Influence of facial convexity on facial attractiveness in Japanese

OBJECTIVE: The purpose of this study was to assess and determine the range of the top three most-favored facial profiles for each sex from a series of varying facial convexity, and to evaluate the clinically acceptable facial profiles for Japanese adults. DESIGN: Questionnaire-based study. SUBJECTS AND METHODS: Silhouettes of average male and female profiles were constructed from the profiles of 30 Japanese males and females with normal occlusions. Chin positions were protruded or retruded by 2 degrees , 4 degrees , 6 degrees , 8 degrees and 10 degrees , respectively, from the average profile. Forty-one orthodontists and 50 dental students were asked to select the three most-favored profiles for each sex, and they were also asked to indicate whether they would seek surgical orthodontic treatment if that image represented their own profile. RESULTS: For males, both the orthodontists and dental students chose the average profile as the most-favored profile. For females, both the orthodontists and dental students chose a slightly more retruded chin position as the most-favored profile. Japanese raters tended to choose class II profiles as more acceptable profiles than class III profiles for both males and females. CONCLUSIONS: These findings suggest that Japanese patients with class III profiles tend to seek surgical orthodontic treatment more often.     

Effect of lower facial vertical proportion on facial attractiveness in Japanese

The purpose of this study was to assess the range of the top three most-favored facial profiles for each sex from a series of varying lower facial vertical proportion, and to evaluate clinically acceptable facial profiles for Japanese adults. Silhouettes of average male and female profiles were constructed from the profiles of 30 Japanese males and females with normal occlusions. Lower facial vertical proportions were increased or decreased by intervals of 5% of Sn–Me′ for each sex from the average profile. Forty-one orthodontists and 50 dental students were asked to select the 3 most-favored, well-balanced profiles for each sex. They were also asked to indicate whether they would seek surgical orthodontic treatment for each of the shorter or longer lower facial profiles if those images represented their own profile. For male profiles, both the orthodontists and dental students chose the average profile as the most-favored. For female profiles, the dental students chose a slightly shorter lower facial as the most-favored profile while the orthodontists chose the average profile. The dental students chose shorter lower facial profiles as more acceptable than longer lower facial profiles for females (p < 0.05). These findings suggest that an average lower facial profile tended to be favored overall by Japanese people, whereas for females a slightly shorter lower facial profile was favored by young adults.     

Effect of facial convexity on antero-posterior lip positions of the most favored Japanese facial profiles

Soft tissue analyses are basic tools in planning orthodontic treatment. However, the perception of a well-balanced Japanese facial profile has not yet been established, particularly with respect to changes in facial convexity. The purpose of this study was to assess and determine the range of antero-posterior (A-P) lip positions of the top three most favored, well-balanced profiles from a series of various facial silhouettes with changing facial convexity. The average profile was constructed from the profiles of 30 Japanese males and females with Class I occlusions. Changes in facial convexity were established by altering the A-P chin position by protruding or retruding the chin in increments of 5 degrees and 10 degrees from the average profile. A series of 11 profiles were developed from each of the four changes in facial convexity. The lips were then protruded or retruded in one-mm increments from the average profile. Forty orthodontists were asked to rate the top three most favored, well-balanced profiles. We found that the raters tended to prefer more retruded lip positions as facial convexity decreased, for both males and females. The raters also tended to prefer slightly more protruded lip positions as the facial convexity increased. Because chin position is inherent in each patient, others may equate a retrusive or protrusive chin with certain personalities, thus, it is important for orthodontists to take into account the balance between the lips and the chin.     

An evaluation of preferred lip positions according to different age groups

The purpose of this study was to compare preferred facial profiles rated by different age groups. An average profile of each gender was constructed from subjects with normal occlusions. Each average profile was located in the centre, and then the lips were protruded or retruded in six 1 mm increments in each direction. 70 lay people were divided into 3 groups: young adult (20-39 years); middle-aged (40-54 years); and senior (55-70 years). They were asked to rank their 3 most preferred profiles for each gender. The distribution of the most pleasing profile was compared according to age groups by the Kruskal-Wallis test and according to the rater's gender by the Mann-Whitney U-test. There was a significant difference between the three age groups regarding the preferred male and female profiles (P < 0.001). Both the middle-aged and the senior groups tended to select a slightly more retruded lip/flat profile than the young adult group. There was no gender dimorphism in the selection of the preferred profile. The young adult group preferred the straight profile while the middle-aged and senior groups favoured the slightly retruded profile. This may provide useful information for treatment planning in orthodontics and orthognathic surgery.     

Long-term profile changes in extraction and nonextraction patients.

INTRODUCTION: The purpose of this investigation was to determine the long-term differences in soft tissue profile changes between extraction and nonextraction patients who had been treated to the same incisor position and lip line. METHODS: Twenty extraction and 20 matched nonextraction patients, with posttreatment and long-term follow-up (average 15 years) records, were selected from a single private orthodontic practice. Posttreatment and long-term follow-up profile photos of the patients' nose, lip, and chin areas were evaluated by 105 orthodontists and 225 laypeople, who indicated their preferences and the amount of change they perceived among the 40 profiles. The patients had similar dental protrusion, soft tissue profile measurements, and ages at the posttreatment observation. RESULTS: No significant cephalometric differences between the extraction and nonextraction groups were found at long-term follow-up; both groups showed similar long-term changes. Significant (P < .05) differences were found between males and females at long-term follow-up; male lips became relatively more retrusive, and their profiles became flatter. Significant (P < .05) changes in the profiles were also perceived over time, but there was no relationship between the amount of change perceived and profile changes measured cephalometrically. There were also no significant (P < .05) differences in preferences between orthodontists and laypeople, between extraction and nonextraction patients, or between males and females. CONCLUSIONS: If extraction and nonextraction patients are treated to the same incisor position and lip line, the treatment modality does not affect long-term soft tissue profile changes. Furthermore, the amounts of change perceived by either orthodontists or laypeople were not related to the amount of change measured cephalometrically.     

A comparative assessment of the perception of Chinese facial profile esthetics

INTRODUCTION: The aim of this study was to compare the perception of male and female Chinese facial profile esthetics between dental professionals, dental students, and laypersons. MATERIAL: The sample comprised 31 dental professionals (20 orthodontists, 11 oral surgeons), 92 dental students, and 152 laypersons in an Asian community. The facial profile photographs and lateral cephalometric radiographs of a Chinese man and a woman, each with a normal profile, a Class I incisor relationship, and a Class I skeletal pattern, were digitized. The digital images were modified to obtain 7 facial profiles for each sex. The images were constructed by altering cephalometric skeletal and dental hard tissue Chinese normative values by 2 standard deviations in the anteroposterior plane only. The 7 profiles were (1) bimaxillary protrusion, (2) protrusive mandible, (3) retrusive mandible, (4) normal profile (Class I incisor with Class I skeletal pattern), (5) retrusive maxilla, (6) protrusive maxilla, and (7) bimaxillary retrusion. RESULTS: Normal and bimaxillary retrusion Chinese male and female profiles were perceived to be highly attractive by all 3 groups. Profiles with a protrusive mandible were perceived to be the least attractive. Dental professionals, dental students, and laypersons were highly correlated for the perception of male (r > 0.67) and female (r > 0.93) profile esthetics. All correlation coefficients were found to be significant for the perception of female profiles, but, for male profiles, only the correlation coefficient between dental students and laypersons was significant. CONCLUSIONS: Chinese male and female profiles that were normal or had bimaxillary retrusion were perceived to be highly attractive by dental professionals, dental students, and laypersons, and profiles with a protrusive mandible were perceived to be the least attractive. Dental students and laypersons were more tolerant of a male profile with a retrusive mandible than were dental professionals, and all groups were more tolerant of bimaxillary protrusion in women than in men. Dental professionals, dental students, and laypersons had a similar trend in male and female esthetic preferences. The perception of female profiles by all 3 groups was highly and significantly correlated. Only the perception of male esthetics by dental students and laypersons was not significantly correlated with dental professionals.     

Is the ethnic factor an orthodontic therapeutic instructor?

Because different groups in human society view beauty in stereotypical terms of their own ethnicity, orthodontists should study the concept of facial beauty with scientific rigor. Is it time for us to re-examine the assumption that the original cephalometric esthetic norms based on samples of North Americans can be applied to other populations? Many cephalometric analyses of Afro-American and Asian subjects who had not received orthodontic treatment but whose occlusions were normal have shown that their esthetic criteria were far different from those of the Caucasian North American sample. The Afro-Americans and Asians share a principal ethnic facial characteristic of bi-maxillary alveolo-dental protrusion with a reduced naso-labial angle. Afro-Americans frequently have maxillae in an anterior position with mandibles in similar or retruded positions. Asians appear to have similar cutaneous profiles but group skeletal profiles differ: Japanese often have more retruded maxillae; Chinese often have protruded maxillae and retruded mandibles. Koreans tend to have characteristics resembling those of Japanese groups. So it would seem necessary for the specialty of orthodontics to establish specific data of facial characteristics that reflect the ethnic origin of potential patients in order for specialists to make accurate and appropriate esthetic diagnoses.     

Facial-profile attractiveness changes in adult patients treated with the Herbst appliance

Aim

The goal of this study was to compare facial profile attractiveness changes of adult patients treated with the Herbst appliance assessed by orthodontists and laypeople.

Materials and methods

The patient sample comprised 28 adult Herbst patients. Facial profile photographs of the patients were randomly divided into two evaluation sets (before T0, after treatment T1). Ten members of the Angle Society of Europe (orthodontists) and 10 dental students in their third semester (laymen) rated both sets of photographs using Visual Analog Scales (VAS) with an interval of 1 day between the ratings.

Results

On average, both orthodontists and students found an improvement in facial profile attractiveness through Herbst appliance treatment (VAS T1–T0?=?0.3?±?1.9 cm). However, the interindividual perception of profile attractiveness varied greatly in the two rater groups. For both time periods (T0, T1), lower VAS ratings were given by students than by orthodontists.

Conclusion

Herbst therapy in adult patients generally improves facial profile attractiveness. Students rated facial profiles more critically than orthodontists.     

Professional assessment of facial profile attractiveness.

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.     

The perception of optimal profile in African Americans versus white Americans as assessed by orthodontists and the lay public.

This study was designed to assess the perceived optimal profiles of African Americans versus white Americans. A survey was conducted using profile silhouettes of 30 African American and 30 white patients, ranging in age from 7 to 17 years. Twenty white orthodontists, 18 African American orthodontists, 20 white laypersons, and 20 African American laypersons evaluated the profiles. The preference of each rater for each of the 60 profiles was scored on an attached visual analog scale. Eighteen cephalometric variables were measured for each profile, and statistical analyses were performed on the profiles that had a mean rating of 60 or greater from an analog scale of 0 to 100. The results show the following 6 cephalometric variables were significant: Z-angle, skeletal convexity at A-point, upper lip prominence, lower lip prominence, nasomental angle, and mentolabial sulcus. All raters preferred the African American sample to have a greater profile convexity than they preferred for the white sample. The raters preferred the African American sample with upper and lower lips that were more prominent compared with the white sample. However, only the choice of the African American orthodontists for the African American sample was significantly different for this parameter. The white orthodontists gave the highest mean scores for the profile chosen, whereas the African American laypersons gave the lowest scores.     

Correlation between occlusal abnormalities and parameters investigated by three-dimensional facial photography

Objective:To clarify, by three-dimensional (3D) facial scans, if 4- to 6-year-old children with intraoral sagittal discrepancies and open-bite occlusion show differences in facial morphology when compared to children without anomalies.Materials and Methods:Scans of 290 children presenting with occlusal abnormalities were compared to 1772 face scans of age-matched individuals photographed with a faceSCAN II® 3D data acquisition system. From these, three study groups were formed comprising 188 children with distal occlusion/increased overjet (Class II), 37 with mesial occlusion/inverse overjet (Class III), and 65 with open-bite occlusion. These groups were evaluated by age and gender for each group compared to the control individuals.Results:The Class II group showed statistically significant reduced dimensions of head width, upper face width, and midface length. In addition, the mean values for mouth width and lip thickness were higher, and their upper lips were located more anteriorly than in the control group. The Class III group exhibited more markedly retruded upper lips. The facial profile of female 5-year-old Class III patients was significantly more concave. Patients in the open-bite group showed reduced upper lip length, with differences only being statistically significant in male 4-year-olds.Conclusion:Dental Class II with increased overjet and dental Class III with decreased overjet influence soft tissue morphology and are represented on 3D facial scans.     

The effects of commonly prescribed premolar extraction sequences on the curvature of the upper and lower lips

The potential for premolar extractions to produce adverse facial effects after orthodontic treatment is still controversial. Detailed documentation of the predictability, or otherwise, of various soft tissue treatment effects would obviously be of assistance to clinical orthodontists in day-to-day treatment planning, by potentially refining the criteria for appropriate selection of various premolar extraction sequences. With this in mind, a retrospective lateral cephalometric study of 80 premolar extraction cases was undertaken to assess whether different patterns of premolar extraction do in fact produce predictably different lateral profile effects. A comparison was made of the changes in lip curvature after the extractions of all first premolars (4/4), all second premolars (5/5), or upper first and lower second premolars (4/5). Changes in the depths of curvature of both the upper and lower lips were not solely dependent on the selection of a particular premolar extraction sequence. Instead, there were wide ranges of individual variation in the changes in the depths of the lip curves. Therefore, in addition to the inherent soft tissue morphology of the lips in individual patients, it is the combined effect of the lip response to various dental and skeletal changes and the competent clinical management of extraction spaces that apparently affects the shapes of the lips within the lateral profile during treatment. In other words, it would seem possible for the clinician to carefully manage either first or second premolar extraction spaces while still protecting the facial profile.     

A longitudinal study on influence of primary facial deformities on maxillofacial growth in patients with cleft lip and palate.

OBJECTIVE: The goal of this study was to use three-dimensional (3D) analysis to characterize the primary facial deformities in children with unilateral cleft lip and palate (UCLP) and then serially analyze the relationships between facial deformities and maxillofacial growth from infancy to adolescence. PARTICIPANTS: Twenty-one Japanese subjects with unilateral cleft lip and alveolus (UCLA) and 20 with UCLP who had been operated on and then followed up for more than 15 years were enrolled in this study. MAIN OUTCOME MEASURES: Facial cast models taken at cheiloplasty were scanned with a 3D laser scanner. Lateral cephalographs taken when subjects were 15 years of age or older were traced, and linear and angular measurements were calculated. The correlation between primary facial forms and maxillofacial morphology in adolescence was analyzed. RESULTS: Three-dimensional analysis showed larger ocular hypertelorism, wider cleft, greater deviation of the columella base, and more severe retruded position of the affected nasal alar base in subjects with UCLP than those with UCLA. Total surface area of the upper lips in subjects with UCLP was significantly smaller than those with UCLA. Correlation analyses revealed that the width of cleft lip, deviation of the columella base, difference of the nose base width, and surface area of the upper lip were statistically correlated with the maxillary length, the anterior position of the maxillary alveolar base, the posterior facial height, and the high angle of the mandible. CONCLUSION: The subjects who had less severe facial deformities and more tissue volume of the upper lips at cheiloplasty showed better maxillofacial growth.     

A comparison of the perception of facial profile by the general public and 3 groups of clinicians

Orthodontists and maxillofacial surgeons frequently plan orthognathic treatment to produce an "ideal" Class I occlusion and skeletal relationship. The aim of this study was to investigate whether the preferred facial profile chosen by orthodontists, maxillofacial surgeons, dental students, and members of the general public conformed to a Class I profile. Photographs were taken of 2 male and 2 female adult subjects with Class I profiles, and by means of a computer program the images were manipulated to produce Class II, Class III, and long face profiles. The orthodontists, surgeons, dental students, and members of the general public ranked each group of 4 photos in order of their attractiveness. Orthodontists and maxillofacial surgeons were found to be significantly more likely to choose a Class I skeletal relationship as the most attractive profile. A significant difference was found between orthodontists and dental students (P < 0.01) and between orthodontists and the general public (P < 0.001) with regard to the assessment of the Class I profile as the most attractive, when all 4 subjects were considered. Similar results were noted for maxillofacial surgeons. Whether the assessor was an orthodontist, maxillofacial surgeon, or a member of the general public was found to be significant when examining subjects 1 (female) and 3 (male). The sex of the assessor was also a significant factor for subject 3 (male), where female assessors were more likely to rank the Class I profile as most attractive (P < 0.05).     

Effects of vermilion height on lip esthetics in Japanese and Korean orthodontists and orthodontic patients

Objective:To evaluate the influence of vermilion height on the assessment of lip attractiveness by Japanese and Korean orthodontists and orthodontic patients.Materials and Methods:Vermilion heights were modified by increasing or decreasing the vermilion height in 1.0-mm increments from −3.0 mm to 3.0 mm with reference to an average vermilion height. Participants ranged from 15 to 29 years of age and comprised 29 Japanese and 25 Korean orthodontists and 96 Japanese and 72 Korean orthodontic patients. They all rated the attractiveness of seven images with altered vermilion height using a visual analog scale.Results:Across the participant groups, there were significant differences in the median esthetic scores for the seven vermilion height levels tested. The Japanese and Korean raters assigned the highest scores to the average vermilion height and assigned the lowest scores to the +3-mm increased vermilion height. The ranges of vermilion height preferred by orthodontists were found to be within the ranges preferred by orthodontic patients when evaluating the preferences in lip esthetics by country.Conclusions:We conclude that the −1-mm to +1-mm range for the average vermilion height is considered attractive for lips for both Japanese and Korean people.     

Changes in soft tissue profile after orthodontic treatment with and without extractions.

The effects of orthodontic treatment on the facial profile, with or without the extraction of teeth, have greatly concerned orthodontists. A study was made of 80 patients with Angle Class I malocclusion. Forty patients (24 girls, 16 boys) did not undergo extraction of teeth, and 40 patients (23 girls, 17 boys) underwent extraction of maxillary and mandibular first premolars. Data were obtained from the corresponding lateral radiographs of the head taken before and after orthodontic treatment. The purpose of this study was to compare the response of the soft tissue of the facial profile in Class I malocclusions treated with and without the extraction of the 4 first premolars. The main soft tissue differences between the groups at the end of treatment were more retruded upper and lower lips in the extraction patients.     

Facial profile preferences of black women before and after orthodontic treatment.

INTRODUCTION: The purposes of this study were to determine (1) profile preferences of black female patients and (2) whether they can recognize their own profile images before and after orthodontic treatment. METHODS: Fifteen black orthodontists, 15 white orthodontists, and 15 black female patients were asked to indicate the images they considered most pleasing and to determine a zone of acceptability for 3 black female profiles. Raters used the PERCEPTOMETRICS computer program (Health Programs International, Wellesley, Mass). In addition, the 15 patients were asked to identify their most accurate pretreatment and posttreatment profile images. RESULTS: Analyses of variance showed that the white orthodontists preferred flatter profiles than the black women, who in turn preferred fuller profiles than the black orthodontists. Significant differences in lip position were detected for most pleasing and midpoint of acceptability among the 3 groups of judges, with no significant differences in any variables measured between treatments in rating the 3 images. No significant differences were detected for the magnitude of the zone of acceptability. All 15 black women recalled having fuller profiles than they actually did before treatment, but they could correctly identify their own profile images after treatment. CONCLUSIONS: The results of this study will facilitate the understanding of the physical bases of the esthetic judgments of black and white orthodontists and black female patients.     

An evaluation of the nasolabial angle and the relative inclinations of the nose and upper lip.

The purpose of this study was to develop a consistent and reproducible method of constructing a nasolabial angle that would also permit an evaluation of the relative inclination of the lower border of the nose and the upper lip, as well as their relationship to each other. Comparison of repeated individual measurements of soft tissue profile landmarks on 15 subjects, as completed by four orthodontists, revealed that the proposed method of constructing the nasolabial angle was consistent and reproducible by the same orthodontist and among different orthodontists. Normative data for the three nasolabial parameters were produced from a sample of 104 young white adults determined by the authors to have well-balanced faces. Mean and standard deviation values from this pooled sample demonstrated a lower border of the nose to Frankfort horizontal plane angle at 18 degrees +/- 7 degrees, upper lip to Frankfort horizontal plane angle 98 degrees +/- 5 degrees, and nasolabial angle 114 degrees +/- 10 degrees. No statistically significant difference was demonstrated between the values for men and women in this study, but the women did have a slightly larger nasolabial angle. A linear comparison of the three nasolabial parameters with six skeletal measurements revealed no significant relationship between the soft tissue profile of the nasolabial region and the underlying skeletal relationships.     

年轻美貌人群颜面美学评判分析

目的 分析不同层次人群对南昌市海选的年轻美貌男女正侧面美学审美标准,以指导正畸临床工作。方法 从南昌市各大高校中海选的赣籍青年美貌男女中选出14名年轻美貌男生和15名年轻美貌女生,近期拍摄正、侧面近观照片。由10名口腔正畸医师和85名不同年龄、不同性别的非口腔正畸专业人员独立对所有照片进行美学评判,分别选出各自心目中的最美貌年轻男女各1名,进行分组比较。结果 正畸医师对于青年男女面容美学评判存在明显差异,10名评判者结果差异极大,尤其对男生评判各不相同;非正畸专业人员对于年轻男女面容美学评判存在差异,但对于男生评判的统一性较女生高。具体来说,年轻人评判结果是男生13号、女生1号,年长者评判结果是男生7号、女生9号。男性评判者的结果是男生7号和13号、女生1号和9号,女性评判者的结果是男生13号、女生1号。结论 不论是正畸医师或非正畸专业人员,对于年轻男女面部美学评判标准均存在明显差异。提示正畸临床上对于矫治中患者面部的改善,应尊重患者及家属意见。     

Facial profile and dental changes before, during and after treatment with Hansaplate/Headgear

In this prospective study the changes of facial profile and dentition in 19 boys and 19 girls treated for 1 year with Hansaplate/Headgear were analyzed yearly over a 4-year period. On average the boys were 10.2 and the girls 9.2 years old at the first recording, i.e., 1 year pretreatment. The actual values are compared with standard growth data presented by Bathia and Leighton (1993). Irrespective of the initial face morphology, the Hansaplate/Headgear appliance straightened the facial hard and soft tissue profiles favorably. The upper lip became more retruded while the lower lip was unaffected by therapy. During the 2-year post-treatment period these changes continued, probably as a consequence of growth. The overjet was reduced by 5 mm during treatment and was found to be quite stable 2 years after treatment.