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Objective: To identify esthetic characteristics of the orbital soft tissues of attractive Italian adult women and men., Materials and Methods: Three-dimensional computerized digitizers were used to collect the coordinates of facial landmarks in 199 healthy, normal subjects aged 18 to 30 years (71 women, 128 men; mean age, 22 years) and in 126 coetaneous attractive subjects (92 women, 34 men; mean age, 20 years) selected during beauty competitions. From the landmarks, six linear distances, two ratios, six angles, and two areas were calculated. Attractive subjects were compared with normal ones by computing z-scores., Results: Intercanthal width was reduced while eye fissure lengths were increased in both genders. Orbital heights (os-or) were increased only in attractive women, with a significant gender-related difference. The inclinations of the eye fissure were increased in attractive subjects, while the inclinations of the orbit were reduced. For several of the analyzed measurements, similar patterns of z-scores were observed for attractive men and women (r  =  .883)., Conclusion: Attractive women and men had several specific esthetic characteristics in their orbital soft tissues; esthetic reference values can be used to determine optimal goals in surgical treatment.

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses according to All-on-Four(®) principles and in control healthy dentate subjects. Twenty-six subjects aged 50-74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All-on-Four(®) implant-supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All-on-Four(®) implant-supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working-side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All-on-Four(®) implant-supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal-Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All-on-Four(®) implant-supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume., (© 2012 Blackwell Publishing Ltd.)

The orbital region of subjects with Down syndrome (DS) has been scanty described so far. We wanted to detail the morphologic characteristics of the soft tissue orbital region in Italian and North Sudanese subjects with DS. The three-dimensional coordinates of 10 landmarks on the orbital soft tissues were obtained using computerized anthropometry in 53 Italian and 64 North Sudanese subjects with DS aged 4 to 52 years, and in 461 (Italian) and 682 (North Sudanese) sex- and age-matched controls. From the landmarks, linear distances, ratios, areas, and angles were calculated, z scores computed, and compared by t-tests and analyses of covariance. In North Sudanese DS subjects, intercanthal width and height-to-length ratio were increased; biorbital width, eye height, length, and area were reduced. Eye fissure and orbital inclinations relative to Frankfort plane were reduced, whereas orbital inclinations versus the true horizontal were increased. In Italian DS men, orbital height and height-to-length ratio were increased, eye length was decreased; orbital inclination versus the true horizontal was increased. For almost all measurements, a significant effect of age was found. No effects of sex were found. Ethnic group influenced orbital height, area, and orbital inclination versus Frankfort plane. All paired measurements had similar discrepancies on both sides. The orbital soft tissues of North Sudanese DS subjects differed from those of their reference subjects, but this was only partially true for Italian subjects. The 2 ethnic groups had different alterations in their soft tissue orbital regions that were influenced by age, but not by sex.

Objective: To identify the main directions of growth of facial structures in subjects with hypohidrotic ectodermal dysplasia (HED)., Materials and Methods: The 3D noninvasive facial measurements were collected in 12 subjects (6 boys, 6 girls) with HED during four assessments (at 8, 11, 12, and 15 years) using an electromagnetic digitizer. The modifications of linear distances in the upper, middle, and lower third of the face were analyzed and compared with cross-sectional data obtained in normal healthy coetaneous. For each distance, differential values between the last and the initial data were calculated individually, separately for a first (8-11 years) and a second growth period (12-15 years)., Results: In the first time span, the growth of all facial measurements was reduced in HED subjects compared with control subjects. During this interval, most of the HED children underwent a functional and/or prosthetic treatment. During adolescence, the width and height of the lower and upper facial thirds showed a larger growth in HED subjects than in control subjects, while all facial depths and all distances in the middle facial third maintained a reduced growth., Conclusions: The deviation from normal facial growth of HED subjects tends to lessen with age. Functional and prosthetic appliances may have enhanced facial growth.

Soft tissue analysis plays an increasing, strategic role in the recognition of facial alterations, but there are scanty three-dimensional reference data during normal growth, development and aging. In the current study, 532 male and 386 female healthy subjects aged 4 to 73 years were analyzed using a non-invasive, computerized electromagnetic digitizer, and normal dimensions of mouth and lips were obtained in the three-dimensional space. Labial thickness and curvature were also assessed in a selected group of 40 men and women, equally divided into young (age 21-30 yr, mean 25 yr) and old persons (age 45-65 yr, mean 55 yr). Lip vermilion area to volume, and vermilion height to cutaneous lip height ratios decreased with age in both sexes. On average, the lips were thicker in men and in young persons than in women and in old persons. Mean labial curvature was larger in young men than in the other groups, and it was more variable in young than in old persons. Data collected in the present investigation can be used as a data base for the quantitative description of human lip morphology during normal growth, development and aging.

The orbital region plays a predominant role in the evaluation of the craniofacial complex. In the current study information about normal sex-related dimensions of the orbital region, and growth, development and aging, were provided. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by a non-invasive, computerized electromagnetic digitizer in 531 male and 357 female healthy subjects aged 4-73 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, soft-tissue orbital area, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Biocular and intercanthal widths, length of the eye fissure, soft-tissue orbital area, and the inclination of the orbit relative to the true horizontal, were significantly larger in men than in women (p<0.01), with a significant effect of age (p<0.001), and significant agexsex interactions (p<0.001). Orbital height, and the height-to-width ratio increased as a function of age (p<0.001), but without gender-related differences. The inclination of the orbit relative to Frankfurt plane, and the inclination of the eye fissure did not differ between men and women, but modified as a function of age (p<0.001), with different sex-related patterns (sexxage interaction, p<0.001). On average, the paired measurements were symmetric, with similar values within each sex and age group. Overall, when compared to literature data, some differences were found due to both ethnicity, and different instruments. Nevertheless, during childhood, adolescence, and young adulthood, the age-related trends for linear dimensions were similar to those found in previous studies, while no previous data exist for older adults. During aging an increment in soft-tissue orbital area was found, with a progressive downward shift of landmark orbitale. Data collected in the present investigation could serve as a data base for the quantitative description of human orbital morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks.

Objective: To compare the facial characteristics of two different groups of attractive women with those of reference women., Materials and Methods: The three-dimensional coordinates of 50 facial landmarks were collected in 71 healthy reference women (18-30 years old) and in 24 coetaneous "attractive" women selected during two different beauty competitions; soft tissue facial angles, distances, areas, and volumes were computed and compared using analysis of variance., Results: When compared with reference women, both groups of attractive women shared several similar facial characteristics: relatively large forehead (P < .001), reduced mandible (P = .008), and rounded face (reduced surface-to-volume ratio, P = .002). They had a more acute soft tissue profile, an increased upper facial width (P < .001) and middle facial depth, larger mouth, and more voluminous lips (P = .005) than reference women., Conclusions: Both groups of attractive women had several facial characteristics suggesting babyness. Nonetheless, each group of women was characterized by a different development of these features. Esthetic reference values can be a useful tool for clinicians, but should always consider the characteristics of individual faces.

Objectives: To identify possible esthetic canons in facial size and shape of Italian adolescent boys and girls., Materials and Methods: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) were collected in 231 healthy, reference adolescents (10- 17 years old) and in 93 similar age group "attractive" adolescents selected by a commercial casting organization. Soft-tissue facial angles, distances, areas, and volumes were computed. Comparisons were made with analysis of variance., Results: Attractive adolescents had wider, shorter, and less deep faces than reference adolescents, with a relatively larger forehead and maxilla, and a reduced mandible relative to the maxilla. Lips were larger and more prominent, and the nasolabial angle was reduced, but in older boys the effect was reversed. The prominence of the soft-tissue profile, and of the maxilla relative to the mandible, were larger in attractive boys, but smaller in attractive girls than in their reference peers. In the horizontal plane, attractive "young" adolescents had a flatter face, while the opposite pattern was observed in the "old" adolescents, with a relatively more prominent chin. Attractive adolescents had smaller noses than reference subjects of the same age and sex., Conclusions: Overall, all the measurements appeared sufficiently homogenous, and the quantitative characteristics of an "attractive" face well defined. Esthetic reference values can be used to determine optimal timing and goals in orthodontic treatment.

Objectives: To identify possible esthetic canons in facial size and shape of Italian children., Materials and Methods: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) were collected in 220 healthy reference children (4-9 years old) and in 89 "attractive" children of a similar age group selected by a commercial casting organization. Soft-tissue facial angles, distances, and volumes were computed. Comparisons were made with the Student's t-test., Results: Attractive children had a larger face than the reference children, with a larger maxilla and forehead; overall, their faces were wider and deeper, but less vertically developed. Lips were more voluminous in attractive children, with a higher mouth. The nose was larger in attractive children than in reference children. The soft-tissue facial profile was more convex in attractive children, with a more prominent maxilla relative to the mandible., Conclusions: Overall, considering that in the analyzed ages body growth and dental changes are very fast and individually determined, all the measurements appeared sufficiently homogenous, and the quantitative characteristics of an "attractive" face well defined. Esthetic reference values can be used to determine optimal timing and goals in orthodontic treatment.

The aim of the present study was to evaluate palatal morphology in Down syndrome (Ds) subjects, focusing on the effect of dental formula on the hard palate to assist clinicians when planning dental rehabilitation. Palatal landmarks were digitized with a three-dimensional (3D) computerized digitizer on the dental casts of 47 Ds subjects (23 dentate males, 9 edentulous males, and 15 dentate females) aged 20-45 years, 37 dentate reference individuals (20 males and 17 females) aged 30-39 years, and 14 edentulous reference males aged 55-72 years. The co-ordinates of the palatal landmarks were used to construct a mathematical equation of palatal shape, independent of dimensions. Palatal length, slope, width, and maximum palatal height in both the sagittal and frontal planes were measured. In males, palatal length, width, and height were significantly influenced by both the syndrome and edentulism (analysis of variance, P < 0.05). The same measurements were significantly reduced in Ds compared with dentate females (t-test, P < 0.05). In the sagittal plane, Ds did not modify palatal shape; in the frontal plane, Ds individuals showed a higher palate. Overall, palatal shape was influenced by both Ds and edentulousness. Therefore, Ds seems to alter the normal palatal size and shape, although verification on larger samples is required. The findings of the present study may encourage more interdisciplinary dentofacial therapy in the dental and orthodontic care of Ds subjects.

Objectives: To identify reference standards and possible esthetic features in facial proportion and form of Italian adult women., Methods and Subjects: A three-dimensional electromagnetic digitizer was used to collect the coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) in 71 healthy, reference women (18-30 years old) and in 48 "attractive" women selected during a beauty competition; soft tissue facial angles, distances and volumes were computed., Results: Attractive women had wider faces with a relatively larger upper facial third (forehead); a larger facial width relative to facial height. The mouth was larger, and lips were more prominent; the interlabial angle was reduced. Overall, the soft-tissue profile was more prominent, with a larger maxillary prominence relative to the mandible. Faces in the attractive women were more flat in the horizontal plane. For several of the analyzed measurements, similar patterns were observed for the 36 women participants to the semi-final stage of the beauty competition, the 12 finalists, and the winner. The winner of the beauty competition deviated from the reference women more than the other two groups of attractive women., Conclusion: Esthetic reference values were determined for a population of 18-30 year olds that reflect contemporary society.

Objectives: To identify reference standards and possible esthetic features of facial size and form of Italian adolescent boys and girls., Methods and Subjects: A three-dimensional electromagnetic digitizer was used to collect the coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) in 231 healthy, reference adolescents (10-17 years old) and in 93 "attractive" adolescents selected by a commercial casting; soft tissue facial angles, distances and volumes were computed., Results: Attractive adolescents had wider and shorter faces than reference subjects of the same age and sex, with relatively larger upper and middle facial thirds, and a reduced mandible relative to the maxilla. Lips were larger and more prominent, and the nasolabial angle was reduced, but in older boys the effect was reversed. The prominence of the soft-tissue profile, and of the maxilla relative to the mandible, were larger in attractive boys, but smaller in attractive girls than in their reference peers. Attractive adolescents had a relatively less prominent chin relative to the lower lip, with increased values of the mentolabial angle. In the horizontal plane, attractive "young" adolescents had a more obtuse mandibular convexity angle, while the opposite pattern was observed in the "old" adolescent subjects, with a relatively more prominent chin. Attractive adolescents had smaller noses than reference subjects of the same age and sex., Conclusion: Esthetic reference values have been identified which could be used to determine optimal timing and goals in orthodontic treatment.

Objective: To analyze the size and shape of the hard tissue palate of Italian subjects with hypohidrotic ectodermal dysplasia (HED)., Materials and Methods: The morphology and the dimensions of the hard tissue palate were analyzed in eight 6-year-old boys affected by HED. Four of the boys were completely edentulous and four partially dentate. Palatal landmarks were identified on stone casts and digitized with three-dimensional computerized electromagnetic instrumentation. Palatal length, slope, width, and maximum palatal height in both the sagittal and frontal planes were measured. From the coordinates of palatal landmarks, a mathematical equation of palatal shape was constructed, independent of size. HED palatal data were compared with reference data obtained from 12 healthy boys with a complete deciduous dentition., Results: Palatal length and height in both the sagittal and frontal planes were significantly reduced in HED as compared with control individuals. A less steep (not significant) palatal slope was found in HED than in reference subjects, whereas similar palatal width values were observed. All palatal measurements were larger in partially dentate than in edentulous patients. Both HED and edentulousness influenced palatal shape. The HED boys had a relatively lower palate than the reference boys. In the edentulous HED boys, the hard tissue palate was relatively lower than in partially dentate HED subjects., Conclusions: Palatal size and shape were significantly modified by the presence of hypohidrotic ectodermal dysplasia, and the major alterations were found in edentulous HED subjects.

The number of obese adolescents is increasing in the Western society. For a deeper understanding of the mechanisms underlying this pathology, the quantitative characteristics of the facial soft tissues should also be investigated. The three-dimensional coordinates of 12 soft tissue facial landmarks were obtained by computerized digitizers in 11 male and 14 female adolescents aged 13-17 years, all with a body mass index larger than 30 kg/m2 (mean 31.67 kg/m2, SD 1.58). From the landmarks, several facial dimensions were calculated. Data were compared with those collected in normal individuals of the same age, ethnicity, and sex by computing z scores. Significant (paired Student's t-test, P < .05) larger dimensions were found for skull base width (girls), mandibular width (both sexes), lower face depth (girls), and mandibular corpus length (girls). In the pooled sample (boys plus girls), the faces of obese adolescents were significantly wider transversally (skull base width, mandibular width), deeper sagittally (mid and lower face depth, mandibular corpus length), and shorter vertically (upper facial height) than those of their normal school companions. "Borderline" obese adolescents possessed some facial characteristics typical of patients with more substantial obesity. The effect of an increased body weight-per-height was therefore present also in subjects not already referred to a medical control.

The normal growth, development, and aging of facial soft tissues was studied by three-dimensional (3D) computerized mesh diagram analysis. The 3D coordinates of 50 soft-tissue landmarks were collected from 591 healthy white northern Italians (351 males, 240 females) 6-40 years of age. For each gender and age class, mean values were computed, and a standardized mesh of equidistant horizontal, vertical, and anterior-posterior lines was constructed. Within each age group, male meshes were superimposed on female meshes. For each gender, the 6-year-old reference mesh was superimposed on the reference mesh of each age group. The global (size plus shape) difference was evaluated by calculating the relevant displacement vectors for each landmark. Consequently, a size normalization was carried out and the shape difference was evaluated by calculating new relevant displacement vectors for each landmark. Growth and development were different along the three spatial planes: the largest increment was observed in the vertical dimension, with major modifications in the soft-tissue profile. The vertical dimension in males increased even after 30 years of age: ear dimensions increased, trichion moved superiorly and posteriorly, and pogonion, menton, and gonion moved anteriorly and inferiorly. In all age groups, size-standardized shape differences were found in the forehead, lower-third facial profile, eyes, cheeks, and ears. In each age class, male dimensions were larger than female dimensions. During childhood, gender differences in size were limited; shape differences were even less manifest. Overall, the profile was more anterior and inferior, the gonia were more inferior and more lateral, the forehead was more anterior, and the ears were larger in males than in females of corresponding age., (Copyright 2003 Wiley-Liss, Inc.)

In the present study, the within-subject normal symmetry of footprint shape and size was analyzed from a mathematical standpoint. On the standardized left and right footprints of 83 adolescents (46 boys, 37 girls) aged 12-15 years (mean 13 years), the outline of each foot excluding the toes was identified and automatically digitized by a computerized video analyzer. Only those subjects with both left and right continuous footprints were further analyzed (36 boys, 26 girls). The footprint area was computed. The footprint shape, independent of its size, was quantified using the elliptic Fourier analysis with a 20-harmonic truncation. The symmetry in shape was quantified on an intra-subject basis by calculating a morphological distance D between the mathematical reconstructions of the left and right footprints of each subject. Symmetry in size was assessed by right-to-left area ratio. Subjects were grouped for sex, and the mean values computed. Mean footprint area was significantly larger in boys than in girls (p < 0.05). Asymmetry in size (area ratio) was 1.01 in girls, 1 in boys. Within-subject symmetry in footprint shape appeared high, with mean morphological distances of 5.95 in girls, and 6.06 in boys. No consistent associations between footprint symmetry and age, height and body weight, or shoe size were found. The mean size-independent shapes of the male and female left and right footprints were also calculated. Together with the analysis of individual asymmetry, they could be used as quantitative parameter in clinical diagnosis.

The normal growth and development of facial soft tissues from 6 years to adulthood has been studied by the 3D computerized mesh diagram analysis. The analysis allows independent quantifications of size and shape modifications both between different age groups, and between males and females. Normal age-related and sex-related references are provided. The three-dimensional facial morphometry method has been used for the collection of the x, y, z coordinates of 22 soft tissue landmarks in 2023 examinations performed on 1157 healthy white children and adolescents between 6 and 17 years of age and 191 young adults. The method detects the three-dimensional coordinates of retroreflective, wireless markers positioned on selected facial landmarks using two charge-coupled device cameras working in the infrared field. For each sex and age class, mean values were computed, and a standardized mesh of equidistant horizontal, vertical, and anteroposterior lines was consequently constructed. Within each age group, male meshes were superimposed on female meshes. Moreover, within each sex, the adult reference mesh was superimposed on the reference mesh of each age group. The global (size plus shape) difference was then evaluated by the calculation of the relevant displacement vectors for each soft tissue landmark. A global difference factor was calculated as the sum of the modules of all the displacement vectors. Consequently, a size normalization was performed, and the shape difference (size standardized) was then evaluated by the calculation of new relevant displacement vectors for each landmark, as well as a shape-global difference factor. When compared to the young adult situation, the largest child discrepancies were found in the soft tissue profile. After size standardization, shape differences were found in the forehead, nose, and chin. The soft tissue facial dimensions of boys and girls grow with similar characteristics and at the same rate between 6 and 11 years of age, but showed different patterns after this age. Within each age class, most of the sex-related differences were dimensional discrepancies that were corrected after size standardization. Nevertheless, before adolescence even these size differences were limited. On average, male faces had a larger forehead, longer and more vertical nose, more inferior and posterior gonia, more inferior and prominent lips, and a larger mouth than female faces of corresponding age.

Race and ethnicity variably influence the form of the human craniofacial complex. In the present study, the effects of ethnicity and sex on the global size of normal adult dental arches were analyzed. The dental arches of 47 northern Chilean mestizos (25 men, 22 women) and 95 northern Italian Caucasians (50 men, 45 women) were cast in stone. All subjects had a complete dentition in both arches. In all models the coordinates of dental cusp tips were digitized using an image analyzer. The center of gravity of each tooth was computed and arches were interpolated using a polynomial model (y = ax + bx2 + cx3 + dx4). In all arches, the intercanine, intermolar, and mid-intercanine to mid-intermolar distances were computed from the dental centers of gravity. These arch distances were entered in a linear discriminant function analysis. The polynomial model accurately interpolated data points in all instances, and most of the dental arch form was determined by the first and second degree coefficients. On average, Italian Caucasian arches were smaller than Chilean mestizo arches. Male mean distances were larger than female distances regardless of ethnic group or arch. The linear discriminant analysis performed between male and female arches within ethnic groups was significant only for both Italian Caucasian arches, but the percentage errors for the classification of a new individual were very high (about 30%). Conversely, Italian Caucasian arches could always be discriminated from Chilean mestizo arches of the same sex with a much smaller error.

The masseter, temporalis anterior and digastric anterior muscles of five volunteers have been investigated by means of surface electromyography. Each muscle was tested by three operators at different times and under three distinct conditions of intermaxillary relationship: resting, with no occlusal contact (physiological rest position); occlusion in centric occlusion (C.O.) without clenching force; and maximum voluntary clench. In all the trials the BIO-PAK system (Bio-Research Associates Inc., Milwaukee, WI, USA) was used. Measurements were made in two consecutive experimental trials separated by an interval of about 15 days. In the first trial the operators had minimal instrumental experience, while in the second trial the same operators had minimal instrumental experience, while in the second trial the same operators had performed at least 30 measurements each. The data have been analysed by a factorial variance analysis, particularly with a view to comparing the variability between operators for each volunteer subject. The analysis revealed statistically significant differences only in the first experimental trial, due to the operators' lack of experience. The study demonstrates that the electromyographic system and protocol used allow good reproducibility of measurements. Furthermore, they have potential applications in both clinics and research.