SOFT TISSUE ANALYSIS
• BURSTONE

• FACIAL FORM ( describes overall
horizontal soft tissue profile )

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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G – Sn – Pg ( angle )
• Facial convexity / contour angle.
• Drop a line form Glabella ‘G’ to Subnasale
‘Sn’ and a line Sn ...
www.indiandentalacademy.com
• Inference
• +ve value =angle is smaller (clockwise)
• -ve value=angle is large
(counterclockwise)
• increased +ve value ...
• Disadvantages
• The location of deformity cannot be
assessed since it is not specific.

• Uses
• To analyze the soft tis...
G - Sn
• Maxillary prognathism
• Drop line perpendicular to horizontal plane
from Glabella. Measure the distance from
perp...
www.indiandentalacademy.com
Inference
• Describes the amount of maxillary
excess/deficiency in anteroposterior
dimension

• +ve=maxillary retrusion (a...
• Disadvantages

• some individuals have Glabella placed
more anteriorly / posteriorly. Therefore
correction of placement ...
USES
• To determine whether the problem is in
maxilla/mandible.
• In treatment plan for anterior maxillary
advancement set...
G - Pg
• Mandibular prognathism
• Drop a perpendicular line to HP from
Glabella. Measure the position of the
pogonion from...
www.indiandentalacademy.com
• Inference
• Increased –ve value indicated mandibular
deficiency is severe.
• Uses
• Indicates mandibular prognathism or
...
• Disadvantages
• This measurement should be evaluated in
conjunction with other values to distinguish
between microgenia ...
G-Sn / Sn-Me

• Vertical height ratio
• (G-Sn / Sn-Me) 1:1

• Drop a perpendicular line to HP from
Glabella, to this line ...
1:1

www.indiandentalacademy.com
• INFERENCE
• The ratio of middle 3rd to lower 3rd facial
height measured perpendicular to HP.
• Ratio less than 1 = denot...
• Uses

• Anterior face proportionality is assessed by
taking the ratio of middle 3rd facial height to
lower 3rd facial he...
Sn – Gn - C
• Lower face throat length/angle
• Formed by the intersection of lines Sn-Gn
& Gn-C.
• Mean value:100* +/- 7*
...
C

www.indiandentalacademy.com
• INFERENCE
• Obtuse lower face neck angle indicates
that any procedures that reduce the
prominence of chin should not be ...
• Class III patients also have short , heavy
throats and obtuse lower face throat
angles . Should not undergo mandibular
s...
( Sn – Gn / C – GN )
• Lower vertical height depth ratio.
• Drop a line from Sn to Gn and C to Gn .
Measure the distance f...
Sn
1.2
C
1
www.indiandentalacademy.com
• Ratio of Sn – Gn and C – Gn is a little
larger than 1.
• If the ratio is more than 1 = short neck .
• Useful in determin...
LIP POSITION AND FORM

www.indiandentalacademy.com
Cm – Sn - Ls
• NASOLABIAL ANGLE
• Draw a line from Sn to Cm and drop a line
from Sn to Ls. Measure the angle formed.
• Mea...
• Useful in evaluating the position of upper
lip.
• ACUTE nasolabial angle => treated by
retracting the maxilla / maxillar...
Ls To Sn - Pg
• Upper lip protrusion.
• It denotes the amount of protrusion of
upper lip.
• Draw a line from Sn to soft ti...
www.indiandentalacademy.com
• The abnormal values can be treated by
retracting / protracting the incisors ,
surgically / orthodontically / advancing t...
Li to Sn-Pg
• Denotes the amount of protrusion of lower
lip.

• Drop a line from Sn to Pg and the amount
of lip protrusion...
• By retracting / protracting the incisors
surgically / orthodontically
advancing / reducing the chin prominence
, possibl...
Si to Li - Pg
• Mento labial sulcus.
• To assess the prominence of the chin.
• Measured from the depth of the sulcus
perpe...
www.indiandentalacademy.com
•

Deepened mento labial sulcus is due to :

1. Flared lower incisors.
2. Extruded upper incisors impinging on
lower lip.
...
• TREATMENT
• Up righting the lower incisors.
• Intruding the maxillary incisors.
• Cheiloplasty to retract lower lip – he...
( Sn – Stms / Stmi – Me )
• Vertical Lip Chin Ratio
• To assess lower third of face .
• Hjfhwhfwhfoihfoi

• Mean values : ...
• Lower 3rd of the face ( Sn-Me ) can be
divided into three parts :
length of the upper lip ( distance from SnStms ) shoul...
www.indiandentalacademy.com
Stm-U1 Maxillary Incisor
Exposure

• Distance from upper lip to maxillary
incisor, is the key factor in determining
vertic...
• 2mm of maxillary incisor show below the
upper lip when lip at rest is desirable.
• Pts with vertical maxillary excess te...
• Short face : pts with maxillary deficiency
tend to show maxillary teeth with lip
relaxed and may have incisors at a leve...
Stms-Stmi Interlabial gap
• To measure the distance between the
upper and lower lip with lips in rest.
• Measure the dista...
• Patients with vertical maxillary deficiency
often have no interlabial gaps and lip
redundancy.
• Treatment : raising the...
Zero Meridian
• By dropping a line from the soft tissue (N),
the soft tissue surface directly anterior to
the hard tissue ...
www.indiandentalacademy.com
SHORTCOMINGS
• Normal values for the COGS analysis are
best suited for the white adults population
only.
• Most patients p...
• Similarly patients of advanced age may
show changes simply due to aging
process such as loss of vertical dimension
( att...
Cephalometric norms for orthognathic surgery in Black American
Adults.
Thomas R , Riccardo A , Samuel J

Journal of maxill...
•
•
•
•
•
•
•
•
•
•

Post. Cranial base
Skeletal angle of facial convexity
Maxillary skeletal protrusion
Skeletal lower an...
• Were all significantly greater in Black Adults
• Less nasal depth and projection , bony chin
depth , and smaller nasolab...
www.indiandentalacademy.com
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Cogs soft tissue cephalometric analysis /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • Cogs soft tissue cephalometric analysis /certified fixed orthodontic courses by Indian dental academy

    1. 1. SOFT TISSUE ANALYSIS • BURSTONE • FACIAL FORM ( describes overall horizontal soft tissue profile ) www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. G – Sn – Pg ( angle ) • Facial convexity / contour angle. • Drop a line form Glabella ‘G’ to Subnasale ‘Sn’ and a line Sn to soft tissue pogonion ‘Pg’. • Mean value : 12 +/- 4* www.indiandentalacademy.com
    4. 4. www.indiandentalacademy.com
    5. 5. • Inference • +ve value =angle is smaller (clockwise) • -ve value=angle is large (counterclockwise) • increased +ve value  convex profile increased-ve value  concave profile (class3 skeletal and dental relationship) www.indiandentalacademy.com
    6. 6. • Disadvantages • The location of deformity cannot be assessed since it is not specific. • Uses • To analyze the soft tissue profile. www.indiandentalacademy.com
    7. 7. G - Sn • Maxillary prognathism • Drop line perpendicular to horizontal plane from Glabella. Measure the distance from perpendicular line to Sn ( parallel to HP) • Mean value: 6 +/- 3 www.indiandentalacademy.com
    8. 8. www.indiandentalacademy.com
    9. 9. Inference • Describes the amount of maxillary excess/deficiency in anteroposterior dimension • +ve=maxillary retrusion (anterior) • –ve=maxillary procumbency (posterior) www.indiandentalacademy.com
    10. 10. • Disadvantages • some individuals have Glabella placed more anteriorly / posteriorly. Therefore correction of placement of glabella and then analyzing is recommended www.indiandentalacademy.com
    11. 11. USES • To determine whether the problem is in maxilla/mandible. • In treatment plan for anterior maxillary advancement setback(+) total alveolar/lefort-1 maxillary horizontal advancement/set back . www.indiandentalacademy.com
    12. 12. G - Pg • Mandibular prognathism • Drop a perpendicular line to HP from Glabella. Measure the position of the pogonion from this line parallel to HP. • Mean value: 0 +/- 4 www.indiandentalacademy.com
    13. 13. www.indiandentalacademy.com
    14. 14. • Inference • Increased –ve value indicated mandibular deficiency is severe. • Uses • Indicates mandibular prognathism or retrognathism www.indiandentalacademy.com
    15. 15. • Disadvantages • This measurement should be evaluated in conjunction with other values to distinguish between microgenia ,macrogenia / retognathia ie, if Pg is positioned posteriorly further examination is necessary to determine if the defect is a small hard tissue chin, small mandible, average sized mandible positioned posteriorly thin softtissue chin or a combination of these . www.indiandentalacademy.com
    16. 16. G-Sn / Sn-Me • Vertical height ratio • (G-Sn / Sn-Me) 1:1 • Drop a perpendicular line to HP from Glabella, to this line drop a perpendicular line from Sn. Transfer the HP through Menton. Measure the distance from G-Sn and Sn – Me ( all perpendicular to HP ) • Mean value: 1 +/- 1 www.indiandentalacademy.com
    17. 17. 1:1 www.indiandentalacademy.com
    18. 18. • INFERENCE • The ratio of middle 3rd to lower 3rd facial height measured perpendicular to HP. • Ratio less than 1 = denotes disproportionality and there is large lower 3rd face and vice versa. • Disadvantages • Further evaluation of lower 3rd of face is needed. www.indiandentalacademy.com
    19. 19. • Uses • Anterior face proportionality is assessed by taking the ratio of middle 3rd facial height to lower 3rd facial height measured perpendicular to HP. www.indiandentalacademy.com
    20. 20. Sn – Gn - C • Lower face throat length/angle • Formed by the intersection of lines Sn-Gn & Gn-C. • Mean value:100* +/- 7* www.indiandentalacademy.com
    21. 21. C www.indiandentalacademy.com
    22. 22. • INFERENCE • Obtuse lower face neck angle indicates that any procedures that reduce the prominence of chin should not be done (worms & others) • USES • For treatment planning to correct anteroposterior facial dysplasias. www.indiandentalacademy.com
    23. 23. • Class III patients also have short , heavy throats and obtuse lower face throat angles . Should not undergo mandibular setbacks. • Alternate such as maxillary advancement , mandibular subapical, mandibular setback with advancement genioplasty / compromised tooth position may be employed. www.indiandentalacademy.com
    24. 24. ( Sn – Gn / C – GN ) • Lower vertical height depth ratio. • Drop a line from Sn to Gn and C to Gn . Measure the distance from Sn – Gn and C –Gn . • Mean value : 1.2 : 1 www.indiandentalacademy.com
    25. 25. Sn 1.2 C 1 www.indiandentalacademy.com
    26. 26. • Ratio of Sn – Gn and C – Gn is a little larger than 1. • If the ratio is more than 1 = short neck . • Useful in determining the feasibility of reducing / increasing the chin prominence. www.indiandentalacademy.com
    27. 27. LIP POSITION AND FORM www.indiandentalacademy.com
    28. 28. Cm – Sn - Ls • NASOLABIAL ANGLE • Draw a line from Sn to Cm and drop a line from Sn to Ls. Measure the angle formed. • Mean value : 102* +/- 8* • Important measurement in assessing the anteroposterior maxillary dysplasias. www.indiandentalacademy.com
    29. 29. • Useful in evaluating the position of upper lip. • ACUTE nasolabial angle => treated by retracting the maxilla / maxillary incisors / both. • OBTUSE nasolabial angle => suggests the degree of maxillary hypoplasia and indicates for maxillary advancement or orthodontic proclination of maxillary incisors. www.indiandentalacademy.com
    30. 30. Ls To Sn - Pg • Upper lip protrusion. • It denotes the amount of protrusion of upper lip. • Draw a line from Sn to soft tissue Pg and the amount of lip Protrusion / Retrusion is measured with perpendicular linear distance from this line to the prominent point of the lip. www.indiandentalacademy.com
    31. 31. www.indiandentalacademy.com
    32. 32. • The abnormal values can be treated by retracting / protracting the incisors , surgically / orthodontically / advancing the maxilla. www.indiandentalacademy.com
    33. 33. Li to Sn-Pg • Denotes the amount of protrusion of lower lip. • Drop a line from Sn to Pg and the amount of lip protrusion / retrusion is measured with perpendicular linear distance from this line to the most prominent point of both lips . www.indiandentalacademy.com
    34. 34. • By retracting / protracting the incisors surgically / orthodontically advancing / reducing the chin prominence , possible to achieve desired lower lip . www.indiandentalacademy.com
    35. 35. Si to Li - Pg • Mento labial sulcus. • To assess the prominence of the chin. • Measured from the depth of the sulcus perpendicular to Li – Pg. • Mean value : 4 +/- 2 www.indiandentalacademy.com
    36. 36. www.indiandentalacademy.com
    37. 37. • Deepened mento labial sulcus is due to : 1. Flared lower incisors. 2. Extruded upper incisors impinging on lower lip. 3. Flaccid lip tone and abnormal morphology of the lip itself . 4. Prominence of the chin also contributes to deepened mento labial sulcus. www.indiandentalacademy.com
    38. 38. • TREATMENT • Up righting the lower incisors. • Intruding the maxillary incisors. • Cheiloplasty to retract lower lip – helps in reducing the MLS. • Advancement genioplasty  increases the deepening of MLS. • Reduction genioplasty  decreases the excess MLS. www.indiandentalacademy.com
    39. 39. ( Sn – Stms / Stmi – Me ) • Vertical Lip Chin Ratio • To assess lower third of face . • Hjfhwhfwhfoihfoi • Mean values : ( 1 : 2 ) www.indiandentalacademy.com
    40. 40. • Lower 3rd of the face ( Sn-Me ) can be divided into three parts : length of the upper lip ( distance from SnStms ) should be approximately 1/3rd the total and distance from Stmi to Me should be 2/3rd. • 1:2 ratio should be maintained. • If the ratio becomes less than the normal ( ½ ) -- vertical reduction genioplasty is www.indiandentalacademy.com recommended.
    41. 41. www.indiandentalacademy.com
    42. 42. Stm-U1 Maxillary Incisor Exposure • Distance from upper lip to maxillary incisor, is the key factor in determining vertical position of maxilla. Also corresponds to the pleasing smile. • Drop a line parallel to HP from Stms and another line from U1 ( incisal edge ) . Measure the distance between them. www.indiandentalacademy.com
    43. 43. • 2mm of maxillary incisor show below the upper lip when lip at rest is desirable. • Pts with vertical maxillary excess tend to show a larger amount of upper incisors with the lips in repose. • Treated orthodontic ally establishing large curve of Spee. • Long face pts with open bites may have acceptable tooth-lip relations but may need superior repositioning of post. Portion of maxilla www.indiandentalacademy.com
    44. 44. • Short face : pts with maxillary deficiency tend to show maxillary teeth with lip relaxed and may have incisors at a level superior to upper lip  giving a edentulous look. • Treatment : orthodontically extruding the incisors and surgically positioning maxilla inferiorly thereby increasing vertical dimension. www.indiandentalacademy.com
    45. 45. Stms-Stmi Interlabial gap • To measure the distance between the upper and lower lip with lips in rest. • Measure the distance between line drawn from Stms and Stmi parallel to HP. • Patients with vertical maxillary excess have increased interlabial gaps and lip incompetence. www.indiandentalacademy.com
    46. 46. • Patients with vertical maxillary deficiency often have no interlabial gaps and lip redundancy. • Treatment : raising the level of maxilla to shorten the height will decrease the large interlabial gap and help patient to close the lips without muscle tension. www.indiandentalacademy.com
    47. 47. Zero Meridian • By dropping a line from the soft tissue (N), the soft tissue surface directly anterior to the hard tissue (N) at right angles to the FH or the constructed HP. • Ideally passes through the soft tissue pogonion ( 0 +/- 2 ) to zero meridian and 8mm posterior to Sn. • Variation indicates Retrusion / Protrusion in mandible and maxilla separately. www.indiandentalacademy.com
    48. 48. www.indiandentalacademy.com
    49. 49. SHORTCOMINGS • Normal values for the COGS analysis are best suited for the white adults population only. • Most patients presenting for orthognathic surgery are young adults , due to the process of facial growth and development , cephalometric norms for children can be expected to differ from those of adults. www.indiandentalacademy.com
    50. 50. • Similarly patients of advanced age may show changes simply due to aging process such as loss of vertical dimension ( attrition of teeth / loss of teeth ) . www.indiandentalacademy.com
    51. 51. Cephalometric norms for orthognathic surgery in Black American Adults. Thomas R , Riccardo A , Samuel J Journal of maxillofacial surgery , 1989 • Purpose of this study was to develop normal values for COGS analysis in Black American Adults .and compare it with the White adults and among black males and females. www.indiandentalacademy.com
    52. 52. • • • • • • • • • • Post. Cranial base Skeletal angle of facial convexity Maxillary skeletal protrusion Skeletal lower anterior facial height Upper post. Face height Upper ant. Dental height Lower ant. Dental height Mandibular body length Soft tissue thickness in lower lip Lip length www.indiandentalacademy.com
    53. 53. • Were all significantly greater in Black Adults • Less nasal depth and projection , bony chin depth , and smaller nasolabial angle was observed . www.indiandentalacademy.com
    54. 54. www.indiandentalacademy.com

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