research article correlation assessment between three ...craniofacial diagnosis and orthodontic...

Research ArticleCorrelation Assessment between Three-DimensionalFacial Soft Tissue Scan and Lateral Cephalometric Radiographyin Orthodontic Diagnosis

Piero Antonio Zecca Rosamaria Fastuca Matteo BerettaAlberto Caprioglio and Aldo Macchi

Department of Surgical and Morphological Sciences University of Insubria 21100 Varese Italy

Correspondence should be addressed to Rosamaria Fastuca rosamariafhotmailit

Received 21 February 2016 Accepted 12 April 2016

Academic Editor Thomas Fortin

Copyright copy 2016 Piero Antonio Zecca 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

Purpose The aim of the present prospective study was to investigate correlations between 3D facial soft tissue scan and lateralcephalometric radiography measurements Materials and Methods The study sample comprised 312 subjects of Caucasian ethnicorigin Exclusion criteria were all the craniofacial anomalies noticeable asymmetries and previous or current orthodontictreatment A cephalometric analysis was developed employing 11 soft tissue landmarks and 14 sagittal and 14 vertical angularmeasurements corresponding to skeletal cephalometric variables Cephalometric analyses on lateral cephalometric radiographieswere performed for all subjects The measurements were analysed in terms of their reliability and gender-age specific differencesThen the soft tissue values were analysed for any correlations with lateral cephalometric radiography variables using Pearsoncorrelation coefficient analysis Results Low medium and high correlations were found for sagittal and vertical measurementsSagittal measurements seemed to be more reliable in providing a soft tissue diagnosis than vertical measurements ConclusionsSagittal parameters seemed to be more reliable in providing a soft tissue diagnosis similar to lateral cephalometric radiographyVertical soft tissue measurements meanwhile showed a little less correlation with the corresponding cephalometric values perhapsdue to the low reproducibility of cranial base and mandibular landmarks

1 Introduction

Skeletal and dental components are of great importance incraniofacial diagnosis and orthodontic treatment planning[1] Hard tissue is routinely evaluated by means of lateralcephalometric radiography collected by clinicians prior toorthodontic therapy Besides skeletal evaluation facial softtissue analysis is assuming a relevant role in orthodontic diag-nosis and treatment planning since clinicians need to care-fully assess the effects of dental and skeletal changes on thesoft tissue profile when managing orthodontic treatment inorder to estimate facial changes along with occlusal improve-ments [2] Therefore soft tissue analysis might representan important source of treatment outcome evaluation andadditional information for diagnosis

Although cephalometric analysis of lateral radiographyis spreading among orthodontists its role in diagnosis andtreatment planning is still debated [3] Moreover the funda-mental principles of justification optimization and dose limi-tation should always be considered when radiographic exam-inations are performed at the beginning of the orthodontictreatment

Thegrowing interest in noninvasive diagnosis has allowedthe development of new imaging tools which could enhancethe role of soft tissue in diagnosis Nevertheless the diffi-culty of performing facial examinations reliably is probablyresponsible for the secondary role of soft tissue analysis insupporting diagnosis compared with skeletal analysis [4 5]

Several analyses have been proposed for the evaluation offacial soft tissue Most of them include photographic images

Hindawi Publishing CorporationInternational Journal of DentistryVolume 2016 Article ID 1473918 8 pageshttpdxdoiorg10115520161473918

2 International Journal of Dentistry

N

s

Po

ANSA

Or

B

Pg

(a)

Po

S

N

Ar

Or

Pg

GnMe

Go

(b)

Figure 1 2D tracings and cephalometric analysis performed with lateral cephalometric radiography (a) Sagittal measurements and (b)vertical measurements

in lateral position [6ndash9] Some authors [4 5] have also pro-posed soft tissue evaluation with frontal pictures and under-lined the importance of reproducible head position duringimage acquisition

Among the recently introduced noninvasive imagingtechniques stereophotogrammetry and laser scanning allowaccurate acquisition of three-dimensional (3D) facial soft tis-sue with the possibility of locating landmarks and measuringangles distances surfaces and volumes [10ndash13] Even thoughnormative values of 3D facial soft tissue are not available forthe general population some proposals have been made forspecific sagittal and verticalmeasurements [14 15] but furtherstudies are needed to improve their reliability

The difficulties related to the use of the appropriateequipment and software and the absence of reliable normativevalues for 3D facial soft tissue measurements might preventtheir adoption by clinicians who are still using lateralcephalometric radiography to perform their diagnosis

The relationships between facial soft tissue and underly-ing hard tissue should be considered and investigated for anycorrespondences that might improve noninvasive orthodon-tic diagnosis and thus reduce patientsrsquo exposure to ionizingradiation

The soft tissue profile may reflect the underlying skeletaland hard tissue and it would be possible to estimate theskeletal configuration by visual inspection of the soft tissueprofile alone as suggested by previous studies [16] Validationof the anatomy of facial soft tissue is fundamental for anobjective analysis of craniofacial morphologies

The aim of the present study was therefore to investi-gate correlations between facial soft tissue scans and lateralcephalometric radiography measurements

2 Materials and Methods

21 Patient Selection Signed informed consent to the releaseof diagnostic records for scientific purposes was obtainedfrom patients prior to enrolment in the present prospectivestudyThe protocol was reviewed and approved by the EthicalCommittee (Approval number 6154) and procedures fol-lowed adhered to the Declaration of Helsinki The final studysample comprised 312 subjects 155 males (mean age of 243)and 157 females (mean age of 258) Inclusion criteria wereCaucasian ethnic origin age between 20 and 30 years to avoiderrors arising from soft tissue laxity which might increasewith age and normal body mass index (BMI) [17] Subjectswere selected from those patients seeking orthodontic treat-ment for whoma diagnostic lateral cephalometric radiographhad been recorded within the previous six months Exclusioncriteria were craniofacial syndromes or anomalies noticeableasymmetries and previous or current orthodontic treatmentthat might affect the homogeneity of the sample

Lateral cephalometric radiographs were then collectedfor all subjects and cephalometric measurements were per-formed with Deltadent software (Outside Format MilanItaly) (Figure 1)

A facial scanner (Primesense Carmine 109 Subsidiaryof Apple Inc Israel 2005) was employed for acquisition of

International Journal of Dentistry 3

Figure 2 Facial soft tissue scan Frontal prospective and rightlateral 3D views of facial soft tissue scan of female patient

the facial soft tissue of the subjects The subject-to-scannerdistance was set at 80 cm and scan time was 30 s on averageThe scanner depth sensor data were 640 times 480 pixels Datawere recorded on a desktop workstation with a 26GHz i7Intel processor (Dell Wicklow Ireland)

Light conditions were set in order for reliable datacapture The subjects were seated with the lips relaxed andwith the head in natural head position (NHP) (self-balanceldquomirrorrdquo position) as described by previous authors [18ndash20]If a subjectmoved between scans the procedure was repeatedand the data of the first scan were eliminated from the study

The data were acquired by dedicated Skanect software(developed by the ManCTL Company 2011 Madrid) (Fig-ure 2) Mimics software (version 1011 Materialise MedicalCo Leuven Belgium) was used to import the surface modeland to perform 3D cephalometric analysis

All the lateral cephalometric radiographs underwentreposition of the head on the basis of the orientation of thesoft tissue scan position by superimposition on the rightlateral view of the 3D facial scan using Deltadent software

A set of reproducible landmarks was developed to com-pute the soft tissue cephalometric analysis (Figure 3) Four-teen sagittal (Figures 4 5 and 6) and 14 vertical (Figures 7 8and 9) angular measurements were selected and performedfor good anatomical correspondence between hard tissue andsoft tissue structures and reference landmarksThe average ofthe angles was computed for symmetric structures

Then every skeletal measurement was coupled andassigned to one or more soft tissue measurement (Table 1) forthe correlation analysis

22 Statistical Analysis A pilot study was executed on 20patients (12 males and 8 females) for the power analysis

One sagittal and three vertical measurements wereemployed as main outcome for the power analysis as followsSsN1015840Sl TrOr1015840andGo1015840Gn1015840 TrN1015840andGo1015840Gn1015840 and ObsN1015840andGo1015840Gn1015840No differences in gender were included in the power analysis

According to the power analysis 300 subjects wererequired in order to obtain power of 080 for the present study

SPSS software version 220 (SPSS Inc Chicago IllinoisUSA) was used to run statistical analyses The Shapiro-Wilktest revealed a normal distribution of tested variables Themean and standard deviation (SD) of each of the variableswere then calculated Independent 119905-test was used to compare

Figure 3 Set of reproducible landmarks employed to perform sagit-tal and vertical soft tissue 3Dmeasurements N1015840 Nasion Obs Otoba-sion Tr Tragus Or1015840 Orbitale Sp Spinal Ss Subspinal Go1015840 GonionSl Sublabial Pg1015840 Pogonion Me1015840 Menton Gn1015840 Gnation

Figure 4 Sagittal angular measurements for 3D facial soft tissue Rright Maxillary sagittal measurements

themeandifferences between females andmales and119875 lt 005was set as the level of significance All the variables werethen further analysed for any correlationswith correspondinglateral cephalometric radiography measurements with thePearson correlation coefficient (119903) with the level of signifi-cance set at 119875 lt 005

23 Method Error All the measurements were performedby the same trained operator Thirty of the 3D facial scanswere repeated two weeks after the first recording and mea-surements were performedTheDahlberg coefficient [21] wasused to test the reproducibility of all the soft tissue landmarks


Figure 5 Sagittal angular measurements for 3D facial soft tissue Rright Mandibular sagittal measurements

Figure 6 Sagittal angular measurements for 3D facial soft tissue Rright Maxillomandibular sagittal measurements

Figure 7 Vertical angular measurements for 3D facial soft tissue Rright Part 1



employed All the parameters displayed a method error lt 1∘which is considered clinically irrelevant

3 Results

Mean and standard deviations were calculated for each lateralcephalometric radiograph and soft tissue measurement

The tested variables such as mean and SD did not showsignificant differences in terms of gender-specific differences(Table 2) and the following statistical analyses were per-formed for the total sample

Medium low and high correlations were found forsagittal parameters and vertical parameters in assessmentof correlation with the corresponding lateral cephalometricradiographymeasurements previously assigned (Tables 3 and4)

ANB ANPg and FHandAB were the only sagittal variableswhich showed high correlation coefficients compared with


Table 1 2D and 3D cephalometric analyses Cephalometric sagittaland vertical analyses and corresponding 3D soft tissue measure-ments

Cephalometrics 3D soft tissueSagittal

SNA TrN1015840SsObsN1015840Ss

SNans TrN1015840SpObsN1015840Sp

FHandNA TrOr1015840andN1015840Ss

SNB TrN1015840SlObsN1015840Sl

SNPg TrN1015840Pg1015840

ObsN1015840Pg1015840

FHandNB TrOr1015840andN1015840SlFHandNPg TrOr1015840andN1015840Pg1015840

ANB SsN1015840SlANPg SsN1015840Pg1015840

FHandAB TrOr1015840andSsSlVertical

SNandFH TrN1015840andTrOr1015840

ObsN1015840andTrOr1015840

FMA TrOr1015840andGo1015840Gn1015840

SNandGoGn TrN1015840andGo1015840Gn1015840

ObsN1015840andGo1015840Gn1015840

Gonial s ArGoN ObsGo1015840N1015840

Gonial i NGoMe N1015840Go1015840Me1015840

Articulare SArGo N1015840ObsGo1015840

NPg-GoMe N1015840Pg1015840andGo1015840Me1015840

SNandArGo TrN1015840andObsGo1015840

ObsN1015840andObsGo1015840

FHandArGo TrOr1015840andObsGo1015840

FHandSPg TrOr1015840andTrPg1015840

TrOr1015840andObsPg1015840

the respective soft tissue variables Conversely FHandNA andSNans showed low correlation coefficients (Table 3)

No high correlations coefficients were found for thevertical parameters which showed medium correlation coef-ficients except for SNandFH that exhibited low correlationcompared with the respective soft tissue variables (Table 4)

4 Discussion

The purpose of this study was to compare facial soft tissueanalysis obtained from facial scans with lateral cephalomet-ric radiography in order to highlight possible correspon-dences between hard tissue and soft tissue diagnoses Thegrowing role of noninvasive imaging tools could be of greatimportance in orthodontic diagnosis since 3D facial softtissue might be employed as the first screening examinationfor guiding clinicians through skeletal diagnosis and perfor-mance of further radiological exams only when needed

Table 2 Sex differences Data are shown asmean (in bold) and stan-dard deviation (SD) (in italic) for the whole sample for females andfor males 119875 values resulting from 119905-test to explore gender-specificdifferences are shown

3D soft tissue Meanfemale

SDfemale

Meanmale

SDmale 119875 value

SagittalTrN1015840Ss 7975 253 8146 341 008ObsN1015840Ss 8203 273 8402 374 006TrN1015840Sp 8266 259 8408 339 012ObsN1015840Sp 8494 243 8663 383 008TrOr1015840andN1015840Ss 8667 182 8583 247 017TrN1015840Sl 7163 339 7174 393 047ObsN1015840Sl 7391 348 7430 429 041TrN1015840Pg1015840 7116 369 7186 379 033ObsN1015840Pg1015840 7344 381 7442 421 028TrOr1015840andN1015840Sl 8424 363 8392 353 042TrOr1015840andN1015840Pg1015840 8371 397 8402 338 043SsN1015840Sl 811 199 972 243 006SsN1015840Pg1015840 859 245 960 214 017TrOr1015840andSsSl 7010 577 6574 782 006

VerticalTrN1015840andTrOr1015840 1265 229 1243 109 041ObsN1015840andTrOr1015840 1041 306 968 147 028TrOr1015840andGo1015840Gn1015840 3052 610 2822 412 018TrN1015840andGo1015840Gn1015840 4317 619 4065 402 016ObsN1015840andGo1015840Gn1015840 4092 641 3791 372 013ObsGo1015840N1015840 6409 603 6540 263 029N1015840Go1015840Me1015840 7019 584 7036 551 047N1015840ObsGo1015840 8409 394 8215 466 014N1015840Pg1015840andGo1015840Me1015840 6572 463 6776 646 018TrN1015840andObsGo1015840 8556 370 8458 379 027ObsN1015840andObsGo1015840 8409 394 8215 466 014TrOr1015840andObsGo1015840 7624 523 7247 452 005TrOr1015840andTrPg1015840 3831 285 3662 186 008TrOr1015840andObsPg1015840 4447 301 4399 180 035

The tested infrared scanner showed good reliability andreproducibility in facial morphology acquisition Moreoverthe facial scans proved appropriate for landmark locationand the method error for soft tissue cephalometric analysiswas acceptable The possibility of evaluating soft tissue com-ponents in 3D allowed us to relocate the head and did notpresent the limitation of bidimensional (2D) photographicpictures where head position errors can be of great impor-tance in landmark identification

The sample was first tested for any gender-specific dif-ferences Kochel et al [14] employed stereophotogrammetryfor the evaluation of facial soft tissue focusing on sagittalmeasurements and found significant differences betweenmales and females with the mean age (254 years) similarlyto the sample in the present study According to the presentresults no significant differences in facial soft tissue sagittal


Table 3 Sagittalmeasurement correlations Pearson correlation coefficients (119903) are shown for sagittalmeasurements as low (in italic)medium(lightface) and high (in bold) lowast119875 lt 005

Cephalometrics 3D soft tissue119903

Variable Mean SD Variable Mean SD

SNA 8143 335 TrN1015840Ss 8008 281 036lowast

ObsN1015840Ss 8241 305 034

SNans 8555 384 TrN1015840Sp 8294 282 031lowast

ObsN1015840Sp 8527 284 027FHandNA 8713 193 TrOr1015840andN1015840Ss 8651 199 016lowast

SNB 7679 302 TrN1015840Sl 7166 350 059lowast

ObsN1015840Sl 7399 366 062lowast

SNPg 7747 302 TrN1015840Pg1015840 7130 372 054lowast

ObsN1015840Pg1015840 7363 391 056lowast

FHandNB 8646 263 TrOr1015840andN1015840Sl 8417 361 067lowast

FHandNPg 8670 220 TrOr1015840andN1015840Pg1015840 8377 387 066lowast

ANB 465 236 SsN1015840Sl 842 218 074lowast

ANPg 403 261 SsN1015840Pg1015840 879 243 074lowast

FHandAB 7992 612 TrOr1015840andSsSl 6926 646 081lowast

Table 4 Vertical measurement correlations Pearson correlation coefficients (119903) are shown for vertical measurements as low (in italic) andmedium (lightface) lowast119875 lt 005



SNandFH 1038 276 TrN1015840andTrOr1015840 1260 211 025lowast

ObsN1015840andTrOr1015840 1026 284 015lowast

FMA 2500 442 TrOr1015840andGo1015840Gn1015840 3007 584 059lowast

SNandGoGn 3538 506 TrN1015840andGo1015840Gn1015840 4268 592 054lowast

ObsN1015840andGo1015840Gn1015840 4034 610 053lowast

Gonial s ArGoN 5346 406 ObsGo1015840N1015840 6435 556 042lowast

Gonial i NGoMe 7566 456 N1015840Go1015840Me1015840 7022 578 045lowast

Articular SArGo 14206 662 N1015840ObsGo1015840 8372 416 045lowast

NPg-GoMe 6715 428 N1015840Pg1015840andGo1015840Me1015840 6612 510 061lowast

SNandArGo 8469 397 TrN1015840andObsGo1015840 8537 374 033ObsN1015840andObsGo1015840 8372 416 043

FHandArGo 7587 538 TrOr1015840andObsGo1015840 7551 532 045

FHandSPg 5716 313 TrOr1015840andTrPg1015840 3798 277 057TrOr1015840andObsPg1015840 4438 282 059

and vertical dimensions were found between the genderseven though a tendency toward statistical significance (119875 lt008) was reported for TrN1015840Ss and ObsN1015840Ss measurements(Table 2) These measurements indicated maxillary protru-sion and were reported to be smaller in females Althoughsimilar samples were tested the results of the present studywere not in agreement with those of Kochel et al [14]Indeed the methods of facial scanning and the soft tissueanalysis employed should be considered as possible reasonsfor the different results in the variability of sagittal dimen-sions between genders Moreover in the present samplegender differences seemed to have no influence on verticaldimensions in agreement with previous investigations [15]

Since no differences were assessed between genders thesample was considered as a whole and Pearson correlationcoefficients were computed for each variable in order to checkfor any correlations between sagittal and vertical soft tissuemeasurements and corresponding skeletal measurements inlateral cephalometric radiography Little previous evidencehas been presented for correspondences between soft tissueand skeletalmeasurements with 3D and 2D image acquisitiontools [22 23] but they showed high correlations between thetested variables The present results were analysed for sagittaland vertical measurements separately

Most of the sagittal parameters showed medium corre-lation coefficients (between 031 and 067) (Table 3) ANB


ANPg and FHandAB showed high correlation coefficients (119903 gt07) when compared with the respective soft tissue variablesThese angles are usually applied in the evaluation of sagittalrelationships between maxilla and mandible and accountfor the diagnosis of skeletal malocclusion According to thepresent results the diagnosis performed on soft tissue seemedto be reliable in predicting skeletal cephalometric outcomessince the coefficients showed high values and reached thelevel of significance Kochel et al [14] evaluated sagittal softtissue measurements and their correspondences with lateralcephalometric radiography describing a set of variablesdefined on the basis of common skeletal cephalometric mea-surements Their findings are in agreement with the presentinvestigation The selection of the corresponding landmarksbetween skeletal and soft tissue seemed very important inthe outcomes of correlation coefficients Previous studies [24]found no correlation between soft tissue measurements offacial profile and cephalometric ANB angle employing thelandmarks subnasal and skin pogonion as correspondentof skeletal landmarks A and B respectively The presentinvestigation used the landmarks subspinal (Ss) and sublabial(Sl) and high correlation between soft tissue andANB skeletalangle was found showing that different outcomes might beowing to the selection of different landmarks

The measurements of maxillary sagittal position (SNASNans and FHandNA) showed the lowest 119903 values (rangingfrom 016 to 036) in relation to soft tissue correspondingmeasurements On the other hand the converse was the casefor measurements of mandible sagittal position such as SNBSNPg FHandNPg and FHandNBwith 119903 values ranging from 054to 081 This result suggested that stronger sagittal relationsbetween soft tissue and underlying hard tissue involved thelower third of the face compared with the middle third of theface

Medium correlation coefficients were found for the verti-cal parameters (Table 4) in agreement with other studies [15]Only SNandFH exhibited low correlation with the respectivesoft tissue variables (119903 = 015 and 119903 = 025) This may bebecause of the difficulty of locating corresponding soft tissuelandmarks for the middle cranial base and the Go1015840 landmarkthat might have a small correspondence with the external softtissues

All the facial scans in the present study were performedwith relaxed lips and this position was considered accurate interms of diagnosis and treatment planning [4 5] and allowedcomparison with lateral cephalometric radiographs that areroutinely performed with relaxed lips

Unfortunately the collected lateral cephalometric radio-graphs were not all performed with the same X-ray machineand this could be seen as a limitation of the present studyMoreover only selected cephalometric landmarks wereemployed and only one operator analysed the data Also theinclusion of Caucasian patients only could be considered alimitation of the present investigation

Even though encouraging results were obtained fromthe present study they are still limited to our sample andmethods Also the selected sample showed normal BMI pos-sibly the ideal condition for the present investigations sinceexcessive BMI was reported to have significant effects on

the ratio between skeleton and overlying soft tissue so theresults should not be extended to altered BMI conditionswhere the correspondences betweenhard and soft tissuesmaybe less precise Further studies are needed in order to clarifythe complex relationships between soft and hard tissues andhelp clinicians and researchers with diagnosis and treatmentplanning with noninvasive tools

5 Conclusions

From the results of the present study the following facts canbe stated

(i) No statistically significant differences were found forsagittal and vertical soft tissuemeasurements betweenfemales and males in the tested sample

(ii) Sagittal measurements seemed to be more reliable interms of providing a soft tissue diagnosis than lateralcephalometric radiography measurements (ANB andANPg) especially for the lower third of the face (SNBSNPg FHandNPg and FHandNB)

(iii) Vertical soft tissuemeasurements showedweaker cor-relation with the corresponding lateral cephalometricradiography variables

The present soft tissue analysis proposal based on 3Dfacial scans showed good reliability and reproducibility eventhough further studies are needed in order to confirm thefindings of the research

Competing Interests

The authors report no competing interests related to thisstudy

Authorsrsquo Contributions

Piero Antonio Zecca acquired the clinical data and processedall the images for the analyses Rosamaria Fastuca performedthe statistical analysis and drafted the paper Matteo Berettasupervised drafting the paper and revising it critically forimportant intellectual content Alberto Caprioglio super-vised acquiring clinical data drafting the paper and revisingit critically for important intellectual content Aldo Macchisupervised the entire research project drafting the paper andrevising it critically for important intellectual content

References

[1] P G Nijkamp L L M H Habets I H A Aartman andA Zentner ldquoThe influence of cephalometrics on orthodontictreatment planningrdquo European Journal of Orthodontics vol 30no 6 pp 630ndash635 2008

[2] N Kilic G Catal A Kiki and H Oktay ldquoSoft tissue profilechanges following maxillary protraction in Class III subjectsrdquoEuropean Journal of Orthodontics vol 32 no 4 pp 419ndash4242010

[3] L Devereux D Moles S J Cunningham and M McK-night ldquoHow important are lateral cephalometric radiographs


in orthodontic treatment planningrdquo American Journal ofOrthodontics and Dentofacial Orthopedics vol 139 no 2 ppe175ndashe181 2011

[4] G W Arnett and R T Bergman ldquoFacial keys to orthodonticdiagnosis and treatment planning Part Irdquo American Journal ofOrthodontics and Dentofacial Orthopedics vol 103 no 4 pp299ndash312 1993

[5] G W Arnett and R T Bergman ldquoFacial keys to orthodonticdiagnosis and treatment planning Part IIrdquo American Journalof Orthodontics and Dentofacial Orthopedics vol 103 no 5 pp395ndash411 1993

[6] W B Downs ldquoAnalysis of the dentofacial profilerdquo AngleOrthodontist vol 26 pp 191ndash212 1956

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

[9] L LMerrifield ldquoTheprofile line as an aid in critically evaluatingfacial estheticsrdquoAmerican Journal of Orthodontics vol 52 no 11pp 804ndash822 1966

[10] V F Ferrario C Sforza V Ciusa C Dellavia and G MTartaglia ldquoThe effect of sex and age on facial asymmetry inhealthy subjects a cross-sectional study from adolescence tomid-adulthoodrdquo Journal of Oral and Maxillofacial Surgery vol59 no 4 pp 382ndash388 2001

[11] C H Kau and S Richmond ldquoThree-dimensional analysis offacial morphology surface changes in untreated children from12 to 14 years of agerdquo American Journal of Orthodontics andDentofacial Orthopedics vol 134 no 6 pp 751ndash760 2008

[12] E Nkenke E VairaktarisM Kramer et al ldquoThree-dimensionalanalysis of changes of the malar-midfacial region after LeFort Iosteotomy and maxillary advancementrdquo Oral and MaxillofacialSurgery vol 12 no 1 pp 5ndash12 2008

[13] F Ras L L M H Habets F C Van Ginkel and B Prahl-Andersen ldquoQuantification of facial morphology using stereo-photogrammetrymdashdemonstration of a new conceptrdquo Journal ofDentistry vol 24 no 5 pp 369ndash374 1996

[14] J Kochel P Meyer-Marcotty F Strnad M Kochel and AStellzig-Eisenhauer ldquo3D soft tissue analysismdashpart 1 sagittalparametersrdquo Journal of Orofacial Orthopedics vol 71 no 1 pp40ndash52 2010

[15] J Kochel P Meyer-Marcotty M Kochel S Schneck and AStellzig-Eisenhauer ldquo3D soft tissue analysismdashpart 2 verticalparametersrdquo Journal of Orofacial Orthopedics vol 71 no 3 pp207ndash220 2010

[16] AMMcCance J PMossWR Fright AD Linney and JamesldquoThree-dimensional analysis techniquesmdashpart 3 color-codedsystem for three-dimensional measurement of bone and ratioof soft tissue to bone the analysisrdquoTheCleft Palate-CraniofacialJournal vol 34 no 1 pp 52ndash57 1997

[17] M L Riolo R E Moyers T R TenHave and C A MayersldquoFacial soft tissue changes during adolescencerdquo in CraniofacialGrowth during Adolescence D S Carlson and K A RibbensEds Monograph 20 Craniofacial Growth Series Center forHuman Growth and Development University of MichiganAnn Arbor Mich USA 1987

[18] C SWChiu andRK F Clark ldquoReproducibility of natural headpositionrdquo Journal of Dentistry vol 19 no 2 pp 130ndash131 1991

[19] B Solow and A Tallgren ldquoNatural head position in standingsubjectsrdquoActaOdontologica Scandinavica vol 29 no 5 pp 591ndash607 1971

[20] A Lundstrom F Lundstrom L M L Lebret and C F AMoorrees ldquoNatural head position and natural head orientationbasic considerations in cephalometric analysis and researchrdquoEuropean Journal of Orthodontics vol 17 no 2 pp 111ndash120 1995

[21] G Dahlberg Statistical Methods for Medical and BiologicalStudents Interscience Publications New York NY USA 1940

[22] A K Incrapera C H Kau J D English KMcGrory and DMSarver ldquoSoft tissue images from cephalograms compared withthose froma 3D surface acquisition systemrdquoAngleOrthodontistvol 80 no 1 pp 58ndash64 2010

[23] M A Shamlan and A M Aldrees ldquoHard and soft tissuecorrelations in facial profiles a canonical correlation studyrdquoClinical Cosmetic and Investigational Dentistry vol 7 pp 9ndash152015

[24] A M Schwarz Die Rontgenostatik Urban amp SchwarzenbergMunich Germany 1958

Submit your manuscripts athttpwwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oral OncologyJournal of

DentistryInternational Journal of



International Journal of

Biomaterials


BioMed Research International


Case Reports in Dentistry


Oral ImplantsJournal of


Anesthesiology Research and Practice


Radiology Research and Practice

Environmental and Public Health

Journal of


The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014


Dental SurgeryJournal of

Drug DeliveryJournal of



Oral DiseasesJournal of


Computational and Mathematical Methods in Medicine

ScientificaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PainResearch and TreatmentHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Preventive MedicineAdvances in


EndocrinologyInternational Journal of



OrthopedicsAdvances in


N

s

Po

ANSA

Or

B

Pg

(a)

Po

S

N

Ar

Or

Pg

GnMe

Go

(b)

Figure 1 2D tracings and cephalometric analysis performed with lateral cephalometric radiography (a) Sagittal measurements and (b)vertical measurements

in lateral position [6ndash9] Some authors [4 5] have also pro-posed soft tissue evaluation with frontal pictures and under-lined the importance of reproducible head position duringimage acquisition

Among the recently introduced noninvasive imagingtechniques stereophotogrammetry and laser scanning allowaccurate acquisition of three-dimensional (3D) facial soft tis-sue with the possibility of locating landmarks and measuringangles distances surfaces and volumes [10ndash13] Even thoughnormative values of 3D facial soft tissue are not available forthe general population some proposals have been made forspecific sagittal and verticalmeasurements [14 15] but furtherstudies are needed to improve their reliability

The difficulties related to the use of the appropriateequipment and software and the absence of reliable normativevalues for 3D facial soft tissue measurements might preventtheir adoption by clinicians who are still using lateralcephalometric radiography to perform their diagnosis

The relationships between facial soft tissue and underly-ing hard tissue should be considered and investigated for anycorrespondences that might improve noninvasive orthodon-tic diagnosis and thus reduce patientsrsquo exposure to ionizingradiation

The soft tissue profile may reflect the underlying skeletaland hard tissue and it would be possible to estimate theskeletal configuration by visual inspection of the soft tissueprofile alone as suggested by previous studies [16] Validationof the anatomy of facial soft tissue is fundamental for anobjective analysis of craniofacial morphologies

The aim of the present study was therefore to investi-gate correlations between facial soft tissue scans and lateralcephalometric radiography measurements

2 Materials and Methods

21 Patient Selection Signed informed consent to the releaseof diagnostic records for scientific purposes was obtainedfrom patients prior to enrolment in the present prospectivestudyThe protocol was reviewed and approved by the EthicalCommittee (Approval number 6154) and procedures fol-lowed adhered to the Declaration of Helsinki The final studysample comprised 312 subjects 155 males (mean age of 243)and 157 females (mean age of 258) Inclusion criteria wereCaucasian ethnic origin age between 20 and 30 years to avoiderrors arising from soft tissue laxity which might increasewith age and normal body mass index (BMI) [17] Subjectswere selected from those patients seeking orthodontic treat-ment for whoma diagnostic lateral cephalometric radiographhad been recorded within the previous six months Exclusioncriteria were craniofacial syndromes or anomalies noticeableasymmetries and previous or current orthodontic treatmentthat might affect the homogeneity of the sample

Lateral cephalometric radiographs were then collectedfor all subjects and cephalometric measurements were per-formed with Deltadent software (Outside Format MilanItaly) (Figure 1)

A facial scanner (Primesense Carmine 109 Subsidiaryof Apple Inc Israel 2005) was employed for acquisition of
























3 Results












SNPg TrN1015840Pg1015840

ObsN1015840Pg1015840






FMA TrOr1015840andGo1015840Gn1015840


ObsN1015840andGo1015840Gn1015840












4 Discussion




SDfemale

Meanmale

SDmale 119875 value









SNA 8143 335 TrN1015840Ss 8008 281 036lowast

ObsN1015840Ss 8241 305 034



SNB 7679 302 TrN1015840Sl 7166 350 059lowast

ObsN1015840Sl 7399 366 062lowast


ObsN1015840Pg1015840 7363 391 056lowast



ANB 465 236 SsN1015840Sl 842 218 074lowast





























5 Conclusions






Competing Interests




References


































Biomaterials












Journal of










































3 Results












SNPg TrN1015840Pg1015840

ObsN1015840Pg1015840






FMA TrOr1015840andGo1015840Gn1015840


ObsN1015840andGo1015840Gn1015840












4 Discussion




SDfemale

Meanmale

SDmale 119875 value









SNA 8143 335 TrN1015840Ss 8008 281 036lowast

ObsN1015840Ss 8241 305 034



SNB 7679 302 TrN1015840Sl 7166 350 059lowast

ObsN1015840Sl 7399 366 062lowast


ObsN1015840Pg1015840 7363 391 056lowast



ANB 465 236 SsN1015840Sl 842 218 074lowast





























5 Conclusions






Competing Interests




References


































Biomaterials












Journal of


























SNPg TrN1015840Pg1015840

ObsN1015840Pg1015840






FMA TrOr1015840andGo1015840Gn1015840


ObsN1015840andGo1015840Gn1015840












4 Discussion




SDfemale

Meanmale

SDmale 119875 value









SNA 8143 335 TrN1015840Ss 8008 281 036lowast

ObsN1015840Ss 8241 305 034



SNB 7679 302 TrN1015840Sl 7166 350 059lowast

ObsN1015840Sl 7399 366 062lowast


ObsN1015840Pg1015840 7363 391 056lowast



ANB 465 236 SsN1015840Sl 842 218 074lowast





























5 Conclusions






Competing Interests




References


































Biomaterials












Journal of























SNA 8143 335 TrN1015840Ss 8008 281 036lowast

ObsN1015840Ss 8241 305 034



SNB 7679 302 TrN1015840Sl 7166 350 059lowast

ObsN1015840Sl 7399 366 062lowast


ObsN1015840Pg1015840 7363 391 056lowast



ANB 465 236 SsN1015840Sl 842 218 074lowast





























5 Conclusions






Competing Interests




References


































Biomaterials












Journal of



























5 Conclusions






Competing Interests




References


































Biomaterials












Journal of

















































Biomaterials












Journal of



















research article correlation assessment between three ...craniofacial diagnosis and orthodontic...

Documents