Predicted Y
48. Graph 23
Graph 22
PREDICTION OF Ia-LS FROM POINT UI
PREDICTION OF Pro-LS FROM POINT UI
8.00
4.00
7.00
3.00
6.00
2.00
5.00
1.00
La-LS
Pro-LS
4.00
3.00
2.00
-2.00
0.00
0.00
-1.00
2.00
4.00
6.00
8.00
-2.00
1.00
-3.00
-2.00
0.00
0.00
-1.00
2.00
4.00
6.00
8.00
-4.00
10.00
-5.00
-2.00
-6.00
-3.00
UI
Y
UI
Y
Predic
Predicted Y
Graph 23
PREDICTION OF Ia-LS FROM POINT UI
Ratio
Parameters
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
0.16
0.18
0.15
0.18
4.00
3.00
2.00
La-LS
1.00
-2.00
0.00
0.00
-1.00
UPPER
INCISOR
Pro-LS
2.00
3.5:1
4.00
6.00
8.00
10.00
-2.00
-3.00
-4.00
UPPER
INCISOR
5.7:1 (-)
-5.00
-6.00
Ia-Ls
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Y
UI
Predicted Y
49. PT.A
Y
Predicted Y
LIP LENGTH CHANGE
Graph 24
Graph 25
PREDICTION OF Sn-STO FROM POINT A
PREDICTION OF LIPLT FROM POINT A
3.5
4.0
3.0
3.0
2.5
2.0
2.0
1.0
LIPLT
SN-STO
1.5
1.0
0.5
0.0
-10.0
-8.0
-6.0
-4.0
-2.0
0.0
-10.0
-8.0
-6.0
-4.0
-2.0
0.0
2.0
-1.0
0.0
2.0
4.0
4.0
-0.5
-2.0
-1.0
-3.0
-1.5
PT.A
PT.A
Y
Predicted Y
Y
Predicted Y
Graph 25
PREDICTION OF LIPLT FROM POINT A
Ratio
Parameters
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
0.21
-0.1
4.0
Point A
3.0
(-)2.9:1
2.0
LIPLT
Sn-STO
-10.0
-8.0
-6.0
-4.0
Point A
LIPLT
1.0
0.0
-2.0
0.0
2.0
4.0
-1.0
(-)4.6:1
0.24
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-2.0
-3.0
0.11
50. Graph 27
Graph 26
PREDICTION OF LIPLT FROM POINT ANS
PREDICTION OF Sn-STO FROM POINT ANS
3.5
3.0
4.0
2.5
3.0
2.0
2.0
Sn-STO
1.5
1.0
1.0
LIPLT
0.5
0.0
0.0
-10.0
-8.0
-6.0
-4.0
-2.0
-0.5
0.0
2.0
4.0
6.0
-8.0
8.0
-6.0
-4.0
-2.0
0.0
2.0
4.0
6.0
8.0
-1.0
-1.0
-2.0
-1.5
ANS
-3.0
ANS
Y
Y
Predicted Y
Predicted Y
Graph 27
PREDICTION OF LIPLT FROM Ratio ANS
POINT
Parameters
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
-0.14
-0.05
0.19
0.07
4.0
ANS
3.0
(-)2.1:1
2.0
Sn-STO
LIPLT
1.0
-8.0
-6.0
-4.0
ANS
0.0
-2.0
0.0
-1.0
LILPT
2.0
(-)3.3:1
4.0
6.0
8.0
-2.0
-3.0
ANS
Y
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Predicted Y
51. Graph 28
Graph 29
PREDICTION OF Sn-STO FROM POINT UI
PREDICTION OF LIPLT FROM POINT UI
4.00
3.00
3.5
3.0
2.00
2.5
2.0
1.00
LIPLT
Sn-STO
1.5
1.0
-14.00
0.5
-12.00
-10.00
-8.00
-6.00
-4.00
-12.0
-10.0
-8.0
-6.0
-4.0
-2.0
-0.5
0.00
0.00
2.00
0.0
2.0
4.0
-2.00
-1.5
Y
Predicted Y
UI
-3.00
UI
Graph 29
PREDICTION OF LIPLT FROM POINT UI
Ratio
Parameters
Change
Pearson correlation
Coefficient (r-value)
Regression
Coefficient
0.11
4.00
NS
0.01
NS
3.00
LIPLT
-14.00
-12.00
Sn-STO
-10.00
-8.00
-6.00
2.00
(-)3.5:1
1.00
-4.00
-2.00
0.00
0.00
-2.00
(-)5.6:1
-3.00
LILPT
2.00
4.00
6.00
-1.00
UPPER
INCISOR
UI
6.00
6.0
-1.0
UPPER
INCISOR
4.00
-1.00
0.0
-14.0
-2.00
Y
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Predicted Y
Y
Predicted Y
53. • Cephalometric radiographs, photographic
analysis, and mounted casts are routinely
used for diagnosis and treatment planning
of maxillary surgeries. In these, prediction
tracings are mainly based on the
functional and esthetic requirements of
the patient
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54. • The predictability of maxillary surgery is
influenced by the ability of the surgeon
to accurately place the maxilla, the
stability of the maxilla in its new
location, and the variability of the soft
tissue response.
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55. • It was found that most of the hard
tissue points showed a good correlation
with the final outcome, in both the
horizontal and vertical position.
• Jacobson and Sarver, Bryan and
Hunt as well as Mankad et al. also
showed a good correlation with various
predicted and post treatment results.
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56. • In this study it was found out that the lip
thickness decreased at the base of the
nose and at the soft tissue point A,
however at the vermillion border of the
upper lip the thickness actually
increased.
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57. • Lines and Steinhauser reasoned that
the soft tissue in the maxilla was
prevented from following the hard
tissue in a one-to-one manner, as in the
mandible, because of the fact that it
was firmly connected to the base of the
nose.
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58. • In this study the length of the upper lip
was divided into two parts one being
Sn-STO which was seen to be
increasing
with
the
superior
repositioning of the maxilla. The other
being LIPLT which tells us of the
curvature which was seen to be
decreasing showing that the upper lip
became straighter.
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60. 1. The hard tissue prediction done using the method
devised by Fish and Epker was found to be
reliable.
2. The upper lip thickness (ANS-Sn) decreased at
the base of the nose after a Lefort I osteotomy.
3. The vermillion border of upper lip (Pro-Ls, Ia-Ls)
becomes thicker after a lefort I osteotomy.
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61. 4.
On doing a lefort I osteotomy the upper lip length
(Sn-STO) increases.
5.
Lefort I osteotomy decreases the mid lip length
(LIPLT) because of straightening of the lip.
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