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HOLD AWAY SOFT TISSUE NORMS IN A SAMPLE OF PESHAWAR POPULATION.

Byline: SAIRA BANO, AHSAN MAHMOOD SHAH, UMMAR HUSSAIN, MUHAMMAD SAOOD and SYED SULEMAN SHAH

Abstract

The objective of this study was to determine soft tissue norms in a sample of Peshawar population. Holdaway soft tissues were determined for 150 individuals (78 males and 72 females) from the lateral cephalograms taken in natural head position. All radiographs were traced and measured by the same investigator. Twelve variables of Holdaway's analysis were determined.

The data were analysed using SPSS version 20. The minimum, maximum, mean and SD were calculated for each variable. Differences between males and females were examined using independent sample t-test. The mean age in this study was 19.18+- 3.43 years. Most values in this study were similar to the Hold away soft tissue norms. For H angle, nose prominence, upper lip thickness and basic upper lip thickness there were variation from the Hold away norms. The males and females had almost similar means for soft tissue norms except for H angle, skeletal profile convexity and upper lip thickness and basic upper lip thickness. H angle, nose prominence, upper lip thickness and basic upper lip thickness were differed from Holdaway's norms. Males have relatively prominent upper lip thickness and basic upper lip thickness than do the females.

Orthodontist and surgeons should consider these variations in mind while formulating camouflage and surgical orthodontic treatment to achieve optimal esthetics.

Key Words: Holdaway's norms, Cephalometry, Soft tissue, Orthodontics.

INTRODUCTION

Physical appearance is an important feature of face. Interestingly, facial features are usually studied in profile. Various methods have been used to evaluate facial characteristics, such as anthropometry photogrammetry computer imaging and cephalometry. Czarnecki et al1 (1993) evaluated the perception of facial balance by varying the length of the nose, lip protrusion, and chin development. They found that the interrelationships of these facial features must be in balance in order to achieve facial harmony. The success of orthodontic treatment is frequently related to the improvement gained in the patient's facial appearance, which includes the soft tissue profile and since there is considerable variation in the soft tissue covering the face.2 Evaluation of soft tissue analysis during orthodontic diagnosis and treatment planning is very important.3,4 Facial harmony and balance is influenced by soft tissue.5

Holdaway6 stated that better treatment goals can be set if we quantitate the soft tissue features which contribute to or detract from that 'physical attractiveness stereotypes' which has been ingrained into our culture.

During orthodontic practice, diagnosis is made by comparing cephalometric measurements to standard norms.7 These norms are however set for specific ethnic and racial population.8 In several studies, soft tissue cephalometric norm for esthetically pleasing profile have been established by various researcher by using cephalometric radiographs.9 Different racial groups must be treated differently according to their own norms.10

According to Hwang et al, attempts have been made to investigate the differences in the faces of various ethnic groups including American blacks,11 Africans,12

Chinese13, Japanese,14 Koreans,15 Indians,16 saudia Arabians,17 maxican-americans,18 Brazilians,19 Puerto Ricans.20

The objective of this study was to determine soft tissue norms in a sample of Peshawar population.

It will give us cephalometric soft tissue norms for this population, which will aid in optimal diagnosis and treatment planning of orthodontic cases.

METHODOLOGY

The lateral cephalometric radiographs of 150 individuals (78 males and 72 females) were included in this study. These radiographs were obtained from the Department of Orthodontics Khyber College of Dentistry, Peshawar. Their age range was 19-29 years. The criteria used for sample selection included: (1) normal occlusion with bilateral Class I molar and canine relationship with normal overjet and overbite (1-4mm). (2) well aligned upper and lower dental arches with minor rotations and/or spacing (less than 1mm). (3) balanced facial profile, with competent lips, relaxed closed lip relation, and with no excessive protrusion or retrusion of the profile. (4) no previous history of orthodontic treatment or maxillofacial surgery.

The cephalometric radiographs were taken using SS White cephalometric machine, each subject was radiographed in the standing position with the head adjusted so that the FH plane is parallel to the floor and the midsagittal plane perpendicular to the floor. All radiographs were traced and measured by the same investigator. The H angle, Soft tissue facial angle, Nose prominence, Upper lip sulcus depth (upper lip curl), Basic upper lip thickness, Upper lip thickness, Upper lip strain, Skeletal profile convexity, Soft tissue subnasale to H line, Lower lip to H line, Inferior sulcus to the H line (lower lip sulcus depth), and Soft tissue chin thickness measurements were analyzed using the definitions provided by Holdaway10 (Fig 1).

The data were analyzed using SPSS software package (version 20.0). The minimum, maximum, mean and SD were calculated for each variable. The differences between males and females were determined using independent sample t-test.

RESULTS

One hundred and fifty patients were included in the current study in which 72 were females and 78 were males. The mean age in this group was 19.18+- 3.43 years. Table 1 shows descriptive statistics for Hold away norms, means, and SD are given. Most of the values in this study were similar to the Holdaway's soft tissue norms. For H angle, nose prominence, upper lip thickness, and basic upper lip thickness, there were variation from the Holdaway's norms.

Table 2 shows the descriptive statistics stratified by genders. The males and females had almost similar means for soft tissue norms except for H angle, skeletal profile convexity and upper lip thickness. Upper lip thickness and basic upper lip thickness was statistically different between males and females (P < 0.001). Upper lip thickness and basic upper lip thickness measurement of the males was larger than those of the females. Soft tissue facial angle, nose prominence, H angle, soft tissue subnasale to H line, lower lip to H line, inferior sulcus to H line, soft tissue chin thickness, and basic upper lip thickness were not statistically different by gender (Table 3).

TABLE 1: DESCRIPTIVE STATISTICS OF CEPHALOMETRIC SOFT TISSUE PARAMETERS

Soft tissue parameters###N###Mini-###Maxi-###Mean###Std. Devia-###Holdaway

###mum###mum###tion###norms

Soft tissue subnasale to H-line###150###2.00###10.00###5.1600###2.02030###5+-2

(mm)

Soft tissue facial angle (degree)###150###89.00###97.00###92.5600###2.33133###91+-7

H angle (degree)###150###6.00###22.00###16.6300###4.41593###10 (7-14)

Skeletal profile convexity (degree)###150###2.00###15.00###6.4600###2.70875###0 (-3 to 3)

Soft tissue chin thickness (mm)###150###7.00###17.00###12.5000###1.90504###10-12

Lower lip to H line (mm)###150###-2.00###2.00###.2000###1.12486###0-0.5 (-1 to 2)

Inferior sulcus H-line (mm)###150###3.00###7.00###4.7600###1.02140###3-7

Nose prominence (mm)###150###10.00###20.00###12.6800###2.41965###14-24

Upper lip sulcus depth (mm)###150###1.00###6.00###3.2600###1.10306###3 (1-4)

Basic upper lip thickness (mm)###150###9.00###16.00###12.9400###1.93158###15

upper lip thicknes (mm)###150###8.00###16.00###11.7400###2.11708###13-14

TABLE 2. COMPARISON OF MEAN AND SD DIFFERENCES OF CEPHALOMETRIC SOFT TISSUES MEASUREMENT BETWEEN MALES AND FEMALES

Soft tissue parameters###Gender of patient###N###Mean###Std. Devia-###Std. Error

###tion###Mean

Facial angle (degree)###male###78###92.6154###2.28621###.25886

###female###72###92.1250###2.42021###.28522

Soft tissue subnale to H-line(mm)###male###78###5.5769###2.23618###.25320

###female###72###4.7083###1.65672###.19525

Lower lip to H-line (mm)###male###78###.2963###1.17689###.22529

###female###72###.0870###1.08357###.22521

H angle (degree)###male###78###17.1224###4.19816###.84703

###female###72###15.4783###4.43357###.78758

Soft tissue chin thickness (mm)###male###78###11.7778###1.64862###.31728

###female###72###10.3910###1.90076###.41650

Skeletal profile convexity (degree)###male###78###8.2593###2.67859###.55329

###female###72###6.3478###2.74984###.32407

Nose prominence (mm)###male###78###12.4075###1.98750###.38215

###female###72###13.0000###2.86039###.59546

Upper lip sulcus depth (mm)###male###78###3.3333###1.14354###.22008

###female###72###3.1739###1.08689###.16809

Inferior sulcus H-line (mm)###male###78###4.8889###.84753###.16307

###female###72###4.6087###1.19765###.25709

Basic upper lip thickness (mm)###male###78###14.4815###2.65785###.39302

###female###72###12.3089###1.79835###.37601

Upper lip thickness (mm)###male###78###12.7037###1.97708###.38049

###female###72###10.6087###1.69864###.35419

TABLE 3: INDEPENDENT T TEST OF HOLDAWAY'S NORMS BETWEEN MALES AND FEMALES

Soft tissue variables###t-test for Equality of Means

###95% Confidence

###Interval

###t###df###Sig.###Mean Dif-###Std. Error###Lower###Upper

###(2-tailed)###ference###difference

Facial angle (degree)###1.276###148###.204###.49038###.38430###-.26903###1.24980

Soft tissue subnasale to###2.685###148###.008###.86859###.32351###.22930###1.50788

H-line (mm)

Lower lip to H-line (mm)###.654###148###.510###.20934###.33456###-.43621###4.13384

H angle (degree)###1.312###148###.190###1.63245###1.124388###-8.91454###4.32263

Soft tissue chin thick-###2.126###148###.008###1.84295###.50834###.37744###2.3994

ness(mm)

Skeletal profile convex-###2.730###148###.007###1.92372###.64339###.55247###3.9990

ity (degree)

Nose prominence (mm)###-.861###148###1.394###-.59259###.68840###-1.9765###.7953

Upper lip sulcus depth###.505###148###.617###.15987###.31563###-.47454###.79979

(mm)

Inferior sulcus H-line###.966###148###.339###.28019###.29002###-.30294###.86332

(mm)

Basic upper lip thick-###3.540###148###.000###2.1729###.48493###1.79620###3.18796

ness (mm)

Upper lip thickness###7.649###148###.000###2.45513###.32098###1.82084###3.08942

(mm)

DISCUSSION

In orthodontic practice, various analysis are used to evaluate cephalometric radiographs. Soft tissue values are often as important as hard tissue values, when assessing the success of orthodontic treatment. Therefore, soft tissue values must accurately reflect ideal norms throughout treatment. It was thought that a study to determine the soft tissue norms in a sample of Peshawar population would be beneficial for orthodontic diagnosis and treatment planning.

The purpose of this project was to define current soft tissue norms in a sample of Peshawar population. An aim of this study was to determine the Hold away norms for Peshawar individual with esthetically pleas- ing appearance and ideal skeletal relationship in anteroposterior and vertical direction. It was hypothesized that Holdaway's21 soft tissue norms and the Peshawar population values were generally similar, except in H angle, nose prominence, upper lip thickness and basic upper lip thickness measurements.

The H angle is formed by a line tangent to the chin and the upper lip with the NB line. Holdaway6 said the ideal face has an H angle of 7-150, which is dictated by the patient's skeletal convexity. H angle values in a sample of Peshawar population were greater to those given by Hold away.10

According to Hold away, upper lip sulcus depth has an acceptable range of 1-4 mm, with the mean of 3mm being ideal. The measurement of soft tissue subnasale to H line has an acceptable range of 3-7 mm, with mean values 5 mm being ideal. The distance between the lower lip and H line has an acceptable range between 1 and 2 mm, with the ideal between 0 and 0.5. Holdaway10 also specified that "the contour in the inferior sulcus area should fall into harmonious lines with the superior sulcus form" therefore a range of 3-7 mm will also be acceptable as normal for the inferior sulcus to the H line. According to all given values as stated above , the Peshawar population has ideal values for soft tissue angle, upper lip sulcus depth, soft tissue subnasale to H line, lower lip to H line and inferior sulcus to H line measurement.

It was found that approximately all of the Holdaway's soft tissue measurements in males and females were similar to those of this study's sample. However, upper lip thickness and basic upper lip thickness measurements were statistically significant by gender. Upper lip was more protrusive in males than in females in relation to Holdaway's H line. In northern Mexican population the Holdaway soft tissue facial angle was significantly greater in 13-year-old boys than in girls, indicating a more convex soft tissue profile.22 However, in the present study, no statistically significant gender differences were found for soft tissue facial angle for Peshawar population.

According to Holdaway,10 nose prominence has an acceptable range of 14-24 mm. Holdaway5 suggested that nose less than 14 mm is small, and those above 24 mm are large or prominent. In the present study it was found that nose prominence values were less than Hold away norms. In our study upper lip thickness and basic upper lip thickness values are also less than Holdaway's norms. These differences may due to ethnic and genetic variations

CONCLUSION

1 H angle, nose prominence, upper lip thickness and basic upper lip thickness were differed from Holdaway's norms.

2 Males have relatively prominent upper lip thickness and basic upper lip thickness than do the females.

3 Orthodontist and surgeons should consider these variations in mind while formulating camouflage and surgical orthodontic treatment to achieve optimal esthetics.

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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Jun 30, 2017
Words:3037
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