Correlations between cephalometric and photographic measurements of facial attractiveness in Chinese and US patients after orthodontic treatment

Facial profile evaluation and prediction of skeletal class II patients during camouflage extraction treatment: a pilot study

BACKGROUND

The evaluation of the facial profile of skeletal Class II patients with camouflage treatment is of great importance for patients and orthodontists. The aim of this study is to explore the key factors in evaluating the facial profile esthetics and to predict the posttreatment facial profile esthetics of skeletal Class II extraction patients.

METHODS

124 skeletal Class II extraction patients were included. The pretreatment and posttreatment cephalograms were analyzed by a trained expert orthodontist. The facial profile esthetics of pretreatment and posttreatment lateral photographs were evaluated by 10 expert orthodontists using the visual analog scale (VAS). The correlation between subjective facial profile esthetics and objective cephalometric measurements was assessed. Three machine-learning methods were used to predict posttreatment facial profile esthetics.

RESULTS

The distances from lower and upper lip to the E plane and U1-APo showed the stronger correlation with profile esthetics. The changes in lower lip to the E plane and U1-APo during extraction exhibited the stronger correlation with changes in VAS score (r = - 0.551 and r = - 0.469). The random forest prediction model had the lowest mean absolute error and root mean square error, demonstrating a better prediction accuracy and fitting effect. In this model, pretreatment upper lip to E plane, pretreatment Pog-NB and the change of U1-GAll were the most important variables in predicting the posttreatment score of facial profile esthetics.

CONCLUSIONS

The maxillary incisor protrusion and lower lip protrusion are key objective indicators for evaluating and predicting facial profile esthetics of skeletal Class II extraction patients. An artificial intelligence prediction model could be a new method for predicting the posttreatment esthetics of facial profiles.

Anteroposterior relationship of the maxillary central incisors to the forehead in adult Chinese females

Objectives:

The objectives of the study were to evaluate the anteroposterior (AP) relationship of the maxillary central incisors to the forehead in adult Chinese females.

Material and Methods:

The study sample consisted of 100 lateral smiling photographic images of adult Chinese females who were seeking orthodontic treatment (mean age = 24.0 + 6.5 years old). The study sample was compared to a control sample consisting of 100 images of adult Chinese females with harmonious facial profiles downloaded from the internet. The images were resized and rotated to the upright head position in an image editing software. Reference lines were constructed to evaluate forehead inclinations and AP positions of the maxillary central incisors.

Results:

In the control sample, 80% of the maxillary central incisors were positioned between the facial axis point of the forehead (FFA) and the glabella. About 13% were positioned posterior to the FFA point and 7% anterior to the glabella. In the study sample, 31% of the maxillary central incisors were positioned between the FFA point and glabella, 52% posterior to the FFA point, and 18% anterior to the glabella. There was a strong correlation between the position of the maxillary central incisors and forehead inclination in the control sample (r2 = 0.827). The difference in AP maxillary central incisor position relative to the forehead between the two groups was found to be statistically significant (P = 0.000).

Conclusion:

The forehead may be an important landmark when evaluating the AP position of maxillary incisors in adult Chinese female patients.

Perception of facial esthetics in young North Indian population

INTRODUCTION:

A person's ability to recognize a beautiful face is innate, but translating this into defined treatment goals is a challenge for clinicians.

AIM:

To determine if faces considered esthetic and pleasing in the young North Indian population (both males and females) exhibit similar cephalometric measurements as used for ideal treatment and successful results.

MATERIALS AND METHOD:

A panel of five judges evaluated a set of one frontal, one frontal during smiling, and one profile extra-oral photograph of 160 students (80 females and 80 males) on a five-point attractiveness scale. For each photographic set, the mean and final scores were calculated. Once the sample was assessed, 60 subjects (30 females and 30 males) with the highest final facial aesthetic score were selected and cephalometric analysis was performed. The obtained data were subjected to statistical analysis using SPSS 20 software.

RESULTS:

Both males and females with class I skeletal jaw bases were found to be attractive. The females with short faces; mild facial convexity and lower lip closer to the esthetic line were found to be attractive. The males with a prominent chin, straight profile, prominent nose, increased upper lip thickness, upper lip length, and lower lip length were found to be attractive.

CONCLUSION:

The faces considered attractive in this study fulfilled most of the cephalometric norms commonly used for the diagnosis and treatment planning except for a few inconsistencies which may be attributed to the gender and demographic origin.

Correlation between objective evaluation and subjective evaluation of facial profile in skeletal Type II females

Objectives:

The objective of this study was to find the cephalometric measurements that correlate with the visual perception.

Materials and Methods:

A total of 250 lateral cephalograms of patients from the year 2016 to 2018 were hand traced and analyzed. Thirty-six hard- and soft-tissue measurements were obtained from the lateral cephalometric analysis. Silhouettes obtained from cephalometric films were rated by 10 orthodontists based on their level of convexity. For each sample, the rating of visual perception was correlated with all the cephalometric (hard and soft) measurements.

Results:

ANB, AF-BF, L1-NB (mm), overjet, anterior maxillary alveolar height, posterior maxillary alveolar height, lower lip to E plane, and H angle were positively correlated with the visual perception. On the contrary, Pg. to N perpendicular and Pg. to NB (mm) were negatively correlated with the visual perception. However, the measurements in the vertical dimensions did not have any significant correlations with visual perception. H angle showed a higher correlation with visual perception than the nasolabial angle, facial contour angle, and lower lip to E plane.

Conclusion:

The agreement between objective cephalometric measurements and subjective visual perception was less than expected. In general, only 27% of the cephalometric measurements had a significant correlation with visual perception. Therefore, orthodontic treatment planning based solely on cephalometric analysis can result in unsatisfactory treatment outcomes. An inclusion of subjective measures such as visual perception in orthodontic diagnosis and treatment planning is necessary.

Sagittal Relationship between the Maxillary Central Incisors and the Forehead in Digital Twins of Korean Adult Females

OBJECTIVE

Digital twins of adult Korean females were created as a tool to evaluate and compare the sagittal relationship between the maxillary central incisors and the forehead before and after orthodontic treatment.

METHODS

Digital twins were reconstructed for a total of 50 adult female patients using facial scans and cone-beam computed tomography (CBCT) images. The anteroposterior position of the maxillary central incisor and the forehead inclination were measured.

RESULTS

The control group presented a mean of 6.7 mm for the sagittal position and 17.5° for forehead inclination. The study group showed a mean of 9.3 mm for the sagittal position and 13.6° for forehead inclination. Most Korean females seeking orthodontic treatment had their maxillary central incisor anterior to the glabella. In contrast, fewer Korean females who completed their orthodontic treatments had their maxillary central incisor anterior to the glabella. Furthermore, patients who had completed the orthodontic treatment were more likely to have the maxillary central incisor between the forehead facial axis and glabella.

CONCLUSION

The use of digital twins for three-dimensional (3D) analysis of the profile implies a high clinical significance. In addition, as the facial profile of Koreans is different from that of Caucasians, careful consideration should be made when setting treatment goals for the anteroposterior position of the maxillary central incisors.

[Use of skeletal-related diagnostic methods in articles published from 2018 to 2020 in four major orthodontics journals]

Objective

To determine the skeletal-related diagnostic methods most commonly used according to the four most important orthodontics journals in the period from 2018 to 2020.

Methods

A review of the data available regarding the diagnostic procedures most frequently used to determine skeletal relationships in the four most important orthodontics journals from 2018 to 2020. Article review was performed using SCIMAGO 2018, which provides a series of parameters ranking the importance of the impact of publications and journals. We made a synopsis of the information analyzed to establish a correlation and compare sources, and critically examined the articles collected on the subject of interest. An online bibliographic search of databases including mainly Medline was carried out, followed by evaluation and selection of the bibliography, organized according to the significance and nature of the study.

Results

The four journals included in the bibliographic search were: AJODO, AO, EJO and KJO. The A point-Nasion-B point (ANB) method was used in 92.2% of the articles published in AJODO, and 7.8% did not describe the method used. Twenty-three articles in the AO journal were evaluated, all of which referred to the use of ANB as the method used. Finally, 16 and 11 articles from the EJO and KJO journals, respectively, were evaluated, with 93.8% and 95%, respectively of the articles using ANB as the method of choice for determining skeletal relationships.

Conclusion

The method of choice for skeletal-related diagnostics is ANB, although this widely known method presents a risk of geometric effect.

Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients

Supplemental Digital Content is available in the text.

Background:

Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study.

Methods:

We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions.

Results:

Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics.

Conclusions:

Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.

Correlations between objective measurements and subjective evaluations of facial profile after orthodontic treatment

Objective

To investigate the correlations between objective measurements and subjective evaluations of post-treatment facial attractiveness.

Methods

Ten orthodontists rated the subjective visual analog scale (VAS) scores of the facial profiles of 95 patients who had undergone orthodontic treatment. Post-treatment cephalograms and photographs were used. Eleven soft tissue measurements and eight maxillary incisor measurements were constructed and analyzed. Correlations between objective measurements and subjective VAS scores were evaluated using Pearson correlation and quadratic regression analysis.

Results

The VAS scores of different facial proportions were all correlated with the total VAS score. Among soft tissue measurements, the distances from the upper and lower lips to the E line, H angle, forehead inclination, distance from lower lip to the H line, and pogonion-menton angle were negatively correlated with the VAS scores. The Z angle, with a parabolic distribution, was also correlated with the VAS scores. Among maxillary incisor measurements, the distance from the maxillary incisors to the forehead’s anterior limit line and the angulation of the maxillary incisors to the APo line were negatively correlated with the VAS scores.

Conclusions

Several soft tissue and maxillary incisor position measurements were correlated with facial profile evaluation and therefore might be used to evaluate facial attractiveness.

The Importance of the Occlusal Plane in Predicting Better Facial Soft Tissue in Class II Malocclusion in Ethnic Javanese

Objectives  Class II malocclusion is largely due to a retrognathic mandible. Mandibular rotation is closely related to changes in the occlusal plane during growth. The problems in the occlusal plane could cause disadvantages in the soft tissue profile in Class II malocclusion, presenting treatment challenges for an orthodontist. This study aimed to investigate the importance of the occlusal plane for a better soft tissue profile in Class II malocclusion for Javanese patients.

Materials and Methods  The total number of cephalogram softcopies of patients with skeletal Class II malocclusion were selected based on ANB values (> 4 degrees), no agenesis teeth except the third molar, and all permanent teeth. The cephalograms were calculated using digital tracing by Morpheus 3D imaging. The points and areas to be analyzed on the cephalogram were predetermined. The examination was performed in a span of 1 month and performed via a statistical test using Pearson’s test and multiple regression analysis ( p < 0.05).

Results  There were significant correlation values between the angles produced by the occlusal plane to sella national, Frankfurt horizontal, mandibular plane, and Z-angle ( p < 0.05).

Conclusion  Patients with skeletal Class II malocclusion have a significant correlation between the occlusal plane and the vertical plane, thereby affecting the shape of the soft tissue profile, which causes a facial imbalance. By improving mandibular movement, the soft tissue profile can also be corrected.

Factors associated with the beauty of soft-tissue profile

INTRODUCTION

Factors affecting the attractiveness of soft-tissue profile have been assessed in only a few studies, with limited methodologies (such as few variables, small sample sizes) and bivariable analyses. Therefore, this study was conducted to elucidate esthetic factors of profile silhouettes among a long list of cephalometric variables with the use of multivariable analyses for the first time.

METHODS

Profile silhouettes of 70 Iranians (35 men and 35 women) with Class I/good occlusions and balanced faces were rated twice by 10 Iranian laypersons, and were given overall profile beauty scores (from 10 to 50). After careful landmark identification by 3 orthodontists, unrepeated cephalometric measurements (from Holdaway, Ricketts, Z-Merrifield, Epker, and Legan-Burstone analyses) were traced twice on all cephalographs. The effects of these variables (plus sex and age) on profile beauty scores were assessed with the use of Pearson coefficient and multiple linear regression. Cephalometric characteristics of Persian attractive profiles (scores from 40 to 50) were compared with Caucasian orthodontic norms (α = 0.05).

RESULTS

The following variables were significant in the best models: soft-tissue facial angle (β = -0.348, P = 0.016), nose prominence (β = -0.245; P = 0.044), skeletal profile convexity (β = 0.255; P = 0.052), upper lip curvature (β = 0.405; P = 0.042), nasolabial angle (β = 0.546; P = 0.000), nasofacial angle (β = 0.259; P = 0.028), Z-angle (β = 0.557; P = 0.015), H-angle (β = -0.360; P = 0.013), upper lip to E-plane (β = 0.691; P = 0.001), lower lip to E-plane (β = -0.674; P = 0.002), Sn-lower lip (β = 0.338; P = 0.055), lower lip-menton (β = -0.299; P = 0.025), Sn FH-perp to upper lip (β = -0.425; P = 0.001), Sn-Stms:Stms-Me' (β = -0.372; P = 0.016), facial convexity angle (β = 0.710; P = 0.000), lower lip protrusion (β = -0.342; P = 0.005), and interlabial gap (β = -0.179; P = 0.050). Sex and age were not associated with profile attractiveness (P > 0.75).

CONCLUSIONS

More convex skeletal and soft-tissue profiles, less prominent noses with higher tips, subnasales anterior to the upper lip, more protruded upper lips, less prominent lower lips, smaller interlabial gaps, and more protruding chins might improve profile esthetics.

Anteroposterior and vertical soft tissue cephalometric norms of Iranians, interethnic comparisons, sex dimorphism, and the effect of age on cephalometric variables

INTRODUCTION

This study established about 50 anteroposterior and vertical cephalometric norms of five tracing analyses in Iranians, using a large sample.

METHODS

Lateral cephalographs of 130 subjects (85 females, 45 males, with an average age of 22.77 ± 2.55 years (range 20-29)) were traced manually using the Ricketts, Holdaway, Z-Merrifield, Epker, and Legan-Burstone soft tissue analyses. The role of age and sex on measurements, as well as the comparisons between Iranian norms with Caucasians from European decent, was determined statistically (α = 0.001).

RESULTS

Age had no significant effect (all P values > 0.01). Sexual dimorphism existed in terms of numerous parameters. Compared to analysis standards, upper lip to E-plane, nose prominence, upper lip thickness, nasomental angle, Z angle, interlabial distance, subnasale perp to chin, subnasale-stomion:stomion-menton, subnasale-lower lip:lower lip-menton, interlabial gap, and vertical lip-chin ratio were smaller in Iranians. Superior sulcus depth, skeletal profile convexity, upper lip strain, upper lip curvature, H-angle, soft tissue chin thickness, nasofacial angle, subnasale perp to upper lip, subnasale perp to lower lip, maxillary prognathism, lower face throat angle, upper lip protrusion, lower lip protrusion, mentolabial sulcus, and lower vertical height-depth ratio were greater in Iranians compared to the norm (P ≤ 0.001).

CONCLUSIONS

A great degree of sex dimorphism might exist among Iranians. Many textbook norms might not be the best options for diagnosis or treatment of Iranians.

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey

Abstract

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether “being beautiful” would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid’s bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cephalometric characteristics of postorthodontic female patients with attractive and unattractive frontal posed smiles

OBJECTIVES:

To identify differences in skeletal, dental, and soft-tissue morphology between postorthodontic patients with attractive and unattractive frontal posed smiles.

MATERIALS AND METHODS:

The attractiveness of close-up photographs of frontal posed smiles in 100 adult female patients after conventional orthodontic treatment was evaluated by 20 dental students (10 men, 10 women) using a visual analogue scale. Posttreatment cephalograms of the 20 patients with the most attractive smiles (attractive group; mean age 23.75 ± 3.35 years) and the 20 patients with least attractive smiles (unattractive group; mean age 23.11 ± 4.45 years) were selected, and 41 measurements were made and compared between groups using the Mann-Whitney U-test ( P < .05).

RESULTS:

When compared with the attractive group, the unattractive group exhibited greater values for sella-nasion plane to mandibular plane, palatal plane to mandibular plane, anterior facial height, lower facial height, and lower facial height/anterior facial height as skeletal measurements; for occlusal plane to sella-nasion plane, palatal plane to occlusal plane, and maxillary central incisor to palatal plane as dental measurements; and for lower face, upper lip length, and upper lip superior to palatal plane as soft-tissue measurements.

CONCLUSIONS:

Cephalometric analysis revealed that postorthodontic Japanese female patients with unattractive frontal posed smiles are characterized by a hyperdivergent skeletal pattern with extruded maxillary incisors and a steep occlusal plane, accompanied by a longer upper lip than patients achieving attractive posed frontal smiles.

Soft-Tissue Anthropometric Norms of Iranians with Proper Occlusion and Inter-Ethnic Norm Comparisons

Background

Photographic soft-tissue norms of Iranian race are not reported previously, nor are they compared with other ethnicities. Besides, sex dimorphism is assessed in only very few studies on soft-tissue profile. The aim of this study was to assess the soft-tissue measurements of Iranians with good occlusion and the existing sex dimorphism and to compare the Iranian norms with other ethnicities.

Materials and Methods

Twelve anthropometric variables were measured by a dentist in 100 Iranian subjects with good occlusions. The subjects included 50 males and 50 females. The differences between the two genders, as well as the differences between Iranian norms and the norms in all other ethnicities available in the literature were statistically analyzed using a t test (α = 0.05).

Results

There were significant differences between males and females regarding frontonasal angle (P = 0.0000), mentolabial sulcus (P = 0.0000), vertical height ratio (P = 0.0000), vertical lip-chin ratio (P = 0.0013), nasolabial angle (P = 0.0019), lower vertical height-depth ratio (P = 0.0029), maxillary prognathism (P = 0.0045), and mandibular prognathism (P = 0.0118). The difference in facial convexity was marginally significant (P = 0.0543). Protrusions of both lips and horizontal distance between the lips were not significantly different between sexes (P > 0.2).

Conclusions

Unlike Americans and Brazilians but similar to Koreans, there was considerable sex dimorphism in Iranians. Compared to Iranian men, women might have more convex profiles, more advanced mandibles (unlike all other races studied), more protruded maxillae, lips closer to the middle of nose-chin vertical distance, deeper mentolabial sulci, less protruded noses with higher nose tips, and smaller lower faces.

Diagnostic value of profile photography in identifying departures from the norm of growth pattern and horizontal jaw relationship

BACKGROUND

Although the importance of facial photography in orthodontics has been recognized, there is only one study on its validity and absolutely no studies on its diagnostic value. This study was conducted, therefore, to evaluate for the first time the diagnostic merit of photography in detecting growth pattern and jaw relationships.

METHODS

Standardized lateral cephalographs and profile photographs were taken from 54 girls and 26 boys. On cephalometry, growth pattern (normal, horizontal, and vertical) and horizontal bimaxillary classification (Classes I to III) were determined. Using photographs, the angles FH-MP', CP'-MP', Sn-T-Me', cutaneous analog of ANB, facial convexity, and head position were calculated. Diagnostic photography-based measurements for detecting departures from the norm were calculated by counting correct and incorrect diagnoses, according to the gold standard (lateral cephalometry).

RESULTS

The sensitivity, specificity and positive predictive values, and the negative predictive value of FH-MP' photographic measurements in detecting growth disorders were 51.4, 77.8, 64.3, and 67.3 percent, respectively. These values were 45.7, 95.6, 88.9, and 69.4 percent for the CP'-MP' measurement, and were 40.0, 93.3, 82.4, and 66.7 percent for Sn-T-Me', and 51.4, 100, 100, and 72.6 percent for all of them combined. In detecting the horizontal relationship between the jaws, the photographic method showed an overall sensitivity, specificity, PPV, and NPV of 80.9, 63.6, 76.0, and 70.0 percent, respectively. These values were 80.9 57.6 73.1 67.9 percent for cutaneous analog of ANB, 87.2, 45.5, 69.5, and 71.4 percent for facial convexity, and 61.7, 66.7, 72.5, and 55.0 percent for head position.

CONCLUSIONS

Profile photography can be used as a perfectly accurate measurement tool for detecting horizontal and vertical growth patterns. It is also a rather accurate method for detecting the normal growth pattern, as well as both Class I and non-Class I jaw relationships. These results highlight this non-invasive and economic method as an effective clinical diagnostic tool.

Effects of Objective 3-Dimensional Measures of Facial Shape and Symmetry on Perceptions of Facial Attractiveness

PURPOSE

Meeting patient desires for enhanced facial esthetics requires that providers have standardized and objective methods to measure esthetics. The authors evaluated the effects of objective 3-dimensional (3D) facial shape and asymmetry measurements derived from 3D facial images on perceptions of facial attractiveness.

MATERIALS AND METHODS

The 3D facial images of 313 adults in Iowa were digitized with 32 landmarks, and objective 3D facial measurements capturing symmetric and asymmetric components of shape variation, centroid size, and fluctuating asymmetry were obtained from the 3D coordinate data using geo-morphometric analyses. Frontal and profile images of study participants were rated for facial attractiveness by 10 volunteers (5 women and 5 men) on a 5-point Likert scale and a visual analog scale. Multivariate regression was used to identify the effects of the objective 3D facial measurements on attractiveness ratings.

RESULTS

Several objective 3D facial measurements had marked effects on attractiveness ratings. Shorter facial heights with protrusive chins, midface retrusion, faces with protrusive noses and thin lips, flat mandibular planes with deep labiomental folds, any cants of the lip commissures and floor of the nose, larger faces overall, and increased fluctuating asymmetry were rated as significantly (P < .001) less attractive.

CONCLUSION

Perceptions of facial attractiveness can be explained by specific 3D measurements of facial shapes and fluctuating asymmetry, which have important implications for clinical practice and research.

Photogrammetric Analysis of Attractiveness in Indian Faces

Background

The objective of this study was to assess the attractive facial features of the Indian population. We tried to evaluate subjective ratings of facial attractiveness and identify which facial aesthetic subunits were important for facial attractiveness.

Methods

A cross-sectional study was conducted of 150 samples (referred to as candidates). Frontal photographs were analyzed. An orthodontist, a prosthodontist, an oral surgeon, a dentist, an artist, a photographer and two laymen (estimators) subjectively evaluated candidates' faces using visual analog scale (VAS) scores. As an objective method for facial analysis, we used balanced angular proportional analysis (BAPA). Using SAS 10.1 (SAS Institute Inc.), the Turkey's studentized range test and Pearson correlation analysis were performed to detect between-group differences in VAS scores (Experiment 1), to identify correlations between VAS scores and BAPA scores (Experiment 2), and to analyze the characteristic features of facial attractiveness and gender differences (Experiment 3); the significance level was set at P=0.05.

Results

Experiment 1 revealed some differences in VAS scores according to professional characteristics. In Experiment 2, BAPA scores were found to behave similarly to subjective ratings of facial beauty, but showed a relatively weak correlation coefficient with the VAS scores. Experiment 3 found that the decisive factors for facial attractiveness were different for men and women. Composite images of attractive Indian male and female faces were constructed.

Conclusions

Our photogrammetric study, statistical analysis, and average composite faces of an Indian population provide valuable information about subjective perceptions of facial beauty and attractive facial structures in the Indian population.

Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

AIM

The aim of this study was to assess the soft tissue measurements of Iranians with good occlusion and to compare the Iranian norms with other ethnicities.

MATERIALS AND METHODS

A total of 25 anthropometric variables were measured by a dentist in 50 Iranian Class I subjects (25 males, 25 females) with good occlusion and well-balanced faces. The differences between the two genders, as well as the differences between Iranian norms and the Holdaway and Burstone analyses, were statistically analyzed using a t-test (α=0.05).

RESULTS

The subjects' mean age was 21.6±4.1 years. There were significant differences between males and females regarding the mentocervical angle, the nasolabial angle, Merrifield's Z-angle, the angle of facial convexity, soft tissue chin thickness, and upper lip thickness (P<0.05). The Holdaway norms can be used for the Iranian population, except for the following measurements which might be significantly different: facial convexity angle, nasolabial angle, interlabial gap, soft tissue facial angle, skeletal profile convexity, H-angle, lower lip to H-line, lower sulcus depth, and soft tissue chin thickness (P<0.05).

CONCLUSIONS

There was a considerable sex dimorphism in the Iranian population. The Holdaway norms are not useful for the Iranian population regarding most measurements.

Comparison of short-term effects between face mask and skeletal anchorage therapy with intermaxillary elastics in patients with maxillary retrognathia

INTRODUCTION

The aim of this study was to compare the short-term dental and skeletal effects of a face mask (FM) with those of skeletal anchorage (SA) therapy with intermaxillary elastics in prepubertal patients with skeletal Class III malocclusion.

METHODS

Fifty patients with skeletal Class III malocclusion and maxillary deficiency were divided into two groups. In the FM group, an FM was applied by a bite plate with a force of 400g for each side. In the SA group, mini-plates were placed between mandibular lateral incisors and canines, and mini-implants were inserted between maxillary second premolars and first molars. A bite plate was inserted into the upper arch, and Class III elastics were applied with a force of 200g between each mini-plate and mini-implant.

RESULTS

Mean treatment durations were 0.52±0.09 years for FM and 0.76±0.09 years for SA. After the treatment, statistically significant increases in SNA°, ANB°, A-y, 1-NA, SnGoGn°, Co-A, Co-Gn, and A-Nperp, and reductions in SNB° and FH┴N-Pg were observed in both groups, and these changes were similar in both groups. In the FM group, 1-NB decreased significantly, and in the SA group, it increased significantly (P < 0.05).

CONCLUSIONS

The undesired dentoalveolar effects of the FM treatment were eliminated with SA treatment, except with regard to lower incisor inclination. Favourable skeletal outcomes can be achieved by SA therapies, which could be an alternative to the extraoral appliances frequently applied to treat skeletal Class III patients with maxillary deficiency.

Sagittal lip positions in different skeletal malocclusions: a cephalometric analysis

BACKGROUND

The objectives of this paper are to (1) study use of soft tissue analyses advocated by Steiner, Ricketts, Burstone, Sushner and Holdway to develop soft tissue cephalometric norms as baseline data for sagittal lip position in Northeast Chinese adult population, (2) compare the sagittal lip positions in different skeletal malocclusions and (3) compare the sagittal lip positions in Northeast Chinese adults with other reported populations.

METHODS

Lateral cephalometric radiographs of subjects were taken in natural head position. Radiographs were manually traced and five reference lines - Sushner, Steiner, Burstone, Holdway and Ricketts, were used. The linear distance between the tip of the lips and the five reference lines were measured. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) 21. Descriptive analysis was done for each variable for each subject. Coefficient of variation between lip positions as assessed by reference lines was determined. Post hoc Tukey's test was used for comparison of the mean cephalometric values of three skeletal malocclusions. The level of significance for the analysis was set at p < 0.05.

RESULTS

The findings showed significant difference in the sagittal lip positions in different skeletal malocclusions. There was variation in consistent reference line in each skeletal malocclusion. The S2 line was the most consistent reference line in skeletal class I and class II group. The B line was the most consistent line in skeletal class III. In skeletal class II group, upper lips were the most protrusive and lower lips were retrusive than in skeletal class I and class III groups. In case of skeletal class III group, upper lips were retrusive and lower lips were more protrusive than in skeletal class I and class II groups.

CONCLUSIONS

The sagittal lip positions were found to be associated with the skeletal malocclusion pattern. Northeast Chinese population has protrusive upper and lower lip in comparison to Caucasians. Each skeletal malocclusion group showed different preferable reference lines for analysis of sagittal lip position.

Influence of bimaxillary protrusion on the perception of smile esthetics

OBJECTIVES

To evaluate the impact of bimaxillary protrusion on smile esthetics as perceived by dental professionals and laypersons.

METHODS

One hundred and fifty evaluators, equally distributed into their respective panels (orthodontists, general dentists, and laypersons), participated in this cross-sectional study conducted in April to December 2012 in Riyadh, Saudi Arabia. The patient sample consisted of 14 female patients divided equally into 2 groups: bimaxillary protrusion patients, and patients who have had 4-premolar extraction treatment. Two standardized photographs (frontal and three-quarter close-up smile views), and a lateral cephalogram were taken for each patient. The evaluators were asked to rate the attractiveness of each photo according to a 100-mm visual analog scale. These esthetic ratings were correlated with the patients' cephalometric measurements.

RESULTS

The bimaxillary protrusion group was rated significantly as less attractive than the treatment group by each evaluator panel. Panel comparison showed that laypeople were less receptive of bimaxillary protrusion than dental professionals. Frontal and three-quarter views of the same smiles were not similarly rated for esthetic perceptions. Correlational analysis revealed that the dentoalveolar measurement with the highest significant negative correlation to the smile esthetics was the upper incisors to palatal plane (U1-PP) angle.

CONCLUSION

Patients with bimaxillary protrusion were found to be less attractive than patients who were treated for the condition. This was especially evident among the laypersons. An increase in the upper incisor inclination, as well as a decrease in the interincisal angle compounds the bimaxillary effect. 

Correlation between objective and subjective evaluation of profile in bimaxillary protrusion patients after orthodontic treatment

OBJECTIVE

To correlate the objective cephalometric measurements with subjective facial esthetics in patients with bimaxillary protrusion.

MATERIALS AND METHODS

The sample consisted of 60 Asian-Chinese patients with bimaxillary protrusion who met the inclusion criteria. The facial esthetics of posttreatment profile and the change of profile on standardized lateral photographs were rated by a panel of 10 orthodontists and a panel of 10 lay persons with bimaxillary protrusion. All of the pretreatment and posttreatment cephalograms were digitized and traced. Twenty-five cephalometric measurements were constructed and analyzed. Correlations between the subjective facial esthetic scores and each cephalometric measurement were evaluated.

RESULTS

The cephalometric measurements correlated with the facial esthetic scores of posttreatment profile given by the orthodontist and the lay persons were basically the same. For the evaluation of posttreatment profile in bimaxillary protrusion patients, the upper and lower lip to E-line, upper and lower incisor tip to AP plane, Pg-NB distance, mentolabial angle, and sulcus depth correlated significantly with the esthetic score. For the evaluation of profile change during orthodontic treatment, retraction of upper incisor relative to AP plane or the perpendicular line through sella (line Y), change of upper incisor inclination, change of mentolabial sulcus depth, and retraction of lips relative to E-line were correlated positively with the esthetic value.

CONCLUSIONS

Cephalometric measurements of lip position, incisor position, and chin morphology were key parameters correlated to facial esthetics.

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman r_s values, ranging from –0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R²=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R²=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r_{(SC+LX)vs.(SC+LX+PH)}=0.96, r_{(SC+PH)vs.(SC+LX+PH)}=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

Factors influencing attractiveness of soft tissue profile

BACKGROUND AND AIM

The factors affecting the attractiveness of the soft tissue profile are assessed in only very few nonmatched and controversial studies. We aimed to evaluate these factors in a matched comprehensive study.

METHODS

Profile photographs of 100 students with good occlusion were sorted according to facial beauty by 20 judges. After excluding 40 unmatched subjects or those with marginal scores, 12 soft tissue variables were compared among profiles of 30 attractive and 30 unattractive matched participants (t test, α = 0.05).

RESULTS AND CONCLUSION

As the most important factor, excessive mandibular retrusion made both men and women unattractive. Both attractive men and women tended to have less prominent noses with higher nose tips, protruded upper lips compared with the position of lower lips, and deeper lower faces. Closeness of lips to the middle of vertical chin-nose distance enhanced female beauty only. Straight profiles and more protruded maxillae merely made men more attractive.