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Comparisons of Soft Tissue Thickness Measurements in Adult Patients With Various Vertical Patterns/Farkli Vertikal Paternlere Sahip Bireylerde Yumusak Doku Kalinliklarinin Degerlendirilmesi.

Abstract

Objective: The purposes of this study were to evaluate to study soft tissue facial profile among the different vertical patterns using the Holdaway analysis and the soft tissue thickness measurements.

Materials and Methods: The study sample consisted of 90 patients divided into 3 groups: low angle group (30 patients; mean age, 20.38[+ or -]3.76 years), normal angle group (30 patients; mean age, 19.36[+ or -]2.83 years) and high angle group (30 patients; mean age, 19.44[+ or -]2.14 years). The study sample, comprised a total of 90 patients (54 women and 36 men) divided into low-angle, normal-angle and high angle groups based on vertical growth pattern using the SN/GoGn angle (high-angle group >37[degrees]; low-angle group <27[degrees]; and control group or normal angle group 27-37[degrees]). Facial soft-tissue thickness and Holdaway measurements were analyzed on each radiograph with Image J programme. One-way analysis of variance and post-hoc test (Tukey) were used to compare Holdaway measurements and soft tissue thicknesses among the three groups.

Results: Significant differences among vertical patterns were observed for the 'gnathion', 'menton', 'stomion' and 'inferior sulcus to H line' when both genders were combined. These measurements were thinner in the high-angle group. Significant differences among vertical patterns were observed for 'gnathion' and 'lower lip to H line' in women; for 'stomion' and 'nose prominence' in men when examined separately.

Conclusion: Facial soft tissue measurements except some for in high angle group were thinner than in low angle group. All soft tissue measurements were greater except for gnathion in low angle group in men than in women.

Keywords Holdaway, soft tissue, divergence, cephalometrics, facial profile, thickness

Oz

Amac: Bu calismanin amaci, Holdaway analizi ve yumusak doku kalinlik olcumleri kullanilarak farkli vertikal paternlerde yumusak doku profilini degerlendirmektir.

Gerec ve Yontemler: Doksan hastadan olusan calisma grubu SN/GoGn acisi kullanilarak vertikal gelisim paternine gore 3 gruba ayrildi (hiperdiverjan>37[degrees]; hipodiverjan<27[degrees]; ve kontrol grup veya normodiverjan 27-37[degrees]); hipodiverjan (30 hasta; ortalama yas, 20,38[+ or -]3,76 yil), normodiverjan (30 hasta; ortalama yas, 19,36[+ or -]2,83 yil) ve hiperdiverjan (30 hasta; ortalama yas, 19,44[+ or -]2,14 yil). Yuz yumusak doku kalinlik olcumleri ve Holdaway olcumleri her bir radyograf uzerinde Image J programi ile yapildi. Uc grup arasinda yumusak doku ve Holdaway olcumleri arasindaki fark, one-way analysis of variance ve post-hoc test (Tukey) ile degerlendirildi.

Bulgular: Vertikal paternler arasinda 'gnathion', 'menton', 'stomion' and 'inferior sulcus to H line' olcumlerinde, cinsiyet ayrimi yapilmaksizin degerlendirildiginde istatistiksel olarak onemli bir fark bulundu. Cinsiyet ayrimi yapildiginda ise kadinlarda 'gnathion' and lower lip to H line' olcumlerinde, erkeklerde 'stomion' and 'nose prominence' olcumlerinde istatistiksel olarak anlamli fark bulundu.

Sonuc: Sadece hiperdiverjandaki bazi olcumler haric tum yumusak doku kalinlik olcumleri hipodiverjan en az bulundu. 'Gnathion' olcumu haric diger tum yumusak doku olcumleri ise erkeklerde kadinlardan daha fazla bulundu.

Anahtar Kelimeler Holdaway, yumusak doku, diverjans, sefalometri, fasiyal profil, kalinlik

Introduction

It is generally accepted that there is a relationship between occlusal forces and facial morphology. Three basic types of facial morphology exist: short face, average, and long face. Long face has excessive vertical facial growth and typically associated with anterior open bite and an increased maxillary/mandibular planes angle, sella-nasion/mandibular plane angle and gonial angle (1). Short face has decreased vertical growth and typically accompanied by deep bite, reduced facial heights, and decreased SN/mandibular plane angle (2). Average face has normal vertical pattern angles (3). The relationship between bite force and craniofacial morphology has been studied (4). Average face subjects have higher bite force in molar region as compared with long face subjects, while short face subjects had still higher maximum forces than the normal face subjects (4).

The changes that occur in the soft-tissue profile during orthodontic treatment have played a significant role in the diagnosis and treatment planning process (5). Facial harmonyand balance are determined by the facial skeleton and its soft tissue drape. Most previous studies were routinely used to evaluate the position of the teeth in relation to the skeletal components. However, sporadic attempts were made to include an element of soft tissue profile assessment, such as Ricketts (6) esthetic plane, Holdaway (7) analysis and Burstone's (8) soft tissue analysis.

Previous studies have studied facial soft tissue thickness in Japanese children having different skeletal classes (9,10). Utsuno et al. (9) indicated that measurements differed among these various classes. Several studies have made similar measurements in the Turkish population (11-13). Bascifci et al. (11) made a study to determine Holdaway soft tissue norms in Anatolian Turkish adults and found significant differences between genders for soft tissue chin thickness and upper lip thickness. Kamak and Celikoglu (14) found that soft tissue thickness at all regions was higher in men than in women.

The purposes of this study was to evaluate the soft tissue facial profiles among the different vertical patterns using the Holdaway analysis and the soft tissue thickness measurements, compare all values with the Holdaway soft-tissue norms of Anatolian Turkish adults and to determine any sexual differences between the soft tissue facial profile of men and women in each vertical group.

Materials and Methods

This study was designed to evaluate the differences in soft-tissue characteristics as determined by the Holdaway soft-tissue analysis of orthodontic patients and to determine the soft tissue thickness of orthodontic patients with different vertical growth patterns. This study was approved by the Ethics Committee of Karadeniz Technical University Faculty of Medicine (ethics committee approval no: 2013/91). A total of 90 patients (36 boys and 54 girls), referred to the Department of Orthodontics at the Karadeniz Teknik University Faculty of Dentistry, were included in this study. The study sample, comprised a total of 90 patients aged 20-26 years divided into low-angle, normal-angle and high angle groups based on vertical growth pattern using the SN/GoGn angle (high-angle group >37[degrees]; low-angle group <27[degrees]; and control group or normal angle group 27-37[degrees]). The images used in the present study were part of the diagnostic records collected due to dental treatment need. Lateral cephalometric radiographs were taken from all patients. The age of the subjects ranged between 20-26 years, with a mean age of 20.38[+ or -]3.76 years, 19.36[+ or -]2.83 years and 19.44[+ or -]2.14 years in groups 1, 2 and 3, respectively. Gender and age distributions are shown in Table 1. All subjects were selected on the basis of the following criteria:

* Balanced facial profiles with competent lips,

* No history of previous orthodontic treatment,

* No congenitally missing teeth,

* Subjects with skeletal Class I malocclusions (1[degrees] <ANB<5[degrees]),

* Subjects with different vertical relationships (SN/GoGn=32[+ or -]6[degrees]),

* Nongrowing patients.

The subjects were divided into three groups based on SN/GoGn[degrees] angle. All patients had skeletal Class I (1[degrees]<ANB<5[degrees]) malocclusions.

* Group 1 included 30 hipodiverjant subjects,

* Group 2 included 30 normodiverjant subjects,

* Group 3 included 30 hiperdiverjant subjects.

The radiographs were analyzed by the same researcher. Eighteen linear and two angular measurements were analyzed on each radiograph with Image J software. The landmarks were located according to the definition provided by Holdaway (15). The following measurements were used (Figures 1 and 2):

* H line: Tangent drawn from the tip of the chin to the upper lip;

* Soft tissue facial angle (STA): The downward and inner angle formed at a point where the sella-nasion line crosses the soft tissue and a line combining the suprapogonion with the Frankfort horizontal plane;

* Lower lip to H line (LLH): The measurement of the lower lip to the H line;

* H angle: The angle formed between the soft-tissue facial plane line and the H line;

* Skeletal profile convexity (SPC): The dimension between point A and facial line;

* Nose prominence (NP): The dimension between the tip of the nose and a perpendicular line drawn to the Frankfort plane from the vermillion;

* Soft tissue subnasale (Sn) to H line: The distance from Sn to H line;

* Upper lip sulcus depth (USD): The measurement between the upper lip sulcus and a perpendicular line drawn from the vermillion to the Frankfort plane;

* Inferior sulcus to the H line (lower lip sulcus depth) (ISH): The measurement at the point of greatest convexity between the vermillion border of the lower lip and the H line;

* Basic upper-lip thickness (BULT): The dimension measured approximately three mm below point A and the drape of the upper lip;

* Upper-lip thickness (ULT): The dimension between the vermillion point and the labial surface of the upper incisor;

* Pogonion (Pog): Length between bony Pog and its horizontal projection (Pog') over the vertical passing through soft tissue pogonion.

* Gnathion (Gn): Distance between bony Gn and soft tissue (Gn').

* Menton (Me): Distance between bony Me and its vertical projection (Me') on the horizontal passing through soft tissue menton.

* Glabella (G): Length between bony G and its horizontal projection (G') over the vertical passing through soft tissue glabella.

* Nasion (N): Length between bony N and its horizontal projection (N') over the vertical passing through soft tissue nasion.

* Rhinion (Rhi): Length between bony Pog (Rhi) and its horizontal projection (Rhi') over the vertical passing through soft tissue Rhi.

* Subnasale (Sn): The distance between point A and subnasale.

* Stomion (Sto): The shortest distance between the upper incisor and the attachment points of the upper and lower lip.

* Labrale inferior (Li): The distance between infradentale and the vermilion border of the lower lip;

* Labiomental (Labm): The distance between point B and the deepest point of the Labm crease.

Descriptive statistics (mean and standard deviation) were calculated using the SPSS program version 12.0 (SPSS Inc, Chicago, III). One-way analysis of variance (ANOVA) and post-hoc test (Tukey) were used to compare Holdaway measurements and soft tissue thicknesses among the three groups. Age difference among the groups was also evaluated with ANOVA. Comparison of differences between genders within each group was achieved with the Student's t-test. The level of significance was established at 5%.

Results

Table 1 shows the demographic data of the patients included to the groups. The groups were statistically well matched on vertical relationships. All groups had corresponding vertical cephalometric measurement (high-angle group, 39.66[+ or -]2.14[degrees]; low-angle group, 24.72[+ or -]2.05[degrees]; and normal-angle group, 31.07[+ or -]2.37[degrees]). Age was not statistically significantly different across the three groups.

Student's t-test was used to compare men with women for each group. Table 2 compares the mean and standard deviation of the soft-tissue thicknesses between men and women in each group. Statistically significant differences were found only for the variable basic upper lip thickness, upper lip thickness, Pog, Rhi, Sn, Labiale inferior, labiomentale in high-angle group; for the variables basic upper lip thickness, upper lip thickness, nasion, Rhi, Sn, Sto, labiale inferior in low-angle group; for the variables basic upper lip thickness, upper lip thickness, Pog, H angle, Nasion, Rhi, Sn, Sto, Labiale inferior in normal angle group between the genders. The thickness values for male were higher in all vertical growth patterns compared with the values for female. Therefore female and male were separately examined for further comparisons.

Table 3 shows norms of Anatolian Turkish adults and comparisons of three studied groups for Holdaway soft-tissue values.

The results of this study showed that, except for four variables, all vertical groups have the same soft tissue norms as reported by Holdaway (Table 3).

Table 4 compares the mean and standard deviation of the soft tissue measurements among the studied groups. Four variables (the thickness values at the 'Gn', 'Me', 'Sto' and 'ISH') showed statistically significant differences and higher in low-angle group compared with the values in the high-angle group (p=0.001, 0.015, 0.006 and p=0.012, respectively).

The comparison of soft tissue thickness values for women and men are shown in Tables 5-6. Two variables showed statistically significant differences for both women and men. For women, the thickness values at the 'Lower lip-H line' and 'Gn' was found to be statistically significantly higher in the low-angle group (1.26[+ or -]0.86 mm and 8.95[+ or -]2.60 mm, respectively) compared with the values in the normal-angle group (0.55[+ or -]0.53 mm and 7.45[+ or -]1.33 mm, respectively). For men, the thickness value at the 'Nose prominence' in the high-angle group and at the 'Sto' in the low-angle group were found to be statistically significantly higher compared with the values in the normal-angle group. Soft tissue thickness values at the lower anterior face (Pog', Gn', Me') were the lowest in the high-angle group for both women and men.

Discussion

In the literature, there are few studies with which the pre-and posttreatment and extraction treatment Holdaway soft-tissue measurements can be directly compared. Few studies have also been carried out to assess the soft tissue thickness in adult patients with different vertical growth patterns (16,17). In our study, we also used Holdaway (15) analysis because it presents the soft tissue more in details with simplicity and directness in mind, and it is widely used for evaluation of soft tissue profiles.

The vertical groups included in the study were statistically well matched on gender distribution. Because statistically significantly greater values were found for soft tissue thickness measurements in male than in female, further comparisons were done separately for women and men to eliminate the effect of gender on findings. In the present study the thickness values for men were higher in all vertical growth patterns compared with the values for the women except for 'LLH' and 'Gn-Gn' in low-angle group and 'Soft tissue angle' in N group. But statistically significant differences were found only for the thicknesses at Rhi, N, Sto, basic upper lip thickness, upper lip thickness, Li and Sn in low-angle group; at Pog, N, Rhi, subnasale, stomion, H angle, upper lip thickness, BULT and Li in normal-angle group and at Pog, Rhi, subnasale, nose prominence, upper lip thickness, basic upper lip thickness, Li and labiomentale in high-angle group between women and men. According to Uysal et al. (18), statistically significant gender differences were found for the thickness of the labrale superius, labrale inferius, Pog and menton measurements. Celikoglu et al. (17) found that the soft tissue thickness measurements at the lower anterior face for men were higher in all vertical growth patterns compared with the values for the women. In another study they found that all soft tissue thickness measurements in men were higher than those in women (19). However, statistically significant gender differences were not found for all values in each skeletal class (Class I, Class II, Class III). The previous studies (20-22) has shown that the soft-tissue thicknesses of male patients were significantly greater than those of female patients, although some had no statistically significant difference. In general, women's skin lacks collagen synthesis and facilitates synthesis of hyaluronic acid because of estrogen. In contrast, men tend to have thicker skin because testosterone facilitates collagen synthesis (22). Macari and Hanna (16), except for gender differences in high angle group, found thicker soft tissue in all aspects of the face in men compared with women. The exception in high angle group might be related to the similar effect of the soft tissue at the chin (STC) reduction in subjects with the most hyperdivergence and increased lower face height.

Taki et al. (23) reported that significant differences were found in nose prominence, upper lip thickness, basic upper lip thickness, ISH, and soft tissue chin thickness measurements in comparison of sexes and the soft tissue chin thickness was significantly larger in male than in female. Similar results were obtained by Bascifci et al. (11) who reported that Anatolian Turkish men have a more distinctive chin than women. Conversely Baum (24) found that soft-tissue growth tendencies are different between the two sexes. Baum's (24) studies of children between 11 and 14 years of age indicate that girls develop at an earlier age than boys and tend to achieve a mature adult face earlier. Therefore, in this study to limit growth effects on lip thickness and lip strain, an effort was made to select subjects who have a similar age.

In the literature, few studies (16,17) using conventional lateral cephalometric radiographs and cone-beam computed tomography investigated soft tissue chin thickness in adult patients with various mandibular divergence patterns. In the present study soft tissue facial profile was investigated for different vertical patterns using the Holdaway analysis and soft tissue thickness values.

The H angle measures the prominence of the upper lip in relation to the overall soft-tissue profile (15). As the skeletal convexity increases, the H angle must also increase if a harmonious drape of soft tissues is to be realized in varying degrees of profile convexity. Our results showed that the SPC and H angle were larger than Holdaway norms in group 3, indicating that high angle people have a slightly more convex profile compared with other groups. Also, the BULT and ULT were decreased in all groups in relation to Holdaway norms. Hajighadimi et al. (25) found that Persians have a more convex soft tissue profile compared with Tweed's and Steiner's standards and Taki et al. (23) found that Persian adults have slightly more convex profiles when compared with Holdaway norms. Bascifci et al. (11) found that H angle showed a significant decrease during the orthodontic treatment and becomes closer to the Anatolian Turkish norms.

The present study aimed to compare the soft tissue thicknesses of orthodontic patients with different vertical patterns. In this study statistically significant differences were found 'Gn', 'Me', 'Sto' and 'ISH' values among the vertical groups when both genders were combined and these were higher in the low-angle group. Whereas statistically significant differences were found for 'LLH' and 'Gn' values in women, statistically significant differences were found for 'Sto' and 'NP' values in men when examined separately. We found that whereas 'Gn' values were the thinnest in the high-angle group, 'LLH' values were the thinnest in the normal-angle group for women and 'Sto' measurements were the thinnest in the high-angle group for men. The thickness measurements at the Gn and menton were thinner in the high-angle group when both genders were combined.

Macari and Hanna (16) evaluated the association between STC thickness and mandibular divergence. They found statistically significantly difference at 'Gn' and 'Me' but not at 'Pog' that suggests the presence of a differential extension between hard and soft tissues during growth. However, the difference for Gn was statistically significant for both women and men when examined separately. The STC thickness apparently adapts to severe hyperdivergence, presumably through increased stretching of the STC in children with progressive increase in facial divergence. Celikoglu et al. (17) compared the soft tissue thickness values at the lower anterior face among the adult patients with different vertical growth patterns using cone-beam computed tomography and found that soft tissue thickness values were the thinnest in the high-angle group for both women and men. However, statistically significant differences were found at the labrale superius, inferius, and Pog values for women, whereas the differences among the vertical groups were not significant for the men. In addition, women in the low-angle and normal-angle groups showed similar thickness values.

Conclusion

Significant differences in soft tissue thickness among vertical patterns were investigated for the gnathion, menton and Sto when both genders were combined. These measurements were thinner in the high-angle group.

Significant differences in soft tissue thickness among vertical patterns were observed for the Gn in women; for the Sto in men, when examined separately.

Significant differences in Holdaway measurements among vertical patterns were observed for 'inferior sulcus to H line' when both genders were combined. 'ISH' was thinner in the high-angle group.

Significant differences in Holdaway measurements among vertical patterns were observed for 'LLH' in women; for 'nose prominence' in men when examined separately.

In low angle group all soft tissue measurements were greater in men than in women, except for gnathion.

Ethics

Ethics Committee Approval: This study was approved by the Ethics Committee of Karadeniz Technical University Faculty of Medicine (ethics committee approval no: 2013/91).

Informed Consent: It was taken.

Peer-review: Externally peer-reviewed.

Financial Disclosure: The author declared that this study received no financial support.

References

(1.) Fields HW, Proffit WR, Nixon WL, Phillips C, Stanek E. Facial pattern differences in long-faced children and adults. Am J Orthod 1984; 85: 217-23.

(2.) Opdebeeck H, Bell WH. The short face syndrome. Am J Orthod 1978; 73: 499-511.

(3.) Edgerton VR. Neuromuscular adaptation to power and endurance work. Can J Appl Sport Sci 1976; 1: 49-58.

(4.) Proffit WR, Fields HW, Nixon WL. Occlusal forces in normal- and long-face adults. J Dent Res 1983; 62: 566-70.

(5.) Garner LD. Soft tissue changes concurrent with orthodontic tooth movement. Am J Orthod 1974; 66: 367-77.

(6.) Ricketts RM. Planning treatment on the basis of facial pattern and an estimate of its growth. Angle Orthod 1957; 27: 14-37.

(7.) Holdaway RA. Changes in relationship of points A and B during orthodontic treatment. Am J Orthod 1956; 42: 176-93.

(8.) Burstone CJ. Integumental contour and extension patterns. Angle Orthod 1959; 23: 146-57.

(9.) Utsuno H, Kageyama T, Uchida K, Yoshino M, Miyazawa H, Inoue K. Facial sof tissue thickness in Japanese children. Forensic Sci Int 2010; 199: 109.

(10.) Utsuno H, Kageyama T, Uchida K, Yoshino M, Oohigashi S, Miyazawa H, et al. Pilot study of facial sof tissue thickness differences among three skeletal classes in Japanese females. Forensic Sci Int 2010; 195: 165.

(11.) Bascifci FA, Uysal T, Buyukerkmen A. Determination of Holdaway soft tissue norms in Anatolian Turkish adults. Am J Orthod Dentofacial Orthop 2003; 123: 395-400.

(12.) Erbay EF, Caniklioglu CM. Sof tissue profle in Anatolian Turkish adults: Part II. Comparison of different soft tissue analyses in the evaluation of beauty. Am J Orthod Dentofacial Orthop 2002; 121: 65-72.

(13.) Erbay EF, Caniklioglu CM, Erbay SK. Soft tissue profle in Anatolian Turkish adults: Part I. Evaluation of horizontal lip position using different soft tissue analyses. Am J Orthod Dentofacial Orthop 2002; 121: 57-64.

(14.) Kamak H, Celikoglu M. Facial soft tissue thickness among skeletal malocclusions: is there a difference? Korean J Orthod 2012; 42: 23-31.

(15.) Holdaway RA. Soft-tissue cephalometric analysis and its use in orthodontic treatment planning. Am J Orthod 1983; 84: 1-28.

(16.) Macari AT, Hanna AE. Comparisons of soft tissue chin thickness in adult patients with various mandibular divergence patterns. Angle Orthod 2014; 84: 708-14.

(17.) Celikoglu M, Buyuk SK, Ekizer A, Sekerci AE, Sisman Y. Assessment of the soft tissue thickness at the lower anterior face in adult patients with different skeletal vertical patterns using cone-beam computed tomography. Angle Orthod 2015; 85: 211-7.

(18.) Uysal T, Yagci A, Basciftci FA, Sisman Y. Standards of soft tissue Arnett analysis for surgical planning in Turkish adults. Eur J Orthod 2009; 31: 449-56.

(19.) Celikoglu M, Buyuk SK, Sekerci AE, Ersoz M, Celik S, Sisman Y. Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: a retrospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2014; 146: 573-8.

(20.) Hamdan AM. Soft tissue morphology of Jordanian adolescents. Angle Orthod 2010; 80: 80-5.

(21.) Kalha AS, Latif A, Govardhan SN. Soft-tissue cephalometric norms in a South Indian ethnic population. Am J Orthod Dentofacial Orthop 2008; 133: 876-81.

(22.) Cha KS. Soft-tissue thickness of South Korean adults with normal facial profiles. Korean J Orthod 2013; 43: 178-85.

(23.) Taki AA, Oguz F, Abuhijleh E. Facial soft tissue values in Persian adults with normal occlusion and well-balanced faces. Angle Orthod 2009; 79: 491-4.

(24.) Baum AT. Age and sex differences in the dentofacial changes following orthodontic treatment and their significance in treat-ment planning. Am J Orthod 1961; 47: 355-69.

(25.) Hajighadimi M, Dougherty HL, Garakani F. Cephalometric evaluation of Iranian children and its comparison with Tweed's and Steiner's standards. Am J Orthod 1981; 79: 192-7.

Neslihan Seyhan Cezairli

Ordu University Faculty of Dentistry, Department of Orthodontics, Ordu, Turkey

Address for Correspondence/Yazisma Adresi:

Neslihan Seyhan Cezairli MD, Ordu University Faculty of Dentistry, Department of Orthodontics, Ordu, Turkey Phone : +90 452 212 50 11 E-mail : nesli_seyhan_13@hotmail.com ORCID ID: orcid.org/0000-0001-8750-4161

Received/Gelis Tarihi : 22.03.2017

Accepted/Kabul Tarihi : 25.05.2017
Table 1. Comparison of the demographic variables among different
vertical patterns

                  N   Female/Male  Mean Age           ANB[degrees]
                                   (Years)

High-angle group  30  19/11        19.44[+ or -]2.14  3.08[+ or -]1.39
Low-angle group   30  18/12        20.38[+ or -]3.76  2.63[+ or -]1.76
Normal-angle      30  17/13        19.36[+ or -]2.83  2.75[+ or -]1.05
group
Total             90  54/36
p                                  NS

                     SN/GoGn[degrees]

High-angle group     39.66[+ or -]2.14
Low-angle group      24.72[+ or -]2.05
Normal-angle         31.07[+ or -]2.37
group
Total
p

NS: Not significant, ANB: Angle between NA and NB lines, SN/GoGn: Angle
between SN and GoGn lines

Table 2. Comparison of facial soft-tissue thickness measurements
between the sexes in each group

Measurements        Group     Gender   Mean [+ or -] SD      p

Pogonion            Group 1   Female   10.7[+ or -]1.87     0.161
                              Male     11.71[+ or -]1.90
                    Group 2   Female   10.36[+ or -]1.66    0.015 (*)
                              Male     12.02[+ or -]1.81
                    Group 3   Female   10.29[+ or -]1.76    0.037 (*)
                              Male     11.94[+ or -]2.34
Gnathion            Group 1   Female    8.95[+ or -]2.60    0.763
                              Male      8.69[+ or -]1.87
                    Group 2   Female    7.45[+ or -]1.37    0.072
                              Male      8.42[+ or -]1.43
                    Group 3   Female    6.70[+ or -]1.88    0.264
                              Male      7.41[+ or -]1.01
Menton              Group 1   Female    7.81[+ or -]2.03    0.255
                              Male      8.62[+ or -]1.58
                    Group 2   Female    6.65[+ or -]1.11    0.058
                              Male      7.66[+ or -]1.66
                    Group 3   Female    6.52[+ or -]1.84    0.121
                              Male      7.59[+ or -]1.61
Glabella            Group 1   Female    5.52[+ or -]0.95    0.393
                              Male      5.79[+ or -]0.57
                    Group 2   Female    5.39[+ or -]0.73    0.154
                              Male      5.82[+ or -]0.86
                    Group 3   Female    5.34[+ or -]0.79    0.224
                              Male      5.84[+ or -]1.42
Nasion              Group 1   Female    5.58[+ or -]6.67    0.025 (*)
                              Male      6.67[+ or -]1.38
                    Group 2   Female    5.25[+ or -]0.94    0.011 (*)
                              Male      6.28[+ or -]1.11
                    Group 3   Female    5.24[+ or -]0.99    0.117
                              Male      5.89[+ or -]1.15
Rhinion             Group 1   Female    1.54[+ or -]0.40    0.033 (*)
                              Male      2.18[+ or -]1.10
                    Group 2   Female    1.51[+ or -]0.38    0.019 (*)
                              Male      1.92[+ or -]0.51
                    Group 3   Female    1.31[+ or -]0.43    0.016 (*)
                              Male      1.77[+ or -]0.52
Subnasale           Group 1   Female   14.08[+ or -]1.47    0.001 (***)
                              Male     16.77[+ or -]2.32
                    Group 2   Female    5.25[+ or -]0.94    0.001 (***)
                              Male      6.28[+ or -]1.11
                    Group 3   Female   14.03[+ or -]1.97    0.001 (***)
                              Male     16.77[+ or -]1.67
Stomion             Group 1   Female    4.63[+ or -]1.70    0.001 (***)
                              Male      6.90[+ or -]1.55
                    Group 2   Female    3.56[+ or -]1.49    0.005 (**)
                              Male      5.35[+ or -]1.73
                    Group 3   Female    4.06[+ or -]1.86    0.949
                              Male      4.11[+ or -]1.33
Labrale inferior    Group 1   Female   12.55[+ or -]1.88    0.001 (***)
                              Male     15.14[+ or -]1.95
                    Group 2   Female   11.47[+ or -]2.06    0.000 (***)
                              Male     14.47[+ or -]1.23
                    Group 3   Female   12.10[+ or -]1.24    0.006 (**)
                              Male     13.80[+ or -]1.88
Labiomentale        Group 1   Female   10.30[+ or -]1.06    0.240
                              Male     10.88[+ or -]1.55
                    Group 2   Female   10.05[+ or -]1.60    0.058
                              Male     11.09[+ or -]1.15
                    Group 3   Female   10.28[+ or -]1.40    0.013*
                              Male     11.63[+ or -]1.26
Soft-tissue         Group 1   Female   84.83[+ or -]21.48   0.392
facial angle
                              Male     90.29[+ or -]3.19
                    Group 2   Female   88.60[+ or -]2.65    0.695
                              Male     88.20[+ or -]2.83
                    Group 3   Female   88.44[+ or -]2.56    0.356
                              Male     87.44[+ or -]3.23
H angle             Group 1   Female   12.03[+ or -]5.91    0.575
                              Male     13.26[+ or -]5.69
                    Group 2   Female   12.52[+ or -]2.80    0.016 (*)
                              Male     15.51[+ or -]3.57
                    Group 3   Female   14.68[+ or -]3.85    0.576
                              Male     15.44[+ or -]2.84
Nose                Group 1   Female   14.63[+ or -]3.74    0.927
prominence
                              Male     14.73[+ or -]1.59
                    Group 2   Female   15.31[+ or -]2.68    0.148
                              Male     13.89[+ or -]2.48
                    Group 3   Female   14.69[+ or -]2.42    0.008
                              Male     16.53[+ or -]3.08
Soft-tissue         Group 1   Female    3.08[+ or -]1.74    0.471
subnasale to
H line
                              Male      3.68[+ or -]2.76
                    Group 2   Female    2.56[+ or -]1.59    0.088
                              Male      3.89[+ or -]2.51
                    Group 3   Female    3.49[+ or -]2.29    0.126
                              Male      4.75[+ or -]1.72
Inferior sulcus     Group 1   Female    4.50[+ or -]1.87    0.096
to H line
                              Male      5.80[+ or -]2.23
                    Group 2   Female    4.58[+ or -]1.54    0.340
                              Male      5.15[+ or -]1.66
                    Group 3   Female    3.61[+ or -]1.51    0.485
                              Male      4.00[+ or -]1.31
Lower lip to H      Group 1   Female    1.26[+ or -]0.86    0.225
line
                              Male      0.88[+ or -]0.74
                    Group 2   Female    0.54[+ or -]0.54    0.075
                              Male      1.11[+ or -]1.12
                    Group 3   Female    1.14[+ or -]0.88    0.646
                              Male      1.29[+ or -]0.74
Upper-lip           Group 1   Female   10.55[+ or -]1.93    0.008 (**)
thickness
                              Male     12.45[+ or -]1.47
                    Group 2   Female    9.54[+ or -]2.41    0.000 (***)
                              Male     12.83[+ or -]1.47
                    Group 3   Female    9.80[+ or -]1.45    0.001 (***)
                              Male     11.80[+ or -]1.57
Basic upper-lip     Group 1   Female   12.65[+ or -]1.64    0.004 (**)
thickness
                              Male     14.82[+ or -]2.11
                    Group 2   Female   11.38[+ or -]1.86    0.000 (***)
                              Male     14.76[+ or -]1.47
                    Group 3   Female   11.57[+ or -]1.73    0.002 (**)
                              Male     14.14[+ or -]2.40
Upper-lip sulcus    Group 1   Female    1.44[+ or -]1.29    0.644
depth
                              Male      1.67[+ or -]1.29
                    Group 2   Female    0.85[+ or -]0.69    0.058
                              Male      1.48[+ or -]1.05
                    Group 3   Female    1.26[+ or -]1.07    0.821
                              Male      1.34[+ or -]0.51
Skeletal profile    Group 1   Female    1.65[+ or -]1.06    0.281
convexity
                              Male      2.23[+ or -]1.82
                    Group 2   Female    1.53[+ or -]0.96    0.338
                              Male      1.96[+ or -]1.44
                    Group 3   Female    1.96[+ or -]1.32    0.462
                              Male      2.36[+ or -]1.53

(*)p<0.05, (**)p<0.01, (***)p<0.001
NS: Not significant, SD: Standard deviation

Table 3. Comparison of the Holdaway measurements among the groups

                                                       Group 1
            Anatolian Turkish    Holdaway norms     Mean [+ or -] SD
            norms

STA         87.31[+ or -]8.84    91[+ or -]7        87.02[+ or -]16.78
NP, mm      18.74[+ or -]3.59    14 to 24           14.67[+ or -]3.03
USD, mm      2.97[+ or -]1.53     3 (1 to 4)         1.53[+ or -]1.28
STSH, mm     5.12[+ or -]3.33     5[+ or -]2         3.32[+ or -]2.18
SPC, mm     -0.21[+ or -]2.31     0                  1.88[+ or -]1.41
BULT, mm    16.64[+ or -]2.43    15                 13.52[+ or -]2.10
ULT, mm     13.96[+ or -]2.7     13 to 14           11.31[+ or -]1.98
H angle     13.75[+ or -]3.01    10 (7 to 14)       12.52[+ or -]5.76
LLH, mm      0.03[+ or -]1.91     0 to 0.5(1 to 2)   1.11[+ or -]0.83
ISH, mm      6.2[+ or -]2.3      No norms            5.02[+ or -]2.08

                 Group 2               Group 3
               Mean [+ or -] SD       Mean [+ or -] SD    p

STA            88.41[+ or -]2.65      88.08[+ or -]2.81   0.849
NP, mm         14.60[+ or -]2.66      15.36[+ or -]2.78   0.511
USD, mm         1.19[+ or -]0.97       1.29[+ or -]0.89   0.448
STSH, mm        3.27[+ or -]2.20       3.95[+ or -]2.16   0.406
SPC, mm         1.73[+ or -]1.17       2.11[+ or -]1.39   0.530
BULT, mm       12.84[+ or -]2.35      12.51[+ or -]2.33   0.221
ULT, mm        11.02[+ or -]2.59      10.53[+ or -]1.76   0.375
H angle        13.92[+ or -]3.44      14.96[+ or -]3.48   0.100
LLH, mm         0.79[+ or -]0.86       1.20[+ or -]0.82   0.139
ISH, mm         4.80[+ or -]1.57       3.75[+ or -]1.43   0.012 (*)

(*)p<0.05, p<0.01; p<0.001
SD: Standard deviation, STA: Soft tissue facial angle, NP: Nose
prominence, USD: Upper lip sulcus depth, STSH: Soft tissue subnasale
to H line, SPC: Skeletal profile convexity, BULT: Basic upper-lip
thickness, ULT: Upper-lip thickness, LLH: Lower lip to H line, ISH:
Inferior sulcus to the H line

Table 4. Comparison of the soft tissue thickness and Holdaway values
with different vertical patterns

               Group 1             Group 2            Group 3

Pog            11.10[+ or -]1.92   11.10[+ or -]1.87  10.90[+ or -]2.11
Gn              8.85[+ or -]2.30    7.86[+ or -]1.43   6.96[+ or -]1.63
Me              8.13[+ or -]1.88    7.09[+ or -]1.42   6.91[+ or -]1.81
G               5.83[+ or -]0.82    5.62[+ or -]0.82   5.52[+ or -]1.07
N               6.01[+ or -]1.32    5.70[+ or -]1.11   5.48[+ or -]1.08
Rhi             1.79[+ or -]0.81    1.66[+ or -]0.50   1.48[+ or -]0.51
Sn             15.16[+ or -]2.26   15.13[+ or -]2.28  15.04[+ or -]2.27
Sto             5.54[+ or -]1.97    4.36[+ or -]1.79   4.08[+ or -]1.66
Li             13.59[+ or -]2.27   12.77[+ or -]2.25  12.72[+ or -]1.69
Labm           10.53[+ or -]1.29   10.48[+ or -]1.48  10.77[+ or -]1.48
Holdaway
measurements
STA            87.02[+ or -]16.78  88.41[+ or -]2.65  88.08[+ or -]2.81
H angle        12.52[+ or -]5.76   13.92[+ or -]3.44  14.96[+ or -]3.48
NP, mm         14.67[+ or -]3.03   14.60[+ or -]2.66  15.36[+ or -]2.78
STSH, mm        3.32[+ or -]2.18    3.27[+ or -]2.20   3.95[+ or -]2.16
ISH, mm         5.02[+ or -]2.08    4.80[+ or -]1.57   3.75[+ or -]1.53
LLH, mm         1.11[+ or -]0.83    0.79[+ or -]0.86   1.20[+ or -]0.82
ULT, mm        11.31[+ or -]1.98   11.02[+ or -]2.59  10.53[+ or -]1.76
BULT, mm       13.52[+ or -]2.10   12.84[+ or -]2.35  12.51[+ or -]2.33
ULT, mm         1.53[+ or -]1.28    1.19[+ or -]0.97   1.29[+ or -]0.89
SPC, mm         1.88[+ or -]1.41    1.73[+ or -]1.17   2.11[+ or -]1.39
USD, mm         1.53[+ or -]1.28    1.19[+ or -]0.97   1.29[+ or -]0.89

                                            Tukey
                  p             I-II         I-III          II-III

Pog               0.896         1.000        0.914          0.912
Gn                0.001 (**)    0.093        0.000 (***)    0.140
Me                0.015 (*)     0.051        0.020 (*)      0.916
G                 0.881         0.998        0.888          0.914
N                 0.213         0.546        0.188          0.749
Rhi               0.151         0.692        0.129          0.484
Sn                0.977         0.999        0.977          0.986
Sto               0.006 (**)    0.035 (*)    0.007 (**)     0.818
Li                0.203         0.283        0.253          0.996
Labm              0.694         0.988        0.790          0.700
Holdaway
measurements
STA               0.849         0.847        0.910          0.990
H angle           0.100         0.424        0.083          0.624
NP, mm            0.511         0.994        0.611          0.542
STSH, mm          0.406         0.997        0.502          0.450
ISH, mm           0.012         0.876        0.015          0.050
LLH, mm           0.139         0.294        0.919          0.145
ULT, mm           0.375         0.861        0.349          0.652
BULT, mm          0.221         0.473        0.204          0.842
ULT, mm           0.448         0.434        0.656          0.933
SPC, mm           0.530         0.887        0.790          0.500
USD, mm           0.448         0.434        0.656          0.933

(*) p<0.05, (**) p<0.01, (***) p<0.001
Pog: Pogonion, Gn: Gnathion, Me: Menton, G: Glabella, N: Nasion, Rhi:
Rhinion, Sn: Subnasale, Sto: Stomion, Li: Labrale inferior, Labm:
Labiomental, STA: Soft tissue facial angle, NP: Nose prominence, STSH:
Soft tissue subnasale to H line, ISH: Inferior sulcus to the H line,
LLH: Lower lip to H line, ULT: Upper-lip thickness, BULT: Basic
upper-lip thickness, SPC: Skeletal profile convexity, USD: Upper lip
sulcus depth

Table 5. Comparison of the soft tissue thickness and Holdaway values
for female subjects with different vertical patterns

               Group 1             Group 2            Group 3

Pog            10.70[+ or -]1.87   10.44[+ or -]1.65  10.29[+ or -]1.76
Gn              8.95[+ or -]2.60    7.45[+ or -]1.33   6.70[+ or -]1.88
Me              7.81[+ or -]2.03    6.68[+ or -]1.09   6.52[+ or -]1.84
G               5.52[+ or -]0.95    5.47[+ or -]0.79   5.34[+ or -]0.79
N               5.58[+ or -]1.12    5.28[+ or -]0.93   5.24[+ or -]0.99
Rhi             1.54[+ or -]0.40    1.48[+ or -]0.40   1.31[+ or -]0.43
Sn             14.08[+ or -]1.47   14.00[+ or -]1.72  14.03[+ or -]1.97
Sto             4.63[+ or -]1.70    3.65[+ or -]1.50   4.06[+ or -]1.86
Li             12.55[+ or -]1.88   11.54[+ or -]2.02  12.10[+ or -]1.24
Labm           10.30[+ or -]1.06   10.04[+ or -]1.56  10.28[+ or -]1.40
Holdaway
measurements
STA            84.83[+ or -]21.48  88.56[+ or -]2.58  88.44[+ or -]2.56
H angle        12.03[+ or -]5.91   12.78[+ or -]2.92  14.68[+ or -]3.85
NP, mm         14.63[+ or -]3.74   15.11[+ or -]2.74  14.69[+ or -]2.42
STSH, mm        3.08[+ or -]1.74    2.83[+ or -]1.91   3.49[+ or -]2.29
ISH, mm         4.50[+ or -]1.87    4.55[+ or -]1.50   3.61[+ or -]1.51
LLH, mm         1.26[+ or -]0.86    0.55[+ or -]0.53   1.14[+ or -]0.88
ULT, mm        10.55[+ or -]1.93    9.71[+ or -]2.45   9.80[+ or -]1.45
BULT, mm       12.65[+ or -]1.64   11.45[+ or -]1.82  11.57[+ or -]1.73
USD, mm         1.44[+ or -]1.29    0.98[+ or -]0.87   1.26[+ or -]1.07
SPC, mm         1.65[+ or -]1.06    1.56[+ or -]0.94   1.96[+ or -]1.32

                                        Tukey HSD

                 p            I-II        I-III        II-III

Pog              0.780        0.902       0.764        0.963
Gn               0.005 (**)   0.074       0.004 (**)   0.494
Me               0.055        0.128       0.067        0.958
G                0.786        0.980       0.779        0.882
N                0.549        0.651       0.572        0.993
Rhi              0.237        0.886       0.228        0.465
Sn               0.991        0.990       0.996        0.998
Sto              0.233        0.205       0.578        0.738
Li               0.228        0.200       0.710        0.596
Labm             0.808        0.825       0.998        0.852
Holdaway
measurements
STA              0.595        0.644       0.655        1.000
H angle          0.176        0.866       0.169        0.394
NP, mm           0.872        0.882       0.998        0.905
STSH, mm         0.601        0.927       0.807        0.579
ISH, mm          0.154        0.996       0.200        0.234
LLH, mm          0.019 (*)    0.023 (*)   0.884        0.066
ULT, mm          0.385        0.421       0.491        0.990
BULT, mm         0.082        0.105       0.153        0.975
USD, mm          0.458        0.430       0.873        0.723
SPC, mm          0.516        0.964       0.678        0.517

(*) p<0.05, (**) p<0.01
Pog: Pogonion, Gn: Gnathion, Me: Menton, G: Glabella, N: Nasion, Rhi:
Rhinion, Sn: Subnasale, Sto: Stomion, Li: Labrale inferior, Labm:
Labiomental, STA: Soft tissue facial angle, NP: Nose prominence, STSH:
Soft tissue subnasale to H line, ISH: Inferior sulcus to the H line,
LLH: Lower lip to H line, ULT: Upper-lip thickness, BULT: Basic
upper-lip thickness, SPC: Skeletal profile convexity, USD: Upper lip
sulcus depth

Table 6. Comparison of the soft tissue thickness and Holdaway values
for male subjects with different vertical patterns

                   Group 1            Group 2            Group 3

Pog            11.71[+ or -]1.90  12.02[+ or -]1.81  11.94[+ or -]2.34
Gn              8.69[+ or -]1.87   8.42[+ or -]1.43   7.41[+ or -]1.01
Me              8.62[+ or -]1.58   7.66[+ or -]1.66   7.59[+ or -]1.61
G               5.79[+ or -]0.57   5.82[+ or -]0.86   5.84[+ or -]1.42
N               6.67[+ or -]1.38   6.28[+ or -]1.11   5.89[+ or -]1.15
Rhi             2.18[+ or -]1.10   1.92[+ or -]0.51   1.77[+ or -]0.52
Sn             16.77[+ or -]2.32  16.69[+ or -]2.07  16.77[+ or -]1.67
Sto             6.90[+ or -]1.55   5.35[+ or -]1.73   4.11[+ or -]1.33
Li             15.14[+ or -]1.95  14.47[+ or -]1.23  13.80[+ or -]1.88
Labm           10.88[+ or -]1.55  11.09[+ or -]1.15  11.63[+ or -]1.26
Holdaway
measurements
STA            90.29[+ or -]3.19  88.20[+ or -]2.83  87.44[+ or -]3.23
H angle        13.26[+ or -]5.69  15.51[+ or -]3.57  15.44[+ or -]2.84
NP, mm         14.73[+ or -]1.59  13.89[+ or -]2.48  16.53[+ or -]3.08
STSH, mm        3.68[+ or -]2.76   3.89[+ or -]2.51   4.75[+ or -]1.72
ISH, mm         5.80[+ or -]2.23   5.15[+ or -]1.66   4.00[+ or -]1.31
LLH, mm         0.88[+ or -]0.74   1.11[+ or -]1.12   1.29[+ or -]0.74
ULT, mm        12.45[+ or -]1.47  12.83[+ or -]1.47  11.80[+ or -]1.57
BULT, mm       14.82[+ or -]2.11  14.76[+ or -]1.47  14.14[+ or -]2.40
USD, mm         1.67[+ or -]1.29   1.48[+ or -]1.05   1.34[+ or -]0.51
SPC, mm         2.23[+ or -]1.82   1.96[+ or -]1.44   2.36[+ or -]1.53

                                           Tukey

                 p             I-II        I-III         II-III

Pog              0.926         0.923       0.959         0.995
Gn               0.113         0.893       0.115         0.240
Me               0.238         0.313       0.296         0.995
G                0.993         0.997       0.992         0.998
N                0.324         0.706       0.292         0.721
Rhi              0.442         0.694       0.418         0.871
Sn               0.994         0.995       1.000         0.995
Sto              0.001 (***)   0.046 (*)   0.000 (***)   0.144
Li               0.186         0.591       0.160         0.611
Labm             0.391         0.913       0.375         0.592
Holdaway
measurements
STA              0.083         0.222       0.083         0.819
H angle          0.346         0.391       0.443         0.999
NP, mm           0.039 (*)     0.666       0.198         0.033
STSH, mm         0.533         0.973       0.537         0.658
ISH, mm          0.065         0.645       0.055         0.268
LLH, mm          0.560         0.801       0.533         0.882
ULT, mm          0.258         0.800       0.565         0.231
BULT, mm         0.669         0.997       0.696         0.730
USD, mm          0.747         0.897       0.727         0.937
SPC, mm          0.822         0.907       0.980         0.817

(*) p<0.05, (***) p<0.001
Pog: Pogonion, Gn: Gnathion, Me: Menton, G: Glabella, N: Nasion, Rhi:
Rhinion, Sn: Subnasale, Sto: Stomion, Li: Labrale inferior, Labm:
Labiomental, STA: Soft tissue facial angle, NP: Nose prominence, STSH:
Soft tissue subnasale to H line, ISH: Inferior sulcus to the H line,
LLH: Lower lip to H line, ULT: Upper-lip thickness, BULT: Basic
upper-lip thickness, SPC: Skeletal profile convexity, USD: Upper lip
sulcus depth
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Title Annotation:Original Article / Ozgun Arastirma
Author:Cezairli, Neslihan Seyhan
Publication:Meandros Medical and Dental Journal
Article Type:Report
Date:Aug 1, 2017
Words:7478
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