Soft Tissue Cephalometric Norms Research Articles

Residents' journal review

Residents' journal review

Soft Tissue Cephalometric Norms for Orthognathic and Cosmetic Surgery

Proportionality of the lower and middle thirds of the face is a key determinant of successful orthognathic treatment. A flatter profile and marked variance of the soft tissue envelope in the Japanese population complicates the accurate assessment of these proportions. This study aimed to identify gender differences and establish norms for Japanese young adults using the method of soft tissue cephalometric analysis (STCA) by Arnett et al (Am J Orthod Dentofacial Orthop 116:239, 1999). Lateral cephalograms of 49 young normal Japanese subjects (19 men, 30 women) were selected from the archival records and analyzed with STCA. The Student t test was used to compare mean values of the male and female groups. Significant differences were found between women and men. Men had a flatter occlusal plane and a more acute nasolabial angle than women. Men showed larger values for upper and lower lip thickness, menton soft tissue thickness, and vertical face length, especially in the lower third of the face. Women had a more projected midface than men. Compared with established STCA norms, the Japanese have more midfacial projection. Significant gender differences were found in the thickness, lower third length, and midface projection in Japanese young adults, which should be taken into account when interpreting measurements for orthognathic surgical planning. These differences can serve as norms for STCA in young Japanese adults. Differences were noted between the reference values of Arnett et al and Japanese subjects.

Soft tissue Cephalometric Norms for Orthognathic Surgery

Cephalometric norms are different for different ethnie groups. They help making the deformity assessment and surgical planning procedures more appropriate for a particular individual. Hence, the present study was aimed at the development of the soft tissue cephalometric norms for orthognathic surgery for north India. The study sample consisted of fifty adult males and fifty adult females. Standardized lateral cephalogram was taken, traced and analysed for each subject. The statistical analysis involved calculation of mean and standard deviation for thirteen parameters. This data was compared with that reported by Legan and co-workersl using Normal (z) test. Male and female subjects were also compared with each other. For male subjects, all the parameters except facial convexity angle, lower vertical height to depth ratio, nasolabial angle and vertical lip chin ratio; the statistical difference varied from highly significant to most highly significant. For female subjects, five parameters viz. facial convexity angle, maxillary prognathism, lower vertical height to depth ratio, nasolabial angle and maximum incisor exposure have not been found to be significantly different from Legan and co-worker's datai. For all the remaining parameters, the statistical difference varied from highly significant to most highly significant. Comparison between male and females also led to distinctive differences. The soft tissue cephalometric norms for orthognathic surgery were derived for the population of eastern Uttar Pradesh region of north India. Hence, while planning combined orthodontic-orthognathic surgical approach for this particular population, it appears more appropriate to use the norms as developed or modified in the present study.

A cephalometric investigation of horizontal lip position in adult Nigerians

The aims of this study were to (1) identify soft tissue cephalometric norms for horizontal lip position in an adult Nigerian population; (2) compare values for Nigerian males and females; and (3) compare Nigerian norms with established norms for Caucasians and other populations. A cross-sectional descriptive study. Lagos University Teaching Hospital Dental Clinic, Idi-araba, Lagos, Nigeria. One hundred students (44 males and 56 females) of the College of Medicine, University of Lagos, aged 18-25 years, of Nigerian ancestry, with a normal class I occlusion and no facial asymmetry. Lateral cephalometric radiographs of the subjects were taken in natural head position. Radiographs were manually traced and 11 soft tissue cephalometric parameters measured. These were derived from the Steiner, Ricketts, Burstone, Merrifield and Holdaway soft tissue analyses. Male and female values were compared using Student's t-test with a level of significance at P<0·05. Statistically significant differences were observed between Nigerian males and females in eight of the variables studied, with males having more protrusive upper and lower lips than the females. Variables, which did not vary by sex, were soft tissue facial angle, nose prominence and soft tissue chin thickness. In addition, Nigerian norms were higher than norms reported by Steiner, Ricketts, Burstone and Holdaway for Caucasian populations, while the Z-angle was lower than the norm established by Merrifield. Gender-specific soft tissue norms for horizontal lip position should be used for orthodontic treatment planning in Nigerian subjects. Nigerians have more protrusive upper and lower lips compared to Caucasians.

Soft-tissue cephalometric norms for north Indian Mongoloids

IntroductionHarmonious facial esthetics and functional occlusion have long been recognized as the two most important goals of orthodontic treatment. The purpose of this study was: (1) To establish soft tissue cephalometric norms for Mongoloid tribes of north India using Holdaway analysis. (2) To study the sexual dimorphism in soft tissue cephalometric norms of this population. (3) To compare the norms obtained in this study with Holdaway norms. MethodsLateral cephalometric radiographs of 60 north Indian Mongoloid subjects (30 male, 30 female) in the age group of 18–25years with normal occlusion and well balanced faces were used. The cephalograms were analyzed with Holdaway soft tissue cephalometric analysis. Unpaired t-test was used to compare results obtained for Mongoloid subjects with Holdaway norms and to determine sexual dimorphism. ResultsStatistically significant differences were found for nose prominence, superior sulcus depth, soft tissue subnasale to H-line, basic upper lip thickness, max incisor to upper lip, H-angle, lower lip to H-line and soft tissue chin thickness. In comparison of sexes, statistically significant differences were found for basic upper lip thickness, max incisor to upper lip and H-angle. ConclusionThese results show that the soft tissue facial profile of north Indian Mongoloid subjects and North-Europeans are different. These racial differences must be considered during diagnosis and treatment planning.

Soft Tissue Cephalometric Norms of Malabar Population in Northern Kerala: An Epidemiologic Study

Aim: Malabar population is an amalgam of various religious communities sharing the same rich cultural heritage, tradition and language. Soft tissue cephalometric norms of Indians exhibit considerable variability and differ from inhabitants of one state to another in India. No soft tissue study has been conducted for the Malabar population of Northern Kerala. The aim of this study is to formulate soft tissue norms for the population of this area. Materials and methods: Subjects in the age group of 18 to 28 years were checked for their cephalometric parameters. These measurements were then compared with the normal values of the Caucasian population. Statistical comparisons were made using students 't' -test. p value <0.05 was set as statistically significant. Results: Malabar population has a protrusive profile when compared to the Caucasian population as indicated by an increase in the values of lower lip to H-line, skeletal convexity, upper and lower lip to the Ricketts-E plane and H angle. The lip protrusion that is present was found to be acceptable because of the prominent nose and chin. Conclusion: When planning treatment for the Malabar population, it is not always necessary to have an orthognathic profile in mind. A slightly protrusive profile may sometimes be more acceptable when compared to the Caucasian population. Clinical significance: Planning for facial esthetics is both a science and an art, which requires clinical capability, right judgment and skill to evaluate the esthetic needs of an individual. This study will serve to highlight the fact that beauty of the face encompasses all of its segments in harmony; however, interracial characteristics differ in harmonious relationships.

Soft-tissue cephalometric norms in a north Indian ethnic population.

Background:Soft tissues play the primary role of physical appearance and facial esthetics. This study aimed to establish soft-tissue cephalometric standards in North Indian adults, which can be used in diagnosis, treatment planning, and stability of orthodontic outcome and orthognathic patients.Materials and Methods:A group of 60 individuals (30 males and 30 females) with normal occlusion and proportional facial profile were chosen. For the entire chosen sample, lateral cephalograms were obtained. Standard values of 11 soft-tissue measurements were determined.Results:Soft-tissue measurements showed that men had greater soft-tissue facial angle (92.10°) than women (89.92°). Also, they had more nose prominence (18.10 mm) than women (16.44 mm). Skeletal profile convexity (A to N-pog) of men (0.40 mm) was less than women (1.76 mm). Basic upper lip thickness was higher in men (16.60 mm) compared to women (14.24 mm), while H-angle was higher in women (16.68°) as compared to men (14.30°). In the lower face area, inferior sulcus to the H line distance was more in men (7.30 mm) than women (4.80 mm). Men had greater soft-tissue chin thickness (14.10 mm) than women (12.84 mm).Conclusion:The differences in soft-tissue cephalometric norms between men and women of North Indian faces were established, so the orthodontist or surgeon must individualize treatment planning, using local norms as the reference.

Soft-tissue cephalometric norms for the Lambada population in Telangana Region of Andhra Pradesh

Facial contours were traditionally considered to be the result of positioning of underlying hard tissue followed by the soft tissue. However, current trend shows a paradigm shift from the conventional hard tissue analysis to also include both hard- and soft-tissue analysis. The objective of our study was to determine the soft-tissue cephalometric norms for the Lambada population, to define gender differences and to correlate the variables, skeletal convexity (SC), and H angle (HA). Fifty subjects of Lambada ethnic group between 18 and 26 years old, grouped into 25 males and 25 females were taken. Their lateral cephalograms were obtained and analyzed using Holdaway's analysis. Descriptive statistics and the student's t-test were used. Soft-tissue facial angle (SFA), superior sulcus depth (SSD), lower lip to H line (LL-H), and soft-tissue subnasale to H line (S-H) were well within the range given by Holdaway. The variable, lip strain showed that the upper denture is protrusive (P<0.001). Skeletal convexity and HA were significantly correlated in the female sample. HA revealed that a slightly more protrusive profile was acceptable for this ethnic group. Although established Caucasian norms are applicable to the Lambada ethnic tribe, few parameters like basic upper lip thickness (ULT) and upper lip strain (ULS), skeletal convexity, inferior sulcus to H line (LS-H) were significantly different. The male group exhibited straighter profile, thicker lips, prominent nose, deep mentolabial sulcus, and a prominent chin than females. The differences could be considered in diagnosis and treatment planning for orthodontic practice and for orthognathic surgery.

Soft tissue cephalometric norms for a North Indian population group using Legan and Burstone analysis

Cephalometric norms are used for providing guidance to clinicians during diagnosis and treatment planning. Most classical norms are not applicable to diverse racial and ethnic population hence the purpose of this study was to establish the soft tissue norms of a North Indian population group using Legan and Burstone soft tissue analysis. The study was conducted on 60 adult subjects with esthetically pleasing profiles aged 18-25 years. Standardized lateral cephalograms were taken in a natural head position and analyzed. North Indians were found to have more convex faces, protrusive lips and acute nasolabial angles compared with Caucasians. Males had more convex faces and protrusive lips than females. This North Indian population group had significant deviations from the Caucasian standards. Considerable diversity was also found for some of the soft tissue variables in males and females.

Soft Tissue Morphology of Jordanian Adolescents

To determine soft tissue cephalometric norms of a sample of Jordanian adolescents and to compare them with those of North Americans. Forty-one subjects aged 14 to 17 years were selected from a larger random and representative sample of 320 adolescents attending 12 schools in the capital of Jordan, Amman. Seven reference lines were identified and traced according to definitions by Holdaway and Ricketts, and 2 angular and 12 linear measurements were analyzed. Significant differences were found between males and females in measurements of soft tissue facial angle, H angle, subnasale to H line, basic upper lip thickness, upper lip thickness and labrale inferius and superius to E line (P < .05). Males had a more prominent upper lip in relation to the overall soft tissue profile, while the lips of females were considerably more retrusive in relation to the nose and chin. Jordanian norms were similar to those of North Americans, with only two exceptions: the H angle and skeletal convexity which were 5.4 degrees and 3.2 mm greater in Jordanians, respectively. Jordanian soft tissue norms were similar to American norms with the exception of the former having a more prominent upper lip position in relation to the overall soft tissue profile.

Soft-tissue cephalometric norms in a South Indian ethnic population

An esthetically pleasing smile is a key determinant of successful orthodontic treatment and patient satisfaction. The great variance in soft-tissue drape of the human face complicates accurate assessment of the soft-tissue profile. Variability is also characteristic of different faces and facial types, and normative data based on 1 population group do not represent all. This study was undertaken to establish norms for a South Indian ethnic population. The sample comprised lateral cephalograms taken in natural head position of 60 normal subjects (30 men, 30 women). The cephalograms were analyzed with a soft-tissue cephalometric analysis for orthodontic diagnosis and treatment planning, and the Student t test was used to compare the means of the 2 groups. Statistically significant differences were found between South Indian men and women in certain key parameters. Men have thicker soft-tissue structures and a more acute nasolabial angle than women. Men have longer faces, and women have greater interlabial gap and maxillary incisor exposure. Men have more deep-set facial structures than women. Compared with established norms for white people, South Indian subjects have more deep-set midfacial structures and more protrusive dentitions. Statistically significant differences were found between South Indian men and women in certain key parameters. Differences were also noted between white and South Indian faces.

Soft-tissue cephalometric norms in Yemeni men

The main purpose of this study was to develop soft-tissue cephalometric standards for Yemeni men and compare them with the cephalometric standards of normal North American white people. Fifty Yemeni men (ages, 20-27 years; mean, 23.1 years) with normal occlusion were selected. With double selection by orthodontists and laypersons, a subsample of esthetically pleasing subjects was selected. Lateral cephalometric radiographs of all subjects were analyzed according to the Legan-Burstone and the Holdaway analyses. The Yemeni esthetically pleasing subjects (YPG) and the remaining subjects (YNG) showed significant differences with respect to mandibular prognathism, lower face-throat angle, nasolabial angle, mentolabial sulcus depth, and interlabial gap, when compared with the Legan-Burstone norms for white Americans; the YPG also had significantly less obtuse facial convexity angle than the YNG. Most values of both Yemeni groups were generally within the range of the values reported by Holdaway, except for 3 variables: skeletal profile convexity, basic upper-lip thickness, and H-angle, which were all significantly larger than those of Holdaway; the YPG showed less skeletal profile convexity than the YNG. These results show that the soft-tissue facial profiles of white Yemenis and Americans are different in certain respects; these racial differences must be considered during diagnosis and treatment planning. These results should serve as a useful reference for orthodontists and maxillofacial surgeons who treat Yemeni patients and also contribute to more satisfactory diagnosis and treatment planning for them.

Soft tissue cephalometric norms for orthognathic surgery in Indian adults

Orthognathic surgery has become very popular worldwide as well as in India as an integral part of correction of Dentofacial Deformities. The successful treatment of the orthognathic surgical patients is dependent on careful diagnosis and treatment planning. Cephalometrics is a valuable tool with many applications towards this end. Cephalometric analysis confirms the diagnosis of hard and soft tissue deformities and helps in simulating surgery by use of acetate overlays. They are used by the clinicians to communicate with each other and also to educate the patients. Detailed Cephalometric analysis for orthognathic surgery has been reported by Burstone at el. (1978) for hard tissues and by Legan and Burstone (1980) for soft tissues with norms derived from the white population. It has been well established that there are structural differences between different racial populations. Hence, the direct application of the Caucasian norms for the Indian population is erroneous with high probability for misguidance. The Hard Tissue norms for COGS have already been established for Indian Population by us. The current study discusses the norms for the soft tissue parameters of COGS derived from Indian samples considered to have ideal dentofacial aesthetics.

Soft tissue cephalometric norms in Japanese adults

Lateral soft tissue cephalometric standards of Japanese normal adults were developed with the use of Ricketts, Epker, Holdaway, and Legan cephalometric analyses. Cephalometric radiographs of 211 Japanese normal adults were analyzed, and the soft tissue measurements were compared with those of an esthetically pleasant Japanese subgroup and white adult sample. Statistically significant differences were found in the Japanese sample when compared with the white norms. On the other hand, the soft tissue mean values of the Japanese supernormal group were similar to the white norms, with the exception of the nasolabial angle and the lip prominence. Soft tissue cephalometric norms are specific for ethnic groups, but these values should not be interpreted as treatment goals. Normative data represent an aid for the diagnosis and planning of orthodontic treatment and orthognathic surgery. (Am J Orthod Dentofacial Orthop 2000;118:84-9)

Soft-tissue cephalometric norms in Chinese adults with esthetic facial profiles

Using a double selection process comprised of professional and lay judges, the cephalometric tracings on a final sample of 48 Chinese adults with esthetically pleasing profiles were analyzed. The soft-tissue cephalometric norms and standard deviations of two widely accepted soft-tissue analyses, the Legan and Burstone analysis and the Holdaway analysis, were determined. In comparison with white norms, the Chinese nose was less prominent ( P < .01), the nasolabial angle was less obtuse ( P < .01), both the upper and lower lips were more protrusive ( P < .05), the upper lip curvature was greater ( P < .01), and the soft-tissue chin thickness was less ( P < .05). This variance between racial types emphasizes the need to recognize that soft-tissue lateral cephalometric norms are specific for the racial group and cannot always be applied across different racial types.

Discussion: Soft-tissue cephalometric norms in Chinese adults with esthetic facial profiles

Discussion: Soft-tissue cephalometric norms in Chinese adults with esthetic facial profiles