This document summarizes various physiologic changes that occur in the smile and face with age. It discusses changes to the frontal profile, including facial form, symmetry, midline alignments, transverse dimensions, and vertical relationships. It also examines changes to the lip contour and profile view assessments, including the facial contour angle, nasolabial angle, lip-chin-throat angle, and more. The document reviews studies on lip proportions and ratios, as well as how soft tissues are impacted by growth and aging processes.
This document discusses soft tissue analysis for orthodontic treatment planning. It covers clinical examination including natural head position, lip assessment, and frontal and profile views. Key measurements and landmarks are defined such as facial thirds, nasolabial angle, lip lengths, and chin position. Factors that influence soft tissues like tooth movement and growth are also addressed.
Bolton analysis and mixed dentition analysisMasuma Ryzvee
This document summarizes methods for Bolton analysis and mixed dentition analysis. Bolton analysis measures tooth size ratios to determine excess tooth material. Mixed dentition analysis predicts widths of unerupted canines and premolars using methods like radiographs, Moyer's tables, or equations. Radiographic analysis measures primary tooth and unerupted tooth widths on radiographs. Moyer's tables and equations like Tanaka-Johnston predict canine and premolar widths based on measured incisor widths.
“The study of orthodontia is indissolubly connected with that of art as related to the human face.” -Dr. Edward H. Angle.
Each person shares with the rest of the population a great many characteristics, but there are enough differences to make each human being a unique individual. Such limitless variation in the size, shape and relationship of the dental, skeletal and soft tissue facial structures are important in providing each individual with his or her own identity.
Face – Difficult object to measure accurately because of
– complex morphology
– sensitivity to eyes
– its soft nature.
One of goals of orthodontic treatment is creating a balanced & harmonious facial appearance. Craniofacial symmetry is one of the aspect of this harmony. Subject of symmetry or lack of symmetry of human face has been of considerable interest, particularly in the field of Orthodontics. Minor variation is a desirable variation of craniofacial structure which is perceived as esthetically pleasing and has no esthetic or functional significance. Asymmetry becomes important when it affects the function or esthetics of the person.
This document discusses various cephalometric analyses used for orthognathic surgery planning and prediction. It describes analyses like COGS (Cephalometrics for Orthognathic Surgery), the quadrilateral analysis, and the Arnett analysis. It also outlines the steps for doing cephalometric prediction tracings, including tracing stable structures, placing the repositioned skeleton, placing teeth in the new occlusion, and tracing new lip contours. Prediction tracings are important for assessing esthetic and treatment outcomes from orthognathic surgery.
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
1. Arch space analysis methods estimate tooth size and jaw size relationships. Space analysis compares available space to required space for proper tooth alignment.
2. Methods are classified by tooth size estimation method, arch length estimation method, developmental stage, and estimation/digitization method.
3. Common methods include measurements from radiographs, prediction tables using erupted tooth sizes, and combinations of methods. Nance analysis accounts for space changes between deciduous and permanent dentitions.
Anterior Open Bite etiology and differential diagnosisMarwan Mouakeh
This document discusses the etiology and classification of anterior open bite. It defines anterior open bite and discusses its prevalence, which can range from 1.5-11% and varies among races. Anterior open bite is classified as dental, dentoalveolar, or skeletal depending on whether it is restricted to the anterior teeth or involves the underlying skeletal structures. The etiology of anterior open bite is multifactorial, involving genetic, anatomic, and environmental factors. Genetic factors include unfavorable growth patterns and increased tongue size. Environmental factors prominently include non-nutritive sucking habits which can cause dental changes, as well as abnormal tongue function and airway obstructions.
This document provides information about molar distalization, including:
- Molar distalization involves moving molars backwards to correct malocclusions.
- Various appliances can be used for molar distalization, including headgear, K-loops, and pendulum appliances.
- Treatment planning for molar distalization generally involves two phases - a space gaining phase followed by a consolidation phase to achieve ideal occlusion.
This document discusses soft tissue analysis for orthodontic treatment planning. It covers clinical examination including natural head position, lip assessment, and frontal and profile views. Key measurements and landmarks are defined such as facial thirds, nasolabial angle, lip lengths, and chin position. Factors that influence soft tissues like tooth movement and growth are also addressed.
Bolton analysis and mixed dentition analysisMasuma Ryzvee
This document summarizes methods for Bolton analysis and mixed dentition analysis. Bolton analysis measures tooth size ratios to determine excess tooth material. Mixed dentition analysis predicts widths of unerupted canines and premolars using methods like radiographs, Moyer's tables, or equations. Radiographic analysis measures primary tooth and unerupted tooth widths on radiographs. Moyer's tables and equations like Tanaka-Johnston predict canine and premolar widths based on measured incisor widths.
“The study of orthodontia is indissolubly connected with that of art as related to the human face.” -Dr. Edward H. Angle.
Each person shares with the rest of the population a great many characteristics, but there are enough differences to make each human being a unique individual. Such limitless variation in the size, shape and relationship of the dental, skeletal and soft tissue facial structures are important in providing each individual with his or her own identity.
Face – Difficult object to measure accurately because of
– complex morphology
– sensitivity to eyes
– its soft nature.
One of goals of orthodontic treatment is creating a balanced & harmonious facial appearance. Craniofacial symmetry is one of the aspect of this harmony. Subject of symmetry or lack of symmetry of human face has been of considerable interest, particularly in the field of Orthodontics. Minor variation is a desirable variation of craniofacial structure which is perceived as esthetically pleasing and has no esthetic or functional significance. Asymmetry becomes important when it affects the function or esthetics of the person.
This document discusses various cephalometric analyses used for orthognathic surgery planning and prediction. It describes analyses like COGS (Cephalometrics for Orthognathic Surgery), the quadrilateral analysis, and the Arnett analysis. It also outlines the steps for doing cephalometric prediction tracings, including tracing stable structures, placing the repositioned skeleton, placing teeth in the new occlusion, and tracing new lip contours. Prediction tracings are important for assessing esthetic and treatment outcomes from orthognathic surgery.
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
1. Arch space analysis methods estimate tooth size and jaw size relationships. Space analysis compares available space to required space for proper tooth alignment.
2. Methods are classified by tooth size estimation method, arch length estimation method, developmental stage, and estimation/digitization method.
3. Common methods include measurements from radiographs, prediction tables using erupted tooth sizes, and combinations of methods. Nance analysis accounts for space changes between deciduous and permanent dentitions.
Anterior Open Bite etiology and differential diagnosisMarwan Mouakeh
This document discusses the etiology and classification of anterior open bite. It defines anterior open bite and discusses its prevalence, which can range from 1.5-11% and varies among races. Anterior open bite is classified as dental, dentoalveolar, or skeletal depending on whether it is restricted to the anterior teeth or involves the underlying skeletal structures. The etiology of anterior open bite is multifactorial, involving genetic, anatomic, and environmental factors. Genetic factors include unfavorable growth patterns and increased tongue size. Environmental factors prominently include non-nutritive sucking habits which can cause dental changes, as well as abnormal tongue function and airway obstructions.
This document provides information about molar distalization, including:
- Molar distalization involves moving molars backwards to correct malocclusions.
- Various appliances can be used for molar distalization, including headgear, K-loops, and pendulum appliances.
- Treatment planning for molar distalization generally involves two phases - a space gaining phase followed by a consolidation phase to achieve ideal occlusion.
1. The McNamara analysis method relates craniofacial structures including teeth, jaws, and cranial base to evaluate skeletal and dental relationships.
2. For the patient, the analysis found a retrusive maxilla, decreased mandibular length and anteroposterior differential, reduced vertical proportions, and protrusive incisors.
3. The airway measurements were within normal limits, but other findings indicate the patient has a skeletal Class II malocclusion with a vertical growth pattern.
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
This document outlines orthognathic surgery procedures. It discusses diagnosis and planning, including indications, contraindications, and special considerations. Presurgical orthodontics including decompensation and arch coordination are described. Surgical techniques for the maxilla include LeFort I, II, III osteotomies and segmental procedures. For the mandible, procedures include sagittal split and vertical subsigmoid osteotomies. Splint fabrication and post-surgical care are also covered.
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 document discusses the Wits appraisal method for assessing sagittal jaw disharmony. It describes how the Wits appraisal aims to eliminate variations caused by rotations and vertical dimensions seen in measurements like ANB. The Wits appraisal involves drawing perpendiculars from points A and B on the maxilla and mandible to the occlusal plane, and measuring the distance between where they intersect. Studies have found the average distance in males to be 1mm forward for B point, and in females the points generally coincide. The Wits appraisal is said to better reflect the severity of class II and III malocclusions compared to ANB alone. It is influenced less by variations in the cranial base and rotations.
The Steiner analysis was one of the first modern cephalometric analyses. It emphasized the interrelationships between measurements and offered guidelines for treatment planning based on predicted changes from growth and orthodontic therapy. The analysis includes skeletal, dental, and soft tissue measurements. Key skeletal measurements include SNA, SNB, and ANB angles. Key dental measurements include UI-NA and LI-NB angles and distances. The Holdaway ratio evaluates lower incisor prominence. The S-line assesses lower facial balance.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document provides an overview of posteroanterior cephalometric analysis. It defines the setup and landmarks used in PA cephalometry. It then summarizes several common PA cephalometric analyses including Ricketts analysis, Grummons analysis, and Grayson analysis. Ricketts analysis measures dental, skeletal, and jaw relationships. Grummons analysis uses planes, volumes, asymmetries, and ratios to compare sides. Grayson analysis constructs midlines in different frontal planes to analyze asymmetry in 3 dimensions.
Dentoalveolar compensations /certified fixed orthodontic courses by Indian de...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.
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
This document discusses strategies for reducing overjet in orthodontic treatment. It presents four examples of patients requiring overjet reduction and proposes treatment plans for each. The key points covered are the four main ways to reduce overjet: moving the lower incisors forward, moving the upper incisors back, moving the mandible forward, and limiting maxillary growth. Factors like molar relationship, amount of extraction, and facial angle are considered for determining the best mechanics in each case.
This document discusses Class II division 2 malocclusion, including its definition, classification, clinical features, etiology, diagnosis, and treatment options. Class II division 2 is a type of Class II malocclusion characterized by retroclined maxillary incisors. It can be caused by skeletal factors like mandibular deficiency or maxillary excess, or dental factors like premature tooth loss. Diagnosis involves a problem-oriented approach through data collection and establishing a problem list. Treatment may involve orthodontics alone for mild cases, but more severe cases may require orthodontics combined with orthopedics/growth modification or orthognathic surgery.
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
This document summarizes Tweed's analysis of cephalometric landmarks and angles used in orthodontic diagnosis and treatment planning. It describes Tweed's diagnostic facial triangle formed by the Frankfort horizontal plane, mandibular plane, and mandibular incisor plane. Norms for the angles FMA, FMIA, and IMPA are provided based on Tweed's studies. Shortcomings of the ANB angle in assessing jaw relationships are discussed. The Wits appraisal method is introduced as an alternative for measuring anteroposterior jaw disharmony. Related studies validating the Wits appraisal are summarized.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
HI THIS IS A NICE SEMINAR DESCRIBING ABOUT THE ORTHOGNATHIC SURGERY MAINLY RELATED TO ORTHODONTICS VIEWPOINT AND CEPH TRACING ITS INDICATION AND DIFFERENT TYPES OF SURGERIES. JUST HAVE A LOOK TO IT
This document discusses the management of impacted maxillary canines. It defines impacted canines and outlines their epidemiology, embryology, clinical examination, treatment options, and complications. Impacted canines are most commonly caused by genetic factors or loss of tooth guidance. Clinical examination involves inspection, palpation, and radiographic evaluation to determine the position, direction, and state of the unerupted canine. Management is often multidisciplinary and involves orthodontic treatment or surgery to align or expose the impacted tooth.
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
Orthodontic treatment of deep bite part 2 Maher Fouda
1) The document discusses various types of functional appliances used to treat deep bite, including activators.
2) It describes the mode of action of activators, which is believed to involve muscle adaptation leading to skeletal changes. Forces from muscle contraction, compression, and tissue viscoelasticity may play a role.
3) The process of obtaining a working bite registration to construct a functional appliance is outlined, including having the patient practice the correct bite position and using tools to control vertical opening.
This document summarizes a presentation on using facial analysis keys in orthodontic diagnosis and treatment planning. It discusses 18 different facial traits that can be examined, such as lip length, nasolabial angle, and chin position. Specific facial characteristics are associated with different skeletal malocclusions, including vertical maxillary excess, deficiency, Class II and III deformities. Performing a full facial examination is important for developing an accurate orthodontic treatment plan that addresses both dental alignment and facial esthetics.
The document provides an introduction to smile designing, covering topics such as the need for smile designing, diagnosis, facial analysis including lips and teeth, and principles of visual perception and smile design. It discusses analyzing various facial features, lip forms and lengths, tooth sizes and forms, and incisal curves and relationships during speech. With aging, there is a decrease in tooth display during rest, speech and smile for both genders. Gingival display during smile is considered a youthful characteristic. The document outlines factors to consider for a natural yet enhanced smile design.
1. The McNamara analysis method relates craniofacial structures including teeth, jaws, and cranial base to evaluate skeletal and dental relationships.
2. For the patient, the analysis found a retrusive maxilla, decreased mandibular length and anteroposterior differential, reduced vertical proportions, and protrusive incisors.
3. The airway measurements were within normal limits, but other findings indicate the patient has a skeletal Class II malocclusion with a vertical growth pattern.
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
This document outlines orthognathic surgery procedures. It discusses diagnosis and planning, including indications, contraindications, and special considerations. Presurgical orthodontics including decompensation and arch coordination are described. Surgical techniques for the maxilla include LeFort I, II, III osteotomies and segmental procedures. For the mandible, procedures include sagittal split and vertical subsigmoid osteotomies. Splint fabrication and post-surgical care are also covered.
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 document discusses the Wits appraisal method for assessing sagittal jaw disharmony. It describes how the Wits appraisal aims to eliminate variations caused by rotations and vertical dimensions seen in measurements like ANB. The Wits appraisal involves drawing perpendiculars from points A and B on the maxilla and mandible to the occlusal plane, and measuring the distance between where they intersect. Studies have found the average distance in males to be 1mm forward for B point, and in females the points generally coincide. The Wits appraisal is said to better reflect the severity of class II and III malocclusions compared to ANB alone. It is influenced less by variations in the cranial base and rotations.
The Steiner analysis was one of the first modern cephalometric analyses. It emphasized the interrelationships between measurements and offered guidelines for treatment planning based on predicted changes from growth and orthodontic therapy. The analysis includes skeletal, dental, and soft tissue measurements. Key skeletal measurements include SNA, SNB, and ANB angles. Key dental measurements include UI-NA and LI-NB angles and distances. The Holdaway ratio evaluates lower incisor prominence. The S-line assesses lower facial balance.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document provides an overview of posteroanterior cephalometric analysis. It defines the setup and landmarks used in PA cephalometry. It then summarizes several common PA cephalometric analyses including Ricketts analysis, Grummons analysis, and Grayson analysis. Ricketts analysis measures dental, skeletal, and jaw relationships. Grummons analysis uses planes, volumes, asymmetries, and ratios to compare sides. Grayson analysis constructs midlines in different frontal planes to analyze asymmetry in 3 dimensions.
Dentoalveolar compensations /certified fixed orthodontic courses by Indian de...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.
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
This document discusses strategies for reducing overjet in orthodontic treatment. It presents four examples of patients requiring overjet reduction and proposes treatment plans for each. The key points covered are the four main ways to reduce overjet: moving the lower incisors forward, moving the upper incisors back, moving the mandible forward, and limiting maxillary growth. Factors like molar relationship, amount of extraction, and facial angle are considered for determining the best mechanics in each case.
This document discusses Class II division 2 malocclusion, including its definition, classification, clinical features, etiology, diagnosis, and treatment options. Class II division 2 is a type of Class II malocclusion characterized by retroclined maxillary incisors. It can be caused by skeletal factors like mandibular deficiency or maxillary excess, or dental factors like premature tooth loss. Diagnosis involves a problem-oriented approach through data collection and establishing a problem list. Treatment may involve orthodontics alone for mild cases, but more severe cases may require orthodontics combined with orthopedics/growth modification or orthognathic surgery.
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
This document summarizes Tweed's analysis of cephalometric landmarks and angles used in orthodontic diagnosis and treatment planning. It describes Tweed's diagnostic facial triangle formed by the Frankfort horizontal plane, mandibular plane, and mandibular incisor plane. Norms for the angles FMA, FMIA, and IMPA are provided based on Tweed's studies. Shortcomings of the ANB angle in assessing jaw relationships are discussed. The Wits appraisal method is introduced as an alternative for measuring anteroposterior jaw disharmony. Related studies validating the Wits appraisal are summarized.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
HI THIS IS A NICE SEMINAR DESCRIBING ABOUT THE ORTHOGNATHIC SURGERY MAINLY RELATED TO ORTHODONTICS VIEWPOINT AND CEPH TRACING ITS INDICATION AND DIFFERENT TYPES OF SURGERIES. JUST HAVE A LOOK TO IT
This document discusses the management of impacted maxillary canines. It defines impacted canines and outlines their epidemiology, embryology, clinical examination, treatment options, and complications. Impacted canines are most commonly caused by genetic factors or loss of tooth guidance. Clinical examination involves inspection, palpation, and radiographic evaluation to determine the position, direction, and state of the unerupted canine. Management is often multidisciplinary and involves orthodontic treatment or surgery to align or expose the impacted tooth.
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
Orthodontic treatment of deep bite part 2 Maher Fouda
1) The document discusses various types of functional appliances used to treat deep bite, including activators.
2) It describes the mode of action of activators, which is believed to involve muscle adaptation leading to skeletal changes. Forces from muscle contraction, compression, and tissue viscoelasticity may play a role.
3) The process of obtaining a working bite registration to construct a functional appliance is outlined, including having the patient practice the correct bite position and using tools to control vertical opening.
This document summarizes a presentation on using facial analysis keys in orthodontic diagnosis and treatment planning. It discusses 18 different facial traits that can be examined, such as lip length, nasolabial angle, and chin position. Specific facial characteristics are associated with different skeletal malocclusions, including vertical maxillary excess, deficiency, Class II and III deformities. Performing a full facial examination is important for developing an accurate orthodontic treatment plan that addresses both dental alignment and facial esthetics.
The document provides an introduction to smile designing, covering topics such as the need for smile designing, diagnosis, facial analysis including lips and teeth, and principles of visual perception and smile design. It discusses analyzing various facial features, lip forms and lengths, tooth sizes and forms, and incisal curves and relationships during speech. With aging, there is a decrease in tooth display during rest, speech and smile for both genders. Gingival display during smile is considered a youthful characteristic. The document outlines factors to consider for a natural yet enhanced smile design.
This document provides an overview of orthognathic surgery, including its history, goals, indications, patient evaluation process, and cephalometric analysis. Orthognathic surgery involves combining orthodontics and oral surgery to correct jaw and facial deformities. Key aspects of patient evaluation include clinical examination, radiographic and dental model analysis, and facial analysis to assess skeletal, dental, and soft tissue abnormalities. Cephalometric analysis aids in treatment planning by defining skeletal and facial types and the relationships between jaws, teeth, and craniofacial structures.
This document provides definitions and classifications related to esthetic dentistry and smile design. It discusses the key components of esthetic diagnosis and treatment planning, including patient history, clinical examination of facial features, occlusion, periodontal health, and teeth. Elements of smile design are outlined, including analyzing the dental midline, incisal lengths, tooth dimensions, gingival levels, and soft tissue components. Phonetic references that can help determine incisal edges and positions are also described. The goal is to understand all relevant factors for developing a comprehensive treatment plan to achieve an esthetic smile.
The document discusses various aspects of smile design and esthetics. It begins with definitions of esthetics and smile design. It then covers components of an esthetic smile including facial components like lips and dental components like teeth and gingiva. It describes classifications of smiles and properties of color. It also discusses topics like shade selection, esthetic treatment planning, contouring of teeth, and recent advances in smile design.
This document provides a summary of Part II of a two-part article on using facial keys for orthodontic diagnosis and treatment planning. It discusses 19 facial traits examined from the frontal and profile views to identify problems in the three planes of space. These traits include outline form, facial levels, midline alignments, facial thirds, lip lengths, tooth-lip relationships, and more. The document describes how to evaluate each trait and what orthodontic or surgical treatments may be needed to correct disproportions or asymmetries identified based on normal ranges. The goal is to use these facial examinations to accurately diagnose issues and plan treatments aimed at achieving functional occlusion and facial harmony.
This document discusses facial photograph analysis in orthodontic clinics. It begins by defining facial photograph analysis and explaining why photographic records are important. It then describes when analysis should be performed and the necessary clinical equipment. The document provides detailed instructions on the types of extra-oral and intra-oral photographs that should be taken, including frontal, profile, and occlusal views. It explains how to analyze the photographs, assessing proportions, symmetry, deformities, occlusal relationships, and soft tissue levels and contours.
Diagnosis and treatment planning in Orthognathic SurgeryAnil Narayanam
This document discusses diagnosis and treatment planning in orthognathic surgery. It begins with an introduction to malocclusions and their treatment options including orthodontics, dentoalveolar modifications, and orthognathic surgery. It then covers topics such as the history of orthognathic surgery, indications for surgery, patient evaluation including clinical exams, photographs, and cephalometric analysis, and treatment planning. Diagnosis involves assessing both hard and soft tissues to determine the appropriate surgical procedure and expected outcomes.
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
Smile is more than a form of communication; it is kind of socialization
and attraction. Although moderate gummy smile can be quite acceptable and
esthetically pleasing if the gum is healthy, more pronounced cases are
less well tolerated and require treatment.
T m diagnosis /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
This document discusses factors to consider when evaluating borderline cases in orthodontics that are between requiring extraction versus non-extraction treatment. It outlines various clinical examinations, cephalometric evaluations, and indices used to assess tooth-size arch length deficiency, lip prominence, curve of spee, and skeletal and dental variables to determine whether extraction is necessary to achieve functional occlusion or if non-extraction can be used. Borderline cases are defined as those with permanent dentition, healthy periodontium, normal anteroposterior maxilla-mandible relationship, and where extraction may be needed to obtain stable occlusion but could impact facial aesthetics.
Extra oral examination /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.
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
This orthodontic case presentation summarizes the treatment plan for a 15-year-old male patient with space between his upper and lower front teeth. The patient has a Class II skeletal pattern and incompetent thin lips. Key issues include poor oral hygiene, an overjet of 6 mm, crossbite of the upper left lateral incisor, and midline shifts. The proposed treatment plan is non-extraction camouflage using fixed appliances to correct the malocclusion through retroclining the upper incisors and maintaining a Class I molar and canine relationship. Retention includes upper and lower removable and permanent retainers.
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
This document discusses gummy smiles, which refer to excessive gingival display during smiling. It defines gummy smiles and outlines different types of smile lines. Normal gingival display during smiling is 1-2mm. Gummy smiles show more than 4mm of gingiva. The document explores the etiology of gummy smiles, including excessive gum tissue, hyperactive lip muscles, excessive jaw growth, gum disease, and congenital factors. It notes that gummy smiles are more common in females and tend to improve with age. The document provides a checklist for diagnosing and treating gummy smiles, including assessing lip position, tooth exposure, smile arc, tooth proportions, and lip morphology. It includes a case report example
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
Similar to Physiologic changes in smile and face with age (20)
The document discusses the biomechanics of space closure during orthodontic treatment. It covers topics such as determinants of space closure including axial inclination and midline discrepancies. It also discusses fundamentals of anchorage control including extraoral forces, intermaxillary elastics, and tipping movements. Additionally, it describes strategies for differential space closure such as applying different moment-to-force ratios to anterior vs. posterior teeth. The center of resistance during anterior retraction is also examined.
The document discusses occlusion and temporomandibular disorders. It begins with an introduction to the temporomandibular joint (TMJ) and its classification as a compound joint. The presentation then covers the anatomy of the TMJ including ligaments, muscles, the articular disc, movements, and examination. Common TMJ disorders are outlined such as hyperplasia and hypoplasia of the condyle. Treatment options for different disorders are mentioned. The document provides an overview of the structure, function and clinical aspects of the temporomandibular joint and disorders.
role of harmones and vitamins in craniofacial growth and developmentDeeksha Bhanotia
Growth and development of the craniofacial structures is influenced by hormones and vitamins. The pituitary gland secretes growth hormone which acts directly and indirectly to stimulate growth of the maxilla, mandible, and other bones. Studies have shown increased craniofacial growth in patients receiving long-term growth hormone therapy. Deficiencies or excess of growth hormone can result in conditions like dwarfism or gigantism with characteristic dental and skeletal features.
Removable appliances have several advantages including improved oral hygiene, less chair time, ability to do tipping movements and bite reduction, less strain on teeth. They require patient cooperation and have a greater risk of being misplaced. They work by applying single forces to tip teeth around their center of resistance. Key components are retentive elements like clasps to aid retention, active elements like springs and elastics to induce tooth movement, and a base plate for support. Patients must be instructed to wear appliances full-time and maintain oral hygiene.
This document discusses the management of open bite and crossbite under the guidance of Dr. Mridula Trehan. It defines open bite and classifies it based on location and tissues involved. Anterior open bite can be skeletal or dental in nature. Crossbite is classified based on location as anterior or posterior, and based on nature as skeletal, dental, or functional. Treatment depends on the type and includes appliances, elastics, expansion, and in severe skeletal cases, surgery. The goal is to address the underlying cause and intrude or prevent eruption of posterior teeth to correct the bite.
This document discusses the management of deep bites. It defines deep bite, classifies it as skeletal or dental, and outlines factors to consider in treatment. Skeletal deep bites are due to genetic or growth factors, while dental deep bites result from overerupted incisors or infraoccluded molars. Diagnosis involves clinical exams, models, and lateral cephs. Treatment may involve bite planes, myofunctional appliances, or fixed appliances to intrude incisors or extrude molars depending on the individual case. The goal is to achieve functional and aesthetic occlusion.
This document discusses preventive orthodontics and space maintainers. It begins by defining preventive orthodontics and distinguishing it from interceptive orthodontics. It then lists the advantages and disadvantages of preventive orthodontics. The document goes on to describe various preventive orthodontic procedures and space maintainer types, materials, indications, and factors to consider when planning space maintainers. The overall goal is to educate students on the principles and procedures of preventive orthodontics and space maintenance.
The document discusses retention and relapse after orthodontic treatment. It defines relapse as teeth returning to their original position after treatment. Relapse can be caused by bone adaptation, ligament traction, growth changes, muscular forces, failure to address the original cause, third molars, and occlusion issues. Retention aims to hold teeth in their corrected positions and allow tissues to remodel. It discusses different retention philosophies and types of retainers including removable retainers like Hawley, Begg, and Invisalign retainers as well as fixed retainers. The goal of retention is to stabilize teeth after active treatment.
This document discusses prostaglandins and their role in orthodontic tooth movement. It begins with an introduction to orthodontic tooth movement and the various chemical mediators involved, including prostaglandins. It then discusses how drugs can alter the rate of tooth movement, with prostaglandins and other substances like vitamin D and PTH increasing the rate, while NSAIDs and bisphosphonates decrease it. The document concludes by focusing on prostaglandins and their mechanism of action in accelerating orthodontic tooth movement.
This document discusses various orthodontic appliances used under the guidance of Dr. Mridula Trehan. It provides details on commonly used appliances like headgear, face mask, and chin cup. For headgear, it describes the components of the face bow assembly and different types of headgears based on the site of anchorage. Face mask is discussed in terms of its indications, parts, biomechanics and different types. Chin cup is summarized focusing on its principle, parts, types and fabrication process. Force magnitude and duration of wear for various appliances is also highlighted.
This document provides an overview of orthodontic appliances, including their classification, advantages, and disadvantages. It discusses removable appliances, fixed appliances, and the ideal requirements of an orthodontic appliance. Removable appliances are convenient but require patient cooperation, while fixed appliances do not rely on patient compliance but are more difficult for oral hygiene. The ideal appliance should cause desired tooth movement safely, apply controlled forces, and be esthetically acceptable.
MANAGEMENT OF CLASS II & CLASS III MALOCCLUSIONSDeeksha Bhanotia
This document discusses the management of Class II and Class III malocclusions. It describes the features, etiology, treatment objectives, and treatment approaches for Class II Division 1 and 2 malocclusions, including the use of growth modification, camouflage, and surgical correction. Treatment approaches discussed include myofunctional appliances, fixed functional appliances, and extractions. The document also covers the features, etiology, diagnosis, and interceptive and definitive treatment of Class III malocclusions, including the use of FR III, reverse pull headgear, and orthognathic surgery. It distinguishes true skeletal Class III malocclusions from pseudo Class III malocclusions caused by dental or functional factors.
This document discusses the evolution of smile visualization and quantification in orthodontics. It describes how orthodontics has shifted away from solely focusing on the profile and incorporating an analysis of the smile in three dimensions and over time. Dynamic video recordings are highlighted as an important record for understanding smile types and performing measurements of smile characteristics. Direct measurements of smile features are presented as an objective, biometric tool for smile analysis and treatment planning.
This document discusses various procedures and techniques for interceptive orthodontics, which aims to recognize and address developing malocclusions and irregularities in young patients. It describes serial extraction, which involves extracting teeth in a planned sequence to address crowding. It also covers topics like developing anterior crossbites, habits like thumb sucking, space regaining when teeth are extracted, muscle exercises, and intercepting skeletal issues like Class II or III malocclusions. The goal of interceptive orthodontics is to address orthodontic issues early before they worsen.
A 9-year-old female presented with an impacted maxillary right central incisor and canine. The crowns were surgically exposed and Multi-Purpose Attachments (MPAs) with hooks were bonded to apply light eruptive forces and align the teeth over 20 months. MPAs helped avoid soft tissue laceration during incisor eruption and prevented occlusal interference during canine retraction. At the 43-month follow-up, lingual retainers bonded to MPAs had successfully aligned and retained the impacted teeth.
This document provides information on fixed orthodontic appliances. It defines fixed appliances as those that cannot be removed by the patient and discusses their advantages like better control over tooth movement and disadvantages like difficulty maintaining oral hygiene. It describes different types of attachments used in fixed appliances like bands, brackets, and wires. It also covers indications, methods of fixing appliances, components, and techniques like edgewise and Begg appliances.
This document summarizes a presentation on facial asymmetry given by Dr. Deeksha Bhanotia. It discusses the etiology, classification, diagnosis, and management of facial asymmetry. Facial asymmetry can be caused by genetic factors like clefts or environmental factors like trauma. It is classified as dental, skeletal, muscular, or functional asymmetry. Diagnosis involves medical history, dental and facial evaluation, and radiographs. Management depends on the underlying cause and may involve orthodontic treatment and/or orthognathic surgery.
This document discusses cleft lip and palate, including its embryology, historical background, theories of formation, classification systems, etiology, and management. It notes that cleft lip and palate can be caused by hereditary factors, infections, drugs, radiation, or diets during pregnancy. The epidemiology section provides statistics on its prevalence among different racial groups and discusses associated factors like parental age and seasonal variations. Treatment involves a multidisciplinary approach depending on the type and severity of the cleft.
Dr. Deeksha Bhanotia is an assistant professor at a university. She has a PhD in computer science and has published several papers in top conferences in her field of artificial intelligence and machine learning. This document appears to be the header for Dr. Bhanotia including her name and credentials.
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Physiologic changes in smile and face with age
1. Physiologic changes in
smile and face with age
Presented by-
Dr. Deeksha Bhanotia (PG-1ST year)
Department of Orthodontics &
Dentofacial Orthopaedics
Under the guidance of –
Dr. Mridula Trehan (Professor & Head)
2. Introduction
History
Frontal Profile
Facial Form
Facial Symmetry
Midline Alignments
Transverse Facial Dimension
Vertical Relationship
Lip contour and relation
Ferreti- Reyneke Analysis
CONTENTS
Profile View
Facial Contour Angle
Nasolabial Angle
Labiomental Fold
Lip-Chin-Throat Angle
Throat Length
Nose
Orbit
Lip profile
Growth related soft tissue changes
Macro-esthetic evaluation
Micro-esthetic evaluation
Studies on Lips
Golden proportion of face
Soft tissue paradigm
Conclusion
References
3. INTRODUCTION
The clinical assessment of face is probably
the most valuable of all diagnostic
procedures.
The face is a complex and dynamic structure
comprising various soft tissue esthetic
subunits supported by bone & teeth.
Balance and proportion between the various
facial structures in individuals are more
important.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
4. •It is also important to compare the facial
proportion with the patient’s general build and
posture.
•The significance of soft tissue evaluation lies
in the importance of the role of the dentofacial
attractiveness.
•Combining orthodontics and orthognathic
surgeries, not only greatly enhances objectives
beyond merely the correction of malocclusion
but also aid in achieving the best esthetic
treatment outcomes for the patient.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
5. HISTORY
In 13th century
Thomas
Aquinas
expressed a
direct relation
between beauty
and
mathematical
numbers, the
“Fibonacci da
Pisa”
According to
him beauty
results from
dynamic
symmetry.
In 16th
century
Leonardo da
Vinci’s
panting of the
face contained
in a large
square and
further divided
into small
rectangles
was
interpreted as
geometric
recreation.
Edward
Angle
(1907)
believed
that ideal
occlusion
is
necessary
for
esthetics.
According to
Wuerpel, a face
is beautiful and
shows
harmonious
features if the
proportions of
its individual
components are
right, i.e no
individual
structure is over
emphasized in
relation to other
that is what he
refers to as
balance.
Turley, P. K. (2015). Evolution of esthetic considerations in orthodontics. Am J
Orthod Dentofac Orthop, 148(3), 374–379
6. FRONTAL PROFILE
Facial form
Facial symmetry
Midline alignment
Transverse facial dimension
Vertical relationship
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
7. FACIAL FORM
Widest dimension –
Bizygomatic width
Bigonial width –
30% less than bizygomatic dimension
• Females- 1.3:1
• Males- 1.35:1
Chin–
Smooth continuous, with lower border
of mandible
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
8. Reyneke, J. P., & Ferretti,C. (2012). ClinicalAssessment of the Face. Seminars in Orthodontics, 18(3), 172–186
9. FACIAL SYMMETRY
• Assess maxillary & mandibular
dental midlines with facial
midlines.
• Evaluate mandibular dental
midline in relation to midline of
chin – for correction of
mandibular asymmetries.
• Assessment of occlusal cant of
maxilla.
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
10. MIDLINE ALIGNMENTS
• Midlines are assessed with condyles
centered at fossa and first tooth
contact.
• Line through the philtrum of the
upper lip and the center of the nasal
bridge.
• Dentally, upper and lower incisor
midlines should also be assessed
relative to the midline of the face.
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
11. TRANSVERSE FACIAL
DIMENSIONS
• Rule of fifths
• Face is divided into five equal parts- each approximate
the width of eye, from helix of outer ear.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
12. OUTER FIFTH
Helix of ears to the
outer canthus of
the eyes.
Bat ears –
camouflaged by
appropriate
hairstyle.
MEDIAL TWO FIFTHS from outer to inner canthi of eyes
coincide with gonial angle of mandible.
Long & narrow face- gonial angle fall medial to this line.
Broad & square face – gonial angle lateral to this line.
MIDDLE FIFTH
lines through inner
canthus of eyes.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
13. Intercanthal
width should
be equal to alar
basal width
Width of nasal
dorsum should
be
approximately
half the alar
base width
Width of medial irides of the
eyes should coincide with
the corner of the mouth
Width and
shape of the
chin should be
in harmony
with rest of the
face
Gonion should
fall on the line
drawn through
the outer
canthus of eye
Bigonial width is usually 30%
less than the bizygomatic width
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
14. VERTICAL RELATIONSHIP
Upper third of face
Middle third of face
Lower third of face
Upper 1/3rd
Lower 2/3rd
Roman architect Vitruvius
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
15. Middle third of face
- affected by vertical dentofacial deformity
Upper third
- Deformity masked by appropriate hairstyle
- Deformity indicate a craniofacial syndrome.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
16. Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
17. Lower third
LOWER THIRD
• Middle to lower third vertical height =
5:6
• Decision between surgical/orthodontic
or only orthodontics depends upon
analysis of lower third of face.
• If the upper lip is short anatomically,
an increase in interlabial gap and
incisor exposure is seen with a normal
lower face height
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
18. Arnett and Bergman cite a more
quantitative evaluation of the thirds, with
the thirds to be between 55 and 65mm in
height.
Normal upper lip length
• Females 20 ± 2 mm
• Males 22 ± 2 mm
Normal lower lip length
• Females 40 ± 2 mm
• Males 44 ± 2 mm
subnasale
stomion superius
stomion inferius
menton
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
19. Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
20. The normal ratio between upper lip to lower lip is
1:2.1
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
21. Upper incisor exposure – lips at rest
The normal range is 1-5 mm.
Facial rejuvenation is achieved - 3-5 mm
Key measurement when planning surgical vertical
changes, aiming for a range of 3-5 mm post-surgically
Upper incisor and gingival tissue exposure – at smiling
exposure should be in the range of three quarters of the
central incisor crown length (about 8 mm) to 2 mm of
gingival tissue.
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
22. Closed lip position
• Reveals disharmony between skeletal and soft tissue lengths.
• With balanced lip and skeletal lengths, the lips should ideally
close from a relaxed, separated position without lip,
mentalis, or alar base strain
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
23. • Vig and Brundo reported a reduction in the
maxillary central incisor exposure of
approximately 3.4 mm as age increased from 30
years to 60 years.
Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent. 1978;39:502–504.
24. Evaluated in rest position
and smiling.
An interlabial gap of 0-4
mm and an upper-incisor
exposure of 1-4 mm are
considered optimal.
Lower lip -25% more
vermillion than the upper
lip.
Accentuated Cupid’s bow,
only the upper central
incisor may be visible
below the upper lip.
LIPS
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(3-12)
25. TYPES OF LIP
Competant lips – lip has good muscle tone, usually not
dry & is in gentle contact with or slightly apart from
lower lip.
Incompetant lip- upper lips are everted, flaccid & short
thus being unable to provide a good lip seal during
respiration & thereby allow mouth breathing.
Potentially incompetent – normal lips fail to form lip
seal due to proclined upper incisors. Ballard (1956 &
Tulley (1956))
Everted lips – hypertrophied and redundant lips with
weak muscular tonicity.
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(3-12)
26. Most lip incompetent children at the
age 6 experience “self correction of
lip incompetence by age 16.
Extraction therapy on facial profile is
more noticeable in female patients
than male patients.
Sarver DM. Esthetic Orthodontics and Orthognathic Surgery
27. Because lips do not thicken much during
puberty in females , any extraction
treatment plan for females with straight
to convex profile should be considered
with caution.
The analysis of the lip fullness on 12 to 13
years old males should also include the
fact that though the lips will become
thicker, the rate of nasal growth is
proportionally higher- lip fullness relative
to nose will decrease.
Sarver DM. Esthetic Orthodontics and Orthognathic Surgery
28. Tense lower lip
• The marked labial
position of upper
anterior teeth in
conjugation with
the resulting lower
lip dysfunction
(lower lip sucking)
is the cause of this
functional
disturbance
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(3-12)
29. Dysfunction of lips:-
Most common - Sucking or biting of lower lip, known as
mentalis habit because of crinkling ‘golf ball’ appearance of
the symphyseal tissue with excessive mentalis activity.
Upper lip biting – stress-strain-relief syndrome
Tongue function normal with hyperkinetic behavioural
activity and abnormal lip habit.
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(3-12)
30. FERRETTI–REYNEKE ANALYSIS
• Divides the face into 5 zones to facilitate a systematic
clinical evaluation in relation to treatment effects
Forehead zone
trichion (Tr) to glabella
(G).
Oculonasal zone
extends from glabella
(G) to nasal dorsum
and inferior orbital
foramen
Maxillary gnathic zone
extends from inferior
orbital foramen to
stomion (St).
Mandibular
gnathic zone extends
from stomion (St) to
the lower
border of the
mandible.
Genial zone extends
from labiomental fold
(LMF) to menton (M).
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
31. Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
32. PROFILE VIEW
Facial contour angle
Nasolabial angle
Labiomental fold
Lip-chin-throat angle
Throat length
Nose
Orbit
Lips
Chin
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
33. FACIAL CONTOUR ANGLE
• Pleasing facial profile
females -13 ± 4 degrees
males - 11 ± 4 degrees
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
34. Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
35. NASOLABIAL ANGLE
• Measured between upper lip and
columella at subnasale
• Normal range - 85 to 105 degree.
influenced by the position and angle
of the upper incisors and the
anatomy of the nasal columella.
William Arnett & Bergman. (1993). Facial keys to orthodontic diagnosis and treatment planning—part II.
Am J Orthod Dentofac Orthop, 103(5), 395–411.
36. Excessive
orthodontic
retraction of
the upper
incisors
Poor upper-
lip support
increased
nasolabial
angle.
early
wrinkling
and an aging
appearance
of the lip.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
37. LABIOMENTAL FOLD
• Intersection of lower lip and chin
• 120 ± 10 degrees
• The lower lip, the depths of the
labiomental fold, and the chin should
form a smooth and harmonious S-
shaped curve.
Reyneke, J. P., & Ferretti, C.
(2012). Clinical Assessment of the
Face. Seminars in Orthodontics,
18(3), 172–186
38. LIP-CHIN-THROAT ANGLE
• Angle between the lower
border of the chin and a line
connecting the lower lip and
soft-tissue pogonion.
• 100 and 120 degrees
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
39. THROAT LENGTH
• The distance from the throat-neck junction
to soft tissue menton
• 38-48mm
• Important parameter in diagnosis and
treatment planning for patients requiring
horizontal correction of mandibular and
chin deformities
Reyneke, J. P., & Ferretti, C. (2012). Clinical
Assessment of the Face. Seminars in
Orthodontics, 18(3), 172–186
40. • Projection of nasal bridge –
anterior to globes (5-8mm)
• The relationship between the
lengths of the nasal dorsum and
the projection of the nose can be
evaluated by the Goode method.
NOSE
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment
of the Face. Seminars in Orthodontics, 18(3), 172–186
41. Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
42. Vertical nasal length measures one-third of total face
height (distance hairline to gnathion).
Normally,
relationship between
vertical & horizontal
length of the nose is
2:1 as viewed from
the side
Microrhinic –
high root of
nose, short nasal
bridge &
elevated
Large nasal
profile: deep root
of nose, long
nasal bridge &
protruding lip.
Genecov JS, Sinclair PM, Dechow PC. Development of the nose and soft tissue profile. The Angle Orthodontist. 1990 Sep;60(3):191-8.
44. • Genecov demonstrated that nasal bone increased in
anterior projection from age 7 to 17 years as measured
to the S-N.
• Downward and forward growth of nose occurs during
maturity
• Vertical growth of nose is greater than anterio-
posterior growth
• For males growth spurts took place between 10 – 17
years and centered around 13 to 14 years
• Females, have steadier growth curve, till 12 years
Genecov JS, Sinclair PM, and Dechow PC. Development of the nose
and soft tissue profile. Angle Orthod:1990,60, (3), p. 191-198
45. • Angle’s Class II profile exhibits the more pronounced
elevation of the bridge of nose than those with normal
profile
• The configuration in Class II subjects usually follows the
general convexity of the Class II face.
Fig-9. Diagram showing growth and maturation of the nose in male and
female subjects.
Sarver DM. Esthetic Orthodontics and Orthognathic Surgery
46. ORBIT
Globes of the eye generally
project 0-2 mm ahead of the
infraorbital rims.
Lateral orbital rims lie 8-12 mm
behind the most anterior
projection of the globes.
The bridge of the nose should
be approximately 5-8 mm
ahead of the globes.
Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the Face. Seminars in Orthodontics, 18(3), 172–186
47. Lip step according to Korkhaus
Positive lip step
Protrusion of
lower lip in
relation to
upper lip
(class III)
Slight negative lip step
Marked negative lip
step
Marked
retrusion of
lower lip (class
II)
LIPS
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(17-18)
48. LIP PROFILE
Harmonious lip with
narrow mucosal element
Short upper lip with
narrow mucosal
element and disturbed
lip seal
Short cutaneous upper & lower
lip with undisturbed lip closure.
Lip insufficiency is
compensated by eversion of
mucosal part
Alam MK. A to Z Orthodontics. SoftTissue Morphology.Volume 5;(17-18)
49. CHIN
• Configuration of soft-tissue chin – determined by bone
structure & thickness & tone of mentalis muscle.
• Overdeveloped chin height, causes hyperactivity of
mentalis muscle, alters the position of lower lip &
interferes with lip closure.
Macari AT, Hanna AE. Comparisons of soft tissue chin thickness in adult patients with various
mandibular divergence patterns. Angle Orthodontist. 2014 Jul;84(4):708-14.
50. Degree of chin
formation has
marked influence
on entire profile.
Protruding chin
with a marked
mentolabial
sulcus, causing a
retruded lip
profile.
Negative chin
formation with
absence of
mentolabial
sulcus, causing
a protruded lip
profile.
Macari AT, Hanna AE. Comparisons of soft tissue chin thickness in adult patients with various
mandibular divergence patterns. Angle Orthodontist. 2014 Jul;84(4):708-14.
51. The chin (Genecov AO 1990)
• 7 – 9 yrs -- Soft tissue chin thickness in females (11.7mm)
is greater than males (10.8 mm)
• 9 – 17 -- Females had 1.7 mm increase
Males had 2.4 mm increase
Genecov JS, Sinclair PM, and Dechow PC. Development of the nose and soft tissue profile.
Angle Orthod:1990,60, (3), p. 191-198
52. MACRO ESTHETIC EVALUATION
1. Short lower facial height
2. Lip incompetance of 5mm.
3. Convex profile with mandibular deficiency.
4. It is etiology of the Class II malocclusion.
Sarver D. Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic
diagnosis and treatment planning. Am J Orthod Dent Orthop. 2015;148(3):380-386.
53. 1. Philtrum height of 15 mm
2. Maxillary incisor display of 8mm at rest
3. Maxillary central incisor display of 8mm on
smiling.
4. Gingival display of 7mm on smiling
5. Retroclined maxillary incisor in compensation
for the mandibular deficiency.
6. A consonant smile arc
Sarver D. Interactions of hard tissues, soft tissues, and growth over time, and their impact on
orthodontic diagnosis and treatment planning. Am J Orthod Dent Orthop. 2015;148(3):380-386.
MINI – ESTHETIC EXAMINATION
54. • Crown height of 8mm
• Incomplete eruption or passive eruption
• A thick periodontal phenotype
Sarver D. Interactions of hard tissues, soft tissues, and growth over time, and their impact on
orthodontic diagnosis and treatment planning. Am J Orthod Dent Orthop. 2015;148(3):380-386.
56. • Mamandras observed that the maxillary and mandibular
lips, under the influence of growth, increase in length
and width with the advancement of age.
• The length and thickness of the lips of the male subjects
exhibited greater increase both proportionally and
numerically than the corresponding dimensions of female
lips.
Mamandras A. Linear changes of the maxillary and mandibular lips. American Journal of
Orthodontics and Dentofacial Orthopedics. 1988;94(5):405-410.
57. • Vig and Cohen indicated that vertical lip growth goes
beyond the skeletal growth.
• Vertical skeletal and dentoalveolar growth (LAFH) in
adolescence between ages 4-20 generally concluded before
completion of vertical lip length.
• Both upper and lower lips grew more than the skeletal
lower face.
• In both absolute and proportional terms the lower lip grew
vertically more than the upper lip.
Vig P, Cohen A. Vertical growth of the lips: A serial cephalometric study. AJODO 1979;75(4):405-415.
58. • Nanda reported that upper lip height increases,
male- 19.8 to 22.5 mm
female – 19.1 to 20.2 mm
Lower lip height increased by
-- male – 4.2mm
-- female – 1.5mm
Nanda reported that upper lip thickness in point A increased,
- Male –from 12.5 to 17.2mm
- Females – 11.4 to 14.9 mm
Nanda R. Growth changes in the soft tissue facial profile. Angle Orthod. 1989;60(3):177-190.
59. • Upper lip thickness at labrale superious increased,
- Males – 13.9 to 17.1mm
- Females – 11.8 to 12.5mm
Lower lip thickness at labrale inferius increased,
- Males – by 2.4mm
- Females – by 1.4mm
Lower lip thickness at point B increased,
- Males – 2.8mm
- Females – 1.6mm
Nanda R. Growth changes in the soft tissue facial profile. Angle Orthod. 1989;60(3):177-190.
60. GOLDEN PROPORTION OF FACE
• Divine proportion – in human body – by Leonardo da
vinci.
• If width of face is 1, then distance from top of the head
to chin is 1.618(phi/divine proportion).
• Divine proportion – seen in facial width as well as
height.
• Perfect face – 1:1.618
Kharbanda OP. Orthodontics Diagnosis and management of malocclusion and dentofacial deformities. 2nd ed.
New Delhi: Elsevier; 2013.p.147-158
61. • Ideal facial proportion – universal, regardless of
race, age & sex
• If the width of face from check to cheek is 10
inches, then the length of face from top of head to
bottom of chin should be 16.18 to be in ideal
proportion.
Fitzgerald JP.Nanda RS, Currier GF. AN evaluation of the nasolabial angle and the relative
inclination of the nose and upper lip. Am J Orthod Dentofacial Orthop 1992:102(4):328-34
62. For an orthodontist who is planning his treatment to
modify facial appearance it is important to know the
changes that will usually occur within the soft tissue
profile as a consequence of growth. (Subtelny, 1961)
Skeletal foundation-
A good starting point in the interpretation of the facial
form has been in the evaluation of the position of the
skeletal chin. The chin with growth assumes a more
forward position relative to the forehead and rest of the
face.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
63. During the growth span from childhood to adulthood, the
maxillary jaw tends to become less protrusive relative to
the rest of the skeletal profile.
Hence the skeletal profile becomes less convex with
growth.
Point B does not change after 9 years of age, hence the
supposed delineation between the mandibular alveolar
process and skeletal bone remains stable.
The supporting skeletal bases however continue to grow
and change in antero-posterior relationship.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
65. The position of the integumental chin is very closely
related to the skeletal chin.
Soft tissue landmarks overlying the skeletal landmarks do
not show the same pattern of change as that was observed
for the bony profile.
There is a greater increase in the thickness of the soft
tissue covering the maxillary jaw than in the soft tissue
covering the mandibular symphysis and the forehead area.
THE SOFT TISSUE PROFILE
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
66. • The difference in the forward growth of the bony chin
carrying its overlying soft tissue and the comparatively
reduced forward growth of the anterior part of the bony
maxillary jaw, seems to be partially compensated by this
differential in the increase in soft tissue thickness
covering the upper face.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
67. It is important to consider the growth of the nose and its
influence on the soft tissue profile.
The greater proportion of forward growth of the nose
compared to the other soft tissues will increase its projection
relative to the total profile.
1- 1.33mm increase in overall length per year.
The growth of the lips follows the general growth curve for
muscle in the body.
The upper and lower lips gradually increase in length.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
69. • The increase in length of the lips was found to take
place until 15years of age.
• Greater thickness of the lips was attained in the
vermillion regions as compared to the regions
overlying the points A and B.
• The position of the lips is strongly dependent on the
position of the underlying dento-alveolar complex.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
70. • The changes in the basic position of the soft tissue nose
and chin occur mainly due to growth and there is little
the orthodontist can do to modify them.
• Soft tissue chin- modifying skeletal mandibular growth
by functional appliances.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
71. • On the other hand the lip contour can be modified while
changing dento-alveolar position.
• Whereas growth does not usually alter the relationship
between points A and B, orthodontic procedures can alter
their spatial relationship as well as the position of teeth.
• With the changes in the position of the teeth and alveolar
position come changes in the lip position and contour.
Subtelny.The soft tissue profile, growth and treatment changes. AO 1961;331:105-22
72. • Changes in five soft tissue parameters that are
commonly used by orthodontic practitioners in
their diagnosis and treatment planning as well as in
their evaluation of profile changes that occur with
growth and orthodontic treatment.
Bishara S, Jakobsen J, Hession T, Treder J. Soft tissue profile changes from 5 to 45 years of age.
Am J Orthod and Dentofac Orthop. 1998;114(6):698-706.
73. THE SOFT TISSUE PARADIGM
• With soft tissue paradigm, the increased focus on clinical
examination rather than examination of dental casts and
radiographs leads to a different approach to obtain
important diagnostic information, used to develop
treatment plans that would not have been considered
without it.
Ackerman, J. L., Proffit, W. R., & Sarver, D. M. (1999).The emerging soft tissue paradigm in
orthodontic diagnosis and treatment planning. Clinical Orthodontics and Research, 2(2), 49–52
74. Difference of soft tissue paradigm in
treatment planning
1. Primary goal of treatment – soft tissue relationship &
adaptation, not Angle’s ideal classification.
Soft tissue adaptation to position of teeth.
Determine whether the orthodontic result will be stable.
2. Secondary goal- functional occlusion.
to arrange the occlusion to minimize the chance of injury.
3. Broader focus on facial & soft tissues, to determine how
the teeth & jaws would have to be arranged to meet the
soft tissue goal.
Ackerman, J. L., Proffit, W. R., & Sarver, D. M. (1999).The emerging soft tissue paradigm in
orthodontic diagnosis and treatment planning. Clinical Orthodontics and Research, 2(2), 49–52
75. Proffit W, Fields H, Sarver D. Contemporary orthodontics. 5th ed. St. Louis, Mo.: Elsevier/Mosby; 2013.(4-5)
76. CONCLUSION
• Relying on cephalometric dentoskeletal analysis for
treatment planning can sometimes lead to esthetic
problems especially when the orthodontist tries to
predict the soft tissue outcome using only hard tissue
normal values.
• Facial esthetics however do not rely solely on hard
tissue, as soft tissue dimensions vary as a result of the
thickness of the tissue, lip length and postural tone.
Bergman, R. T. (1999). Cephalometric soft tissue facial analysis. Am J Orthod Dentofac Orthop,
77. • It is therefore necessary to study the soft tissue contour to
adequately assess facial harmony.
• Good occlusion does not necessarily mean good facial
balance.
• With a knowledge of the standard facial traits and the
patient’s soft tissue features individualized norms can be
established.
Bergman, R. T. (1999). Cephalometric soft tissue facial analysis. Am J Orthod Dentofac Orthop,
78. REFERNCES
• Reyneke, J. P., & Ferretti, C. (2012). Clinical Assessment of the
Face. Seminars in Orthodontics, 18(3), 172–186
• Turley, P. K. (2015). Evolution of esthetic considerations
in orthodontics. Am J Orthod Dentofac Orthop, 148(3), 374–379
• William Arnett & Bergman. (1993). Facial keys to orthodontic
diagnosis and treatment planning—part II. Am J Orthod Dentofac
Orthop, 103(5), 395–411.
• Vig RG, Brundo GC. The kinetics of anterior tooth display. J
Prosthet Dent. 1978;39:502–504.
• Alam MK. A to Z Orthodontics. Soft Tissue Morphology. Volume
5;(3-12)
79. • Genecov JS, Sinclair PM, Dechow PC. Development of the nose
and soft tissue profile. The Angle Orthodontist. 1990
Sep;60(3):191-8.
• Macari AT, Hanna AE. Comparisons of soft tissue chin thickness in
adult patients with various mandibular divergence patterns. Angle
Orthodontist. 2014 Jul;84(4):708-14.
• Sarver D. Interactions of hard tissues, soft tissues, and growth over
time, and their impact on orthodontic diagnosis and treatment
planning. Am J Orthod Dent Orthop. 2015;148(3):380-386.
• Mamandras A. Linear changes of the maxillary and mandibular
lips. American Journal of Orthodontics and Dentofacial
Orthopedics. 1988;94(5):405-410.
• Nanda R. Growth changes in the soft tissue facial profile. Angle
Orthod. 1989;60(3):177-190.
• Kharbanda OP. Orthodontics Diagnosis and management of
malocclusion and dentofacial deformities. 2nd ed. New Delhi:
Elsevier; 2013.p.147-158
80. • Fitzgerald JP.Nanda RS, Currier GF. AN evaluation of the
nasolabial angle and the relative inclination of the nose and upper
lip. Am J Orthod Dentofacial Orthop 1992:102(4):328-34
• Subtelny.The soft tissue profile, growth and treatment changes.
AO 1961;331:105-22
• Bishara S, Jakobsen J, Hession T, Treder J. Soft tissue profile
changes from 5 to 45 years of age. Am J Orthod and Dentofac
Orthop. 1998;114(6):698-706.
• Ackerman, J. L., Proffit, W. R., & Sarver, D. M. (1999). The
emerging soft tissue paradigm in orthodontic diagnosis and
treatment planning. Clinical Orthodontics and Research, 2(2), 49–
52
• Proffit W, Fields H, Sarver D. Contemporary orthodontics. 5th ed.
St. Louis, Mo.: Elsevier/Mosby; 2013.(4-5)
• Bergman, R. T. (1999). Cephalometric soft tissue facial analysis.
Am J Orthod Dentofac Orthop, 116(4), 373–389
Editor's Notes
When smiling, exposure of the full crown of the upper incisors is considered pleasing.
Redundant- excess of tissue
Analysis of lips – Schwartz,rickets,steiner,holdaway
A number of lip muscle anormalities have been identified
Upper lip biting – seen among school children
Facial evaluation is not the search for deviation from the norm of a single subunit but the search for proportion.
A vertically excessive face means it is excessive in relation to its transverse dimension, not that it is longer than the norm.
anteroposterior relationship between the forehead (glabella), the midface (subnasale), and the chin (pogonion)
Indication of facial convexity or concavity
The angle is recorded above subnasale and expressed as negative when the angle is ahead of the upper facial plane (in convex profiles) and as positive when the angle is behind the upper facial plane (usually in concave profiles).
An overclosed bite - result in an acute angle
Hanging columella of the nose - increase the angle
Measured atnatural head posture
Convex nose- aquiline nose
Crooked nose – from previous trauma, deviation of nasal pyramid from median line
Upper lip protrudes slightly in relation to lower lip
7 to 18 years
Integumental chin – softissue covering chin
Soft tissue paradigm states that both the goals & limitations in modern orthodontics and orthognathic treatment are determined by the soft tissue of the face, not by the teeth & bone.
Paradigm – a set of shared belief and assumption that represent the conceptual foundation of an area of science.
It acknowledges maximum benefit for the patient,ideal occlusion cannot always be major goal of treatment plan.
Soft tissue proportion of face & relationship of dentition to lips & face – major determinant of facial appearance.