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Background: This study aimed to investigate the facial soft tissue characteristics of patients with different types of malocclusion., Methods: The 3dMD scanning data of patients with malocclusion admitted to our hospital from January 2018 to April 2022 were analyzed retrospectively. Forty-seven patients with Class I malocclusion, 43 patients with Class II malocclusion and 44 patients with Class III malocclusion were selected. All patients underwent 3dMD scans prior to orthodontic treatment. Then the differences in the 3D morphological parameters of the facial soft tissues were compared between different sexes and different types of malocclusion. Spearman's correlation was further used to analyze the correlation between each parameter and the classification of malocclusion., Results: In the Class I group and Class II group, there were no significant differences in the 3D morphometric parameters of malocclusion patients of different sexes (P > 0.05). There were significant differences between Al (R)-AL (L), Ac (R)-Ac (L), Prn-Ac (L), n-Prn-Sn, and Al (R)-Al (L)/Ac (L)-Ah (L) values among the three groups of patients. Spearman correlation analysis showed that Ac (R)-Ac (L) and Al (R)-Al (L)/Ac (R)-Ac (L) were correlated with the type of malocclusion., Conclusion: Differences in facial soft tissues exist in patients with Class I, II, and III malocclusion. 3dMD technique may be helpful in developing an effective treatment plan prior to orthodontic treatment., (© 2024. The Author(s).)

Background: The aim of the study was to assess the thickness of the soft tissue facial profile (STFP) in relation to the skeletal malocclusion, age and gender., Methods: All patients, aged 7-35 years, who were seeking orthodontic treatment at the Department of Orthodontics, Medical University of Warsaw between 2019 and 22 were included in the study. All patients had lateral head radiographs taken before the treatment. The cephalometric analysis was performed including the STFP analysis. The patients were allocated to one of six groups based on age and skeletal relations (ANB angle). The minimum number of patients in each group was 60 with equal gender distribution. The STFP analysis included ten linear measurements., Results: A total of 300 patients were included in the study and allocated to five groups. Group 6 (growing patients with skeletal Class III malocclusion) was not included in the study as it failed to achieve the assumed group size. There were significant differences in the thickness of the STFP in relation to the skeletal malocclusions. Adults with skeletal Class III malocclusion had significantly thicker subnasal soft tissues compared to patients with skeletal Class I and Class II malocclusions. The thickness of the lower lip in patients with Class II skeletal malocclusion was significantly bigger compared to the other groups. Children and adolescents with Class II malocclusions had thicker lower lip in comparison to the group with Class I malocclusion. The majority of the STFP measurements were significantly smaller in children and adolescents compared to adults. The thickness of the STFP in males was significantly bigger in all age groups compared to females., Conclusions: The thickness of facial soft tissues depends on the patient's age and gender. The degree of compensation of the skeletal malocclusion in the STFP may be a decisive factor during orthodontic treatment planning regarding a surgical approach or a camouflage treatment of skeletal defects., (© 2024. The Author(s).)

Facial photographs of the subjects are often used in the diagnosis process of orthognathic surgery. The aim of this study was to determine whether convolutional neural networks (CNNs) can judge soft tissue profiles requiring orthognathic surgery using facial photographs alone. 822 subjects with dentofacial dysmorphosis and / or malocclusion were included. Facial photographs of front and right side were taken from all patients. Subjects who did not need orthognathic surgery were classified as Group I (411 subjects). Group II (411 subjects) was set up for cases requiring surgery. CNNs of VGG19 was used for machine learning. 366 of the total 410 data were correctly classified, yielding 89.3% accuracy. The values of accuracy, precision, recall, and F1 scores were 0.893, 0.912, 0.867, and 0.889, respectively. As a result of this study, it was found that CNNs can judge soft tissue profiles requiring orthognathic surgery relatively accurately with the photographs alone.

Introduction: Discrepancy of the upper dental midline to the facial midline plays an important role in smile aesthetic assessment. This study presents different reference points to quantify the deviation of upper dental midline to the facial midline in 2D frontal photographs. The aim was to find the most accurate, precise, and practical reference points to measure dental midline discrepancy in 2D photographs., Methodology: A modified headset with a protractor was developed in order to achieve photographs in nine standardised head positions. Six reference points were used to detect the facial midline in the 2D photographs (eyebrows "EB", inner-canthus of the eyes "ICE", alae of the nose "AN", columella "C", nasolabial folds "NLF", and the philtrum "PH"). The deviation of the maxillary dental midline from the facial midline was measured and compared with clinical measurements., Statistical Analysis: Standard deviations (SD), Root Mean Square Error (RMSE), Method of Moments' Estimator (MME), 2-way repeated measures ANOVA, and multi-level linear model were used to estimate the true errors., Results: The different reference points responded significantly differently to changes in head position and all showed measurement errors, which increased with greater head rotation. Alae of the nose showed the least measurement error and the greatest precision in all head positions., Conclusion: The alae of the nose are the recommended reference points to identify the facial midline in order to quantify dental midline deviation from frontal photographs., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Turner syndrome is associated with an X chromosome abnormality in women and is characterized by infantilism, congenital webbed neck, and cubitus valgus. The aim of this study was to determine the maxillofacial morphology and oral characteristics of Japanese girls (mean age, 8.5 years) with Turner syndrome and early mixed dentition. Lateral cephalograms obtained at the first visit were used to analyze maxillofacial morphology. Oral characteristics were identified using orthopantomograms, intraoral photographs, and study casts. All patients received growth hormone. Lateral cephalograms showed a retrognathic maxilla and mandible and a small gonial angle. Nine patients had a high-arched palate. Nine patients had class II first molar relationship occlusion and one had mesial step-type occlusion. Three patients showed ectopic eruption of the maxillary first permanent molar accompanied by resorption of the maxillary second primary molar. Eruption of the permanent teeth tended to occur early. The median mesiodistal diameter of the maxillary central incisor was smaller than the Japanese norm. Ectopic eruption of the maxillary first permanent molar may be caused by lack of eruption space and a discrepancy between bone growth and timing of tooth maturation., (© 2018 Japanese Teratology Society.)

Blepharocheilodontic (BCD) syndrome is a rare condition characterized by bilateral cleft lip and palate (BCLP), eyelid abnormalities, and oligodontia. Despite orofacial clefting and oligodontia being central features of the condition, detailed reports of dental and craniofacial characteristics are scarce. The aim of this study was to analyze the dental and craniofacial features in a group of patients with BCD syndrome (three of which were related). Cephalometric radiographic analyses were performed on BCD syndrome patients (all radiographs taken at age 8 years) and compared to 40 randomly selected age-matched controls (20 non-syndromic BCLP, 20 non-cleft). Also, we assessed clinical records, photographs, dental study casts, and dental radiographs to determine the extent and pattern of tooth agenesis, dental morphology and malocclusion. BCD syndrome patients showed a very severe skeletal III malocclusion (maxillary-mandibular sagittal discrepancy) and reduced anterior lower face measurement compared to non-syndromic BCLP and non-cleft controls (P = 0.001, P = 0.027). All patients exhibited oligodontia (mean number of missing permanent teeth 13.7, range 7-17). All patients exhibited missing upper central and lateral incisor, upper canine and premolar teeth. Variations in dental morphology included taurodontism, conical-shaped teeth, and notching of the incisal edges. All patients had a short and narrow maxilla which translated into anterior and posterior cross bites. We conclude that, in our BCD syndrome group, the craniofacial skeletal defects are more severe than patients with BCLP. The pattern of tooth agenesis is unusual as it included teeth that are normally highly resistant to agenesis, namely upper central incisor and canine teeth. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Background and Purpose: Cephalometric and arch measurements might predict the occurrence of a palatally-displaced impacted maxillary canine (PDC). Despite their clinical importance, studies in this regard are limited and controversial., Methods: In this case-control study, 35 PDC patients and 77 controls aged over 13 years were examined. Eleven cephalometric measurements: N-S, ANS-PNS, ANS-N, S-N-ANS, facial angle (FH/NPog), SNA, SNB, Y-axis (SN/SGn), gonial angle, Go-Gn/SN, and Jarabak Index were performed. The maxillary and mandibular intermolar and interpremolar widths were measured. Patients' sagittal skeletal relationships and centric occlusions (molar) were measured by radiographic and cast examinations. The differences between the two groups in terms of the above-mentioned cephalometric and anatomic variables were assessed using Chi 2 and Mann-Whitney U-tests (α=0.05)., Results: Chi 2 showed a significant negative association between dentoalveolar class I (molar) and PDC occurrence (P=0.018), but not between PDC and skeletal sagittal relationships. Facial angle (FH/NPog) and Y-axis (SN/SGn) were more obtuse in patients with PDC (P<0.05). No arch dimensions differed between the two groups., Conclusions: PDC tends to accompany molar class II/III but is not associated with upper or lower jaw widths or lengths. Vertical dimensions might be smaller in PDC patients. Some variables were inconclusive and need future assessments., (Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The objective of the present study is to examine the craniofacial development of patients with Down syndrome (DS) and compare them with a neurotypical population., Methods: This study is a cross-sectional analysis of lateral cephalometric radiographs of participants with DS. The study population consisted of children and young adults with DS aged 3-25 years. Cephalometric data were summarized by age and sex. Raw and normalized z-scores were computed. One-sample t tests were used to test whether mean z-scores differed from zero. The demographic characteristics between those with or without lateral cephalograms among all study participants were compared by Fisher's exact tests., Results: The study sample comprised of 27 participants with DS. Study subjects demonstrated a class III skeletal pattern. This was more pronounced in the older age groups as compared to younger age groups. Subjects also had an increased proportionate lower anterior face height to total facial height compared to normative standards. Gonial angles, mandibular plane angles, and airway measurements increased with age., Conclusions: Patients with Down syndrome present typically with class III skeletal pattern and long lower anterior facial heights. In patients with Down syndrome, comprehensive phase of orthodontic treatment may be best initiated following cessation of growth.

Objective: In recent years, the golden proportions have been evaluated by various researchers in the general population and orthodontic patients to establish their correlation with facial attractiveness and esthetics, but with conflicting results. The present study aimed to analyze the frontal facial golden proportions for three groups of young adult females, an attractive group, and two malocclusion groups. Our null hypothesis stated that the golden proportions of attractive females were analogous with or closer to the golden number than those with an established malocclusion., Materials and Methods: Frontal facial photographs of 80 female dental students were scored for facial attractiveness by 10 dental specialists. Thirty females with scores greater than the median score of 48 formed the attractive group. Thirteen females with Class I malocclusion and 15 females with Class II division 1 malocclusion formed the two malocclusion groups. Ten landmarks and 19 golden proportions were calculated for all subjects. One-way ANOVA and unpaired Student's t-test was used to analyze the differences in golden proportions between the attractive and malocclusion groups., Results: Significant differences were observed for 10 proportions (P<0.04 to <0.0001). Five vertical proportions showed significant differences in both subgroups; Attractive versus Class I and Attractive versus Class II division 1; while one vertical and all transverse proportions showed significant differences only in Attractive versus Class II division 1 subgroup. The average values of these proportions varied both toward and away from the golden number for both attractive and malocclusion groups., Conclusion: Facial proportions of the attractive females were significantly different from those with malocclusion, but did not show a constant trend of being closer to the golden number. Furthermore, the golden proportions were not analogous with the facial esthetics of the attractive females.

Introduction: The correction of a deviated midline can involve complicated mechanics and a protracted treatment. The threshold below which midline deviations are considered acceptable might depend on multiple factors. The objective of this study was to evaluate the effect of facial type on laypersons' perceptions of various degrees of midline deviation., Methods: Smiling photographs of male and female subjects were altered to create 3 facial type variations (euryprosopic, mesoprosopic, and leptoprosopic) and deviations in the midline ranging from 0.0 to 4.0 mm. Evaluators rated the overall attractiveness and acceptability of each photograph., Results: Data were collected from 160 raters. The overall threshold for the acceptability of a midline deviation was 2.92 ± 1.10 mm, with the threshold for the male subject significantly lower than that for the female subject. The euryprosopic facial type showed no decrease in mean attractiveness until the deviations were 2 mm or more. All other facial types were rated as decreasingly attractive from 1 mm onward. Among all facial types, the attractiveness of the male subject was only affected at deviations of 2 mm or greater; for the female subject, the attractiveness scores were significantly decreased at 1 mm. The mesoprosopic facial type was most attractive for the male subject but was the least attractive for the female subject., Conclusions: Facial type and sex may affect the thresholds at which a midline deviation is detected and above which a midline deviation is considered unacceptable. Both the euryprosopic facial type and male sex were associated with higher levels of attractiveness at relatively small levels of deviations., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Evidence-based practice in oral and maxillofacial surgery would greatly benefit from an objective assessment of facial harmony or gestalt. Normal reference faces have previously been introduced, but they describe harmony in facial form as an average only and fail to report on harmonic variations found between non-dysmorphic faces. In this work, facial harmony, in all its complexity, is defined using a face-space, which describes all possible variations within a non-dysmorphic population; this was sampled here, based on 400 healthy subjects. Subsequently, dysmorphometrics, which involves the measurement of morphological abnormalities, is employed to construct the normal-equivalent within the given face-space of a presented dysmorphic face. The normal-equivalent can be seen as a synthetic identical but unaffected twin that is a patient-specific and population-based normal. It is used to extract objective scores of facial discordancy. This technique, along with a comparing approach, was used on healthy subjects to establish ranges of discordancy that are accepted to be normal, as well as on two patient examples before and after surgical intervention. The specificity of the presented normal-equivalent approach was confirmed by correctly attributing abnormality and providing regional depictions of the known dysmorphologies. Furthermore, it proved to be superior to the comparing approach., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion.

Objective: To compare the cephalometric and intraoral characteristics between Long Face pattern and Pattern I patients, besides evaluating associations between subjective facial patterns, cephalometric facial patterns and the intraoral characteristics., Methods: Through evaluation of frontal and right side extraoral photographs, three previously calibrated and experienced examiners selected 30 Long Face patients (Group 1) and 30 Pattern I patients (Group 2), aged between 9 and 19 years, of both genders. The cephalometric characteristics were assessed by the following variables: SN.GoGn, NS.Gn, AIFH, SNA, SNB, ANB, 1.1, 1.NA,1-NA, 1.NB, 1-NB, NA.Po, nasolabial angle and H-Nose. Clinical evaluations were also performed to determine the presence of posterior crossbite, anterior open bite and type of Angle's malocclusion. The cephalometric data were compared by independent t test. The chi-square test was used to evaluate the association between qualitative variables., Results: Significant differences were observed between groups regarding the variables SN.GoGn, NS.Gn, AIFH, ANB, NA.Pog, 1-NA, 1.NB and 1-NB, with an increase of these measures in Group 1. There were also significant differences between groups on variable 1.1, being lower in Group 1 than in Group 2., Conclusions: The Long Face was associated to Angle Class II malocclusion, to the presence of posterior crossbite and to anterior open bite. The Long Face subjective facial pattern was associated to dolichofacial cephalometric pattern.

Introduction: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern., Objectives: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parameters are the mostreliable. Material and methods. Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern.These teleradiographies have been performed cephalometric analysis, which includelower incisor position belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway., Study Design: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results. The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane., Conclusions: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern.

Objective: To get individualized facial three-dimensional finite element (FE) model from transformation of a generic one to assist orthodontic analysis and prediction of treatment-related morphological change of facial soft tissue., Methods: A generic three-dimensional FE model of craniofacial soft and hard tissue was constructed based on a volunteer's spiral CT data. Seven pairs of main peri-oral muscles were constructed based on a combination of CT image and anatomical method. Individualized model could be obtained through transformation of the generic model based on selection of corresponding anatomical landmarks and radial basis functions (RBF) method. Validation was analyzed through superimposition of the transformed model and cone-beam CT (CBCT) reconstruction data. Pre- and post-treatment CBCT data of two patients were collected, which were superimposed to gain the amount of anterior teeth retraction and anterior alveolar surface remodeling that could be used as boundary condition. Different values of Poisson ratio ν and Young's modulus E were tested during simulation., Results: Average deviation was 0.47 mm and 0.75 mm in the soft and hard tissue respectively. It could be decreased to a range of +0.29 mm and -0.21 mm after a second transformation at the lip-mouth region. The best correspondence between simulation and post-treatment result was found with elastic properties of soft tissues defined as follows. Poisson ratio ν for skin, muscle and fat being set as 0.45 while Young's modulus being set as 90.0 kPa, 6.2 kPa and 2.0 kPa respectively., Conclusions: Individualized three-dimensional facial FE model could be obtained through mathematical model transformation. With boundary condition defined according to treatment plan such FE model could be used to analyze the effect of orthodontic treatment on facial soft tissue.

In this study, we evaluated the three-dimensional (3D) soft tissue configuration of Japanese females with/without jaw deformity in order to establish the polygonal view of facial soft tissue deformity three-dimensionally. A polygonal chart was applied to assess the outcomes of orthognathic surgery for patients with mandibular hyperplasia with/without deviation. The study included 20 Japanese females with mandibular hyperplasia with/without deviation. All patients received mandibular setback surgery, and 3D measurements were carried out pre-operation, and at 1, 3 and 6 months postoperatively using a non-contact laser scanning system. Eighteen soft tissue landmarks were set on each 3D image and used to calculate a set of selected parameters. As controls, 20 Japanese females with class I occlusion were included. A polygonal chart was constructed based on the mean and S.D. of the control group. Patients with mandibular protrusion characteristically demonstrated significant variances in the items around the lower face. In asymmetric patients, deviation in the mental area disappeared postoperatively, but a small deviation remained when compared to the controls. The method used in this study seems to be a useful index for diagnosis and as a treatment plan for patients with mandibular hyperplasia with/without deviation., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the relation between adenoid hypertrophy and facial morphology across age in a pediatric population., Setting and Sample Population: The American University of Beirut Department of Otolaryngology. Two-hundred consecutive children (age 6.00 ± 2.62 years) referred from the Pediatric Otolaryngology unit to the Orthodontic division and requiring a lateral cephalogram for adenoid hypertrophy assessment., Methods: Cephalometric measurements included relations among cranial base, maxilla and mandible, and airway clearance measured from adenoid to soft palate (AD). The children were classified into two age groups, Group 1: ≤ 6 years (n = 124) and Group 2: ≥ 6.01 years (n = 76), and also stratified in four subgroups (A, B, C, D) based on maxillo-mandibular divergence (palatal to mandibular plane angle, PP-MP): A- PP-MP ≤ 27.5°, n = 34; B- 27.5° < PP-MP ≤ 32°, n = 68; C- 32°

Introduction: Beckwith-Wiedemann syndrome (BWS) is a genetic disorder characterized by exomphalos, macroglossia and gigantism. Previous studies reported a wide variation in the skeletal and occlusal characteristics in individuals affected by BWS. However, these studies were performed by analyzing both individuals who had and those had not received a glossectomy, which has a high impact on the jaw growth and occlusion. To highlight the intrinsic characteristics of BWS, 7 Japanese affected individuals without glossectomy were analyzed in this study., Methods: Seven individuals who had been diagnosed with BWS by medical specialists and had not undergone glossectomy were analyzed. Cephalograms and dental casts were taken and systemic complications were recorded at the first visit., Results: Individuals uniformly showed a higher birth height and weight, macroglossia, large anterior cranial base, and mandibular body. They exhibited a wide dental arch and an anterior open bite due to the undererupted and proclined anterior teeth. A wide variation was seen in the gonial angle, but the facial height was large overall., Conclusions: As intrinsic characteristics of BWS, individuals exhibited macroglossia resulting in an anterior open bite and a wide dental arch. A long facial height and an enlarged anterior cranial base and mandibular body were also noted., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: To evaluate the role of the posed smile in overall facial esthetics, as determined by laypersons and orthodontists., Materials and Methods: Twenty orthodontists and 20 lay evaluators were asked to perform six Q-sorts on different photographs of 48 white female subjects. The six Q-sorts consisted of three different photographs for each of two time points (pre- and posttreatment), as follows: (1) smile-only, (2) face without the smile, and (3) face with the smile. The evaluators determined a split-line for attractive and unattractive images at the end of each Q-sort. The proportions of attractive patients were compared across Q-sorts using a Wilcoxon signed-rank test for paired data. The evaluators also ranked nine facial/dental characteristics at the completion of the six Q-sorts., Results: Evaluators found the pretreatment face without the smile to be significantly more attractive than the face with the smile or the smile-only photographs. Dissimilar results were seen posttreatment; there was not a significant difference between the three posttreatment photographs. The two panels agreed on the proportion of "attractive" subjects but differed on the attractiveness level of each individual subject., Conclusions: The presence of a malocclusion has a negative impact on facial attractiveness. Orthodontic correction of a malocclusion affects overall facial esthetics positively. Laypeople and orthodontists agree on what is attractive. Overall facial harmony is the most important characteristic used in deciding facial attractiveness.

Objective: To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA)., Materials and Methods: Subjects were 120 adult Malays aged 18 to 65 years (mean +/- standard deviation [SD], 33.2 +/- 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test., Results: Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m2 +/- 6.5) than for the control group (22.7 kg/m2 +/- 3.5; P < .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm +/- 6.02; 129.1 mm Hg +/- 17.55) than for the control group (35.6 cm +/- 3.52; 114.1 mm Hg +/- 13.67; P < .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P < .05), but no significant difference in palatal shape was found., Conclusion: The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.

Although there have been some reports on the relationship between craniofacial morphology and the activity of the temporal muscle attached to the coronoid process, such relationship is still unclear. The aim of the present study was therefore to investigate the relationship between the coronoid process and overall craniofacial morphology using lateral cephalograms of 60 female subjects (mean age 9.6 years) without mandibular deviation. Statistical testing was undertaken using stepwise regression analysis. Anterior coronoid marginal depth correlated negatively (r = 0.71) with gonial angle, SNA, and overjet. The coronoid angle also correlated negatively (r = 0.86) with both the vertical and horizontal lengths from sella to the coronoid tip as well as with the horizontal length from sella to the posterior ramus margin. Furthermore, the coronoid length correlated positively (r = 0.61) with the coronoid angle and the anterior coronoid marginal depth. The coronoid width was also positively (r = 0.69) correlated with overbite. Coronoid process morphology is related not only to mandibular morphology and position but also to maxillary position and the dental relationship in the anterior region. It therefore seems clear that coronoid process morphology might be related to temporal muscle functioning and its associated craniofacial morphological measurements.

The aim of this study was to assess, by means of lateral cephalometric radiographs, any differences in the pretreatment soft and hard tissue facial profiles of patients who relatively recently underwent orthognathic surgery compared with those whose surgery occurred 20 years before. The pretreatment soft and hard tissue profiles of 91 orthognathic surgery patients were analyzed. These patients were divided into 2 groups. The first group consisted of 35 patients that were treated within the period from 1982 to 1986. The second group included 56 patients treated between 2000 and 2002. To assess patients' hard and soft tissue profiles, 4 cephalometric variables were evaluated on their pretreatment lateral cephalograms. For each of the 4 variables used, the patients were divided into one of 3 different profile subgroups: orthognathic, retrognathic, or prognathic profile. According to the distribution of profiles in each of the 2 groups, a qualitative comparison was made. Descriptive statistics and chi-squared tests were performed to access the possible differences at P < .05. By comparing pretreatment facial profiles between the 2 groups using the soft and hard tissue measurements, it was demonstrated that some changes actually occurred over the years. These differences in the profiles between the 2 groups indicated that orthodontic-surgical patients treated more recently exhibited smaller deviations from the norm than those treated in the earlier period. These findings may reflect possible changes in what is currently considered to be acceptable.

There is a clearly established relationship between masticatory muscle structure and facial form. Human studies in this area, however, have been limited, especially in consideration of the myosin heavy chain (MyHC) family of contractile proteins. The aim of this pilot study was to assess if differences were detectable between genotype with respect to MyHC isoforms and the vertical facial phenotype in a sample of nine Caucasian female patients, age range 18-49 years, using a novel rapid technique. Masseter muscle biopsies were taken from patients with a range of vertical facial form. The levels of expression of the MyHC isoform genes MYH 1, 2, 3, 6, 7, and 8 were compared with the expression in a female calibrator patient aged 23 years with normal vertical facial form, using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. Statistical analysis was undertaken using Pearson correlation coefficient. The results showed that there were distinct differences in gene expression between patients with a wide range of variation although changes in MYH1 were consistent with one cephalometric variable, the maxillo-mandibular angle. The full procedure, from start to finish, can be completed within half a day. Rapid genotyping of patients in this way could reveal important information of relevance to treatment. This technology has potential as a diagnostic and prognostic aid when considering correction of certain malocclusions.

Introduction: In orthodontics, facial esthetics is assumed to be related to golden proportions apparent in the ideal human face. The aim of the study was to analyze the putative relationship between facial esthetics and golden proportions in white adolescents., Methods: Seventy-six adult laypeople evaluated sets of photographs of 64 adolescents on a visual analog scale (VAS) from 0 to 100. The facial esthetic value of each subject was calculated as a mean VAS score. Three observers recorded the position of 13 facial landmarks included in 19 putative golden proportions, based on the golden proportions as defined by Ricketts. The proportions and each proportion's deviation from the golden target (1.618) were calculated. This deviation was then related to the VAS scores., Results: Only 4 of the 19 proportions had a significant negative correlation with the VAS scores, indicating that beautiful faces showed less deviation from the golden standard than less beautiful faces. Together, these variables explained only 16% of the variance., Conclusions: Few golden proportions have a significant relationship with facial esthetics in adolescents. The explained variance of these variables is too small to be of clinical importance.

Aim: Kabuki make-up Syndrome is so named because of the characteristic facies of the affected patient. The face is similar to a Kabuki actor's mask. The main aim of this report was to describe the oral features in Kabuki Syndrome, focusing on the tooth anomalies., Patients and Methods: Five subjects with Kabuki Syndrome, identified by the Child Neuropsychiatric Clinic of the University of Sassari, Italy, were enrolled. Their medical records were reviewed and oral and dental examinations were completed. The diagnosis was based upon the typical pattern of malformations and dysmorphic features reviewed by Matsumoto and Niikawa., Results: All patients showed typical characteristics of the Syndrome such as a long palpebral fissure, lower palpebral eversion, arched eyebrows, short nasal septum, prominent and large ears, fingertip pads, mental retardation, and paramedian elevation of the lower lip., Conclusion: Kabuki make-up Syndrome is of unknown origin but a genetic aetiopathogenesis has been proposed. It is extremely rare; in Japan, where it is most frequent, it affects 1:32000 newborns. The typical facies of the syndrome, combined with general medical and dental examinations, are very important for diagnosis confirmation.

Objective: To evaluate and compare the anteroposterior relationship of the maxillary central incisors to the forehead in adult white females with harmonious profiles and in adult white female orthodontic patients., Materials and Methods: Ninety-four photographic images of adult white females with good facial harmony (control sample) were compared with 94 photographs of adult white females seeking orthodontic treatment (study sample). All images were of the face in profile with the maxillary central incisors and the forehead in full view. The images were scanned, resized, and rotated to the upright head position. Reference lines were constructed to assess the anteroposterior positions of the maxillary central incisors as well as forehead inclinations., Results: In the control sample, 93% had maxillary central incisors positioned between the FFA point and glabella, 4% posterior to the FFA point, and 3% anterior to glabella. The positions of the maxillary central incisors were strongly correlated with forehead inclination (r2 = .642). In the study sample, 21% had maxillary central incisors positioned between the FFA point and glabella, 64% posterior to the FFA point, and 15% anterior to glabella. The positions of the maxillary central incisors were poorly correlated with forehead inclination (r2 = .094). The difference between the means for anteroposterior maxillary incisor position was statistically significant (P = .0001)., Conclusion: The forehead is an important landmark for anteroposterior maxillary incisor positioning for adult white female patients seeking improved facial harmony.

The objective of this study was to investigate whether it is possible to use a lateral (profile) photograph to determine the underlying skeletal Class and which reference points of the angle of convexity are most suitable for this purpose. Profile photographs and lateral cephalographs included in the baseline data for 180 orthodontic patients were retrospectively evaluated. The subjects were assigned to skeletal Classes based on Wits values obtained by radiolographic analysis. The Class I subjects were 58 patients (22 males, 36 females) with an average age of 13.63 +/- 2.1 years, the Class II subjects 60 patients (37 males, 23 females) with an average age of 13.60 +/- 2.6 years, and the Class III subjects 62 patients (28 males, 34 females) with an average age of 11.65 +/- 3.3 years. The angles measured were A'OrB' (=POrA'-POrA'), A'N'B', and the angle of convexity with its variants (N'SnPog', N'A'Pog', TrSnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). These angles were statistically evaluated using a two-sided t-test and linear discriminant analysis. Class II and Class III subjects exhibited highly significant differences (P < 0.001) for all angles. Class I and Class III exhibited highly significant differences (P < 0.001) for almost all angles, and significant differences for A'N'B' (P < 0.05). Class I and Class II differed significantly (P < 0.05) only for some angles (N'SnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). The error within the linear discriminant analysis was smallest for N'SnPog', GlA'Pog', and TrA'Pog' angles. However, the method error according to Dahlberg yielded rather high values for all angles (1.07-1.17 degrees). Discrimination between skeletal Class I and Class III was easier than that between Class I and Class II. One of the reasons may be that the subclasses division I and division II were not distinguished within the Class II subjects.

Tricho-rhino-phalangeal syndrome (TRPS) is a rare and an autosomal dominant disorder having the following characteristics: slowly growing sparse hair, medially thick and laterally thin eyebrows, bulbous tip of the nose, long flat philtrum and thin upper lip with vermilion border, protruding ears, cone-shaped epiphyses and swelling. Our report intends to introduce TRPS to the dental literature and to present oral, clinical and radiological data of a patient with TRPS. A rare association of supernumerary teeth was also diagnosed and one of them was extracted as it impeded on the eruption path of left premolar tooth.

Introduction: The objective of this study was to evaluate the outcome of standard edgewise orthodontic treatment with extraction of 4 first molars (6xT group) or Tweed edgewise treatment with extraction of 4 first premolars (4xT group)., Materials and Methods: A cephalometric analysis that isolated tipping and bodily tooth movements of the maxillary and mandibular incisors and measured vertical skeletal changes in the anterior region of the maxilla and mandible was used. Thirty subjects treated by 10 practitioners comprised the 6xT group, whereas 31 subjects treated in the Case Western Reserve University orthodontic clinic were used in the 4xT group. Control groups (6xC and 4xC) were selected from untreated subjects enrolled in the Bolton-Brush Growth Study and were matched on age and gender. Data were collected before (T1) and after (T2) treatment., Results: Analysis of the data showed no statistically significant changes between 6xT and 6xC for any of the variables studied. An increase in overbite of 2.1 mm in the 6xT group was the result of small but clinically significant changes in both tipping and extrusion of maxillary and mandibular incisors. In the 4xT group, statistically and clinically significant changes were observed for intrusion of the maxillary and mandibular incisors, resulting in a 4.1-mm decrease in overbite. Importantly, both the 6xT and the 4xT groups showed no increase in mandibular vertical height during treatment., Conclusion: Both treatment strategies showed good control of vertical mandibular growth. Bodily intrusion of anterior teeth was the main contributor to correction of deep overbite in the Tweed edgewise sample.

Objective: The aim of this study is to determine correlations between the parameters of body posture in the sagittal profile and sagittal jaw position by obtaining objective and valid three-dimensional measurements of the dorsal profile by means of rasterstereography., Materials and Methods: Fifty-three adults with Class II or III malocclusions were examined, and six angular parameters were determined. For the sagittal analysis of body posture, the Fleche Cervicale and Lombaire as well as trunk inclination were evaluated., Results: Statistically significant correlations (P < .05) were found between Facial Axis and Fleche Cervicale, Mandibular Plane angle and Fleche Cervicale, and Facial Depth and the Fleche Cervicale., Conclusions: It can be concluded that the mandible seems to have a greater effect on body posture than other craniofacial parameters. As a clinical result of this study, patients with severe malocclusions should be examined interdisciplinarily before orthognathic surgery is performed to minimize postural influence on the altered jaw relationship after surgery.

Aim: To evaluate the accuracy of the 3-dimensional laser scanner and to propose reproducible soft tissue landmarks in the 3-dimensional facial images., Methods: A mannequin head was preliminarily scanned 6 times to calculate scanning errors. Mean errors in the linear measurements from the scanned images and the actual mannequin head were assessed and the magnification rate of the scanned images was calculated. The soft tissue landmarks were defined in the mannequin head and the patients with normal, Class II, and Class III malocclusions. The reliability and the reproducibility were investigated by comparing the x-, y-, and z-coordinate of each landmark gained from repeated landmarking procedure., Results: Scanning errors were 0.16 mm in the x axis, 0.15 mm in the y axis, and 0.15 mm in the z axis. The mean error of scanned image was 0.37 mm and the magnification rate was 0.66%. In the four 3-dimensional images, the standard deviations in the localization of all landmarks were less than 1.0 mm in the x, y, and z axes., Conclusion: The laser scanner is a useful tool for understanding the 3-dimensional facial structure, and the soft tissue landmarks proposed in this study were considered highly reproducible and reliable.

A total of 117 patients with European appearance, orthognatic bite and without noticeable signs of face asymmetry were examined. A modified analysis method was used for anterior-posterior teleroentgenograms (TRG). According to the TRG data, the tables with average meanings of cephalometric signs were made up.

Introduction: The aim of this study was to compare the assessments of Chinese facial profile attractiveness by orthodontists and oral surgeons., Methods: The sample comprised 31 dental professionals (20 orthodontists, 11 oral surgeons) in an Asian community. Facial profile photographs and lateral cephalometric radiographs of 2 Chinese adults (1 man, 1 woman) with normal profiles, Class I incisor relationships, and Class I skeletal patterns were digitized. The digital images were modified by altering cephalometric skeletal and dental hard tissue Chinese normative values in increments of 2 standard deviations in the anteroposterior plane to obtain 7 facial profiles for each sex. The images were bimaxillary protrusion, protrusive mandible, retrusive mandible, normal profile (Class I incisor with Class I skeletal pattern), retrusive maxilla, protrusive maxilla, and bimaxillary retrusion. The Mann-Whitney U test was used to determine professional differences in assessment. Multiple regression analysis was performed with age, professional status, sex, and number of years in practice as independent variables., Results and Conclusions: A strong correlation was found in the profile assessment between orthodontists and oral surgeons. Normal and bimaxillary retrusive Chinese male and female profiles were judged to be highly attractive by orthodontists and oral surgeons. Chinese male and female profiles with protrusive mandibles were judged the least attractive. There was a difference in professional opinion about the most attractive male profile (P < .05), with orthodontists preferring a flatter profile and oral surgeons preferring a fuller normal Chinese profile. Sex of dental professionals and number of years in clinical practice were found to affect profile rankings.

Background: The influence of muscle forces and associated physiologic behaviors on dental and skeletal development is well recognized but difficult to quantify because of the limited understanding of the interrelationships between physiologic and other mechanisms during growth., Methods: The purpose of this study was to characterize fiber-type composition of masseter muscle in 44 subjects during surgical correction of malocclusion. Four fiber types were identified after immunostaining of biopsy sections with myosin heavy chain-specific antibodies, and the average fiber diameter and percentage of muscle occupancy of the fiber types were determined in each of 6 subject groups (Class II or Class III and open bite, normal bite, or deepbite). A 2 x 3 x 4 analysis of variance was used to determine significant differences between mean areas for fiber types, vertical relationships, and sagittal relationships., Results: There were significant differences in percentage of occupancy of fiber types in masseter muscle in bite groups with different vertical dimensions. Type I fiber occupancy increased in open bites, and conversely, type II fiber occupancy increased in deepbites. The association between sagittal jaw relationships and mean fiber area was less strong, but, in the Class III group, the average fiber area was significantly different between the open bite, normal bite, and deepbite subjects. In the Class III subjects, type I and I/II hybrid fiber areas were greatly increased in subjects with deepbite., Conclusions: Given the variation between subjects in fiber areas and fiber numbers, larger subject populations will be needed to demonstrate more significant associations between sagittal relationships and muscle composition. However, the robust influence of jaw-closing muscles on vertical dimension allowed us to conclude that vertical bite characteristics vary according to the fiber type composition of masseter muscle.

In this paper, a semi-automated approach to 3-D landmark digitization of the face is described which uses a combination of active shape model-driven feature detection and stereophotogrammetric analysis. The study aims to assess whether the proposed method is capable of detecting statistically significant changes in facial soft tissue shape due to mandibular repositioning in a cross-sectional patient sample. A hybrid stereophotogrammetric and structured-light imaging system is used for acquiring 3-D face models in the first instance. A landmark-based statistical analysis of facial shape change is then carried out using procrustes registration, principal component analysis and thin plate spline warping on the 2-D facial midline profiles and automatically digitized 3-D landmarks. The proposed method is validated both statistically and visually by characterizing shape changes induced by mandibular repositioning in a heterogeneous cross-sample of 20 orthodontic patients. It is shown that the method is capable of distinguishing between changes in facial morphology due to simulated surgical correction and changes due to other factors such as growth and normal variation within the patient sample. The study shows that the proposed method may be useful for auditing outcomes of clinical treatment or surgical intervention which result in changes to facial soft tissue morphology.

We present a previously undescribed syndrome characterized by triangular facial appearance, mid-facial hypoplasia, cleft palate and mild sensorineural hearing loss in two siblings. The parents were unrelated. The patients' stature and intelligence were normal. We suggest that the inheritance is autosomal recessive.

Laude and the Lille orthodontic department describe the trigeminal nerve as the main architect of the face. Using the points where it emerges into the cranium, the authors propose an analysis, which they base on four concepts: --the stability of the pterygoid base, --the interaction between two activities, prehensile and masticatory, of the oral cavity, --the cranio-mandibular entity, --the importance of the paired fifth cranial nerve. This study deals with vertical dimension of both alveolar and basal bone, as well as global, ramal, and maxillary growth directions, which they conceptualize as three parallel, convergent, or divergent lines. This analysis can be carried out quickly and easily because it requires only four simple measurements.

Statement of Problem: It has been recommended that the anterior tooth midline be placed coincidently with the midline of the face (facial midline). The location of the facial midline depends largely on the judgment of the clinician. The amount of deviation between these 2 midlines that is noticeable to the observer has not been fully investigated., Purpose: The observable deviation between the anterior tooth and facial midlines in a limited sample of dentate subjects was recorded., Material and Methods: Full facial-view, standardized photographs (x1/1.5) of 45 subjects, meeting very limited inclusion/exclusion criteria and undergoing routine dental treatment at Tel Aviv Dental School, were examined by 10 observers: 5 dentists and 5 nondental personnel who were given only a brief explanation of facial and tooth midlines. The examiners asked whether the facial and anterior tooth midlines deviated. The photographs then were scanned onto a computer screen, and the facial midline was determined by bisecting the distance between the medial angles of the eyes. The distance between a line perpendicular to this point and the contact point of the central incisors was measured by one calibrated examiner. The photographs were grouped according to the midline deviation: group 1, <1 mm; group 2, 1 to 2 mm; and group 3, >2 mm. Two photographs with oblique anterior tooth midlines were removed from the study because they were so easily detected. The observers' detection rates for the remaining midline deviation were compared and subjected to 1-way analysis of variance to identify significant differences at the 95% level of confidence. A post hoc Student t test was performed to identify significant differences among the groups., Results: Dentists and nondental personnel demonstrated a similar ability to notice deviations of anterior tooth and facial midlines. Midline deviations of <1 mm (group 1) were detected by 6 of 10 observers in 4 of 29 photographs (14%). Midline deviations of 1 to 2 mm (group 2) were detected by 6 observers in 3 of 8 photographs (37%). Midline deviations of >2 mm (group 3) were detected by 6 observers in 5 of 6 photographs (83%). The greater the deviation, the higher the detection rate. Significant differences were found between group 3 and the other 2 groups (P<.01)., Conclusion: Within the limitations of this study, the greater the deviation of anterior tooth and facial midlines, the higher the detection rate. Nearly half of the 10 observers involved in this investigation were unable to detect midline deviations of <2 mm.

Objectives: To compare the judgments of facial esthetics, defects and treatment needs between laypersons and professionals (orthodontists and oral surgeons) as predictors of patient's motivation for orthognathic surgery., Design: Two panels of expert and naïve raters were asked to evaluate photographs of orthognathic surgery patients for facial esthetics, defects and treatment needs. Results were correlated with patients' motivation for surgery., Setting and Sample Population: Fifty-seven patients (37 females and 20 males) with a mean age of 26.0 +/- 6.7 years were interviewed prior to orthognathic surgery treatment. Three color photographs of each patient were evaluated by a panel of 14 experts and panel of 18 laypersons., Experimental Variables: Each panel of raters were asked to evaluate the facial morphology, facial attractiveness and recommend surgical treatment (independent variables). The dependent variable was the patient's motivation for orthognathic surgery. Outcome measure--Reliability of raters were analyzed using an unweighted Kappa coefficient and a Cronbach alpha coefficient. Correlations and regression analyses were used to quantify the relationship between variables., Results: Expert raters provided reliable ratings of certain morphological features such as excessive gingival display and classification of mandibular facial form and position. Based on the facial photographs both expert and naïve raters agreed on facial attractiveness of patients. The best predictors of patients' motivation for surgery were the naïve profile attractiveness rating and the patients' expected change in self-consciousness., Conclusions: Expert raters provide more reliable ratings on certain morphologic features. However, the layperson's profile attractiveness rating and the patients' expected change in self-consciousness were the best predictors for patients' motivation for surgery. These data suggest that patients' motives for treatment are not necessarily related to objectively determined need. Patients' decision to seek treatment was more correlated to laypersons' rating of attractiveness because they see what other laypersons see, and are directly or indirectly affected by others reactions to their appearance. These findings may provide useful information for clinicians in counseling patients who seek orthognathic surgery.

This study was designed to investigate the changes in a number of facial proportions as a result of combined orthodontic/orthognathic surgical treatment. According to some authors, in beautiful faces, the values of the proportions measured are likely to approximate the divine proportion (1.618:1). The hypothesis for this study was that, as a result of treatment, the faces of patients in the sample would be more esthetic and therefore the measured proportions would be closer to the divine proportion than they were before treatment. Forty-six patients were included in the sample. Pre- and posttreatment photographs were each given a score (out of a possible 100) by 12 judges using a visual analog scale. Judges were shown frontal and profile views simultaneously. Ten ratios were measured from pre- and posttreatment lateral cephalograms, and 11 were measured from the frontal photos. Pearson's correlation coefficient was used to determine the correlation between changes in esthetic rating and changes in the measured proportions. No correlations were found between changes in esthetic ratings and changes in the proportions. While most subjects were considered more esthetic after treatment than before, the proportions were equally likely to move away from or toward the divine proportion. For this reason, if it is to be used as an aid to orthodontic/orthognathic treatment planning, the divine proportion should perhaps be used along with other methods of anteroposterior and vertical cephalometric and facial assessment.

The geometric relationship of the functional occlusal plane to the center of the glenoid fossa, as seen in the sagittal view, is described for males and females from age 7 through 25 years. This relationship is fully described by the distance from the geometric center of the glenoid fossa perpendicular to the functional occlusal plane (L, in millimeters) and its angulation (theta, in degrees) relative to a constructed Frankfort horizontal (SN-7 degrees ). Regression formulas with 95% confidence levels are described for L and theta for both genders combined. The differences between genders were found to be statistically insignificant. No correlation was found between these dimensions relative to the presence of temporomandibular joint dysfunction symptoms. A statistically significant difference in both L and theta was found in males who exhibited a Class III relationship compared with males exhibiting a Class II relationship.

The occlusions of sixty patients treated by one experienced orthodontist were assessed using the PAR Index. For each patient, pretreatment, post-treatment and long-term follow-up study casts were examined. Follow-up casts were taken at least 6.5 years following the removal of all retention appliances. Following pretreatment cephalometric analysis, the patient sample was divided into three vertical facial subgroups according to the Jarabak Facial Height Quotient. Mean weighted PAR scores were then calculated at each stage for the total sample and for the three subgroups. Mean absolute and percentage occlusal changes were also calculated for the post-treatment period. The relationship between post-treatment occlusal change and pretreatment vertical facial pattern was then studied. The mean weighted pretreatment, post-treatment and follow-up PAR scores were 27.3, 3.3 and 8.0, respectively. The mean-absolute and percentage post-treatment increases in weighted PAR score were 4.7 and 25.4, respectively. No statistically-significant relationship could be found between the pretreatment vertical facial pattern and changes occurring in the weighted PAR score during the follow-up period. It was concluded, therefore, that pretreatment vertical facial pattern, at least on its own, is not likely to be predictive of the amount of post-treatment occlusal change.

Lateral cephalograms and study casts of 55 patients were evaluated to determine if any relationships exist between Facial Axis changes occurring during and after active treatment and either the pretreatment Jarabak Facial Height Quotient or the amount of post-treatment occlusal change, as measured with a weighted PAR score. No significant relationships could be found. There was instead a wide range of individual variation in the post-treatment behaviour of both the Facial Axis and the weighted PAR score, in both the total sample and three Jarabak Facial Height subgroups. Long-term Facial Axis changes occurring in individual patients, however, were not necessarily associated with occlusal deterioration. Since the Facial Axis is likely to change to some extent in the long-term, it was suggested that widely recommended methods for Facial Axis control during treatment should be considered primarily for functional and aesthetic reasons, rather than on the basis of directly ensuring long-term occlusal stability.

The shape of the mandible is used by orthodontists as an aid to orthodontic treatment planning, with different shapes displaying different growth characteristics and being associated with different functional patterns. However, the quantification of shape using conventional linear and angular variables does not always include details of some of the more subtle aspects of form. Fourier analysis enables accurate representation, with few coefficients, of a mandibular outer line from articulare to infradentale. The aim of this study was to investigate, using a cluster analysis, the relationship between variation in mandibular form and overall facial morphology. A cluster analysis of the Fourier amplitudes classified mandibular forms into one of seven groups for both males and females. The cluster analysis showed that the gonial angle and the inclination of lower incisor were associated with facial type according to the mandibular variables. Furthermore, the Fourier descriptions of mandibular form could be related to the observed variation in facial form, each of the clusters based on mandibular form being associated with demonstrable differences in dentofacial morphology.

This study investigated the perception of discrepancies between the dental and facial midlines by orthodontists and young laypeople. A smiling photograph of a young adult female was modified by moving the dental midline relative to the facial midline. Twenty orthodontists (10 males and 10 females) and 20 young adult laypeople (10 males and 10 females) scored the attractiveness of the smile on the original image and each of the modified images using a 10-point scale. The results showed that the images were scored as less attractive both by the orthodontists and laypeople as the size of the dental to facial midline discrepancy increased. The scores were unrelated to the direction of the midline discrepancy (left or right) or to the gender of the judge. Further analysis revealed that the orthodontists were more sensitive than laypeople to small discrepancies between the dental and facial midline. It was estimated that the probability of a layperson recording a less favourable attractiveness score when there was a 2-mm discrepancy between the dental and facial midlines was 56 per cent.

The association between the functional oropharyngeal airway (defined as the minimal sagittal dimension at right angles to the airstream) and craniofacial morphology was investigated using 16 craniofacial variables taken from lateral cephalometric radiographs. The sample consisted of 70 subjects (31 males and 39 females) 10 to 13 years of age. There was no difference in ages between males and females, and no correlation with age except upper face height. Oropharyngeal airway was positively correlated with length of the mandible (Gon-Men), the distance between the third cervical vertebra and the hyoid bone (C3-Hy), and cranial base angle (NSBa). Although short mandibular length is a characteristic finding in patients with obstructive sleep apnea, none of the subjects in this study had this diagnosis.

Purpose: This article reviews recent research on the esthetics of the smile, covering the attractiveness of the smile, the effect of aging on the smile, oral condition and the smile, personality and smile, and smile exercises., Material and Methods: The subjects were Koreans with normal occlusion. Photographs of a full smile were taken and the esthetic quality of the subjects' smiles was estimated. Smile scores were correlated with oral condition, personality, the practice of smile exercises, and elements of the smile, such as the position of the lip in a smile. The personality of the subjects was assessed by means of a Sixteen Personality Factor Questionnaire. Gibson's smile exercises were used to investigate the effect of smile exercise., Results: In an attractive smile, the full shape of the maxillary anterior teeth was shown between the upper and lower lip, the upper lip curved upward or was straight, the maxillary anterior incisal curve was parallel to the lower lip, and teeth were displayed to the first molar. The amount of maxillary incisal exposure gradually decreased with age, accompanied by a gradual increase in mandibular incisal exposure. Personality traits such as warmth, calmness, extroversion, and low anxiety were closely related to an attractive smile. Smile exercises were an effective means of improving the esthetic level of the smile if patients exercised continuously., Conclusion: An attractive smile is important for esthetic treatment. The lip position, oral condition, personality traits, and smile exercise affect the esthetics of the smile.

Objective: A method for the quantitative and qualitative analysis of the facial soft-tissue profile has been developed, and applied to analyze the pretreatment lateral head films of 240 orthodontic patients aged 8 to 14 years., Methods: Patients were subdivided for sex, age, and skeletal class. To standardize for different facial sizes, soft-tissue profiles from nasion to pogonion were traced in polar coordinates without modifications of facial shape, and standardized for an equal skeletal vertical dimension., Results: The method allowed a simple and rapid quantitative evaluation of soft-tissue profiles during facial growth. An approximate evaluation of the soft-tissue thickness at nose, lips, and chin was also possible. No particular mathematical knowledge was required at any step of the analysis., Conclusions: Facial soft-tissue size and shape were influenced by age and sex, and to a minor extent by skeletal class.

There is sometimes controversy among colleagues over treatment plans in orthognathic surgery. This is because there are differing ideas about which part of the facial skeleton should be moved to give an optimal result. A study was therefore set up to obtain insight into the differences between surgeons. Ten unbalanced profile drawings were given to seven experienced surgeons with the request that they draw the profile line which they would like to give these patients. It was acceptable either to draw the profiles 'artistically' off the cuff or to use additional construction lines as long as this was not the profile planning according to Brons and Mulié (1993). The evaluation showed that some surgeons drew profiles which resembled each other to some extent in proportions and inclinations, while others produced variations without any evident regularity and basic concept. The variability per profile was very important in almost all cases. Such discrepancies are not acceptable in a teaching centre.