5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Jose A. Bosio, BDS, MS
Assistant Professor
Marquette University School of Dentistry
[email protected]
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Lecture Goals
“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.
• Briefly present a history of facial beauty.
• Discuss our research findings for facial soft tissue
changes during orthodontic treatment.
Nose – a tube with its opening as a
conduit for air and liquids.
• Point out important diagnostic features about facial soft
tissue.
Mouth – mechanical gobbler
of foodstuff and liquids.
The oldest records of facial measurements is not from physicians, dentists
or scientists, but rather from artists.
Toepffer, 1840
R. Arnheim, 1993
Marquette University
School of Dentistry
Marquette University
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.
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)
1
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Is beauty really in the eye of the beholder?
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).
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Renaissance
Germany – Albretch Dürer
Florence – Leonardo da Vinci
the Vitruvian Man
• 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.”
Marquette University
School of Dentistry
Marquette University
School of Dentistry
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”.
Can the face be changed?
• Basic three ways to change facial appearance:
1. By camouflage
2. By surgery
3. By growth
2
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
‘World's Most Beautiful Face'
Who do we treat?
•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.
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Who do we treat?
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)
Marquette University
School of Dentistry
Marquette University
School of Dentistry
What to measure?
Peck and Peck (1993)
• 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.
Interlabial Gap
• 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.
3
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
What to measure?
Reliability Preliminary Studies
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.
Marquette University
School of Dentistry
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.
Marquette University
School of Dentistry
Mollov et al. (JWFO-2012)
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)
Marquette University
School of Dentistry
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.
Marquette University
School of Dentistry
Reliability Preliminary Studies
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
Preliminary Studies
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
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.
Ortho Measure program
Photographic Setup
4
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
Good Reliability
Diagram of frontal and lateral facial soft tissue landmark location
All landmarks (lips and nose) - average deviation less than 1.50 mm both images
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
Master Thesis - Michael Payne – 2013
Photogrammetric Reliability of Facial Soft Tissue Landmarks
Poor Reliability
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.
Marquette University
School of Dentistry
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
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.
Marquette University
School of Dentistry
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
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.
5
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Soft Tissue Facial Measurements and Their Correlation in
Orthodontic Patients
Nov, 2008 - Before
Sep, 2012 - After
Bosio JA, Pruszynski J, Tanaka OM, Closs L, Janson G - Abstract - IADR - 2013
Results
• 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.
A
D B
A. Upper lip length (UL)
B. Mouth height (MH)
C. Mouth width (MW)
D. Inter-Labial Gap (IG)
Marquette University
School of Dentistry
Nov, 2008 - Before
Marquette University
School of Dentistry
C
Marquette University
School of Dentistry
Sep, 2012 - After
Nov, 2008 - Before
Sep, 2012 - After
Marquette University
School of Dentistry
6
5/1/2013
Marquette University
School of Dentistry
Marquette University
School of Dentistry
Differences in photographic assessment
Marquette University
School of Dentistry
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).
7