Clinical facial analysis (CFA) for orthodontists and maxillofacial surgeons

By Mohammed AlmuzianUniversity of Glasgow, 2012

 

What is Clinical Facial Analysis?It is the method utilized by clinician for evaluating and judging the patient‘s face; to define its proportions, volume, appearance, symmetry, and visible

deformities. (Biondi, 2005)

To whom CFA might be beneficial?

Methods of CFA

Direct examination

Clinical photographs

Non Radiographical 3D imaging methods

Conventional & 3D x-ray imaging.

Is CFA parameters are standard?

Racial background

Cultural difference

Gender

Personal preference

Clinician philosophy

Importance of CFA

• To diagnose and classify the deformities especially for border line cases.

• To plan the treatment approach that mainly addresses the patient concerns and complaints.

• To predict the treatment outcomes, stability & prognosis.

When CFA should be performed?

Thorough CFA Initial CFA

Observation stage

Questionnaire stage

Steps in CFA

Positioning the patient • NHP (developed by.., tested by…, described by…. • Centric relation• Relaxed lip position, BOWB (bite opening wax bite)

indicated in………• First tooth contact (wax bite , deprogramming splint)Then 1. Frontal view analysis, 2. Profile view analysis, 3. 45 degree view analysis for profile-frontal shared features.

Frontal view analysis

Vertical analysis of the frontal viewFacial typeVertical heightsLip assessment

Facial type

(Naini 2008)

Vertical analysis of the frontal view

Vertical heights

Vertical analysis of the frontal view

1. upper third 2. middle third 3. lower third • Upper lip• Lower lip and chin• Interlabial gap

Bell et al 1980 Fish and Epker 1981Ricketts et al 1979Farkus 1984

Lip assessment (LAMP),

miniesthetic analysis

• Line, • Activity• Morphology• Position

Mossy 1981Fish & Epker 1981Naini 2008

Vertical analysis of the frontal view

Frontal view analysis

Transverse analysis of frontal viewVertical reference lines (Facial midline, Rule of fifths)Skeletal base assessment(Maxillary & Mandibular)Smile analysis

Dental factors

Transverse analysis of frontal view

Vertical reference linesFacial midlineRule of fifths

Naini 2008Arnett and McLaughlin 2004Sheen, 1978

Transverse analysis of frontal view

Skeletal base assessment

Mandibular assessment Chin jaw line

Maxillary assessment Sclera show

Paranasal hollowing

Naini 2008Hunt & Ruge 1983

Transverse analysis of frontal view

Smile analysis

• The smile arc• Width of smile• Incisor and

gingival show (Posed, social smile)

Naini 2008

Transverse analysis of frontal view

Dental factors

• Overbite• Occlusal plane

(Upper, lower, anterior posterior)

• Maxillary dental midline

• Mandibular dental midline

Profile analysis

Total soft tissue profile analysisAnalysis of the high midfaceAnalysis of the maxillary areaAnalysis of the mandibular area

Facial profile analysis

Total soft tissue profile analysis

Angle of convexity , Burstone 1968, 11-30 degree .

Nasomental angle (Total facial angle) 160 degree

Burstone 1965Moshiri et al, 1982Powell et al 1984

Facial profile analysis

Analysis of the high midface

• Soft tissue glabella • Orbital rim • Check bone contour

Fish & Epker 1981

Facial profile analysis

Analysis of the maxillary area

• Nasal base (Meridian line)

• Nasal projection (TVL)Anteroposterior lip position (TVL, E line, S line, H line) • Relationship of upper

lip to nose

Gonzales-Ulloa 1966Arnett & Bergman 1993

Ricketts 1979Steiner 1966Holdaway 1983Fish & Epker 1981

Facial profile analysis Analysis of the mandibular area

1 .Anteroposterior lip position (TVL, E line, S line)

2 .Relationship of lower lip to chin

3. Anteroposterior chin positionBass aesthetic analysis Facial vertical

Holdaway angleProfile line or Z angle

4. Relationship of chin to submental area• Lip-chin-submental plane • Submental plane length

Gonzales-Ulloa 1966Arnett & Bergman 1993

Ricketts 1979Steiner 1966Bass, 2003Merrifield, 1966Moshiri et al, 1982

Dental Appearance: Micro-Esthetics.

Tooth ProportionsWidth Relationships and the "Golden Proportion "

Height-Width RelationshipsGingival Heights, Shape and Contour

ConnectorsEmbrasures: Black TrianglesTooth Shade and Color

Thank you