clinical study comparison of soft tissue cephalometric...

Hindawi Publishing CorporationThe Scientific World JournalVolume 2013 Article ID 806203 6 pageshttpdxdoiorg1011552013806203

Clinical StudyComparison of Soft Tissue Cephalometric Norms betweenTurkish and European-American Adults

Ahmet Arif Celebi Enes Tan Ibrahim Erhan Gelgor Tugba Colak and Erdem Ayyildiz

Department of Orthodontics Faculty of Dentistry Kirikkale University Kirikkale 71100 Merkez Turkey

Correspondence should be addressed to Enes Tan dentistanyahoocom

Received 2 January 2013 Accepted 13 February 2013

Academic Editors E J Honkala S Minagi and C H Pameijer

Copyright copy 2013 Ahmet Arif Celebi et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

One of the most important components of orthodontic diagnosis and treatment planning is the evaluation of the patientrsquos softtissue profile The main purpose of this study was to develop soft-tissue cephalometric standards for Turkish men and womenand compare themwith the cephalometric standards of normal European-American white peopleThe sample included 96 Turkishadults (48 women 48men) aged 20 to 27 years Turkish subjects have increased facial convexity associated with retrudedmandiblemore obtuse lower face-throat angle increased nasolabial angle and upper lip protrusion deeper mentolabial sulcus and smallerinterlabial gap compared with European-American white people It is appropriate to consider these differences during routinediagnosis and treatment planning of a Turkish patient or an American patient of European ancestry Turkish males reveal moreobtuse mandibular prognathism and upper lip protrusion and smaller nasolabial angle than females

1 Introduction

When Broadbent introduced his cephalometer in 1931 a newperiod began in orthodontics The aim of cephalometricanalyses is to determine the relationships of the dentofacialcomplex Cephalograms can also help the orthodontist deter-mine the changes associated with growth and orthodontictreatment [1] Several cephalometric analyses have beenapplied to defined samples of untreated individual to derivecephalometric ldquonormsrdquo or ldquostandardsrdquo for a given populationusually defined in terms of age and ethnic origin [2 3] Allof them presented average measurements of skeletal andordental patterns with their ranges in a sample Whereas someinvestigators have noted the importance of the soft tissue inthe determination of facial aesthetics on the basis that softtissue behaves independently from the underlying skeletonbecause of the individual differences in soft tissue thickness[4ndash7]

The successful treatment planning for patients who re-quire orthognathic surgery should include both hard andsoft tissue cephalometric analysis [8] Various cephalometricanalyses for orthognathic surgery have been designed [56 9ndash12] Legan and Burstone soft tissue analysis is one of

the most common analysis systems used for orthognathicsurgery [6 13 14] However these cephalometric normswere specific to 1 ethnic groupmdashwhite subjects of European-American ancestrymdashand might not apply to other ethnicgroups Cephalometric norms for different ethnic and racialgroups have previously been established in many studies [15ndash19] Therefore it is important to develop norms of variouspopulations with a standard method

Turkey is an Eurasian country located in Western Asia(mostly in the Anatolian peninsula) and in SoutheasternEurope (East Thracian) Turkish population has genes fromAsiatic Turks Kurds the Balkans Caucasus Middle EastIran as well as from ancient Romans Byzantines and ArabsSeveral studies aimed to determine the Turkish populationrsquosideal norms Erbay et al [17] investigated cephalometricallythe horizontal lip position of Anatolian Turkish adults usingthe soft tissue analyses of Steiner Ricketts Burstone Sushnerand Holdaway In another study Erbay and Caniklioglu [18]evaluated the soft tissue profile to determine orthodontistsrsquoperceptions of Anatolian Turkish adultsrsquo beauty Uysal et al[20] determined cephalometrically the soft tissue norms ofAnatolian Turkish adults using the soft tissue analyses ofArnett et al [11] Gelgor et al used a parental data to evaluate

2 The Scientific World Journal

G

G-Sn

Sn-M

e998400

Sn

Pg998400

Gn998400

Me998400

C

7∘

Figure 1 Legan-Burstone soft tissue analysis facial forms Hori-zontal reference plane (HP) constructed by drawing a line throughnasion (N) 7 degrees up from the sella-nasion line Facial convexityangle (G-Sn-Pg1015840) maxillary prognathism (G vertical-Sn) mandibu-lar prognathism (G vertical-Pg1015840) vertical height ratio (G-SnSn-Me1015840) lower face-throat angle (Sn-Gn1015840-C) lower vertical height-depth ratio (Sn-Gn1015840C-Gn1015840)

soft tissues in an Anatolian Turkish population according toHoldaway soft tissue norms [21] Uysal et al [22] comparingTurkish and European-American adults reported some sig-nificant differences in their soft tissue parameters

Among the several numeric facial analyses currentlyused the analysis proposed by Legan and Burstone is impor-tant because it has been broadly used by orthodontists andmaxillofacial surgeons in diagnosis and treatment planningHowever the measurements in this analysis were based onEuropean-American samples and might not apply to Turkishpatients demonstrating the need for specific studies for thisethnic group The aims of this study were (1) to determinenorms for Legan and Burstone analysis from lateral cephalo-grams of Turkish adults and (2) to identify possible genderdifferences between males and females

2 Materials and Methods

The study group included 96 (48 males mean age 226 and48 female mean age 214) Turkish adults who were chosenfrom 2825 patients and who visited the Department ofOrthodontics at Kirikkale Dental Faculty from 2004 to 2011The following criteria were used for selection of the sample

(1) angle Class I occlusal relationship with normal over-bite and overjet

CmSn

Ls

Li

Si

Pg998400

Me998400

Stm119894

Stm119904

Me998400-Stm

119894Sn

-Stm

119904

Figure 2 Legan-Burstone soft tissue analysis lip positionNasolabial angle (Cm-Sn-Ls) upper lip protrusion (Ls to Sn-Pg1015840)lower lip protrusion (Li to Sn-Pg1015840) mentolabial sulcus (Si to Li-Pg1015840) vertical lip-chin ratio (Sn-StmsStmi-Me1015840) maxillary incisorexposure (Stms-UI) interlabial gap (Stms-Stmi)

(2) well-aligned upper and lower dental arches withmin-imal dental crowding

(3) normal growth and development pattern(4) no history of previous orthodontic treatment prost-

hodontic treatment or facial surgery

Lateral cephalometric radiographs were taken accordingto the following criteria (1) natural head position with teethin centric occlusion (2) the lips in rest position and (3)the lateral cephalometric radiograph was taken at a standardsource-to-cassette holder distance of 130mm (magnification109) with a Planmeca Cephalometer (PM 2002 EC ProlineHelsinki Finland) The subject was asked to look into thereflection of hisher own eyes in themirror to obtain a naturalhead position

Landmarks and angular and linear measurements of thesoft-tissue analysis of Legan and Burstone are shown inFigures 1 and 2

All cephalometric parameters were measured on stan-dardized lateral cephalometric radiographs by AC to test thereliability of the measurements 20 randomly selected cepha-logramswere retraced 2 weeks later by the same orthodontistall measurements were remeasured and the reliabilities of theparameters were examined with analysis of variance indexof reliability The calculated reliabilities ranged from 89 to

The Scientific World Journal 3

Table 1 Comparison of soft tissue cephalometric values of Turkish and European-American using Legan and Burstone analysis

Variable Turkish European-American119875 valueMean SD Mean SD

Facial formFacial convexity angle (∘) 1415 465 12 4 0035lowast

Maxillary prognathism (mm) 55 385 6 3 0724Mandibular prognathism (mm) minus27 725 0 4 0043lowast

Vertical height ratio 105 01 1 mdash 0091Lower face-throat angle (∘) 10565 8 100 7 0004lowastlowast

Lower vertical height-depth ratio 13 09 12 mdash 0458Lip position

Nasolabial angle (∘) 10705 845 102 8 0001lowastlowastlowast

Upper lip protrusion (mm) 335 19 3 1 0005lowastlowast

Lower lip protrusion (mm) 225 175 2 1 0453Mentolabial sulcus (mm) minus565 16 4 2 0001lowastlowastlowast

Vertical lip-chin ratio 048 0075 05 mdash 0876Maxillary incisor exposure (mm) 295 185 2 2 0054Interlabial gap (mm) 11 155 2 2 0046lowast

119875 ge 005ndashnonsignificant (NS) lowast119875 le 005 lowastlowast119875 le 001 lowastlowastlowast119875 le 0001

98 and were statistically significant (119875 lt 0001) There wereno significant differences between the mean values of eachparameter

All statistical analyses were performed using the Statis-tical Package for Social Sciences (Windows version 130SPSS Inc Chicago IL USA) Descriptive statistics (meanstandard deviations) were assessed for each measurementin both sexes separately An independent Studentrsquos t-testwas used to test the gender differences and to compare themean values of Turkish males and females with European-Americanrsquos mean values originally obtained by Legan andBurstone analysis [6] at 5 level (119875 le 005)

3 Results

The results showed descriptive statistics of the soft tissuecephalometric measurements for Turkish male and femalesubjects and compared them to European-American norms(Table 1) The Turkish norms had the following statisticallysignificant differences larger facial convexity angle (119875 =0035) lower face-throat angle (119875 = 0004) nasolabial angle(119875 = 0001) and upper lip protrusion (119875 = 0005) moreretruded pogonion (119875 = 0043) deeper mentolabial sulcus(119875 = 0001) and smaller interlabial gap (119875 = 0046)

Table 2 illustrates the gender differences of soft tissuevariables no statistically significant differences are noticedexcept for the 3 variables Turkish males revealed moreobtuse mandibular prognathism (119875 = 0018) and upper lipprotrusion (119875 = 0041) and smaller nasolabial angle (119875 =0027) than females

4 Discussion

Thenature of the soft tissue profile is affected bymany factorsincluding ethnicity For this reason facial characteristics havebeen studied in various ethnic groups [14 19 23ndash26] In our

daily practice various methods are used to evaluate cephalo-metric radiographs for orthognathic surgery The advantageof such analyses is that they provide the ability to makeobjective evaluation of important structures and relationships[12] In recent years the number of cephalometric studieshas been increased for Turkish population However theapplicability of the norms described in these analyses toTurkish people is controversial Several attempts have beenmade to evaluate the soft tissues of the Turkish population[17 18 22 27 28]

The current study developed and compared cephalomet-ric measurements of soft tissue facial profile of a sample ofTurkish adults to European-Americanrsquos norms using Leganand Burstone analysis

The sample was limited to young adults with a mean ageof 22 years because the vast majority of orthodontic patientsare young adults [24 29 30]

Both Turkishmales and females had a significant increasein facial convexity than the European-Americans as indicatedby statistically significant larger facial convexity angle Thefinding that the soft tissue facial angle is convex supportsanother previous study finding of similar convexity in softtissue profile [22] The angle of facial convexity in theTurkish populationwas smaller inmales than in femalesThisindicates that males have relatively straighter facial profilesthan females However the difference was not statisticallysignificant

Maxillar prognathismdidnot show significant differencesbetween the races However smaller values were recordedfor the mandibular prognathism measurement in Turk-ish subjects compared to the European-American samplesMandibular retrusion may be the reason for increased softtissue convexity for Turkish sample

The lower face-throat angle was more obtuse comparedwith European-American samples However Al-Gunaid et al[25] found that lower face-throat angle is not different


Table 2 Comparison of soft tissue cephalometric values of Turkish males and females using Legan and Burstone analysis

Variable Males Females119875 valueMean SD Mean SD

Facial formFacial convexity angle (∘) 136 42 147 51 0104Maxillary prognathism (mm) 52 37 58 4 0108Mandibular prognathism (mm) minus19 76 minus35 69 0018lowast

Vertical height ratio 11 01 1 01 0181Lower face-throat angle (∘) 1051 81 1062 79 0724Lower vertical height-depth ratio 16 14 14 04 0579

Lip positionNasolabial angle (∘) 1057 95 1084 74 0027lowast

Upper lip protrusion (mm) 39 17 28 21 0041lowast

Lower lip protrusion (mm) 24 19 21 16 0764Mentolabial sulcus (mm) minus54 16 minus59 16 0034Vertical lip-chin ratio 047 01 049 005 0527Maxillary incisor exposure (mm) 27 18 32 19 0216Interlabial gap (mm) 11 14 11 17 0869119875 ge 005ndashnonsignificant (NS) lowast119875 le 005 lowastlowast119875 le 001 lowastlowastlowast119875 le 0001

Table 3 Soft tissue cephalometric values of different ethnic groups using Legan and Burstone analysis

Variable Chinese Japanese North Indians Saudis Yemeni CaucasiansFacial convexity angle (∘) 105 plusmn 35 101 plusmn 57 1334 plusmn 48 1516 plusmn 464 169 plusmn 52 12 plusmn 4Maxillary prognathism (mm) 25 plusmn 3 23 plusmn 46 583 plusmn 43 647 plusmn 427 69 plusmn 41 6 plusmn 3Mandibular prognathism (mm) NA minus57 plusmn 83 minus131 plusmn 64 minus137 plusmn 719 minus49 plusmn 67 0 plusmn 4Vertical height ratio 10 plusmn 01 09 plusmn 01 103 plusmn 01 100 plusmn 009 10 plusmn 01 1Lower face-throat angle (∘) 96 plusmn 4 981 plusmn 95 11157 plusmn 81 10260 plusmn 824 1076 plusmn 79 100 plusmn 7Lower vertical height-depth ratio 11 plusmn 02 13 plusmn 02 122 plusmn 02 114 plusmn 020 14 plusmn 02 12Nasolabialangle (∘) 95 plusmn 3 1023 plusmn 116 9579 plusmn 114 10602 plusmn 1101 1064 plusmn 97 102 plusmn 8Upper lip protrusion (mm) 70 plusmn 15 58 plusmn 21 472 plusmn 17 384 plusmn 156 26 plusmn 12 3 plusmn 1Lower lip protrusion (mm) NA 50 plusmn 25 283 plusmn 16 326 plusmn 207 22 plusmn 22 2 plusmn 1Mentolabial sulcus (mm) 35 plusmn 2 43 plusmn 14 582 plusmn 12 460 plusmn 123 50 plusmn 11 4 plusmn 2Vertical lip-chin ratio 05 04 plusmn 01 044 044 plusmn 005 04 plusmn 01 05Maxillary incisor exposure (mm) 15 plusmn 15 18 plusmn 17 235 plusmn 15 326 plusmn 196 29 plusmn 15 2 plusmn 2Interlabial gap (mm) 10 plusmn 10 19 plusmn 09 024 plusmn 07 224 plusmn 093 06 plusmn 04 2 plusmn 2NA not available

between the races An appreciation of this angle is criticalin planning treatment to correct anteroposterior facial dys-phasia An obtuse lower face-throat angle should warn theclinician not to use procedures that reduce the prominenceof the chin [6]

No statistically significant difference existed for the ver-tical ratio and lower vertical height-depth ratio between theraces Similar results were reported by Uysal et al [22]

Turkish males and females had statistically significantlarger nasolabial angle than those in European-Americansamples Legan and Burstone [6] indicated that in surgicalprocedures this angle should be in the range of 102plusmn8degreesTurkish adult norms were near the upper border of the rangeand showed gender differences The findings for nasolabialangle in the current investigation were distinctly differentfrom those of Uysal et al [20 22]

Sex differences in upper lip protrusion Turkish subjectswere statistically significant It was obvious that the upper

lips were more protrusive in the males Similar results werereported by Uysal et al [22] Erbay et al [17] determinedlips protrusion in Anatolian Turkish adults using the estheticplane analysis According to the findings of Erbay et al[17] upper and lower lips position is dentally and skeletallynormal Anatolian Turkish subjects were not statisticallysignificant

Turkish subjects had significantly more protruded upperlip positions than European-Americans This finding wascompatible with Uysal et al [22] No statistically significantdifference existed for lower lip protrusion between the racesand genders

The mentolabial sulcus depth was significantly greater inTurkish adults than in the European-Americans perhaps thismight be attributed to mandibular retrusion

The interlabial gap in Turkish subjects was significantlyshorter compared with European-Americans which might bedue to the difference in upper lip thickness


When other ethnic groups were compared with Europe-an-Americans using Legan and Burstone analysis significantdifferences were seen (Table 3) Chinese subjects had less con-vex faces retrognathic chin acute nasolabial angle and moreprotrusive lips in comparisonwith European-Americans [14]Japanese subjects had a retrognathic maxilla retruded chinwith less deep inferior sulcus obtuse nasolabial angle andmore protrusive lips compared with European-Americans[24] North Indian subjects had convex profile more obtuselower face-throat angle protrusive lips acute nasolabialangle deep mentolabial sulcus and shorter interlabial gapthan in European-Americans [30] Saudis have a moreconvex profile and reduced lower vertical height depth ratiovalues shorter neck distance and more reduced chin thanEuropean-Americans In a study on a Yemeni populationsoft tissue analyses showed a more convex facial form amore retrudedmandible obtuse lower face throat angle deepmentolabial sulcus shorter interlabial gap and increasedincisor exposure compared with European-Americans

In conclusion the present study has produced normativecephalometric data for a Turkish population that will aid indiagnosis and treatment planning In comparison with anEuropean-American sample Turkish subjects have increasedfacial convexity associated with retruded mandible moreobtuse lower face-throat angle increased nasolabial angleand upper lip protrusion more deep mentolabial sulcus andsmaller interlabial gap

References

[1] S E Bishara andAG Fernandez ldquoCephalometric comparisonsof the dentofacial relationships of two adolescent popula-tions from Iowa and Northern Mexicordquo American Journal ofOrthodontics vol 88 no 4 pp 314ndash322 1985

[2] C H Tweed ldquoThe frankfort-mandibular plane angle in ortho-dontic diagnosis classification treatment planning and prog-nosisrdquoThe Angle Orthodontist vol 24 no 3 pp 121ndash169 1954

[3] W B Downs ldquoVariations in facial relationships their signifi-cance in treatment and prognosisrdquo American Journal of Ortho-dontics vol 34 no 10 pp 812ndash840 1948

[4] R M Ricketts ldquoEsthetics environment and the law of liprelationrdquo American Journal of Orthodontics vol 54 no 4 pp272ndash289 1968

[5] B N Epker J P Stella and L C Fish Dentofacial DeformitiesIntegrated Orthodontic and Surgical Correction Mosby StLouis Mo USA 1998

[6] H L Legan and C J Burstone ldquoSoft tissue cephalometricanalysis for orthognathic surgeryrdquo Journal of Oral Surgery vol38 no 10 pp 744ndash751 1980

[7] R AHoldaway ldquoA soft-tissue cephalometric analysis and its usein orthodontic treatment planning Part Irdquo American Journal ofOrthodontics vol 84 no 1 pp 1ndash28 1983

[8] S F AlBarakati ldquoSoft tissue facial profile of adult Saudis lateralcephalometric analysisrdquo SaudiMedical Journal vol 32 no 8 pp836ndash842 2011

[9] C J Burstone R B James H Legan G A Murphy and L ANorton ldquoCephalometrics for orthognathic surgeryrdquo Journal ofOral Surgery vol 36 no 4 pp 269ndash277 1978

[10] G W Arnett and M J Gunson ldquoFacial planning for orthodon-tists and oral surgeonsrdquo American Journal of Orthodontics andDentofacial Orthopedics vol 126 no 3 pp 290ndash295 2004

[11] G W Arnett J S Jelic J Kim et al ldquoSoft tissue cephalomet-ric analysis diagnosis and treatment planning of dentofacialdeformityrdquo American Journal of Orthodontics and DentofacialOrthopedics vol 116 no 3 pp 239ndash253 1999

[12] G W Arnett and R P McLaughlin Facial and Dental Planningfor Orthodontists and Oral Surgeons Mosby London UK 2004

[13] R Isaacson ldquoCephalometric norms for orthognathic surgeryin black American adultsrdquo Journal of Oral and MaxillofacialSurgery vol 47 no 1 pp 30ndash39 1989

[14] R J Isaacson ldquoDiscussion Soft-tissue cephalometric norms inChinese adults with esthetic facial profilesrdquo Journal of Oral andMaxillofacial Surgery vol 50 no 11 pp 1189ndash1190 1992

[15] D Swlerenga L J Oesterle and M L Messersmith ldquoCephalo-metric values for adult Mexican-Americansrdquo American Journalof Orthodontics and Dentofacial Orthopedics vol 106 no 2 pp146ndash155 1994

[16] K Miyajima J A McNamara Jr T Kimura S Murata andT Iizuka ldquoCraniofacial structure of Japanese and European-American adults with normal occlusions and well-balancedfacesrdquoAmerican Journal of Orthodontics andDentofacial Ortho-pedics vol 110 no 4 pp 431ndash438 1996

[17] E F Erbay C M Caniklioglu and S K Erbay ldquoSoft tissueprofile in Anatolian Turkish adults part I Evaluation of hori-zontal lip position using different soft tissue analysesrdquoAmericanJournal ofOrthodontics andDentofacialOrthopedics vol 121 no1 pp 57ndash64 2002

[18] E F Erbay and C M Caniklioglu ldquoSoft tissue profile in Ana-tolian Turkish adults part II Comparison of different sof tissueanalyses in the evaluation of beautyrdquo American Journal of Or-thodontics andDentofacial Orthopedics vol 121 no 1 pp 65ndash722002

[19] H S Hwang W S Kim and J A McNamara Jr ldquoEthnicdifferences in the soft tissue profile of Korean and European-American adults with normal occlusions and well-balancedfacesrdquo Angle Orthodontist vol 72 no 1 pp 72ndash80 2002

[20] T Uysal A Yagci F A Basciftci and Y Sisman ldquoStandardsof soft tissue Arnett analysis for surgical planning in Turkishadultsrdquo European Journal of Orthodontics vol 31 no 4 pp 449ndash456 2009

[21] I E Gelgor A I Karaman and E Zekic ldquoThe use of parentaldata to evaluate soft tissues in an Anatolian Turkish populationaccording to Holdaway soft tissue normsrdquo American Journal ofOrthodontics and Dentofacial Orthopedics vol 129 no 3 pp330e1ndash330e9 2006

[22] T Uysal A Baysal A Yagci L M Sigler and J A McNamaraJr ldquoEthnic differences in the soft tissue profiles of Turkish andEuropean-American young adults with normal occlusions andwell-balanced facesrdquo European Journal of Orthodontics vol 34no 3 pp 296ndash301 2012

[23] H A Hashim and S F AlBarakati ldquoCephalometric soft tissueprofile analysis between two different ethnic groups a compar-ative studyrdquo Journal of Contemporary Dental Practice vol 4 no2 pp 60ndash73 2003

[24] R E Alcalde T Jinno M G Orsini A Sasaki R MSugiyama and TMatsumura ldquoSoft tissue cephalometric normsin Japanese adultsrdquo American Journal of Orthodontics andDentofacial Orthopedics vol 118 no 1 pp 84ndash89 2000

[25] T Al-Gunaid K Yamada M Yamaki and I Saito ldquoSoft-tissuecephalometric norms in Yemeni menrdquo American Journal ofOrthodontics and Dentofacial Orthopedics vol 132 no 5 pp576e7ndash576e14 2007

[26] A S Kalha A Latif and S N Govardhan ldquoSoft-tissue cephalo-metric norms in a South Indian ethnic populationrdquo American


Journal of Orthodontics and Dentofacial Orthopedics vol 133no 6 pp 876ndash881 2008

[27] A Gulsen C Okay B I Aslan O Uner and R Yavuzer ldquoTherelationship between craniofacial structures and the nose inAnatolian Turkish adults a cephalometric evaluationrdquo Amer-ican Journal of Orthodontics and Dentofacial Orthopedics vol130 no 2 pp 131e15ndash132e25 2006

[28] S Malkoc A Demir T Uysal and N Canbuldu ldquoAngularphotogrammetric analysis of the soft tissue facial profile ofTurkish adultsrdquo European Journal of Orthodontics vol 31 no2 pp 174ndash179 2009

[29] J A McNamara Jr and E Ellis III ldquoCephalometric analysis ofuntreated adults with ideal facial and occlusal relationshipsrdquoThe International Journal of Adult Orthodontics and Orthog-nathic Surgery vol 3 no 4 pp 221ndash231 1988

[30] P Jain and J P S Kalra ldquoSoft tissue cephalometric norms for aNorth Indian population group using Legan and Burstone anal-ysisrdquo International Journal of Oral and Maxillofacial Surgeryvol 40 no 3 pp 255ndash259 2011

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OrthopedicsAdvances in


G

G-Sn

Sn-M

e998400

Sn

Pg998400

Gn998400

Me998400

C

7∘

Figure 1 Legan-Burstone soft tissue analysis facial forms Hori-zontal reference plane (HP) constructed by drawing a line throughnasion (N) 7 degrees up from the sella-nasion line Facial convexityangle (G-Sn-Pg1015840) maxillary prognathism (G vertical-Sn) mandibu-lar prognathism (G vertical-Pg1015840) vertical height ratio (G-SnSn-Me1015840) lower face-throat angle (Sn-Gn1015840-C) lower vertical height-depth ratio (Sn-Gn1015840C-Gn1015840)

soft tissues in an Anatolian Turkish population according toHoldaway soft tissue norms [21] Uysal et al [22] comparingTurkish and European-American adults reported some sig-nificant differences in their soft tissue parameters

Among the several numeric facial analyses currentlyused the analysis proposed by Legan and Burstone is impor-tant because it has been broadly used by orthodontists andmaxillofacial surgeons in diagnosis and treatment planningHowever the measurements in this analysis were based onEuropean-American samples and might not apply to Turkishpatients demonstrating the need for specific studies for thisethnic group The aims of this study were (1) to determinenorms for Legan and Burstone analysis from lateral cephalo-grams of Turkish adults and (2) to identify possible genderdifferences between males and females

2 Materials and Methods

The study group included 96 (48 males mean age 226 and48 female mean age 214) Turkish adults who were chosenfrom 2825 patients and who visited the Department ofOrthodontics at Kirikkale Dental Faculty from 2004 to 2011The following criteria were used for selection of the sample

(1) angle Class I occlusal relationship with normal over-bite and overjet

CmSn

Ls

Li

Si

Pg998400

Me998400

Stm119894

Stm119904

Me998400-Stm

119894Sn

-Stm

119904

Figure 2 Legan-Burstone soft tissue analysis lip positionNasolabial angle (Cm-Sn-Ls) upper lip protrusion (Ls to Sn-Pg1015840)lower lip protrusion (Li to Sn-Pg1015840) mentolabial sulcus (Si to Li-Pg1015840) vertical lip-chin ratio (Sn-StmsStmi-Me1015840) maxillary incisorexposure (Stms-UI) interlabial gap (Stms-Stmi)

(2) well-aligned upper and lower dental arches withmin-imal dental crowding

(3) normal growth and development pattern(4) no history of previous orthodontic treatment prost-

hodontic treatment or facial surgery

Lateral cephalometric radiographs were taken accordingto the following criteria (1) natural head position with teethin centric occlusion (2) the lips in rest position and (3)the lateral cephalometric radiograph was taken at a standardsource-to-cassette holder distance of 130mm (magnification109) with a Planmeca Cephalometer (PM 2002 EC ProlineHelsinki Finland) The subject was asked to look into thereflection of hisher own eyes in themirror to obtain a naturalhead position

Landmarks and angular and linear measurements of thesoft-tissue analysis of Legan and Burstone are shown inFigures 1 and 2

All cephalometric parameters were measured on stan-dardized lateral cephalometric radiographs by AC to test thereliability of the measurements 20 randomly selected cepha-logramswere retraced 2 weeks later by the same orthodontistall measurements were remeasured and the reliabilities of theparameters were examined with analysis of variance indexof reliability The calculated reliabilities ranged from 89 to















3 Results



4 Discussion





























References








































Biomaterials












Journal of

































3 Results



4 Discussion





























References








































Biomaterials












Journal of








































References








































Biomaterials












Journal of
































Biomaterials












Journal of



















clinical study comparison of soft tissue cephalometric...

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