Good morning

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Seminar
on
Soft tissue Cephalometric Analysis
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTS

1.
2.
3.
4.
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HISTORY OF CEPHALOMETRICS
NEED FOR A SOFT TISSUE ANALYSIS
SOFT TISSUE CEPHAL...
HISTORY
Historically the human
form has been
measured for many
reasons. One has been
to aid humanity’s self
–potrayal in
s...
LEONARDO DA VINCI (16 century)

A scientific approach of human
craniofacial pattern was
probably initiated during the
rena...
DURER In his book FOUR
BOOKS OF FACIAL
PROPORTIONS Used
Geometric methods to study the
face .
He provided proportionate an...
CAMPER (18 th century)

Camper made an extensive
studies of cranium from
birth to old age. Campers’s
horizontal, a line
ex...
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EDMOND H WUERPEL - “ A face is beautiful and
shows harmonious features if the proportions of its
individual components are...
Orthodontists have contributed to this
ongoing effort with their study of the
human face and profile, in search of
guideli...
NEED FOR A SOFT TISSUE ANALYSIS
Model analysis
- was assumed to achieve all facial & dental goals
including facial harmony...
Osseous cephalometric analysis
-It was assumed that by placing the skeletal parts
within the range of skeletal cephalometr...
Park and Burstone studied 30 cases in which the
lower incisor was 1.5 mm anterior to the A-Pog
line . This relationship is...
When the cranial base is used as the reference line
to measure the facial profile, bogus findings can
be generated.
Michie...
(3) no measurement is 100% accurate

(4) the soft tissue thickness and axial inclination
of incisors are the most importan...
Clinicians have begun to select treatment based on
direct facial examination and diagnosis.
Treating a face to “what looks...
SOFT TISSUE CEPHALOMETRIC
LANDMARKS
SOFT TISSUE NASION

PRONASALE
SUB NASALE
SUB SPINALE
LABRALE SUPERIUS
STOMION
LABRALE ...
PROFILE ANALYSIS
PROPORTIONAL ANALYSIS
Ideal profile provides a basic standard for
assessment of average profile
Ideal pro...
ANGULAR PROFILE ANALYSIS ( SUBTENLY )

Subtently makes a distinction between skeletal soft tissue and full soft tissue
(in...
SUBTENLYS PROFILE THICKNESS ANALYSIS
Soft tissue thickness at the Glabella remains constant
Thickness of Sulcus Labrale Su...
BOWKER AND MEREDITH STUDIES ON SOFT TISSUE
THICKNESS

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PROFILE ANALYSIS BY A.M. SCHWARZ (1929)

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GNATHIC PROFILE FIELD

TANGENT T - Sn – Pog

T ANGLE OR PROFILE ANGLE
AVG -10 DEGREES

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AVERAGE FACE - Sn on Pn

RETRO FACE

- Sn behind Pn

ANTE FACE - Sn ahead of Pn

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STRAIGHT ANTE FACE
- Displacement of Pog
with Sn anteriorly
- GPF parallel and
anterior to
average face
STRAIGHT RETRO FAC...
OBLIQUE RETRO FACE – Posterior rotation of avg face. Maxilla
positioned posteriorly and mandible even more posteriorly
AVE...
OBLIQUE ANTE FACE- Forward rotation of average face, Maxilla is
anterior and mandible even more anterior.
AVERAGE FACE , G...
CLASS II MALOCCLUSION

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CLASS III MALOCCLUSION

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ANALYSIS OF THE LIPS

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LENGTH OF UPPER LIP
MEAN VALUES
BURSTONE
Boys - 24 mm
Girls - 20 mm
RAKOSI
Boys - 22.5 mm
Girls - 20 mm
CLASS – II
CLASS –...
LENGTH OF LOWER LIP
MEAN VALUES
BURSTONE - Boys- 50 .0 mm
Girls- 46.5 mm
RAKOSI -

Boys- 45.5 mm
Girls- 40.0 mm

CLASS II ...
THICKNESS OF RED PART
OF UPPER LIP
AVERAGE SIZE
11.5 mm ( RAKOSI)
CLASS II : Upper lip thin due
to angulation of
upper inc...
THICKNESS OF RED PART OF
LOWER LIP
AVERAGE SIZE
12.5 mm ( RAKOSI )
CLASS II : Lower lip
is thicker ( 14 mm )
CLASS III : L...
HOLDAWAYS ANALYSIS
( 1983 )

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FACIAL ANGLE AND UPPER LIP CURVATURE
FACIAL ANGLE is formed by the
intersection of FH PLANE
with line joining N TO POG
AVG...
H- LINE ANGLE AND SKELETAL CONVEXITY AT
POINT A
H line angle formed between
H-line and Line Joining N to
Pog
Avg Value- 7-...
RELATIONSHIP BETWEEN H-LINE AND
SKELETAL CONVEXITY AT POINT A

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NOSE TIP TO H-LINE AND UPPER SULCUS DEPTH

NOSE TIP TO H-LINE
AVG VALUE – 12 mm MAX

UPPER SULCUS DEPTH
MEASURED FROM SUB ...
UPPER LIP THICKNESS AND UPPER LIP STRAIN
Upper lip thickness is measured
horizontally from a point 2 mm
below point A to o...
LOWER SULCUS DEPTH AND SOFT TISSUE CHIN THICKNESS

Lower sulcus depth is
measured from the deepest
point in the curvature
...
ACCORDING TO HOLDAWAY
A PERFECT PROFILE SHOULD
HAVE
ANB - 2 degrees
H-LINE ANGLE -7 to 8 degrees
LOWER LIP should touch th...
RICKETTS LIP ANALYSIS
Reference line connects
NOSE TIP TO SOFT TISSUE
POGONION - E LINE
E Line

Lips are analysed
dependin...
STEINERS LIP ANALYSIS
Reference point is the
Centre of the S SHAPED CURVE
between the tip of Nose and Sub Nasale
Reference...
ANALYSIS FOR ORTHOGNATHIC
SURGERY

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HORIZONTAL
PLANE

COLUMELLA

GNATHION

CERVICAL POINT

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ANGLE OF FACIAL CONVEXITY

G TO Sn , Sn TO Pog
MEAN VALUE - 12 DEGREES
POSITIVE VALUE – CLASS II
NEGATIVE VALUE - CLASS II...
LOWER FACE THROAT ANGLE

Sn to Gn , Gn to C
MEAN VALUE – 100 DEGREES
DECREASE IN VALUE INDICATES
PROMINENT CHIN

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ANTERO POSTERIOR MAXILLARY AND MANDIBULAR
MEASUREMENTS
Dist. Sn to perendicular from Glabella - mean value 6 mm
Negative v...
UPPER AND LOWER LIP
PROTRUSION

Sn
Ls
Li
Pog

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Mean Values
Ls – Sn Pog

3 mm

Li – Sn Pog

2 m...
MENTO LABIAL SULCUS

Li
Sm
Pog

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Mean Value- 4 mm
NASOLABIAL ANGLE

Mean Value - 102 degrees

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VERTICAL LIP CHIN RATIO
Mean Value - 1:2
INTER LABIAL GAP
Mean Value - 2 mm
MAXILLARY INCISOR
EXPOSURE
Mean Value - 2 mm

...
ARNETTS ANALYSIS

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Nineteen facial traits were selected
Two views of the patient are used for identification of problems in three
planes of s...
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FRONTAL VIEW Outline form and symmetry

Facial height: Hairline (H) to soft
tissue menton (Me'). Facial
widths: Zygomatic ...
Facial level

Pupil plane (PP) is horizontal line
drawn through pupils. This line is
usually parallel to the horizon
and i...
Constructed horizontal reference line
is formed by drawing line
through pupil area parallel to
floor. This line is used wh...
Midline alignments
Important midline structures are
assessed. Nasal bridge (NB),
nasal tip (NT), filtrum (F), upper
inciso...
When pupils are not level,
constructed horizontal reference
line (Fig. 3) is used. A
perpendicular to the constructed
hori...
Facial one thirds
Face is divided into thirds by
drawing lines through hairline
(H), midbrow (Mb), subnasale
(Sn), and sof...
Lower one-third evaluation

With lips relaxed, lower third is
subdivided by drawing lines
through subnasale (Sn), upper li...
Incisor exposure is measured with
lips relaxed from upper lip
inferior (ULI) to maxillary
incisor edge (MxlE). The upper
t...
Interlabial gap is measured in
relaxed lip position from upper
lip inferior (ULI) to lower lip
superior (LLS).

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PROFILE VIEW

Profile angle

Profile angle is measured by
connecting points glabella (G'),
subnasale (Sn), and soft tissue...
Nasolabial angle
Nasolabial angle is developed by
connecting columella line
(inferior nasal septum) (C),
subnasale (Sn), a...
Maxillary sulcus contour
Maxillary sulcus contour (MxSC) is
subjectively assessed. The
contour is described as either
acce...
Mandibular sulcus contour
Mandibular sulcus contour (MdSC)
is subjectively assessed. The
contour is either accentuated,
ge...
Orbital rim
Orbital rim projection is measured
from the anterior most globe
(Gb) to the orbital rim point
(OR). A subjecti...
Cheekbone contour & Nasal base-lip contour

Cheekbone contour is anteriorly facing, curved line that starts just anterior ...
Maxillary retrusion: Cheekbonenasal base-lip curve is interrupted
at MxP

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Mandibular protrusion: Cheekbonenasal base-lip curve is interrupted
in upper lip area.

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Nasal projection
Nasal projection (NP) is measured
from subnasale (Sn) to nasal tip
(NT). The lines through Sn and
NT are ...
Throat length and contour
Throat length (TL) is assessed from
neck-throat point (NTP) to soft
tissue menton (Me'). This
di...
Subnasale-pogonion line (Sn-Pg')
Subnasale-pogonion reference line is
generated through points
subnasale (Sn) and soft tis...
A, Normal lip relationship to Sn-Pg'
line.
B, Premature aging associated with
premolar extractions and incisor
retraction....
Sn-Pg' line is frequently used to
surgically assess chin-lip-nasal
base balance. With the VTO
occlusion in Class I, the li...
SOFT TISSUE CHARACTERISTICS OF COMMON
SKELETAL DEFORMITIES

Class I occlusion and chin
projection can occur in
combination...
Vertical maxillary excess

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Vertical maxillary deficiency

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Class II bite and chin
projection can be produced
by entirely different
skeletal patterns.
Maxillary protrusion,
mandibula...
Maxillary protrusion

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Vertical maxillary excess

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Mandibular retrusion

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Class III bite and chin
projection can be
produced by entirely
different skeletal
patterns. Maxillary
retrusion, mandibula...
Maxillary retrusion

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Vertical maxillary deficiency

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Mandibular protrusion

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CONCLUSION
Orthodontists use dental and facial keys to diagnose and
to treat malocclusions. Dental keys include overjet,
c...
In contrast, with the help of Soft Tissue Cephalometrics an
organized, comprehensive approach to facial analysis can be
do...
Beauty is in the eyes of
the Beholder

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Soft tissue analysis 2 /certified fixed orthodontic courses by Indian dental academy

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Soft tissue analysis 2 /certified fixed orthodontic courses by Indian dental academy

  1. 1. Good morning www.indiandentalacademy.com
  2. 2. Seminar on Soft tissue Cephalometric Analysis INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. HISTORY OF CEPHALOMETRICS NEED FOR A SOFT TISSUE ANALYSIS SOFT TISSUE CEPHALOMETRIC LANDMARKS PR0FILE ANALYSIS ANALYSIS OF THE LIPS HOLDAWAYS ANALYSIS RICKETTS ANALYSIS STEINERS ANALYSIS ANALYSIS FOR ORTHOGNATHIC SURGERY ARNETTS ANALYSIS CONCLUSION www.indiandentalacademy.com
  4. 4. HISTORY Historically the human form has been measured for many reasons. One has been to aid humanity’s self –potrayal in sculpture,drawing and painting. Another has been to test the relation of physique to health, temperament, and behavioural traits. www.indiandentalacademy.com
  5. 5. LEONARDO DA VINCI (16 century) A scientific approach of human craniofacial pattern was probably initiated during the renaissance period by the accomplishment of Leonardo Da Vinci His paintings included a study of facial proportions, where the profile was divided into 8 parts by 7 horizontal lines www.indiandentalacademy.com
  6. 6. DURER In his book FOUR BOOKS OF FACIAL PROPORTIONS Used Geometric methods to study the face . He provided proportionate analysis of Leptoproscopic (long ) face and Euryproscopic (short) face . www.indiandentalacademy.com
  7. 7. CAMPER (18 th century) Camper made an extensive studies of cranium from birth to old age. Campers’s horizontal, a line extending from middle of porus aucustics to a point below the nose became a reference line used to characterize evolutionary trends in studies of facial morphology and aging www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. EDMOND H WUERPEL - “ A face is beautiful and shows harmonious features if the proportions of its individual components are right ” CALVIN CASE - “ A balanced profile should be one of the key factors in deciding the method of treatment for any form of malocclusion ” www.indiandentalacademy.com
  10. 10. Orthodontists have contributed to this ongoing effort with their study of the human face and profile, in search of guidelines for the reconstruction of facial dysmorphology and the correction of malocclusion. www.indiandentalacademy.com
  11. 11. NEED FOR A SOFT TISSUE ANALYSIS Model analysis - was assumed to achieve all facial & dental goals including facial harmony -Experience shows that it was incomplete -it reveals inter-jaw occlusal discrepancies but does not indicate which jaw is abnormally placed -model based Overjet correction may leave facial imbalances uncorrected or even facial decline www.indiandentalacademy.com
  12. 12. Osseous cephalometric analysis -It was assumed that by placing the skeletal parts within the range of skeletal cephalometric norms, facial balance could be achieved & the result would be beauty -Diagnosis of beauty by conventional osseous cephalometric norms is unreliable -It concentrates mainly on the measurement of hard tissue structures, which are not consistently related to soft tissues of face -Hambleton in his article on the soft tissue covering of the skeletal face, states that the facial curtain is more than just the underlying bone, it is also made up of muscles, fatty tissue, nerves, and blood vessels. www.indiandentalacademy.com
  13. 13. Park and Burstone studied 30 cases in which the lower incisor was 1.5 mm anterior to the A-Pog line . This relationship is proposed by some orthodontists as the key to an esthetic profile. The profiles of these 30 patients were found to be grossly different therefore casting doubt on the reliability of the incisor-to-A-Pog line as a reliable esthetic guideline. www.indiandentalacademy.com
  14. 14. When the cranial base is used as the reference line to measure the facial profile, bogus findings can be generated. Michiels studied 27 nonorthodontic, Class I patients to test the validity of various popular cephalometric measurements used to predict clinical profiles. His conclusions were that (1) measurements involving cranial base landmarks are inaccurate in defining the actual clinical profile (2) measurements involving intrajaw relationships were slightly more accurate in reflecting the true profile www.indiandentalacademy.com
  15. 15. (3) no measurement is 100% accurate (4) the soft tissue thickness and axial inclination of incisors are the most important variables in inaccuracy -When different cephalometric analysis are used for the same patient conflicting diagnoses emerge -Treatment based on cephalometric hard tissue norms in many instances create undesirable facial changes www.indiandentalacademy.com
  16. 16. Clinicians have begun to select treatment based on direct facial examination and diagnosis. Treating a face to “what looks beautiful” will produce a beautiful facial result. Models are analysed, the hard tissues are evaluated, but the overriding key to treatment lies in clinicians perception of the size, shape and position of facial soft tissue parts This kind of treatment planning focuses on where esthetic problem truly exist. www.indiandentalacademy.com
  17. 17. SOFT TISSUE CEPHALOMETRIC LANDMARKS SOFT TISSUE NASION PRONASALE SUB NASALE SUB SPINALE LABRALE SUPERIUS STOMION LABRALE INFERIUS SUB MENTALE SOFT TISSUE POGONION SKIN GNATHION www.indiandentalacademy.com
  18. 18. PROFILE ANALYSIS PROPORTIONAL ANALYSIS Ideal profile provides a basic standard for assessment of average profile Ideal profile ; Can be divided into three equal parts Frontal Third ( Tr- N ) Nasal Third (N - Sn ) Gnathic Third ( Sn – Gn ) ANTERIOR FACE CAN BE PROPORTIONED ( N – Gn ) Midface - N To Sn - 45% Lower Face – Sn To Gn -55% www.indiandentalacademy.com
  19. 19. ANGULAR PROFILE ANALYSIS ( SUBTENLY ) Subtently makes a distinction between skeletal soft tissue and full soft tissue (including nose) SKELETAL PROFILE ( N- POINT A - Pog ) AVG VALUE - 175O Convexity decreases with age as skeletal form straightens with age. b) SOFT TISSUE PROFILE ( NI – Sn – PogI ) AVG VALUE – 161O Convexity does not change with age c) FULL SOFT TISSUE ( NI – No – PogI ) AVG VALUE -137O (M) & 133O (F) Convexity increases with age because of anterior growth of the nose. Soft tissue changes are not analoges to skeletal profile changes. www.indiandentalacademy.com
  20. 20. SUBTENLYS PROFILE THICKNESS ANALYSIS Soft tissue thickness at the Glabella remains constant Thickness of Sulcus Labrale Superius increases by approximately 5 mm Thickness of Sulcus Labrale Inferius increases by approximately 2 mm According to Subtenly there is a greater increase in maxillary than the mandibular soft tissue profile which explains why the soft tissue grows more convex with age www.indiandentalacademy.com
  21. 21. BOWKER AND MEREDITH STUDIES ON SOFT TISSUE THICKNESS www.indiandentalacademy.com
  22. 22. PROFILE ANALYSIS BY A.M. SCHWARZ (1929) www.indiandentalacademy.com
  23. 23. GNATHIC PROFILE FIELD TANGENT T - Sn – Pog T ANGLE OR PROFILE ANGLE AVG -10 DEGREES www.indiandentalacademy.com
  24. 24. AVERAGE FACE - Sn on Pn RETRO FACE - Sn behind Pn ANTE FACE - Sn ahead of Pn www.indiandentalacademy.com
  25. 25. STRAIGHT ANTE FACE - Displacement of Pog with Sn anteriorly - GPF parallel and anterior to average face STRAIGHT RETRO FACE - Displacement of Pog with Sn posteriorly - GPF parallel and posterior to average face www.indiandentalacademy.com
  26. 26. OBLIQUE RETRO FACE – Posterior rotation of avg face. Maxilla positioned posteriorly and mandible even more posteriorly AVERAGE FACE ,GNATHIC PROFILE SLANTING BACKWARDS - Backward rotation of the profile is partly compensated by forward displacement of Midface, therefore Sn avg position RETROFACE GNATHIC PROFILE SLANTING BACKWARDCombined effect of backward rotation and marked forward displacement of the midface www.indiandentalacademy.com
  27. 27. OBLIQUE ANTE FACE- Forward rotation of average face, Maxilla is anterior and mandible even more anterior. AVERAGE FACE , GNATHIC PROFILE SLANTING FORWARD – Forward rotation of profile is compensated by backward displacement of the midface, Sn in average position RETROFACE , GNATHIC PROFILE SLANTING FORWARD – Combined effect of forward rotation and marked backward displacement of Midface www.indiandentalacademy.com
  28. 28. CLASS II MALOCCLUSION www.indiandentalacademy.com
  29. 29. CLASS III MALOCCLUSION www.indiandentalacademy.com
  30. 30. ANALYSIS OF THE LIPS www.indiandentalacademy.com
  31. 31. LENGTH OF UPPER LIP MEAN VALUES BURSTONE Boys - 24 mm Girls - 20 mm RAKOSI Boys - 22.5 mm Girls - 20 mm CLASS – II CLASS – III www.indiandentalacademy.com 22 mm 20.9 mm
  32. 32. LENGTH OF LOWER LIP MEAN VALUES BURSTONE - Boys- 50 .0 mm Girls- 46.5 mm RAKOSI - Boys- 45.5 mm Girls- 40.0 mm CLASS II - Retraction of upper incisors - lower lip curls up and moves forward CLASS III - Lingual tip of lower Incisors - lip moves backward www.indiandentalacademy.com
  33. 33. THICKNESS OF RED PART OF UPPER LIP AVERAGE SIZE 11.5 mm ( RAKOSI) CLASS II : Upper lip thin due to angulation of upper incisors CLASS III : Upper lip thicker as It rests on lower lip DURING COURSE OF Rx: CLASS II : Lip grows thicker CLASS III : Lip grows thinner www.indiandentalacademy.com
  34. 34. THICKNESS OF RED PART OF LOWER LIP AVERAGE SIZE 12.5 mm ( RAKOSI ) CLASS II : Lower lip is thicker ( 14 mm ) CLASS III : Lower lip is thinner ( 11.9 mm ) DURING COURSE OF Rx: CLASS II : Lower lip becomes thinner CLASS III : Lower lip becomes thicker www.indiandentalacademy.com
  35. 35. HOLDAWAYS ANALYSIS ( 1983 ) www.indiandentalacademy.com
  36. 36. FACIAL ANGLE AND UPPER LIP CURVATURE FACIAL ANGLE is formed by the intersection of FH PLANE with line joining N TO POG AVG VALUE -90 -92 DEGREES Greater angle - Protrusive lower jaw Lesser angle - Retrusive lower jaw UPPER LIP CURVATURE Reference line is drawn tangent from FH PLANE TO TIP OF UPPER LIP. Depth of upper sulcus is measured. AVG VALUE – 1.5 – 4.0 mm www.indiandentalacademy.com
  37. 37. H- LINE ANGLE AND SKELETAL CONVEXITY AT POINT A H line angle formed between H-line and Line Joining N to Pog Avg Value- 7- 15 Degrees Measures upper lip prominence or retrognathism of the Soft tissue chin Skeletal convexity at point A is measured from N-pog Line to Point A AVG VALUE - +2 TO -2 mm Assess facial skeletal Convexity relating to lip Position www.indiandentalacademy.com
  38. 38. RELATIONSHIP BETWEEN H-LINE AND SKELETAL CONVEXITY AT POINT A www.indiandentalacademy.com
  39. 39. NOSE TIP TO H-LINE AND UPPER SULCUS DEPTH NOSE TIP TO H-LINE AVG VALUE – 12 mm MAX UPPER SULCUS DEPTH MEASURED FROM SUB SPINALE TO HLINE AVG VALUE- 5 mm www.indiandentalacademy.com
  40. 40. UPPER LIP THICKNESS AND UPPER LIP STRAIN Upper lip thickness is measured horizontally from a point 2 mm below point A to outer border of upper lip. AVG VALUE - 15 mm Upper lip strain is measured from vermillion border of the lip to the labial surface of the Max central incisor IF Upper lip thickness is greater than the upper lip strain then it indicates there Is strain in the Upper lip. www.indiandentalacademy.com
  41. 41. LOWER SULCUS DEPTH AND SOFT TISSUE CHIN THICKNESS Lower sulcus depth is measured from the deepest point in the curvature between the Lower lip and the chin and the h-line AVG VALUE- 5 mm Soft tissue thickness is measured from hard tissue Pogonion to soft tissue Pogonion. AVG VALUE- 10 TO 12 mm www.indiandentalacademy.com
  42. 42. ACCORDING TO HOLDAWAY A PERFECT PROFILE SHOULD HAVE ANB - 2 degrees H-LINE ANGLE -7 to 8 degrees LOWER LIP should touch the H line H-LINE should bisect S curve between Pronasale and Subnasale TIP OF THE NOSE - Should be 9mm anterior to h-line there should be no lip strain factor ( Upper Lip Strain =Upper Lip Thickness ) www.indiandentalacademy.com
  43. 43. RICKETTS LIP ANALYSIS Reference line connects NOSE TIP TO SOFT TISSUE POGONION - E LINE E Line Lips are analysed depending on the distance of the lips from this line NORMAL VALUES UPPER : 2-3 mm LOWER : 1-2 mm www.indiandentalacademy.com
  44. 44. STEINERS LIP ANALYSIS Reference point is the Centre of the S SHAPED CURVE between the tip of Nose and Sub Nasale Reference line extends from this point to the SOFT TISSUE POGONION Lips behind this point are said to be flat (RETRUSIVE) Lips ahead of this line are said to be too prominent ( PROTRUSIVE) www.indiandentalacademy.com
  45. 45. ANALYSIS FOR ORTHOGNATHIC SURGERY www.indiandentalacademy.com
  46. 46. HORIZONTAL PLANE COLUMELLA GNATHION CERVICAL POINT www.indiandentalacademy.com
  47. 47. ANGLE OF FACIAL CONVEXITY G TO Sn , Sn TO Pog MEAN VALUE - 12 DEGREES POSITIVE VALUE – CLASS II NEGATIVE VALUE - CLASS III www.indiandentalacademy.com
  48. 48. LOWER FACE THROAT ANGLE Sn to Gn , Gn to C MEAN VALUE – 100 DEGREES DECREASE IN VALUE INDICATES PROMINENT CHIN www.indiandentalacademy.com
  49. 49. ANTERO POSTERIOR MAXILLARY AND MANDIBULAR MEASUREMENTS Dist. Sn to perendicular from Glabella - mean value 6 mm Negative value - maxillary retrusion Positive value – maxillary procumbency Dist Pog to line- avg value 0mm www.indiandentalacademy.com
  50. 50. UPPER AND LOWER LIP PROTRUSION Sn Ls Li Pog www.indiandentalacademy.com Mean Values Ls – Sn Pog 3 mm Li – Sn Pog 2 mm
  51. 51. MENTO LABIAL SULCUS Li Sm Pog www.indiandentalacademy.com Mean Value- 4 mm
  52. 52. NASOLABIAL ANGLE Mean Value - 102 degrees www.indiandentalacademy.com
  53. 53. VERTICAL LIP CHIN RATIO Mean Value - 1:2 INTER LABIAL GAP Mean Value - 2 mm MAXILLARY INCISOR EXPOSURE Mean Value - 2 mm www.indiandentalacademy.com
  54. 54. ARNETTS ANALYSIS www.indiandentalacademy.com
  55. 55. Nineteen facial traits were selected Two views of the patient are used for identification of problems in three planes of space: I. Frontal A. Relaxed lip B. Functional analysis 1. Closed lip 2. Smile II. Profile A. Relaxed lip www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. FRONTAL VIEW Outline form and symmetry Facial height: Hairline (H) to soft tissue menton (Me'). Facial widths: Zygomatic arch (ZA) to zygomatic arch (ZA), Gonion (Gó) to gonion (Go') www.indiandentalacademy.com
  58. 58. Facial level Pupil plane (PP) is horizontal line drawn through pupils. This line is usually parallel to the horizon and is referred to as frontal postural horizontal. Upper dental arch (UDA) level is a line formed through the left and right maxillary canine tips. Lower dental arch (LDA) level is a line formed through the left and right mandibular canine tips. Chin-jaw line (CJL) is assessed by a line drawn on the under surface of the chin at maximum tissue contact. All four lines should be parallel to each other www.indiandentalacademy.com
  59. 59. Constructed horizontal reference line is formed by drawing line through pupil area parallel to floor. This line is used when the pupil plane is not parallel to the floor (eyes are not level) when the head is in frontal postural horizontal. www.indiandentalacademy.com
  60. 60. Midline alignments Important midline structures are assessed. Nasal bridge (NB), nasal tip (NT), filtrum (F), upper incisor midline (UIM), lower incisor midline (LIM), and chin midline point (Me') should be on a line that is perpendicular to the frontal postural horizontal. Filtrum is usually the least asymmetric of these points and is therefore generally used as a starting point for midline structure assessment. All midline points may not line up. The dental midlines and chin should be placed to integrate with other midlines (most importantly the filtrum center www.indiandentalacademy.com
  61. 61. When pupils are not level, constructed horizontal reference line (Fig. 3) is used. A perpendicular to the constructed horizontal line through filtrum is used to assess other midline structures. www.indiandentalacademy.com
  62. 62. Facial one thirds Face is divided into thirds by drawing lines through hairline (H), midbrow (Mb), subnasale (Sn), and soft tissue menton (Me'). www.indiandentalacademy.com
  63. 63. Lower one-third evaluation With lips relaxed, lower third is subdivided by drawing lines through subnasale (Sn), upper lip inferior (ULI), lower lip superior (LLS), and soft tissue menton (Me'). The upper lip is half the length of the lower www.indiandentalacademy.com
  64. 64. Incisor exposure is measured with lips relaxed from upper lip inferior (ULI) to maxillary incisor edge (MxlE). The upper tooth to lip (UTTL) is the vertical dimension of the incisor exposed between ULI and MxlE. www.indiandentalacademy.com
  65. 65. Interlabial gap is measured in relaxed lip position from upper lip inferior (ULI) to lower lip superior (LLS). www.indiandentalacademy.com
  66. 66. PROFILE VIEW Profile angle Profile angle is measured by connecting points glabella (G'), subnasale (Sn), and soft tissue pogonion (Pg'). The angle is measured on the left hand side with the patient facing right. www.indiandentalacademy.com
  67. 67. Nasolabial angle Nasolabial angle is developed by connecting columella line (inferior nasal septum) (C), subnasale (Sn), and upper lip anterior point (ULA) www.indiandentalacademy.com
  68. 68. Maxillary sulcus contour Maxillary sulcus contour (MxSC) is subjectively assessed. The contour is described as either accentuated, gentle curve (normal) or flat. Measurement of this contour is impractical www.indiandentalacademy.com
  69. 69. Mandibular sulcus contour Mandibular sulcus contour (MdSC) is subjectively assessed. The contour is either accentuated, gentle curve (normal) or flat. Measurement of this contour is impractical. www.indiandentalacademy.com
  70. 70. Orbital rim Orbital rim projection is measured from the anterior most globe (Gb) to the orbital rim point (OR). A subjective orbital rim description is also given: Normal, flat, or protruded. www.indiandentalacademy.com
  71. 71. Cheekbone contour & Nasal base-lip contour Cheekbone contour is anteriorly facing, curved line that starts just anterior to ear, extending forward through cheekbone point (CP), then extending anterior-inferiorly ending at maxilla point (MxP) adjacent to alar base of nose. For descriptive purposes the cheekbone contour is divided into three areas: (1) zygomatic arch, (2) middle contour area, and (3) subpupil areas. These three areas, when taken together, constitute the cheekbone contour. Reconstruction of cheekbone contour, when deficient, should analyze all three parts separately in terms of correction. CP and MxP indicates osseous cheekbone and maxillary base positions, respectively. The nasal base-lip contour (NbLC) extends inferiorly from the maxilla point (MxP) as a gentle, anteriorly facing curve, ending just below and lateral to the mouth commissure. In normoskeletal patients the cheekbone-nasal base-lip contour complex is a smooth continuation, anteriorly facing, curved line. This line, when viewed frontally or from the side, is a definite flowing curve with no interruptions which are apparent with skeletal deformities. www.indiandentalacademy.com
  72. 72. Maxillary retrusion: Cheekbonenasal base-lip curve is interrupted at MxP www.indiandentalacademy.com
  73. 73. Mandibular protrusion: Cheekbonenasal base-lip curve is interrupted in upper lip area. www.indiandentalacademy.com
  74. 74. Nasal projection Nasal projection (NP) is measured from subnasale (Sn) to nasal tip (NT). The lines through Sn and NT are perpendicular to the floor when the head is in a natural postural position www.indiandentalacademy.com
  75. 75. Throat length and contour Throat length (TL) is assessed from neck-throat point (NTP) to soft tissue menton (Me'). This distance is subjectively described as either normal, long or short length, and with or without sag. www.indiandentalacademy.com
  76. 76. Subnasale-pogonion line (Sn-Pg') Subnasale-pogonion reference line is generated through points subnasale (Sn) and soft tissue pogonion (Pg'). Lip projections are evaluated relative to this line. www.indiandentalacademy.com
  77. 77. A, Normal lip relationship to Sn-Pg' line. B, Premature aging associated with premolar extractions and incisor retraction. The lips fall on or behind the Sn-Pg' line giving the "dished-in" orthodontic appearance. The nasolabial angle may also open to unacceptable ranges. www.indiandentalacademy.com
  78. 78. Sn-Pg' line is frequently used to surgically assess chin-lip-nasal base balance. With the VTO occlusion in Class I, the line is oriented from Sn through ideal lip position. If Pg' falls on the chin, balance of chin-lip-nasal base is ideal. If Pg' falls behind the line, a chin advancement is necessary to obtain balance. www.indiandentalacademy.com
  79. 79. SOFT TISSUE CHARACTERISTICS OF COMMON SKELETAL DEFORMITIES Class I occlusion and chin projection can occur in combination with vertical maxillary excess or vertical maxillary deficiency. The anteroposterior profile is normal, but the vertical height of the face is long or short. www.indiandentalacademy.com
  80. 80. Vertical maxillary excess www.indiandentalacademy.com
  81. 81. Vertical maxillary deficiency www.indiandentalacademy.com
  82. 82. Class II bite and chin projection can be produced by entirely different skeletal patterns. Maxillary protrusion, mandibular retrusion and vertical maxillary excess all can produce identical bites with similar chin profiles. The arrows indicate the skeletal abnormality responsible for the bite and profile disharmony. www.indiandentalacademy.com
  83. 83. Maxillary protrusion www.indiandentalacademy.com
  84. 84. Vertical maxillary excess www.indiandentalacademy.com
  85. 85. Mandibular retrusion www.indiandentalacademy.com
  86. 86. www.indiandentalacademy.com
  87. 87. Class III bite and chin projection can be produced by entirely different skeletal patterns. Maxillary retrusion, mandibular protrusion, and vertical maxillary deficiency all can demonstrate identical Class III bite and similar profile characteristics. The arrows indicate the skeletal abnormality responsible for bite and facial profile disharmony www.indiandentalacademy.com
  88. 88. Maxillary retrusion www.indiandentalacademy.com
  89. 89. Vertical maxillary deficiency www.indiandentalacademy.com
  90. 90. Mandibular protrusion www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 92. www.indiandentalacademy.com
  93. 93. CONCLUSION Orthodontists use dental and facial keys to diagnose and to treat malocclusions. Dental keys include overjet, canine occlusion, and molar occlusion. The dental keys are given much weight in the determination of treatment. Facial keys are not used by some orthodontists and sparingly by others. Typically, facial keys used by orthodontists include the relative positions of the upper lip, lower lip, and chin. These give information, but only limited insight into the comprehensive diagnosis. www.indiandentalacademy.com
  94. 94. In contrast, with the help of Soft Tissue Cephalometrics an organized, comprehensive approach to facial analysis can be done. With this analysis normal facial traits are maintained and abnormal characteristics are corrected with orthodontics and surgery. Information from facial examination of the patient dictates which procedures result in optimal cosmetics with Class I function. Mere correction to Class I occlusion can give random, and often poor, cosmetic results. Further, arbitrary correction to Class I occlusion does not ensure even presurgical cosmetic levels, therefore esthetic guidelines must be followed when determining surgical orthodontic plans www.indiandentalacademy.com
  95. 95. Beauty is in the eyes of the Beholder www.indiandentalacademy.com
  96. 96. www.indiandentalacademy.com

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