Facial soft tissue harmony and growth in orthodontic treatment

Soft-tissue facial morphometry from 6 years to adulthood: a three-dimensional growth study using a new modeling

A recently introduced three-dimensional computerized system with landmark representation of the soft-tissue facial surface allows noninvasive and fast quantitative study of facial growth. The aims of the present investigation were (1) to quantify growth changes in soft-tissue facial morphology, (2) to evaluate sex differences in growth patterns, and (3) to provide reference data for selected angular and linear measurements that could be of interest for the objective analysis of maxillofacial surgery or orthodontic patients. The three-dimensional coordinates of 22 standardized facial landmarks were automatically collected by automated infrared photogrammetry using the three-dimensional facial morphometry method in a mixed longitudinal and cross-sectional study, in which 2023 examinations were obtained in 1348 healthy nonpatient subjects between 6 years of age and young adulthood. Selected parameters (angles, linear distances, and ratios) were calculated and averaged for age and sex. Male values were compared with female values by means of Student's t test. Within each age group, linear distances were significantly larger in boys than in girls (p < 0.05) with some exceptions coinciding with the earlier female growth spurt, whereas angular measurements did not show a corresponding sexual dimorphism. Linear distances in girls had almost reached adult dimensions in the 12-to-13-year-old age group, whereas in boys a large increase was still to occur. This was most evident in the middle third of the face, where both sexes showed almost the same dimension and amount of growth up to the age of 13, with significant differences afterward, boys being larger than girls. On the contrary, in the lower third of the face, significant differences occurred throughout the whole investigated period, boys being always larger than girls. The male versus female angular comparison reflected the differential timing in attainment of adult proportions. The three-dimensional facial morphometry method allowed the noninvasive evaluation of a large sample of nonpatient subjects, leading to the definition of three-dimensional normative data about facial soft tissues. The method could supplement more invasive radiographic evaluations, allowing frequent examinations of children and adolescents before and during treatment, as well as in the follow-up.