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Original Article
Pleasantness of facial profile and its correlation
with soft tissue cephalometric parameters:
Perception of orthodontists and lay people
Geraldo Eugênio Marchiori1, Leonardo Oliveira Sodré2, Tereza Cristina Rodrigues da Cunha1,
Fernando César Torres3, Henrique Damian Rosário4, Luiz Renato Paranhos5

Department of Orthodontics, Inapós Dental School,
Pouso Alegre, MG, Brazil,
Private Office, Joinville, SC, Brazil,
Department of Orthodontics, UNICID‑University of São
Paulo City, São Paulo, SP, Brazil,
Department of Orthodontics, FUNORTE, Florianópolis,
SC, Brazil,
Correspondence: Dr. Luiz Renato Paranhos 5
Department of Orthodontics, Federal University of
Email: Sergipe, Lagarto, SE, Brazil

Objective: This study was aimed to evaluate the perception of orthodontists and of lay people about the facial profile and
its possible correlation with cephalometrics parameters. Materials and Methods: A  total of 20 evaluators were divided
into two groups (10 orthodontists and 10 people with no relation to such area – lay people). They were asked to evaluate
the photographs of 25 young males and of 25 young females, aged 17–24‑year‑old  (mean age of 22.3  years, standard
deviation 2.41  years). Photographs were randomly arranged in a photo album. The evaluators rated each photograph by
means of a scale ranging from “good” to “deficient” based on the pleasantness of their facial profile. Nasolabial angle,
Holdaway’s H‑line and the distance from H‑line to nose tip were measured, in order to verify a possible relation between
these soft tissue profile cephalometric measurements and the subjective ratings. Results: The kappa statistics test showed
a concordance of 0.23 among orthodontists and 0.24 among lay people. Regarding the perception of orthodontists and lay
people on facial profile, no significant divergence could be detected. For the correlation between cephalometric parameters
and subjective ratings, there was a statistically significant correlation between the measures H and H‑nose and the rating
ascribed to the profile. Conclusions: It was concluded that smaller the difference from the normal cephalometric pattern,
the higher was the rating given to the profile, demonstrating an important relation between subjective and objective criteria.

Key words: Cephalometrics, esthetics, form perception, orthodontics

INTRODUCTION harmony and aesthetics. [7‑9] This analysis uses
several measurements, such as nasolabial
Angle, the father of modern orthodontics, has stated angle (NLA) – formed by the lower base of the nose
that beauty, balance, and harmony are the important
This is an open access article distributed under the terms of the Creative
points to be considered in facial profiles.[1] Interestingly, Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
harmonious faces do not necessarily are accompanied by others to remix, tweak, and build upon the work non‑commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
a normal occlusion.[2] Facial beauty depends on several
factors, such as personal opinion, cultural patterns, For reprints contact:
media influence, and racial or ethnical factors.[3] Thus, the
facial analysis is currently used as an essential additional How to cite this article: Marchiori GE, Sodré LO, da Cunha TC,
examination in the orthodontic treatment plan.[4‑6] Torres FC, Rosário HD, Paranhos LR. Pleasantness of facial profile and
its correlation with soft tissue cephalometric parameters: Perception of
orthodontists and lay people. Eur J Dent 2015;9:352-5.
The soft tissue cephalometric analysis is widely
employed in orthodontics to evaluate facial DOI: 10.4103/1305-7456.163323

352 © 2015 European Journal of Dentistry | Published by Wolters Kluwer - Medknow

parameters. IP: 189. Holdaway’s H‑line. it authorizing the release of facial photographs for ranges from 90° to 110°. and this was considered the score study had the purpose of verifying the perception assigned to the profile in question. According craniofacial malformations or odontogenic anomalies. These cephalometric variables were chosen due to its large use in treatment diagnosis. Vol 9 / Issue 3 / Jul-Sep 2015 353 . aged the prominence of the upper lip in relation to the between 17 and 24 years (mean age of 22. 2018. April 24. Scores face. diverged from the normally accepted cephalometric Pictures were randomly arranged in a photo album measurements. Patients should stay with teeth in 14–20 cm good. 8°. of these parameters are shown in Figure 2. a Spearman correlation was rank each photograph and make a marking on estimated among scores and absolute differences the corresponding point of a 20 cm scale ranging from the normal values set for each cephalometric from “good” to “deficient” [Figure 1]. European Journal of Dentistry.[12] Thus. The sample consisted of 20 evaluators of both sexes. The H angle is formed by the intersection of the The rating material consisted of photographs of 25 H‑line with the NaPg line. with protocol protocols.[1] against a to six centimeter deficient.28 years). as well as determining whether the subjective ratings To establish the existence of a correlation between are correlated with some cephalometric soft tissue cephalometrics and the ratings given by the evaluators. soft tissues may Figure 1: Scale for the measurement of the pleasantness degree not always follow bone tissue morphology in an absolute ratio. some cephalometric parameters were selected ( on Tuesday. previously instructed and divided into two groups: Ten The relationship between the scores assigned to orthodontists (five men and five women) (mean age of the profile and the cephalometric measurements 31. number 376080‑10.41 years). and the distance from H‑line to the MATERIALS AND METHODS nose tip). et al. as well as the widespread use of the markings made by the evaluators were measured cephalometric measurements for similar goals. and NLA. to Holdaway.214. according measurements. For each of facial harmony on diagnosis and orthodontic photograph.2 years. facial profile. Afterward. Kappa statistics was performed with maximum intercuspation and with lips at rest.[10] the H‑line – tangent to the most salient point of the chin and upper lip. normal values ranging from 9 to 11 mm. the distances from point “deficient” to treatment planning.1 years. After viewing each H  angle.[Downloaded free from http://www.[11] However. with no teeth measured from the H‑line to the tip of the nose. as they This study was approved by the Ethics Committee of are part of many popular soft tissue cephalometric Universidade Metodista de São Paulo. and the upper lip  (Sn‑Ls). The photographs were taken with a Sony digital The score values (scale from 0 to 20) between camera  (model FD95.: Facial profile and its correlation with cephalometrics and by the upper lip. this with a caliper. and is used to measure young male and 25 young female Caucasians. SD 2. and blue background. considering the importance to their perception on facial pleasantness.[2] a pleasant profile is recognized when All individuals accepted to participate in the study. 7–13  cm regular. and the H angle – formed by the intersection of the H‑line with the NaPog line.14] Graphic representations teaching and research purposes. Tokyo. of lay people and orthodontists on facial profiles. with macro orthodontists and lay people were compared using lens and digital zoom (×20). Japan). All patients were asked to stay at a natural in the scale were grouped into three categories: Zero head position as previously described. picture for 30 s. and 10 lay people (five men was verified based on.[13. at a distance of 1.5 m the median scores for each photograph in each with ×1 adjustment of the macro lens to the individual group and the nonparametric Wilcoxon test. In a harmonic profile. the H‑line passes through the center of the nose. participants were asked to subjectively 100°. a 95% confidence interval to check the concordance level between the two groups. 2. H‑line‑nose  –  10  mm.65 years). how much each profile and five women) (mean age of 28.7. with absences and without previous orthodontic treatment.3 years. The and signed a consent form that explained about the NLA is formed by the lower base of the nose (Sn‑Co) objectives and examinations related to the study. Normal values were set as follows: and showed to the evaluators.49] Marchiori.[10] The H‑line‑nose is the linear distance standard deviation [SD] 2.

the of agreement among evaluators within the same kappa value. several professionals meet people and orthodontists. a nonsignificant divergence their patients’ expectations by correcting their teeth was detected [Table 1]. another rather individualized way of defining pleasantness study[16] observed that cephalometrics correlated with of soft tissue profiles.[18] but another survey[19] registered better agreement concerning facial pleasantness.487ns was 4.23 for orthodontists and 0. not After analyzing photograph ratings between lay facial problems. Table 1 lists the comparison between the Table 3: Correlation between the scores assigned scores assigned by orthodontists and lay people. and the score of pleasantness assigned to the profiles. group (0.7.10 0.214. The kappa value Score x NLA 0. Even This study has verified a possible correlation between though the present study has investigated soft tissue selected cephalometric parameters and the perception profile exclusively. Table 3 indicates the Score x H‑Nose −0.001* the two groups of evaluators.19–0.001* statistics is presented in Table  2. et al.077ns Lay people 7.49] Marchiori. Vol 9 / Issue 3 / Jul-Sep 2015 . A previous work on facial pleasantness issue. our findings suggest that the failed to establish any such correlation with evaluators – lay people and orthodontists – have a cephalometric on Tuesday. we can agree with the thoughts of of lay people. April 24.26) and 0. facial pleasantness but highlighted that the patient normally seeks the orthodontist to solve dental. and orthodontists on facial profile Altemus.04 0.54 <0. NLA: nasolabial angle measurement.47 among orthodontists  (confidence interval  [CI] 95%: 0.[22] Moreover.45 0. There was found a significant correlation among H‑line and H‑line‑nose values. supporting the idea that beauty is indeed subjective. when considered the set of orthodontists 354 European Journal of Dentistry.24 among lay people (CI 95%: 0.7 8 3 12 0.[15] Similar levels of agreement were found by other DISCUSSION authors. mean cephalometric pattern of the evaluated measurements The comparison between the classifications of Evaluators Correlation R P orthodontists and lay people by means of kappa Orthodontists Score x H −0. 2018.[17] In general. showing a concordance of 68% between Lay people Score x H −0.eurjdent.57 <0. and the H angle 10% 20% 10% 40% Good 0 3 3 6 0% 6% 6% 12% RESULTS Total 26 15 9 50 52% 30% 18% 100% The kappa statistics showed a concordance of 0.0 6 2 11 ns: Non‑significant difference Table 2: Comparison between the classifications of Orthodontists and Lay people Orthodontists Lay people Deficient Regular Good Total Deficient 21 2 1 24 42% 4% 2% 48% Figure 2: Anatomical sketch illustrating the H‑line.24 for lay people). detected [21] but contradicted another study that verified a significant difference between the opinion Small values in the kappa test suggest a fair level of orthodontists and lay people. kappa=0. Altogether. IP: 189.001* correlation among scores and absolute differences Score x NLA −0.: Facial profile and its correlation with cephalometrics Table 1: Comparison between the scores assigned by Orthodontists and Lay people Evaluators Mean Median 1st quartile 3rd quartile P Orthodontists 7. ns: Non‑significant correlation.23 % concordance=68%.19–0.[20] who believes beauty is a purely personal pleasantness. which had already been while facial disharmonies are sometimes underrated.799ns from the normal values set for each cephalometric *Significant correlation.[Downloaded free from http://www. the nasolabial Regular 5 10 5 20 angle.28).7.[15] On the other hand. to the profile and the absolute difference for the evidencing a nonsignificant difference.001* Score x H‑ Nose −0.46 0.

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