This document discusses the importance of considering facial aesthetics in orthodontic treatment planning. It makes three key points:
1) Attaining and preserving optimal facial attractiveness is a primary goal of orthodontic treatment. However, correcting the bite does not always lead to improved facial traits and can sometimes decrease facial attractiveness if soft tissue outcomes are not considered.
2) Relying solely on cephalometric analysis of hard tissue structures to plan treatment can lead to esthetic problems, as soft tissue profiles vary greatly and are only partially dependent on underlying skeletal structures.
3) A thorough examination of 18 key soft tissue facial traits is necessary for treatment planning to optimize facial attractiveness while correcting the bite. Individual
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Surg analysis ii /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
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Soft tissue based diagnosis and treatment planning /certified fixed orthodont...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Surg analysis ii /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Soft tissue based diagnosis and treatment planning /certified fixed orthodont...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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
Soft tissue analysis 2 /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
Soft tissue cephalometrics analysis /certified fixed orthodontic courses by I...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
Surgery /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar UniversityOrthognathic surgery is the art and science of combining orthodontics and maxillofacial surgery to correct dento-facial deformities.The etiology, prevalence,diagnosis and preoperative planning,and Surgical procedures are presented.
Mc namara analysis /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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
Soft tissue /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Soft tissue cephalometric analysis /certified fixed orthodontic courses by In...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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
Soft tissue analysis 2 /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
Soft tissue cephalometrics analysis /certified fixed orthodontic courses by I...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
Surgery /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar UniversityOrthognathic surgery is the art and science of combining orthodontics and maxillofacial surgery to correct dento-facial deformities.The etiology, prevalence,diagnosis and preoperative planning,and Surgical procedures are presented.
Mc namara analysis /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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
Soft tissue /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Soft tissue cephalometric analysis /certified fixed orthodontic courses by In...Indian dental academy
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
Growth pattern of mandible /certified fixed orthodontic courses by Indian d...Indian dental academy
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
00919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Down's analysis/certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
Wits apprasial /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
00919248678078
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.for more details please visit
www.indiandentalacademy.com
A Beautiful girl paramjeet {name changed} with big Space in her upper interior teeth ,came to our clinic/thind dental clinic{www.thind.com} She was reffered to us by one of patients yogita for smile dessining
Her impressions were taken and her smile was analyscd by our smile dessing team consisting of dr Rajan bir singh thind and Dr Gurinder Kaur thind and our computer expert reena she was advised the diastema closure. the initial & final pictures are attached along with.contact us at thind11@yahoo.com, www.thind.com , www.missionsmile.com, www.danishdental.com or mobile number 09872221544
[www
What are today’s patients looking for?
- What can I provide that will stand out from the crowd?
- Factors Affecting the Perception of Esthetics
- Esthetics in Orthodontics
Differential diagnosis /certified fixed orthodontic courses by Indian dental...Indian dental academy
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.
William R Proffit was respected in orthodontics. His life journey started in 1936 and ended in 2018. In between, he did lots of research work in orthodontics. He publishes around 170 research articles most of the articles are very helpful for postgraduate students. His nickname was Bill. He joined the faculty at the University of Kentucky in 1965 and served as the first chairman of the orthodontics department, and then taught at the University of Florida for 2 years.
In 1975, he returned to UNC and joined the orthodontics faculty. He served as a professor and later became chair of the department of orthodontics, a post he held for 26 years. Dr Proffit's textbook, Contemporary Orthodontics, the standard used in dental schools throughout the world, is the world's most influential orthodontic resource.
He contributed to and guided every chapter in every edition, and that is its strength and reason for its endurance.
He coauthored Contemporary Treatment of Dentofacial Deformity and 2 other books on surgical-orthodontic treatment.
Smile designing is an essential part of aesthetic & prosthetic dentistry.This presentation deals with treatment planning and various aspects of this procedure.
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.for more details please visit
www.indiandentalacademy.com
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
2. 374 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
Each cephalometric study examines several differ-
ent measurements to arrive at the diagnosis and treat-
ment plan. When different cephalometric analyses are
used to examine the same patient, different diagnoses,
treatment plans, and results can be generated.4 In 1
study the basis for an attractive face was found to be the
relationship between individual measurements of the
craniofacial complex. When a proportional index was
performed on numerous measurements, it was found
that measurements are in optimal relationship if they
are statistically in the range of mean 1 standard devia-
tion. This allows for great variation even among attrac-
tive faces. Disproportion reduces the esthetic quality of
the face, and failure to recognize such facial dishar-
monies will undermine the effort to improve negative
traits. Norms of measurements serve as guidelines in
calculating change.11
METHODS
The analysis of facial attractiveness was based on
key cephalometric soft tissue landmarks relevant to
optimal orthodontic and surgical-orthodontic treat-
ment. Because cephalometric measurements are static,
it is critical that the orthodontist consider possible
changes in a soft tissue trait resulting from growth,
orthodontic and/or surgical movement, and possible
muscle forces.
Much of the information from the clinical examina-
tion can be duplicated and preserved for reference in a
lateral cephalometric headfilm. Cephalometric head-
films are taken in natural head posture, relaxed-lip pos-
ture, and with the condyles in centric relation.12 A wax
bite should be used to stabilize the bite on first tooth
contact, as described in the article by Arnett and
Bergman.1
The soft tissue analysis is measured from 13 points
along the facial profile, 2 points on the labial mucosa,
and the tip of the upper incisor (Fig 1). Those measure-
ments most important to soft tissue assessment and
treatment planning are selected. Several factors will
influence the facial trait values: skeletal pattern, dental
pattern, soft tissue thickness, ethnic and cultural origin,
gender difference, and age. If optimal facial attractive-
ness is a treatment goal, all of these influencing factors
must be taken into account.
INDIVIDUALIZED NORMS
To optimize facial attractiveness, norms are used
to define what are acceptable facial traits and to
establish a range of values within which lies accept-
ability. These norms should be used only as a guide.
To make the analysis practical, the orthodontist must
sometimes make exceptions for some patients. Cer-
tain facial features (such as prominent noses, cheek-
Fig 1. Thirteen points along the facial profile, 2 points on the labial mucosa, and 1 at the tip of the
upper incisor are used to measure the soft tissue traits.
3. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 375
Volume 116, Number 4
bones, chins) that appear to represent family or eth-
nic characteristics must be evaluated for size and
arrangement in terms of achieving the solution that
best suits the individual patient. Ideal treatment plan-
ning should affect the facial trait in a positive fashion,
coming closer to the standard norm. This will opti-
mize the facial attractiveness for a patient while cor-
recting the bite.
FACIAL TRAITS
Facial Profile Angle
The facial profile angle determines the primary clas-
sification of the patient’s profile. This angle is formed
by connecting soft tissue glabella, subnasale, and soft
tissue pogonion.1,8,9 The mean for Class I profiles is
168.7° ± 4.1°.10 As the angle increases, the profile angle
is suggestive of a Class III dental and skeletal pattern.
Fig 2. The soft tissue assessment sheet is used to measure facial traits. If a facial trait is in the nomal
range it should be maintained. Growth, orthodontic tooth movement, and surgical procedures should
maintain normal facial traits while moving other facial traits into normal range. Gray areas are major
areas affected by orthodontic treatment.
4. 376 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
Maxillary retrusion, vertical maxillary deficiency, and
mandibular protrusion can all show increased profile
angles. When the angle decreases, it is suggestive of a
Class II dental and skeletal pattern. Maxillary protru-
sion, vertical maxillary excess, and mandibular retru-
sion all have low profile angles.13,14 This angle remains
relatively constant in individuals who experience nor-
mal growth as the result of subnasale movement for-
ward with nose growth and forward displacement of the
pogonion as the result of growth.15
Nasal Projection
The nasal projection is measured horizontally from
the subnasale to the nasal tip. The mean projection is
15.5 ± 2.8 mm.8 Anteroposterior facial harmony can be
accentuated by a large nose. A large nose accentuates a
receded chin. At maturity a nose over 20 mm is consid-
ered large and less than 14 mm is considered small.13,14
From the ages of 7 to 17 years of age the average
growth for boys is 10.3 to 16 mm, a difference of 5.7
mm. The average growth for girls is 10.8 to 14.6 mm, a
difference of 3.8 mm.16
Nasolabial Angle
The nasolabial angle is the angle formed by the
intersection of the upper lip anterior and columella at
subnasale. This angle is greatly affected by orthodon-
tics and surgical procedures. All procedures should
place this angle in the cosmetically desirable 102° ±
8° range.9 Increased angles can be due to a turned up
nose or to lips that slant back.2 The nasolabial angle
is useful in evaluating the anteroposterior position of
the maxilla. An acute angle allows for maxillary
incisor retraction or a maxillary set-back; an obtuse
angle suggests a maxillary retrusion with a need for
maxillary advancement or the advancement of the
maxillary incisors or both.1,11 The nasolabial angle
remains relatively constant in growing individuals
between the ages of 7 and 17 years. In boys, the
change on average goes from 113.7° to 109.8°, a
change of 3.9°. In girls the change is from 111.4° to
108.3°, a change of 3.1°.16
One study of Class II malocclusions where bicus-
pids were extracted, the upper incisors were retracted
6.7 mm on average, and the angle increased on average
10.5° with orthodontic treatment (1.6° for each mil-
limeter the incisors are retracted).17
Lower Face
The lower one third of the face from the base of the
nose to the soft tissue menton is extremely important in
surgical orthodontic diagnosis and treatment planning.
The importance of the relaxed-lip position for these
measurements cannot be over emphasized.
The lower face percentage is used to establish the
proportion for the lower face height. The lower face
Fig 3. Pretreatment photograph of boy (M.V.), aged 15.8
years, with minimal growth skeletal Class II as result of
mandibular hypoplasia and skeletal closed bite.
Fig 4. Pretreatment cephalometric tracing of M.V.
5. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 377
Volume 116, Number 4
height is measured from the subnasale vertically to the
soft tissue menton. The percent is the total face height
measured from soft tissue glabella vertically to soft tis-
sue menton. The normal range for the lower face height
is 53% to 56%. This percentage is relatively constant
throughout development.18 It is extremely important to
control the vertical dimension in patients with exces-
sive lower face heights. One study showed a lower face
height of 53% for very attractive female patients and
54% for attractive female patients.11
Lower Facial Height
The lower facial height is the lower one third of the
face. The face divides vertically into thirds, one third
from hairline to midbrow, one third from midbrow to
subnasale and the lower third from subnasale to soft
Fig 5. Soft tissue assessment sheet with pretreatment measurements of M.V. There are 10 normal
facial traits with 8 facial traits outside normal range.
6. 378 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
tissue menton. The height of the lower face averaged
61.4 mm for boys at age 6 years and increased to 71.9
mm at age 18 years; for girls, the lower face height
average went from 58.8 mm at age 6 years to 65.5 mm
at age 18 years. In boys, the increase averages out to be
0.9 mm per year; in girls, the increase is 0.6 mm per
year between the ages of 8 and 18 years.18 Larger num-
bers can indicate excessive lower face height. This is
seen in vertical maxillary excess or mandibular protru-
sion. Decreased lower one third of the face is found in
vertical maxillary deficiency and deep bite mandibular
retrusion. The important consideration is the propor-
tional measurement as opposed to the absolute mea-
surement of middle and lower one third of the face.
Upper Lip Length
The upper lip length is measured in a relaxed-lip
position. The average length from subnasale to upper lip
inferior is 20.1 ± 1.9 mm for girls and 23.9 ± 1.5 mm for
boys.8 A short upper lip can cause a “gummy” smile.
Long lips make it difficult to see the maxillary incisors.
Excessively long lip length will often be associated with
lip redundancy.1 A long upper lip is 26 mm or longer.8
In boys the average upper lip grows 3.8 mm from age 8
to 18 years. The overall increase for boys is 21.43%,
with the major change taking place between the ages of
10 to 16 years; in girls, the lip grows 2.04 mm from the
ages of 8 to 18 years, an overall increase of 12.11% with
the major change taking place between the ages of 10
and 14 years of age.19 During a typical orthodontic
treatment period in a growing patient, there is only a
minimal lengthening of the upper lip of about 1 mm.
Upper Lip Thickness
The upper lip thickness is measured at the vermilion
border to the inner lining of the lip. The average thick-
ness is 12 ± 2 mm.13 The thickness of the upper lip for
boys increases from 10.77 mm at 8 years of age to
15.76 mm, an increase of 46%, at 18 years of age. The
lip thickness for girls during the same period increases
from 10.90 mm to 12.90 mm, a 14.68% increase. Again
the major increase occurred for boys between the ages
of 8 and 16 years; lip thickness in girls increased pri-
marily between the ages of 10 and 14 years.20 When the
tissue thickness is more than 18 mm in the upper lip,
the lip does not follow the upper incisor. When the
upper lip is thinner than 12 mm, the upper lip moves
back as the teeth are retracted.2 With a thick upper lip,
it is not possible to protrude the upper lip by advancing
the upper incisors. In cleft lips, patients often need
additional tissue as a cross-lip flap.13
Maxillary Sulcus Contour
The maxillary sulcus contour is normally a gentle
curve.1,21 It gives information regarding upper lip ten-
sion. Lip tension can cause the sulcus contour to flat-
ten, wheras flaccid lips have an accentuated curve and
are often thick with the vermilion lip area showing.14
Fig 6. Posttreatment photograph of M.V. Facial traits
were improved by increasing facial angle, increasing
lower lip–chin length, and increasing throat length.
Fig 7. Posttreatment cephalometric tracing of M.V.
7. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 379
Volume 116, Number 4
The angle of the maxillary contour can be measured
from the subnasale to the soft tissue point A to the ante-
rior point of the upper lip. The mean is 136.9 ± 10
mm.10
Upper Lip to Subnasale-Pogonion Line
The upper lip to subnasale-pogonion line is the dis-
tance between the upper lip anterior and the subnasale-
pogonion line. The upper lip is in front of the subnasale-
pogonion line by 3.5 ± 1.4 mm.8 The relationship of the
lips to the subnasale-pogonion line is an important aid in
orthodontic soft tissue analysis and treatment. Tooth
movement changes the relationship of the lips to the sub-
nasale-pogonion line and, therefore, the esthetic result.
Extractions should be avoided when they move the teeth
and create retraction of the lips (dished-in) behind this
line.11 One study23 showed that in extraction cases, the
upper lip retracted an average of 2.2 mm. Ninety percent
Fig 8. Soft tissue assessment sheet posttreatment of M.V. Thirteen facial traits are within normal
range with 5 traits outside normal range. There is significant improvement in facial angle.
8. 380 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
of extraction cases show a retraction of the upper lip as a
result of treatment. The thickness of the lips is a factor in
the response to the orthodontic movement. When the
upper lip thickness at the vermilion border is greater that
18 mm, the upper lip usually changes very little when the
upper incisor is retracted.2,13
Upper Incisor Tip to Inferior Border of the Upper Lip
The upper incisor tip to inferior border of the
upper lip is the distance from the inferior border of the
upper lip to maxillary incisal edge (normal range, 1 to
5 mm).1 Patients with vertical maxillary excess have
increased distance unless the lip length is short. Max-
illary deficiencies will have a decreased distance.
Interlabial Gap
The interlabial gap is the distance between the infe-
rior border of the upper lip and the upper border of the
lower lip (normal range, 2 ± 2 mm).9 There should be no
lip strain when the lips contact. Increased measurements
are suggestive of patients with lip strain. There are 4
factors that determine the interlabial gap: (1) anterior
skeletal height, (2) dental protrusion, (3) inherent lip
length, and (4) lip posture (lip redundancy). Any of
these factors or any combination of them can account
for an excessive interlabial gap.8 A short lip can also
increase the distance.
Lower Lip–Chin Length
The lower lip–chin length is measured from the
superior border of the lower lip to the soft tissue men-
ton. The average length is 46.4 ± 3.4 mm for girls and
49.9 ± 4.5 mm for boys.8 Between the ages of 7 and 17
years, the lip-chin length grew an average of 46 to 55.2
mm or 9.2 mm in boys and from 45.5 to 51.9 mm or 6.4
mm in girls.16 Another study showed that growth in
boys increased an average of 0.77 mm/year between
the age of 9 and 18 years and that the lip length
increased 0.46 mm/year between the age of 8 and 16
years in girls.18 The upper to lower lip length should
have a ratio of 1:2 when the lip posture is measured at
rest.
Lower Lip Thickness
The lower lip thickness at the vermilion border is 13
± 2 mm.13 The lower lip thickness averages 14.4 mm
for boys at age 7 years and increases to 17.0 mm by age
18 years, an increase of 2.6 mm. In girls, the lip aver-
age is 12.3 mm at age 7 years and increases to 16.2 mm
by age 17 years, an increase of 3.9 mm.16
Mandibular Sulcus Contour
The mandibular sulcus contour is a gentle curve21
and can indicate lip tension. A measurement of this
Fig 9. Pretreatment photograph of P.E., man aged 38.9
years. Class II malocclusion as result of vertical maxil-
lary excess, skeletal open bite, and skeletal lingual
crossbite. Fig 10. Pretreatment cephalometric tracing of P.E.
9. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 381
Volume 116, Number 4
curve can be taken by measuring the angle formed by
lower lip anterior, soft tissue point B, and soft tissue
pogonion. The mean is 122.0° ± 11.7°.10 When deeply
curved, the lower lip is flaccid in character and can be
seen in Class II and vertical maxillary deficiency cases.
Flared lower incisors, over-extruded upper incisors, and
poor lip tone are all factors that deepen the sulcus.23
Flattened lower lip demonstrates tension of tissue com-
monly seen in Class III and vertical maxillary excess
cases. The uprighting of the lower incisors tends to
enlarge the angle.20
Lower Lip to Subnasale-Pogonion Line
The lower lip to subnasale-pogonion line is the dis-
tance between the lower lip anterior and the subnasale-
pogonion line. Ideally it should be 2.2 ± 1.6 mm in
Fig 11. Pretreatment soft tissue assessment sheet of P.E.There are 9 normal facial traits and 9 facial
traits outside normal range.
10. 382 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
front of the subnasale-pogonion line.8 The lower lip to
subnasale-pogonion line should also be about 1 mm
less than the upper lip to subnasale-pogonion line mea-
surement. In extraction cases, on average, the distance
the lower lip moves back to the subnasale-pogonion
line is 2.7 mm.22
Soft Tissue B Point–Subnasale Soft Tissue Pogo-
nion
The soft tissue B point–subnasale soft tissue pogo-
nion is the distance of the soft tissue B point to the
subnasale soft tissue pogonion line (ideal range, 4 mm
± 1 mm).1
Lower Face–Throat Angle
The lower face–throat angle is the angle formed by
the subnasale-pogonion line and the throat line. The
mean is 100° ± 7°.9 This angle is critical in anteropos-
terior facial dysplasias. An obtuse angle should warn
against procedures that reduce the prominence of the
chin. In surgical cases, obtuse angles should not have a
mandibular setback.3,9
Throat Length
The throat length is the distance measured from the
neck-throat junction (cervical point) to the intersection
of the subnasale-soft tissue pogonion and the throat line
(normal range, 57 ± 6 mm).13 Short throat length is a
contraindication in mandibular setbacks; long throat
length indicates mandibular protrusion and is an indi-
cation for a mandibular setback.1
Fig 12. Posttreatment photograph of P.E. Patient was
normalized by decreasing lower face height, decreasing
lip protrusion, decreasing interlabial gap, decreasing
lower lip-chin length, and increasing throat length. Fig 13. Posttreatment cephalometric tracing of P.E.
Table I. Case I: Diagnostic summary of a boy (M.V.),
aged 15.8 years, with minimal growth left
Skeletal description
Skeletal Class II as the result of
mandibular hypoplasia
Skeletal closed bite
ANB 8.1°
A to NPo 9.7 mm
Mandibular plane 9.7°
Dental description
Class I right, Class II left
Severely tapered arch form with
4 mm crowding
/1 to APo 1.2 mm
/1 to NB 7.9 mm
/1 to NB 34.5°
Facial description
Facial angle 150° Low
Upper lip protrusion 7.0 mm High
Interlabial gap 10 mm High
Lower lip protrusion 4.8 mm High
Throat length 41 mm Low
Mentalis strain when the lip
are closed
11. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 383
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SOFT TISSUE ASSESSMENT SHEET AND ANALYSIS
The soft tissue assessment sheet is used to record
whether a facial trait should be maintained, increased,
or decreased (Fig 2). If a facial trait falls into the nor-
mal range, it should be maintained. If a facial trait is
outside the normal range, the treatment plan should
change the facial trait so that it comes closer to or into
the normal range.
Case Studies
Examples of cases with a few key skeletal and den-
tal measurements are presented. The measurements
shown help highlight the patient’s condition and are not
meant to be a complete diagnosis.
Case 1. Case 1 was a boy (M.V.), aged 15.8 years,
with minimal growth left (Table I). The treatment plan
was to extract the lower first bicuspids, retract the
Fig 14. Posttreatment soft tissue assessment sheet for P.E. There are 12 normal facial traits with 6
traits outside normal range and 4 other outside traits improved toward normal range.
12. 384 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
lower anterior dentition to increase the overjet, close all
spaces, and round out and level the dental arches.
Orthognathic surgery was performed to advance the
mandible with a midline split and chin augmentation.
The patient was treated to a cuspid Class I and a molar
Class III occlusion (Figs 3 through 5).
The treatment optimized facial attractiveness by
increasing the facial angle, decreasing the upper lip
protrusion, decreasing the interlabial gap, decreasing
the lower lip protrusion, increasing the lower lip-chin
length, increasing the throat length, and eliminating the
mentalis strain.
The original cephalometric headfilm had 10 facial
traits in the normal range. By using the treatment plan,
13 facial traits are now in the normal range and 1 trait,
the facial angle, shows a significant increase of 10°
toward the normal range. The treatment optimized the
patient’s individual norms and increased facial attrac-
tiveness (Figs 6 through 8).
Case II. Case II was a man (P.E.), aged 38.9 years
(Table II). The treatment plan was to refer the patient to
a periodontist for tissue graft on tooth no. 26 and have
his dentist restore the fractured left central incisor, to
extract the first bicuspids, to round out both upper and
Fig 15. Pretreatment photograph of C.M., girl aged 9.11
years, with significant growth left. Class II due to
mandibular hypoplasia and anterior open bite.
Fig 16. Pretreatment cephalometric tracing of C.M.
Table II. Case II: Diagnostic summary of a man (P.E),
aged 38.9 years
Skeletal description
Class II as the result of vertical
maxillary excess
Skeletal open bite and skeletal
lingual crossbite
ANB 9.6°
FMA 31.6°
Facial axis 80.9°
Lower face height 54.5°
Post/ant face ht 57.4%
Dental description
Class I molars with anterior open bite
10 mm crowding in the lower arch
Gingival recession on lower right
lateral incisor
Incisal edge of upper left central is
fractured
1/ to NA 22°
1/ to NA 3.7 mm
/1 to NB 23.7°
/1 to NB 7.9 mm
/1 to APo 1 mm
Overjet 10.8 mm
Overbite –5.9 mm
Facial description
Facial profile 167° Normal
Lower face height 95 mm High
Upper lip protrusion 4.9 mm High
Interlabial gap 7 mm High
Lower lip-chin length 60 mm High
Lower lip protrusion 4.3 mm High
Lower face-throat angle 115° High
Throat length 44 mm Low
13. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 385
Volume 116, Number 4
lower arches, to close the spaces, and to level the curve
of Spee. Orthognathic surgery would be performed
with a LeFort I osteotomy, along with a mandibular
advancement (Figs 9 through 11).
The treatment plan optimized the facial attractive-
ness by decreasing the lower face height, decreasing
the upper lip protrusion, decreasing the interlabial gap,
decreasing the lower lip-chin length, decreasing lower
lip protrusion, increasing the throat length, and elimi-
nating the mentalis strain.
Before treatment, there were 9 facial traits in the
normal range. After treatment, there were 12 facial
traits in the normal range. The treatment plan opti-
mized the facial attractiveness (Figs 12 through 14).
Case III. Case III was a girl (C.M.), aged 9.11
years, with significant growth potential (Table III). The
treatment plan was to extract teeth 5, 12, and 28; to
place a palatal bar to hold the molar position and con-
trol the vertical; and to wait for the remaining bicus-
pids and cuspids to erupt. Full banding would be done
Fig 17. Pretreatment soft tissue assessment sheet of C.M. There are 6 facial traits in normal range
with 12 outside normal range.
14. 386 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
after the remaining bicuspids erupt. Cervical pull head-
gear would be used with orthopedic forces to correct
the Class II. The right side would be treated to a Class
I occlusion and the left side to a Class II occlusion
(Figs 15 through 17).
The treatment optimized the facial attractiveness by
improving facial angle, nasal project in normal range,
decreasing upper lip protrusion, decreasing lower lip
protrusion, decreasing interlabial gap, increasing soft
tissue B point to subnasale-soft tissue pogonion line,
and increasing throat length.
The facial angle improved by controlling the verti-
cal dimension. The retraction of the upper incisors
along with the growth of the lower lip allowed the inter-
labial gap to close. The upper and lower lips fell into the
normal range. The throat length improved by from 41 to
52 mm by controlling the vertical dimension and having
growth. The beginning record showed 6 facial traits in
the normal range; the final tracing has 13 facial traits
within the normal range (Figs 18 through 20).
DISCUSSION
To make optimum facial attractiveness one of the treat-
ment goals, the orthodontist must assess the soft tissue on
its own merit. It is often assumed that if teeth are arranged
Fig 18. Posttreatment photograph of C.M. There is
improved facial angle, decreased upper and lower lip
protrusion, decreased interlabial gap, increased soft tis-
sue B point to subnasale-soft tissue pogonion line, and
increased throat length.
Fig 19. Posttreatment cephalometric tracing of C.M.
Table III. Case III: Diagnostic summary of a girl (C.M.),
aged 9.11 years, with significant growth potential
Skeletal description
Class II as the result of mandibular
hypoplasia
SNA 84.9°
SNB 76.3°
ANB 8.6°
P/A Face height 60%
Mandibular plane 27.8°
Facial axis 82.8°
Dental description
Class II malocclusion with 1 mm
crowding in mixed dentition
Missing tooth #19
1/ to NA 6.6 mm
1/ to NA 27.3°
/1 to NB 7 mm
/1 to NB 33.1°
/1 to APo 5.4 mm
/1 to APo 17.7°
Overjet 10.3 mm
Overbite –4.5 mm
Facial description
Convexed profile with mentalis strain
Facial angle 161° Low
Nasal projection 10 mm Low
Upper lip protrusion 7 mm High
Lower protrusion 5.3 mm High
Interlabial gap 14 mm High
Lower lip-chin length 37 mm Low
B’ to SnPg line 1 mm Low
Throat length 41 mm Low
B’, Soft tissue B point; SnPg, subnasale soft tissue pogonion.
15. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 387
Volume 116, Number 4
to an ideal standard, the soft tissue will automatically be in
a harmonious position. Facial esthetics, however, does not
rely solely on hard tissue. Soft tissue dimensions vary as
the result of the thickness of the tissue, the lip length, and
the postural tone. It is necessary therefore to study the soft
tissue contour to adequately assess facial harmony.15
Quality and Quantity
When looking at facial attractiveness, it is important
to know the quality and quantity of the existing traits.
Quality is represented by the anatomic form of the facial
parts, such as eyes, skin, hair, lips, and teeth. These
facial parts, along with the color and texture of the skin
and hair constitute the most important aspect of facial
attractiveness. Quantity is represented by measuring of
the size and arrangement of the parts: cheekbones,
orbital rims, nose, lips, and chin. These quantitative
measures are the guide to making orthodontic and surgi-
cal changes to improve facial features.
The soft tissue analysis represents a set of quantita-
Fig 20. Posttreatment soft tissue assessment sheet of C.M. has 13 facial traits in normal range and
5 outside, 2 traits are significantly closer to normal range.
16. 388 Bergman American Journal of Orthodontics and Dentofacial Orthopedics
October 1999
tive measures of the facial traits. When one or more
traits are outside the normal range, an individualized
norm can be designed to determine the treatment plan
that will balance the traits for optimal facial attractive-
ness. By measuring the facial traits and estimating
growth potential, a more accurate assessment can be
made of the patient’s individualized needs for treat-
ment. Similarly, measurement also allows for an objec-
tive evaluation of the success of treatment.
Extraction of teeth can affect several traits: increase
the facial angle, increase the nasolabial angle, increase
the lip length, increase the maxillary sulcus, decrease
lip protrusion, decrease upper incisor exposure,
decrease the interlabial gap, increase the mandibular
sulcus, and increase the soft tissue B point–subnasale
soft tissue pogonion line and chin size. Care must be
taken when extracting teeth to estimate how these
facial traits will be affected. All must be balanced with
the position of the teeth in the bone support for peri-
odontal health and long-term stability.
When there is a large nose or chin, caution should
be used with respect to retracting the lips. In cases
where surgery is out of the question, greater facial
compensations may be necessary. This may compro-
mise optimizing facial attractiveness as part of the
treatment goal. The patient should be informed of
this.
When treating a malocclusion nonextraction, the
nasolabial angle, the lower face height, the lip length,
the maxillary sulcus, the lip protrusion, the upper
incisor exposure, the interlabial gap, the mandibular
sulcus, soft tissue B point–subnasale soft tissue
pogonion line, and chin can all be affected. If the lip
posture is pushed too far forward, the result may be a
masking of the chin, an increase in the interlabial
gap, and a reduced lower face height. Again, treat-
ment also has to be balanced with the position of the
teeth in the bone support for periodontal health and
long-term stability.
There are certain facial traits that have a close rela-
tionship with one another. These traits can cause facial
disharmony because of the vertical or disproportionate
ratio between them. For example, the upper lip and the
lower lip and chin height should have a 1:2 ratio. Consid-
erable variation can also be found in the lip protrusion to
the subnasale-soft tissue pogonion line. Patients with pro-
trusion show lips well beyond the subnasale-soft tissue
pogonion line, although in Class II Division 1 cases there
are several variations: (1) Both lips can be very protrusive;
(2) the upper lip can protrude, and the lower lip can be
retrusive; (3) in Class II Division 2, both lips can be retru-
sive.8 It is important to keep the lip posture in front of the
subnasale-soft tissue pogonion line, with the upper lip ide-
ally being 1 mm further forward than the lower lip. When
the lips go behind the subnasale-soft tissue pogonion line,
a concave facial profile occurs. A close relationship also
exists between the tissue thickness of the upper and lower
lips; if there is a significant difference in their thickness,
the facial contour will not be in harmony.
Care must be taken to reduce the number of vari-
ables present when taking the lateral cephalometric
headfilm. Hypotonic or hypertonic lips can cause dis-
tortion because the tension in them may give false
information as to lip posture. The condylar position
must also be accurate. A wax bite may be used to main-
tain the position of the condyle; but in severe centric
occlusion and centric relation discrepancies, the bite
may be opened, thus increasing the lower face height.
Growth and development must likewise be taken into
consideration. The more growth anticipated the greater
will be the change in nose and chin. The direction of
the growth needs to be taken into consideration with
respect to horizontal, vertical, or normal growing
mandibles. Using the soft tissue assessment sheet, the
various facial traits can be measured and recorded, and
treatment mechanics can be planned so that the pro-
posed changes will optimize facial attractiveness.
CONCLUSION
Orthodontists use dental, skeletal, and facial traits
to diagnose and develop treatment plan malocclu-
sions. Dental and skeletal traits help us to understand
tooth position along with anteroposterior and vertical
discrepancies. Both give much weight in the determi-
nation of treatment. The facial traits most often used
by orthodontists include the relative positions of the
upper lip, lower lip, to a facial. These give important
information, but they may provide only limited
insight into the facial changes that will result from the
treatment.
I have presented an organized, comprehensive
approach to soft tissue analysis using the lateral cephalo-
metric headfilm. Soft tissue analysis enhances the main-
tenance of normal facial traits as the abnormal charac-
teristics are corrected with orthodontics and surgery. The
soft tissue analysis should not, of course, take the place
of a comprehensive clinical examination of the patient.
Rather, the facial examination may sway the decision as
to which procedure will result in the most optimal esthet-
ics. Much of this information, however, can be gleaned
from the lateral cephalometric headfilm. Mere correction
of the occlusion may give random and often poor results
in terms of facial attractiveness. Esthetic guidelines must
be followed when determining the orthodontic and/or
surgical plan if optimal facial attractiveness is a treat-
ment goal.
17. American Journal of Orthodontics and Dentofacial Orthopedics Bergman 389
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REFERENCES
1. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning:
part I. Am J Orthod Dentofac Orthop 1993;103:299-312.
2. Holdaway RA. A soft-tissue cephalometric analysis and its use in orthodontic treat-
ment planning: part I. Am J Orthod 1983;84:1-28.
3. Worms FW, Spiedel TM, Bevis RR, Waite DE. Posttreatment stability and esthetics of
orthognathic surgery. Angle Orthod 1980;50:251-73.
4. Wylie, GA, Fish LC, Epker BN. Cephalometrics: a comparison of five analysis currently used
in the diagnosis of dentofacial deformities. Int J Adult Orthod Orthog Surg 1987;2:15-36.
5. Jacobson A. Planning for orthognathic surgery: Art or science? Int J Adult Orthod
Orthog Surg 1990;5:217-24.
6. Park YC, Burstone CJ. Soft tissue profile: fallacies of hard tissue standards in treat-
ment planning. Am J Orthod 1986:90:52-62.
7. Michiels LYF, Tourne LPM. Nasion true vertical: a proposed method for testing the
clinical validity of cephalometric measurements applied to a new cephalometric refer-
ence line. Int J Adult Orthod Orthog Surg 1990;5:43-52.
8. Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod
1967;53:262-84.
9. Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J
Oral Surg 1980;38:744-51.
10. Burstone CJ. The integumental profile. Am J Orthod 1958;44:1-25.
11. Farkas LG, Kolar JC. Anthropometrics and art in the aesthetics of women’s faces. Clin
Plast Surg 1987;14:599-615.
12. Dawson PE. Optimum TMJ condyle position in clinical practice. Int J Periodont
Restor Dent 1985;3:11-31.
13. Lehman JA. Soft-tissue manifestations of the jaws: diagnosis and treatment. Clin Plast
Surg 1987;14:767-83.
14. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning:
part II. Am J Orthod Dentofacial Orthop 1993;103:395-411.
15. Burstone CJ. Soft tissue factors in treatment planning: translations of the 3rd IOC.
Great Britain: Crosby Lockwood Staples Frogmore St. Albans Herts; 1975. p. 26-34.
16. Genecov JS, Sinclair PM, Denchow PC. Development of the nose and soft tissue pro-
file. Angle Orthod 1990;60:191-8.
17. Talass MF, Baker RC. Soft tissue profile changes resulting from retraction of maxil-
lary incisors. Am J Orthod 1987;91:385-94.
18. Farkas LG. Anthropometry of the head and face in medicine. New York: Elsevier
North Holland Inc; 1981.
19. Mamandras AH. Linear changes of the maxillary and mandibular lips. Am J Orthod
1988;94:405-10.
20. Nanda RS, Meng H, Kapila S, Goohuis J. Growth changes in the soft tissue facial pro-
file. Angle Orthod 1990;60:177-90.
21. Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970;40:284-317.
22. Drobocky OB, Smith RJ. Changes in facial profile during orthodontic treatment with
extractions of four first premolars. Am J Orthod 1989;95:220-30.
23. Lines PA, Steinhauser EW. Soft-tissue changes in relationship to movement of hard
structures in orthognathic surgery: a preliminary report. J Oral Surg 1974;32:891-6.