jose... · title: slide 1 author: jose created date: 5/1/2013 11:11:14 am

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Marquette University

School of Dentistry


School of Dentistry

Jose A. Bosio, BDS, MS Assistant Professor

Marquette University School of Dentistry

[email protected]


School of Dentistry

Lecture Goals

• Briefly present a history of facial beauty.

• Discuss our research findings for facial soft tissue changes during orthodontic treatment.

• Point out important diagnostic features about facial soft tissue.


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“In medicine and dentistry, most treatment decisions are made on the basis of science and art, often with the artistic component of the equation playing a primary role in clinical judgment”. (J. McNamara, Jr. 1993)

Eyes – glassy balls for the focusing of light.

Nose – a tube with its opening as a conduit for air and liquids.

Mouth – mechanical gobbler of foodstuff and liquids.

R. Arnheim, 1993 Toepffer, 1840

The oldest records of facial measurements is not from physicians, dentists or scientists, but rather from artists.


School of Dentistry

The proportions of the classical (Greek) face tend to favor a subdivision into three equal parts.

• the forehead (mental functions)

• the nose (will power)

• the mouth and chin (activity drive)

In general, people prefer a regular, average proportion, which meets the norm and is consider beautiful.


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What is physical beauty?

It does not depend of shape as such, but on the dynamic expression conveyed by it. (R. Arnheim, 1993)

When Prof. Olds asked his students to define the word BEAUTY, they almost always replied as the old cliché “beauty is in the eye of the beholder”, or “it is relative, it’s all a matter of individual taste”. (C. Olds, 1993)

mailto:[email protected]

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Is beauty really in the eye of the beholder?


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The standards of facial beauty existent in the Ancient Egypt are almost exactly as those in 2013.

1. Egyptian artist almost always used math to achieve perfection for the human form.

2. Greeks (Galen) established numerical ratios for the face 1:7 (total body height)

3. Roman architect Vitruvius divided the head and face in three parts (it survives up to today).


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Florence – Leonardo da Vinci the Vitruvian Man


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Renaissance Germany – Albretch Dürer

• Determined the human face proportions, by writing 4 books on the subject.

•“Nobody knows what makes a good shape unless he knows before what makes a bad one.”


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Can we improve facial appearance?

• The earliest attempt to improve facial appearance probably started in the mouth when someone tried to align crooked teeth.

• Facial beauty was as important as health and restore function.

• Moyers wrote: “man became orthodontist before he became psychiatrist, speech therapist, or occupational therapist”.


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Can the face be changed?

• Basic three ways to change facial appearance:

1. By camouflage

2. By surgery

3. By growth

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‘World's Most Beautiful Face'

•Florence Colgate, 18 yrs, British.

• She has Mathematically perfect looks. ("optimum ratio" between her mouth, eyes, chin, and forehead.)

• Beauty contest judge by the public.

• No make up, no surgery.


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Who do we treat?


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Who do we treat?


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Soft Tissue Studies Categories

Longitudinal: Broadbent et al. (1975) - 16 ♀/ 16 ♂ - childhood - adolescent Behrents (1985) – adult – geriatric.

Racial Differences: Caucasians, Afro-Americans, Thai, Chinese, Japanese, others…

Methods: Cephalometry: Peck & Peck (70), Margolis (63), Downs (56), Steiner(59), Holdaway (83,84), Ricketts (61), McNamara (92), Arnett(93), Legan(80), Proffit (80).

Anthropometry: Farkas (94), Mollov (12)

Photogrammetry: Anic-Milosevic (11), Fernandez-Riveiro (02)

3D Imaging: Fourier (2011), Hajeer (2004)

Video Imaging: Sarver (96), Desai et al. (2009)


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• Oral health – 3 anatomical categories: Facial, oral and dental. Oral esthetics - the least one studied.

• 88 subjects (46 ♀/ 42 ♂) – direct facial measurements • upper lip length: in ♂ 2.2 mm greater than ♀. (P<0.001); • Interlabial gap: smaller in ♂ - 2:1 ratio (p<0.05);

• Gingival smile line: high for ♀, and low for ♂.

• “Gummy smile”, “high lip line”, “short upper lip”, or “full denture smile”. Considered esthetically undesirable.

Peck and Peck (1993)

What to measure?


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• Peck and Peck (1993) 86% to 93% of the GSL subjects exhibited interlabial gap. However, only 56% of the subjects with interlabial gap had GSL.

• Conclusion: a.Interlabial gap (lip separation) was an associated facial

feature of the GSL, but not predictive. b. Subjects with GSL have more efficient lip elevation

musculature than those with average lip lines.

Interlabial Gap

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What to measure?

Changes to the soft tissue around the mouth and the nose in non-surgical orthodontic patients.

Method: • Anthropometry (availability) • Longitudinal • Prospective • Materials – hopefully all ortho. patients from MUSoD.

Ultimate Goal: Help clinicians to: • predict how lips and nose will behave during orthodontic treatment. • identify changes in the mouth and nose format after treatment.


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Reliability Preliminary Studies

Objective: to determine if facial soft tissue measurements using digital calipers could be reliably taken by the same examiner and by a large group of examiners.


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Mollov et al. (JWFO-2012)

Materials: •10 examiner acquired 18 in clinic facial measurements in 20 dental students (10 ♀/ 10 ♂) using a digital caliper. • Twice over a 3-week period. •ICC + Shrout-Fleiss method (statistical analysis)


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Mollov et al. (JWFO-2012)

Results: • Intra-examiner reliability was high for all measurements (none fell below R = 0.934). • Inter-examiner reliability - wide range of values, some reliable (nasal width at widest nostrils [R = 0.922] and subnasale to upper lip [R = 0.926]), and others unreliable [base of nose (R = 0.590), and soft tissue B point to gnathion (R = 0.623)].

Conclusion: • Soft tissue measurements of clearly identifiable points measured by the same examiner produced highly consistent, accurate and reliable measurements.


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Goals: 1. to define a new, low-cost method for taking standardized

frontal and sagittal facial photographs at the same time, 2. to determine on which photographic view that landmarks

could be more reliably located, 3. to determine which landmarks could best be used for

quantitative facial analysis.

Master Thesis - Michael Payne – 2013 Photogrammetric Reliability of Facial Soft Tissue Landmarks

Reliability Preliminary Studies


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Preliminary Studies

Photographic Setup

Ortho Measure program

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Diagram of frontal and lateral facial soft tissue landmark location



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Good Reliability

All landmarks (lips and nose) - average deviation less than 1.50 mm both images


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Poor Reliability


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Conclusion

1. Landmarks around the nose and mouth were among the most reliable landmarks on frontal and sagittal facial images and are more suitable for facial analysis.

2. All facial soft tissue landmarks showed greater reliability and less mean deviation from the best estimate when measured by a single examiner.


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Objective: to determine the correlation between upper lip length, mouth width, mouth height, Angle Classification of malocclusion and ethnicity in a random orthodontic patient population.

Preliminary Results

Soft Tissue Facial Measurements and Their Correlation in Orthodontic Patients

Bosio JA, Pruszynski J, Tanaka OM, Closs L, Janson G - Abstract - IADR - 2013


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Population: 226 participating patients (94-males/132-females) with a mean age of 15.62+/-5.8, and with different ethnicity (142 Caucasians, 32-African Americans (AA), 52-other ethnicities). Measurements taken by JAB. Statistical Analysis: Pearson’s, Bonferroni’s –p<0.0125, and two way ANOVA.



Preliminary Results

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Results

A. Upper lip length (UL) B. Mouth height (MH) C. Mouth width (MW) D. Inter-Labial Gap (IG)

A

C D

•MW to UL (A/C) – ICC whole sample - 0.21 (p<0.0114) – a positive linear relationship. •Two-way ANOVA - ethnicity did not affect the

relationship - Angle and UL. •MH & UL (A/B) all other ethnicities, except

Caucasian and AA - negative linear relationship (p<0.0065). Expected, the higher the MH, the shorter UL and vice-versa. •MH & MW (B/C) - positive correlation (p<0.0042)

–entire group. No relationship for specific ethnicity. •The IG & UL (A/D) negative correlation (p<0.0096)

– Caucasians &all other ethnicities combined (p<0.0069), but not for AA. The shorter the lip the greater the IG.

B


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Nov, 2008 - Before Sep, 2012 - After


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Differences in photographic assessment


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Conclusion

• Presented a brief history of the facial beauty.

• Anthropometric soft tissue clinical measurements can generate reliable information when taken by the same examiner.

• Demonstrated aspects of facial soft tissue diagnosis (such as photographic assessment).

jose... · title: slide 1 author: jose created date: 5/1/2013 11:11:14 am

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