1. Clinical facial analysis (CFA) for
orthodontists and maxillofacial
surgeons
By Mohammed Almuzian
University of Glasgow, 2012

2. What is Clinical Facial Analysis?
It is the method utilized by clinician for evaluating and judging the patient‘s
face; to define its proportions, volume, appearance, symmetry, and visible
deformities. (Biondi, 2005)

3. To whom CFA might be beneficial?

4. Methods of CFA
Direct examination
Clinical photographs
Non Radiographical 3D imaging methods
Conventional & 3D x-ray imaging.

5. Is CFA parameters are standard?
Racial
background
Cultural
difference
Gender
Personal preference
Clinician philosophy

6. Importance of CFA
• To diagnose and classify the deformities
especially for border line cases.
• To plan the treatment approach that mainly
addresses the patient concerns and
complaints.
• To predict the treatment outcomes, stability &
prognosis.

7. When CFA should be performed?
Thorough CFA Initial CFA
Observation
stage
Questionnaire
stage

8. Steps in CFA
Positioning the patient
• NHP (developed by.., tested by…, described by….
• Centric relation
• Relaxed lip position, BOWB (bite opening wax bite)
indicated in………
• First tooth contact (wax bite , deprogramming splint)
Then
1. Frontal view analysis,
2. Profile view analysis,
3. 45 degree view analysis for profile-frontal shared
features.

9. Frontal view analysis
Vertical analysis of the frontal view
Facial type
Vertical heights
Lip assessment

10. Facial type
(Naini 2008)
Vertical analysis of the frontal view

11. Vertical heights
Vertical analysis of the frontal view
1. upper third
2. middle third
3. lower third
• Upper lip
• Lower lip and chin
• Interlabial gap
Bell et al 1980
Fish and Epker 1981
Ricketts et al 1979
Farkus 1984

12. Lip assessment
(LAMP),
miniesthetic
analysis
• Line,
• Activity
• Morphology
• Position
Mossy 1981
Fish & Epker 1981
Naini 2008
Vertical analysis of the frontal view

13. Frontal view analysis
Transverse analysis of frontal view
Vertical reference lines (Facial midline, Rule of fifths)
Skeletal base assessment(Maxillary & Mandibular)
Smile analysis
Dental factors

14. Transverse analysis of frontal view
Vertical reference lines
Facial midline
Rule of fifths
Naini 2008
Arnett and McLaughlin 2004
Sheen, 1978

15. Transverse analysis of frontal view
Skeletal base assessment
Mandibular assessment
Chin jaw line
Maxillary assessment
Sclera show
Paranasal hollowing
Naini 2008
Hunt & Ruge 1983

16. Transverse analysis of frontal view
Smile analysis
• The smile arc
• Width of smile
• Incisor and
gingival show
(Posed, social
smile)
Naini 2008

17. Transverse analysis of frontal view
Dental factors
• Overbite
• Occlusal plane
(Upper, lower,
anterior
posterior)
• Maxillary
dental midline
• Mandibular
dental midline

18. Profile analysis
Total soft tissue profile analysis
Analysis of the high midface
Analysis of the maxillary area
Analysis of the mandibular area

19. Facial profile analysis
Total soft tissue profile
analysis
Angle of convexity , Burstone
1968, 11-30 degree.
Nasomental angle (Total facial
angle) 160 degree
Burstone 1965
Moshiri et al, 1982
Powell et al 1984

20. Facial profile analysis
Analysis of the high
midface
• Soft tissue glabella
• Orbital rim
• Check bone contour
Fish & Epker 1981

21. Facial profile analysis
Analysis of the
maxillary area
• Nasal base (Meridian
line)
• Nasal projection
(TVL)
Anteroposterior lip
position (TVL, E line, S
line, H line)
• Relationship of upper
lip to nose
Gonzales-Ulloa 1966
Arnett & Bergman 1993
Ricketts 1979
Steiner 1966
Holdaway 1983
Fish & Epker 1981

22. Facial profile analysis
Analysis of the mandibular area
1. Anteroposterior lip position (TVL,
E line, S line)
2. Relationship of lower lip to chin
3. Anteroposterior chin position
Bass aesthetic analysis
Facial vertical
Holdaway angle
Profile line or Z angle
4. Relationship of chin to submental
area
• Lip-chin-submental plane
• Submental plane length
Gonzales-Ulloa 1966
Arnett & Bergman 1993
Ricketts 1979
Steiner 1966
Bass, 2003
Merrifield, 1966
Moshiri et al, 1982

23. Dental Appearance: Micro-Esthetics.
Tooth Proportions
Width Relationships and the "Golden Proportion"
Height-Width Relationships
Gingival Heights, Shape and Contour
Connectors
Embrasures: Black Triangles
Tooth Shade and Color

24. Thank you