 A kid with GHD  The best worldwide player Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 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

 Increased demand of orthodontic Tx  Esthetic problems  Importance of facial soft tissues balance  Increased demand of orthodontic Tx  Esthetic problems  Importance of facial soft tissues balance Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

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

Facial breadth:  “Rule of transverse fifths”  Between helix of outer ears.  Each fifth = width of 1 eye. 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

 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 balance Effects of cheek and lips are counteracted by the tongue. 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)  Alteration of muscle balance: Equilibrium theory  Tooth position changed in response to the exerted pressures (light and sustained) Teeth Lips Cheeck Tongue Cheeck Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

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

 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

 In lower third face  Importance: 1. Lip seal (mouth breathing, swallow). 2. Phonation, facial esthetic. Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

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

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. 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

Features: Wide gap between upper and lower lip in relaxed state (without minimal muscle activity) 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”  Lip strain  Excessive muscular activity to close the lips is indicated by puckering of the chin due to mentalis contraction.  “ Potentially competent lip” Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

Causes: 1- Morphological Short upper lip. “primary incompetent lips”. Causes: 1- Morphological Short upper lip. “primary incompetent lips”. Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Causes: 2-Antero-posterior discrepancy “ class II division 1”  Causes: 2-Antero-posterior discrepancy “ class II division 1” Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Causes: 3- Vertical discrepency: Increased lower face height  Causes: 3- Vertical discrepency: Increased lower face height Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Causes: 4- Maxillary dental protrusion: lower lip falls between upper and lower incisors  Causes: 4- Maxillary dental protrusion: lower lip falls between upper and lower incisors Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Normal oral seal:  Lip contact  No muscular activity  Jaws in rest position  Normal oral seal:  Lip contact  No muscular activity  Jaws in rest position Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 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

 muscular structure that forms part of the floor of the oral cavity.oral cavity  Plays a major role in  Oral seal  Swallowing Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

NORMAL LIP SEAL ADOPTIVE ORAL SEAL Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Contact “tongue – lower lip” Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Seen in open bite 2- Lip-palate contact Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Seen in class III 3- Tongue-upper lip Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 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

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

1- Oral Phase. 2- Pharyngeal Phase. 3- Esophageal Phase. Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

1- ORAL PHASE 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.  The bolus passes through the fauces  Nasopharynx is closed  Tongue and hyoid move upward. Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

3- ESOPHAGEAL PHASE  Food passes through the esophagus to the stomach. Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 Primary atypical swallowing:  Increased over jet  Decreased overbite  Posterior cross bite  Primary atypical swallowing:  Increased over jet  Decreased overbite  Posterior cross bite Dr. Maamar Al-Samet, Faculty of dentistry, Jazan University

 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

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

Causes of mouth breathing: Adenoidism Rhinitis Pharyngitis …etc Effect of mouth breathing:  Adenoid facies  Abnormalities in all planes of space 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

The End

 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

Thank you