Soft tissue cephalometric analysis /certified fixed orthodontic courses by Indian dental academy

Department Of Orthodontics And Dentofacial Orthopaedics
A.B.Shetty Memorial Institute Of Dental Sciences

SOFT TISSUE CEPHALOMETRIC
ANALYSIS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

LEONARDO DA VINCI


(16 th century )

DURER In his book
FOUR BOOKS OF
FACIAL
PROPORTIONS Used
Geometric methods to
study the face .
He provided
proportionate analysis of
Leptoproscopic (long )
face and Euryproscopic
(short) face .


CAMPER

(18 th century)


EDMOND H WUERPEL - “ A face is beautiful and
shows harmonious features if the proportions of
its individual components are right ”

CALVIN CASE - “ A balanced profile should be
one of the key factors in deciding the method of
treatment for any form of malocclusion ”


SOFT TISSUE CEPHALOMETRIC LANDMARKS

SOFT TISSUE NASION

PRONASALE
SUB NASALE
SUB SPINALE
LABRALE SUPERIUS
STOMION
LABRALE INFERIUS
SUB MENTALE
SOFT TISSUE POGONION
SKIN GNATHION

PROFILE

ANALYSIS

PROPORTIONAL ANALYSIS
Ideal profile provides a basic standard for
assessment of average profile
Ideal profile ; Can be
divided into three equal parts
Frontal Third ( Tr- N )
Nasal Third (N - Sn )
Gnathic Third ( Sn – Gn )
ANTERIOR FACE CAN BE
PROPORTIONED ( N – Gn )
Midface - N To Sn - 45%
Lower Face – Sn To Gn -55%


ANGULAR PROFILE ANALYSIS SUBTENLY )
(

•

Subtently makes a distinction between skeletal soft tissue and full soft tissue
(including nose)
O
SKELETAL PROFILE ( N- POINT A - Pog ) AVG VALUE - 175
Convexity decreases with age as skeletal form straightens with age.
I

I

b) SOFT TISSUE PROFILE ( N – Sn – Pog ) AVG VALUE – 161
Convexity does not change with age
I

I

O

O

O

c) FULL SOFT TISSUE ( N – No – Pog ) AVG VALUE -137 (M) & 133 (F)
Convexity increases with age because of anterior growth of the nose.
Soft tissue changes are not analoges to skeletal profile changes.


SUBTENLYS PROFILE THICKNESS ANALYSIS

Soft tissue thickness at the Glabella remains constant
Thickness of Sulcus Labrale Superius increases by
approximately 5 mm
Thickness of Sulcus Labrale Inferius increases by
approximately 2 mm
According to Subtenly there is a greater increase in
maxillary than the mandibular soft tissue profile which
explains why the soft tissue grows more convex with age


BOWKER AND MEREDITH STUDIES ON SOFT TISSUE THICKNESS


PROFILE ANALYSIS BY A.M. SCHWARZ (1929)


GNATHIC PROFILE FIELD

TANGENT T - Sn – Pog

T ANGLE OR PROFILE ANGLE

AVG -10 DEGREES

Tan T


AVERAGE FACE - Sn on Pn
RETRO FACE
behind Pn

- Sn

ANTE FACE - Sn ahead
of Pn


STRAIGHT ANTE FACE
- Displacement of Pog
with Sn anteriorly
- GPF parallel and
anterior to
average face
STRAIGHT RETRO FACE
- Displacement of Pog
with Sn posteriorly
- GPF parallel and
posterior to
average face

OBLIQUE RETRO FACE – Posterior rotation of avg face. Maxilla
positioned posteriorly and mandible even more posteriorly
AVERAGE FACE ,GNATHIC PROFILE SLANTING BACKWARDS - Backward
rotation of the profile is partly compensated by forward
displacement of Midface, therefore Sn avg position
RETROFACE GNATHIC PROFILE SLANTING BACKWARD- Combined effect
of backward rotation and marked forward displacement of
the midface

OBLIQUE ANTE FACE- Forward rotation of average face, Maxilla is
anterior and mandible even more anterior.
AVERAGE FACE , GNATHIC PROFILE SLANTING FORWARD – Forward
rotation of profile is compensated by backward displacement of the midface,
Sn in average position
RETROFACE , GNATHIC PROFILE SLANTING FORWARD – Combined effect
of forward rotation and marked backward displacement of Midface

CLASS II MALOCCLUSION

AVG FACE

RETRO FACE


ANTE FACE

CLASS III MALOCCLUSION

AVE FACE

RETRO FACE


ANTE FACE

ANALYSIS OF THE LIPS


LENGTH OF UPPER LIP
MEAN VALUES
BURSTONE
Boys - 24 mm
Girls - 20 mm
RAKOSI
Boys - 22.5 mm
Girls - 20 mm
CLASS – II

22

mm

CLASS – III

20.9 mm


LENGTH OF LOWER LIP
MEAN VALUES
BURSTONE - Boys- 50 .0 mm
Girls- 46.5 mm
RAKOSI -

Boys- 45.5 mm
Girls- 40.0 mm

CLASS II - Retraction of upper
incisors - lower lip
curls up and moves
forward
CLASS III - Lingual tip of lower
Incisors - lip moves
backward


THICKNESS OF RED PART OF UPPER LIP
AVERAGE SIZE
11.5 mm ( RAKOSI)
CLASS II : Upper lip thin due
to angulation of
upper incisors
CLASS III : Upper lip thicker as
It rests on lower
lip
DURING COURSE OF Rx:
CLASS II : Lip grows
thicker
CLASS III : Lip grows
thinner


THICKNESS OF RED PART OF LOWER LIP
AVERAGE SIZE
12.5 mm ( RAKOSI )
CLASS II : Lower lip
is thicker ( 14 mm )
CLASS III : Lower lip is
thinner ( 11.9 mm )
DURING COURSE OF Rx:
CLASS II : Lower lip
becomes thinner
CLASS III : Lower lip
becomes thicker

STEINERS LIP ANALYSIS
Reference point is the
Centre of the S SHAPED
CURVE between the tip of
Nose and Sub Nasale
Reference line extends from
this point to the SOFT TISSUE
POGONION
Lips behind this point are said
to be flat
(RETRUSIVE)
Lips ahead of this line are said
to be too prominent
( PROTRUSIVE)

RICKETTS LIP ANALYSIS

Reference line connects
NOSE TIP TO SOFT TISSUE
POGONION - E LINE
Lips are analysed
E Line depending on the distance
E
of the lips from this line
NORMAL VALUES
UPPER : 2-3 mm
LOWER : 1-2 mm


HOLDAWAYS ANALYSIS
( 1983 )


FACIAL ANGLE AND UPPER LIP CURVATURE
FACIAL ANGLE is formed by the
intersection of FH PLANE
with line joining N TO POG
AVG VALUE -90 -92 DEGREES
Greater angle - Protrusive
lower jaw
Lesser angle - Retrusive
lower jaw
UPPER LIP CURVATURE
Reference line is drawn
tangent from FH PLANE TO
TIP OF UPPER LIP. Depth of upper
sulcus is measured.
AVG VALUE – 1.5 – 4.0 mm


H- LINE ANGLE AND SKELETAL CONVEXITY AT POINT A
H line angle formed between
H-line and Line Joining N to
Pog
Avg Value- 7- 15 Degrees
Measures upper lip prominence
or retrognathism of the
Soft tissue chin
Skeletal convexity at point a
is measured from N-pog Line
to Point A
AVG VALUE - +2 TO -2 mm
Assess facial skeletal
Convexity relating to lip
Position


RELATIONSHIP BETWEEN H-LINE AND SKELETAL CONVEXITY
AT POINT A


NOSE TIP TO H-LINE AND UPPER SULCUS DEPTH
NOSE TIP TO H-LINE
AVG VALUE – 12 mm MAX

UPPER SULCUS DEPTH
MEASURED FROM SUB
SPINALE TO H-LINE
AVG VALUE- 5 mm


UPPER LIP THICKNESS AND UPPER LIP STRAIN
Upper lip thickness is measured
horizontally from a point 2 mm
below point a to outer border
of upper lip.
AVG VALUE - 15 mm
Upper lip strain is measured
from vermillion border of the
lip to the labial surface of the
Max central incisor
IF Upper lip thickness is greater
than the upper lip strain then it
indicates there Is strain in the
Upper lip.


LOWER SULCUS DEPTH AND SOFT TISSUE CHIN THICKNESS
Lower sulcus depth is
measured from the deepest
point in the curvature
between the Lower lip and
the chin and the h-line
AVG VALUE- 5 mm
Soft tissue thickness is
measured from hard tissue
Pogonion to soft tissue
Pogonion.
AVG VALUE- 10 TO 12 mm


ACCORDING TO HOLDAWAY
A PERFECT PROFILE SHOULD
HAVE
ANB - 2 degrees
H-LINE ANGLE -7 to 8 degrees
LOWER LIP should touch the
H line
H-LINE should bisect S curve
between Pronasale and
Subnasale
TIP OF THE NOSE - Should be
9mm anterior to h-line
there should be no lip strain
factor
( Upper Lip Strain =Upper Lip
Thickness )


ANALYSIS OF TONGUE
POSITION


THREE REFERENCE POINTS
ARE USED

I – INCISAL EDGE OF LOWER
INCISORS

Mc – DISTAL AND CERVICAL
THIRD OF LAST ERUPTED
MOLAR

V – MOST CAUDAL POINT ON
THE SHADOW OF SOFT
PALATE

IV LINE IS BISECTED AT
POINT O WHICH IS THE
MIDPOINT


ASSESSMENT OF TONGUE POSITION
.
1Represents distance between soft palate and tongue
2 – 6 Represents distance between dorsum of tongue and roof of mouth
3-

Represents distance between tongue and incisors

MOBILITY OF THE TONGUE - Position of tongue in occlusion is
compared with that in rest position. Occlusal position is taken zero.
+VE - HIGHER IN REST POSITION
-VE - LOWER IN REST POSITION

ANALYSIS FOR
ORTHOGNATHIC SURGERY
BY HARRY LEGAN AND CHARLES BURSTONE


HORIZONTAL
PLANE

COLUMELLA

GNATHION
CERVICAL
POINT


ANGLE OF FACIAL CONVEXITY

G TO Sn , Sn TO Pog
MEAN VALUE - 12 DEGREES
POSITIVE VALUE – CLASS II
NEGATIVE VALUE - CLASS III


LOWER FACE THROAT ANGLE
Sn to Gn , Gn to C
MEAN VALUE – 100 DEGREES
DECREASE IN VALUE INDICATES
PROMINENT CHIN


ANTERO POSTERIOR MAXILLARY AND MANDIBULAR
MEASUREMENTS , mean value 6 mm
VERTICAL FACIAL HEIGHT PROPORTIONALITY

UPPER AND LOWER LIP
PROTRUSION
Mean Values
Ls – Sn Pog

3 mm
Sn

Li – Sn Pog

2 mm

Ls
Li

Pog


MENTO LABIAL SULCUS

Mean Value- 4 mm

Li
Sm
Pog


NASOLABIAL ANGLE

Mean Value - 102

O


VERTICAL LIP CHIN RATIO
Mean Value - 1:2
INTER LABIAL GAP
Mean Value - 2 mm
MAXILLARY INCISOR
EXPOSURE
Mean Value - 2 mm


CONCLUSION
Soft tissue changes during the course of treatment
should be considered.
Method of treatment chosen or modified to improve or
atleast not compromise the patient profile.
Possible variations in soft tissue profile should be
discussed with the patients and consent obtained for
treatment if undesirable changes are anticipated


THOMAS AQUINAS FUNDAMENTAL TRUTH OF ESTHETICS

“ THE SENSES DELIGHT IN THINGS DULY
PROPORTIONED ”


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