Tripti Tikku et al
5005/jp-journals-10021-1250
Original research
Arnett’s Soft-tissue Cephalometric Analysis Norms for
the North Indian Population: A Cephalometric Study
1
Tripti Tikku, 2Rohit Khanna, 3Kiran Sachan, 4Rana Pratap Maurya, 5Geeta Veram, 6Mayank Agarwal
ABSTRACT
Objective: To determine the soft-tissue cephalometric norms
as per Arnett’s analysis for male and female subjects of North
Indian population and to compare these cephalometric norms
with Arnett’s norms for Caucasian population.
Materials and methods: Frontal and profile photographs of
150 subjects with normal occlusion and pleasing profile were
rated by a panel of judges, from which 50-male and 50-female
subjects were selected and their lateral cephalograms were
taken for the present study. Arnett’s soft-tissue cephalometric
analysis (STCA) was done on these cephalograms using
Nemotech cephalometric software. Mean values of various
parameters were obtained and these values were compared to
Arnett’s norms for Caucasian population using Student t-test.
These values were also compared among males and females
of North Indian population.
Results: High overjet, thicker soft-tissue, less facial length,
retruded lower face and midface and convex profile were
observed in the North Indian population as compared to
Caucasian population. Males of North Indian population have
thicker soft-tissue structures, more acute nasolabial angle,
longer faces and more deep-set facial structures than females
whereas females have greater interlabial gap and maxillary
incisor exposure.
Conclusion: Statistically significant differences in certain
parameters were found between North Indian population and
Caucasian population and also between males and females of
North Indian population.
Keywords: Arnett’s STCA, TVL, Soft tissue, Nemotech software.
How to cite this article: Tikku T, Khanna R, Sachan K, Maurya
RP, Veram G, Agarwal M. Arnett’s Soft-tissue Cephalometric
Analysis Norms for the North Indian Population: A Cephalometric
Study. J Ind Orthod Soc 2014;48(4):224-232.
Source of support: Nil
Conflict of interest: None
Received on: 19/7/13
Accepted after Revision: 12/8/13
1
Professor and Head, 2,3Professor, 4Reader, 5Senior Lecturer
6
Postgraduate Student (3rd Year)
1-6
Department of Orthodontics and Dentofacial Orthopedics
Babu Banarasi Das College of Dental Sciences, Lucknow, Uttar
Pradesh, India
Corresponding Author: Rana Pratap Maurya, Reader
Department of Orthodontics and Dentofacial Orthopedics, Flat
No. 204, TG Campus, Khadra, Lucknow, Uttar Pradesh, India
Phone: 9936198408, e-mail: ranapmaurya@yahoo.co.in
224
10.
Introduction
Throughout recorded history and even earlier, human
beings have been aware of and concerned about beauty
and facial esthetics. An esthetically pleasing smile is a
key determinant of successful orthodontic treatment and
patient satisfaction.
After the introduction of cephalometric radiography in
1931 by Broadbent1 and Hoffrath, many authors like Steiner,2
Down,3 Broadbent1 and associates, Ricketts,4 Sassouni5,
etc. have developed hard tissue cephalometric analysis and
corresponding norms which provide useful guide­lines for
diagnosis and treatment planning.
The recent shift to soft tissue paradigm in orthodontic
diagnosis and treatment planning has made accurate assess­
ment of soft-tissue structures of considerable importance.
This led to development of various soft tissue cephalometric
analysis by Holdaway6 and Legan.7 As there is variability in
the craniofacial morphology and nature of soft-tissue profile
among different population and ethnic groups, most of the
norms which are based on the Caucasian population cannot
always be applied to the other racial groups. Considering
this, many authors established cephalometric norms for
different populations as orthodontic treatment is best when
the facial and cephalometric charac­teristics of the patients of
different ethnic group and race are taken into consideration.
Recently, facial balance, diagnosis and treatment plan­
ning have been improved by Arnett GW,8 by means of a
combination of clinical facial analysis, hard tissue and soft
tissue cephalometric analysis (STCA). Arnett’s STCA has
the advantage of gender consideration over other soft tissue
analysis. As previous studies have reported differences
between males and females for amount, rate and growth
patterns, therefore separate norms were established for males
and females.
As there are no cephalometric norms for Arnett’s soft
tissue analysis for the population of the North Indian region
at present, this study was aimed to determine the same
in a representative sample of the population of the North
Indian region and to compare these cephalometric norms
with the Arnett’s norms for the Caucasian population and
also between the males and females of the North Indian
population.

Arnett’s Soft-tissue Cephalometric Analysis Norms for the North Indian Population: A Cephalometric Study
Materials and Methods
The present study was conducted on pretreatment lateral
cephalograms of 100 orthodontically untreated subjects
(50 males and 50 females) having normal occlusion and
pleasing facial profile, in the age group of 18 to 25 years. The
subjects who were the natives of North India were selected
from 150 students of Engineering College, College of Dental
Sciences and Institute of Charted Accountants on the basis of
their frontal and profile photographs. Ethical approval from
ethical committee of BBDCODS and consent from subjects
had been taken for use of their photographs and radiographs.
Criteria for Sample Selection
All subjects had the following:
1. Pleasing profile.
2. Age group of 18 to 25 years so that complete growth of
soft tissues had taken place.
3. Angle’s Class I occlusion with well-aligned maxillary
and mandibular dental arches.
4. Subjects and their parents were resident of Uttar Pradesh,
Uttarakhand, Punjab, Haryana, Delhi and Rajasthan,
were only included in the study.
5. All permanent teeth except third molars.
6. No facial asymmetry.
7. Normal growth and development.
8. No significant medical history or history of any trauma.
9. No previous history of orthodontic or prosthodontic
treatment and maxillofacial or plastic surgery.
The frontal and profile photographs of all the subjects
were taken with digital camera (Sony Cyber Shot with Carl
Zeiss, lens 26 mm wide angle, 14.1 megapixels, 4× optical
zoom). All photographs were evaluated by a panel of judges
comprising of two each of experienced orthodontists, plastic
surgeons and beauticians. The panel members were given
a profile rating chart and were asked to rate the subjects on
the basis of a five point scale with 1—poor, 2—fair, 3—
good, 4—very good and 5—excellent. The scores given by
the judges for each subject were then added up separately
and the mean score was calculated. Only the subjects who
had a total score equal to or above the average score were
selected for cephalometric evaluation.
Sample Groups
The selected subjects were divided into two groups as follows:
• Group I: Fifty males in the age group of 18 to 25 years
with a mean age of 22.4 years.
• Group II: Fifty females in the age group of 18 to 25 years
with a mean age of 21.5 years.
The Journal of Indian Orthodontic Society, October-December 2014;48(4):224-232
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Methods
Digital lateral cephalograms of the selected subjects were
taken on a digital cephalometric machine (Planmeca Proline
XC, Finland) by positioning the subjects head in the natural
head position with teeth in centric occlusion and lips in
relaxed position. The ear posts were used for correct sideways
align­ment of the patient’s head so that the image would be
symmetric and undistorted in the right-left direction. A wall
mirror was used as an external source of eye reference for
orien­ting the head in the natural head position. The receptor-
source distance was fixed at 60 inch. The exposure values
were set at 68 kV, 5 mA and exposure time of 23 seconds.
The lateral cephalograms so obtained were then transferred
to Nemotech digital imaging software (Version 6.0) for
STCA analysis. A scale of 10 mm had been marked on the
nasal positioner of the cephalostat which was visible on the
cephalo­gram. This was used to eliminate the magnification
error as it was compared to a 10 mm scale on the Nemotech
software. The error, if any, was compensated by the Nemo­
tech software in its subsequent linear measurements. All
the required cephalometric landmarks (except orbital rim,
cheekbone, subpupil and nasal bone which were located by
the Nemotech software) were identified and marked with the
help of cursor/mouse manually (Fig. 1A). The measurements
of various parameters in Arnett’s analysis was done by the
Nemotech software itself.
A total of 43 parameters were measured for the Arnett’s
STCA, of which 37 were linear and six were angular
measure­ments. The soft tissue cephalometric parameters
were divided into five groups: dentoskeletal factors (Figs 1B
and C), soft tissue structures (Fig. 2A), facial lengths (Fig. 2B),
projections to the TVL (Fig. 2C) and harmony values (Figs
1C and D). The data so obtained was subjected to statistical
analysis.
Statistical Analysis
All statistical analysis was done using Statistical Package
for Social Sciences (SPSS) version 15.0 statistical analysis
software. Arithmetic mean and standard deviation (SD) was
calculated for each measurement. Student t-test was used
to compare the mean values of various parameters among
males and females of North Indian population and was
also compared to Arnett’s norms of Caucasian population.
Reproducibility of points and measurement of reliability was
done by tracing and measurement of 10 radiographs after
3 weeks using Nemotech software, the difference between
the first and second measurement was found to be statistically
insignificant using ICC test.
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Fig. 1A: Hard and soft-tissue landmarks and reference planes Fig. 1B: Dentoskeletal factors

Fig. 1C: Dentoskeletal factors and harmony values Fig. 1D: Harmony values

Fig. 2A: Soft-tissue structures Fig. 2B: Facial lengths

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Arnett’s Soft-tissue Cephalometric Analysis Norms for the North Indian Population: A Cephalometric Study
Fig. 2C: Projections to TVL
Results
The results of the North Indian population were compared
with the standards norms as established by Arnett in the
Caucasian population (Tables 1 and 2) and it was found
that both the population were facially similar in some
measure­ments but different in others. High overjet, thicker
soft-tissue, less facial length, retruded lower face and mid
face and convex profile were observed in the North Indian
population as compared to the Caucasian population. Stati­
s­tical analysis of the differences between males and females
of the North Indian population was done for skeletal, soft-
tissue and facial parameter (Table 3). Statistical analysis
showed that both the sexes were similar in some but not in
all measurements. Males of North Indian population had
thicker soft-tissue structures, more acute nasolabial angle,
longer faces and more deep-set facial structures than females
whereas females had a greater interlabial gap and maxillary
incisor exposure.
Discussion
Diagnosis and treatment planning are necessary for suc­
cessful treatment of malocclusions. However, facial esthetics
does not rely solely on hard tissues, as analysis of hard tissue
alone might be inadequate or misleading. This inadequacy
is because of the soft-tissue dimensions vary as a result of
the variation in thickness of the soft-tissue, the lip length
and the postural tone. Subtelny JD9 observed that all parts
of the soft-tissue profile do not directly follow the changes
in the underlying skeletal profile. Burstone10 emphasized
the importance of soft-tissue evaluation as one of the most
impor­tant diagnostic tools in orthodontic diagnosis and
treatment planning. So, it is necessary to study the soft-tissue
contour to adequately assess the facial harmony.
The Journal of Indian Orthodontic Society, October-December 2014;48(4):224-232
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As craniofacial morphology and thickness of soft-tissue
varies among different population groups, hence there is a
need of establishing separate cephalometric norms for the
different population, races or ethnic groups. Uysal et al,11
Scavone et al12 and Gunaid et al13 also found that the
Caucasian norms for different soft-tissue cephalometric ana­
lysis were not applicable on the Turkish, Japanese-Brazillian
and Yemeni population respectively, so they estab­lished
separate soft-tissue cephalometric analysis norms for their
population.
To ensure that the variability in mean values of various
parameters was not affected by growth, all the male and
female subjects selected were above 18 years of age wherein
complete growth had taken place.
Among the various soft-tissue analysis, Arnett’s analysis
is a combination of hard tissue and soft-tissue analysis, it
evaluates the upper face, mid face and lower face structures
and has the advantage of gender consideration. This is the
reason for establishing the Arnett’s analysis norms for the
North Indian population.
The cephalometric parameters were divided into five
groups, dentoskeletal factors, soft-tissue structures, facial
lengths, projections to the TVL and harmony values.
On comparison of mean values of dentoskeletal para­
meters (see Figs 1B and C) of the North Indian population to
Arnett’s norms, only overjet was found higher in the present
study for both males and females. In other studies11,14,15
significant difference was found for different dentoskeletal
parameters between their respective population and the
Caucasian population which shows the existence of
racial varia­tion between different population. None of the
dentoskeletal parameters showed statistically significant
difference between males and females for population of
the North Indian region, which could be because male and
female possessed a similar type of dentofacial morphology
being of same ethnic origin. Similar results were found by
Arnett et al,8 Uysal et al11 and Lalitha and Kumar.14
On comparing the soft tissue structure (see Fig. 2A)
norms of present study with the Arnett’s norms, upper lip
thickness and lower-lip thickness had lower values whereas
nasolabial angle was significantly higher for north Indian
population. Similar results were found by Kalha et al15
in South Indian males and females when compared with
Arnett’s norms. Soft-tissue structures showed statistically
significant difference for upper lip thickness, lower lip
thickness and Me-Me’ with greater values for males than
females in north Indian population. Similar results were
seen in previous studies.8,11,14-16
When the facial length parameters (see Fig. 2B) of the
present study were compared with the Arnett’s norms, it
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Table 1: Comparison for skeletal, soft-tissue and facial parameters between Group I and Arnett’s values for males
Variable North Indian Arnett Difference Significance of
(n = 50) (n = 20) difference
Mean SD Mean SD Mean SE ‘t’ ‘p’ Level
Dentoskeletal factors
Mx occlusal plane angle 95.71 3.89 95.0 1.4 0.71 0.90 0.793 0.434 NS
Mx1-Mx occlusal plane angle 58.54 5.53 57.8 3.0 0.74 1.31 0.564 0.577 NS
Overbite 3.11 1.32 3.2 0.7 –0.09 0.31 0.288 0.775 NS
Md1-Md occlusal plane angle 63.50 6.82 64.0 4.0 –0.5 1.63 0.307 0.761 NS
Overjet 3.88 1.08 3.2 0.6 0.68 0.26 2.649 0.013 *
Soft-tissue structures
Upper lip thickness (ULT) 12.49 1.79 14.8 1.4 –2.31 0.45 5.166 0.000 ***
Lower lip thickness (LLT) 12.84 1.79 15.1 1.2 –2.26 0.44 5.188 0.000 ***
Pogonion-pogonion' (Pog-Pog’) 12.04 1.74 13.5 2.3 –1.46 0.51 2.885 0.007 **
Menton-menton' (Me-Me’) 7.71 1.69 8.8 1.3 –1.09 0.42 2.590 0.015 *
Nasolabial angle 111.63 6.82 106.4 7.7 5.23 1.87 2.793 0.009 **
Upper lip angle (ULA) 9.88 7.45 8.3 5.4 1.58 1.84 0.861 0.396 NS
Facial lengths
Nasion’-Menton' (N’-Me’) 115.79 4.63 137.7 6.5 –21.91 1.38 15.863 0.000 ***
Lower 1/3 of face (Sn-Me') 66.27 2.75 81.1 4.7 –14.83 0.90 16.442 0.000 ***
Upper lip length (Sn-ULI) 21.01 2.07 24.4 2.5 –3.39 0.58 5.828 0.000 ***
Lower lip length (LLS-Me’) 45.34 2.58 54.3 2.4 –8.96 0.67 13.380 0.000 ***
Interlabial gap (ULI-LLS) 0.39 0.80 2.4 1.1 –2.01 0.24 8.498 0.000 ***
Mx1 exposure 2.78 1.24 3.9 1.2 –1.12 0.33 3.445 0.002 **
Maxillary height (Sn-Mx1) 23.74 2.13 28.4 3.2 –4.66 0.66 7.114 0.000 ***
Mandibular height (Md1-Me') 38.18 2.74 56 3 –17.82 0.74 23.926 0.000 ***
Projections to TVL
Glabella (G') –9.77 3.99 –8 2.5 –1.77 0.96 1.840 0.076 NS
Orbital rim (OR) –23.94 2.10 –22.4 2.7 –1.54 0.60 2.549 0.016 *
Cheek bone (CB) –26.13 1.72 –25.2 4 –0.93 0.68 1.368 0.182 NS
Nose tip (NT) 13.23 1.69 17.4 1.7 –4.17 0.45 9.311 0.000 ***
Subpupil (SP) –21.89 2.34 –18.4 1.9 –3.49 0.59 5.926 0.000 ***
Alar base (AB) –12.02 3.70 –15 1.7 2.98 0.86 3.448 0.002 **
Soft tissue point A (A') –1.35 1.21 –0.3 1 –1.05 0.31 3.436 0.002 **
Upper lip anterior (ULA) 2.44 2.07 3.3 1.7 –0.86 0.52 1.647 0.110 NS
Lower lip anterior (LLA) 0.01 2.81 1 2.2 –0.99 0.70 1.410 0.169 NS
Soft tissue point B (B') –9.19 3.70 –7.1 1.6 –2.09 0.86 2.429 0.022 *
Pogonion’ (Pog') –5.68 4.27 –3.5 1.8 –2.18 0.99 2.199 0.036 *
Mx1 –11.21 2.39 –12.1 1.8 0.89 0.59 1.501 0.144 NS
Md1 –14.74 2.55 –15.4 1.9 0.66 0.63 1.045 0.304 NS
Harmony values
Md1-Pogonion' (Md1-Pog’) 9.06 2.98 11.9 2.8 6.47 0.78 8.344 0.001 **
Lower lip anterior-pogonion’ 5.41 2.48 4.4 2.5 1.01 0.66 1.536 0.135 NS
(LLA-Pog')
Soft tissue point B-pogonion’ (B'-Pog') 3.57 1.86 3.6 1.3 –0.03 0.46 0.066 0.948 NS
Subnasale-pogonion’ (Sn-Pog') 5.69 4.18 4 1.7 1.69 0.97 1.745 0.092 NS
Soft tissue point A-soft tissue point B 7.60 3.04 6.8 1.5 0.8 0.71 1.120 0.272 NS
(A'-B')
Upper lip anterior-lower lip anterior –2.64 1.80 –2.3 1.2 –0.34 0.44 0.777 0.444 NS
(ULA-LLA)
Orbital rim-soft tissue point A (OR-A') 22.64 1.98 22.1 3 0.54 0.61 0.883 0.384 NS
Orbital rim-pogonion’ (OR-Pog') 18.18 4.43 18.9 2.8 –0.72 1.07 0.673 0.506 NS
Glabella-soft tissue point A (G'-A') 8.37 3.72 7.8 2.8 0.57 0.92 0.618 0.542 NS
Glabella-pogonion’ (G'-Pog') 4.12 5.39 4.6 2.2 –0.48 1.25 0.384 0.704 NS
Facial angle 165.21 6.14 169.4 3.2 –4.19 1.45 2.890 0.007 **
NS: Nonsignificant (p > 0.05); *Significant (p < 0.05); **Highly significant (p < 0.01); ***Very highly significant (p < 0.001);
Mx: Maxillary; Md: Mandibular

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Arnett’s Soft-tissue Cephalometric Analysis Norms for the North Indian Population: A Cephalometric Study

Table 2: Comparison for skeletal, soft-tissue and facial parameters between Group II in North Indian
population with Arnett’s values for females
Variable North Indian Arnett Difference Significance of
(n = 50) (n = 20) difference
Mean SD Mean SD Mean SE ‘t’ ‘p’ Level
Dentoskeletal factors
Mx occlusal plane angle 96.78 3.55 95.6 1.8 1.18 0.74 1.588 0.123 NS
Mx1-Mx occlusal plane angle 56.45 5.36 56.8 2.5 –0.35 1.11 0.315 0.755 NS
Overbite 2.81 1.47 3.2 0.7 –0.39 0.31 1.277 0.212 NS
Md1-Md occlusal plane angle 62.47 7.02 64.3 3.2 –1.83 1.45 1.260 0.218 NS
Overjet 3.80 1.02 3.2 0.4 0.6 0.21 2.879 0.007 **
Soft tissue structures
Upper lip thickness (ULT) 11.24 1.76 12.6 1.8 –1.36 0.43 3.171 0.004 **
Lower lip thickness (LLT) 11.20 1.76 13.6 1.4 –2.4 0.40 6.026 0.000 ***
Pogonion-pogonion' (Pog-Pog’) 11.39 1.99 11.8 1.5 –0.41 0.44 0.922 0.364 NS
Menton-menton' (Me-Me’) 6.90 1.82 7.4 1.6 –0.5 0.42 1.183 0.247 NS
Nasolabial angle 113.16 7.70 103.5 6.8 9.66 1.79 5.393 0.000 ***
Upper lip angle (ULA) 12.75 7.94 12.1 5.1 0.65 1.72 0.378 0.708 NS
Facial lengths
Nasion’-Menton' (N’-Me’) 110.47 5.18 124.6 4.7 –14.13 1.21 11.634 0.000 ***
Lower 1/3 of face (Sn-Me') 60.83 3.57 71.1 3.5 –10.27 0.86 11.977 0.000 ***
Upper lip length (Sn-ULI) 18.41 2.34 21.0 1.9 –2.59 0.53 4.866 0.000 ***
Lower lip length (LLS-Me’) 41.86 2.82 46.9 2.3 –5.04 0.64 7.849 0.000 ***
Interlabial gap (ULI-LLS) 0.79 1.25 3.3 1.3 –2.51 0.31 8.193 0.000 ***
Mx1 exposure 3.33 1.64 4.7 1.6 –1.37 0.39 3.483 0.002 **
Maxillary height (Sn-Mx1) 22.20 2.15 25.7 2.1 –3.5 0.52 6.786 0.000 ***
Mandibular height (Md1-Me') 35.40 2.65 48.6 2.4 –13.2 0.62 21.257 0.000 ***
Projections to TVL
Glabella (G') –8.95 3.84 –8.5 2.4 –0.45 0.83 0.544 0.591 NS
Orbital rim (OR) –21.43 1.74 –18.7 2 –2.73 0.44 6.163 0.000 ***
Cheek bone (CB) –23.44 2.21 –20.6 2.4 –2.84 0.55 5.161 0.000 ***
Nose tip (NT) 12.74 1.68 16 1.4 –3.26 0.38 8.475 0.000 ***
Subpupil (SP) –19.46 3.02 –14.8 2.1 –4.66 0.66 7.024 0.000 ***
Alar base (AB) –10.77 1.52 –12.9 1.1 2.13 0.34 6.327 0.000 ***
Soft tissue point A (A') –1.33 1.33 –0.1 1 –1.23 0.30 4.141 0.000 ***
Upper lip anterior (ULA) 2.38 2.15 3.7 1.2 –1.32 0.46 2.899 0.007 **
Lower lip anterior (LLA) 0.32 2.88 1.9 1.4 –1.58 0.60 2.634 0.013 *
Soft tissue point B (B') –7.47 3.46 –5.3 1.5 –2.17 0.71 3.045 0.005 **
Pogonion’ (Pog') –4.68 4.28 –2.6 1.9 –2.08 0.88 2.354 0.026 *
Mx1 –8.49 4.30 –9.2 2.2 0.71 0.90 0.788 0.437 NS
Md1 –12.21 4.51 –12.4 2.2 0.19 0.94 0.202 0.841 NS
Harmony values
Md1-pogonion' (Md1-Pog’) 7.53 3.42 9.8 2.6 5.83 0.77 7.614 0.001 **
Lower lip anterior-pogonion’ 4.91 2.71 4.5 2.1 0.41 0.61 0.673 0.506 NS
(LLA-Pog')
Soft tissue point B-pogonion’ (B'-Pog') 2.77 1.73 2.7 1.1 0.07 0.37 0.187 0.853 NS
Subnasale-pogonion’ (Sn-Pog') 5.00 3.73 3.2 1.9 1.8 0.78 2.305 0.029 *
Soft tissue point A-soft tissue point B 6.24 2.88 5.2 1.6 1.04 0.61 1.706 0.099 NS
(A'- B')
Upper lip anterior-lower lip anterior 2.46 1.68 1.8 1 0.66 0.36 11.860 0.000 ***
(ULA-LLA)
Orbital rim-soft tissue point A (OR-A') 20.21 2.03 18.5 2.3 1.71 0.51 3.328 0.002 **
Orbital rim-pogonion’ (OR-Pog') 16.43 3.92 16 2.6 0.43 0.85 0.504 0.618 NS
Glabella-soft tissue point A (G'-A') 7.60 3.70 8.4 2.7 –0.8 0.82 0.974 0.338 NS
Glabella-pogonion’ (G'-Pog') 4.30 4.71 5.9 2.3 –1.6 0.98 1.630 0.114 NS
Facial angle 165.74 5.94 169.3 3.4 –3.56 1.26 2.820 0.009 **
NS: Nonsignificant (p > 0.05); *Significant (p < 0.05); **Highly significant (p < 0.01); ***Very highly significant (p < 0.001);
Mx: Maxillary; Md: Mandibular

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Table 3: Comparison for skeletal, soft-tissue and facial parameters between Groups I and II
Variable Male norms Female norms Difference Significance of difference
Mean SD Mean SD Mean SE ‘t’ ‘p’ Level
Dentoskeletal factors
Mx occlusal plane angle 95.71 3.89 96.78 3.55 1.07 0.74 –1.435 0.155 NS
Mx1-Mx occlusal plane angle 58.54 5.53 56.45 5.36 2.10 1.09 1.927 0.057 NS
Overbite 3.11 1.32 2.81 1.47 0.30 0.28 1.079 0.283 NS
Md1-Md occlusal plane angle 63.50 6.82 62.47 7.02 1.03 1.38 0.744 0.459 NS
Overjet 3.88 1.08 3.80 1.02 0.08 0.21 0.391 0.697 NS
Soft tissue structures
Upper lip thickness (ULT) 12.49 1.79 11.24 1.76 1.25 0.35 3.534 0.001 ***
Lower lip thickness (LLT) 12.84 1.79 11.20 1.76 1.63 0.35 4.609 0.000 ***
Pogonion-pogonion' (Pog-Pog’) 12.04 1.74 11.39 1.99 0.65 0.37 1.726 0.088 NS
Menton-menton' (Me-Me’) 7.71 1.69 6.90 1.82 0.81 0.35 2.311 0.023 *
Nasolabial angle 111.63 6.82 113.16 7.70 –1.53 1.45 –1.051 0.296 NS
Upper lip angle (ULA) 9.88 7.45 12.75 7.94 –2.88 1.54 –1.868 0.065 NS
Facial lengths
Nasion’-menton' (N’-Me’) 115.79 4.63 110.47 5.18 5.31 0.98 5.405 0.000 ***
Lower 1/3 of face (Sn-Me') 66.27 2.75 60.83 3.57 5.44 0.64 8.541 0.000 ***
Upper lip length (Sn-ULI) 21.01 2.07 18.41 2.34 2.60 0.44 5.874 0.000 ***
Lower lip length (LLS-Me’) 45.34 2.58 41.86 2.82 3.48 0.54 6.431 0.000 ***
Interlabial gap (ULI-LLS) 0.39 0.80 0.79 1.25 –0.40 0.21 –1.892 0.061 NS
Mx1 exposure 2.78 1.24 3.33 1.64 –0.55 0.29 –1.904 0.060 NS
Maxillary height (Sn-Mx1) 23.74 2.13 22.20 2.15 1.53 0.43 3.582 0.001 ***
Mandibular height (Md1-Me') 38.18 2.74 35.40 2.65 2.77 0.54 5.149 0.000 ***
Projections to TVL
Glabella (G') –9.77 3.99 –8.95 3.84 –0.82 0.78 –1.046 0.298 NS
Orbital rim (OR) –23.94 2.10 –21.43 1.74 –2.51 0.39 –6.511 0.000 ***
Cheek bone (CB) –26.13 1.72 –23.44 2.21 –2.69 0.40 –6.786 0.000 ***
Nose tip (NT) 13.23 1.69 12.74 1.68 0.50 0.34 1.481 0.142 NS
Subpupil (SP) –21.89 2.34 –19.46 3.02 –2.43 0.54 –4.509 <0.001 ***
Alar base (AB) –12.02 3.70 –10.77 1.52 –1.25 0.57 –2.209 0.029 *
Soft tissue point A (A') –1.35 1.21 –1.33 1.33 –0.02 0.25 –0.095 0.925 NS
Upper lip anterior (ULA) 2.44 2.07 2.38 2.15 0.06 0.42 0.152 0.880 NS
Lower lip anterior (LLA) 0.01 2.81 0.32 2.88 –0.31 0.57 –0.552 0.582 NS
Soft tissue point B (B') –9.19 3.70 –7.47 3.46 –1.72 0.72 –2.408 0.018 *
Pogonion’ (Pog') –5.68 4.27 –4.68 4.28 –1.01 0.86 –1.176 0.242 NS
Mx1 –11.21 2.39 –8.49 4.30 –2.72 0.70 –3.900 0.000 ***
Md1 –14.74 2.55 –12.21 4.51 –2.53 0.73 –3.460 0.001 ***
Harmony values
Md1-pogonion' (Md1-Pog’) 9.06 2.98 7.53 3.42 1.46 0.64 2.273 0.025 *
Lower lip anterior-pogonion’ (LLA-Pog') 5.41 2.48 4.91 2.71 0.50 0.52 0.956 0.342 NS
Soft tissue point B-pogonion’ (B'-Pog') 3.57 1.86 2.77 1.73 0.80 0.36 2.219 0.029 *
Subnasale-pogonion’ (Sn-Pog') 5.69 4.18 5.00 3.73 0.69 0.79 0.867 0.388 NS
Soft tissue point A-soft tissue point B 7.60 3.04 6.24 2.88 1.37 0.59 2.307 0.023 *
(A'-B')
Upper lip anterior-lower lip anterior –2.64 1.80 –2.46 1.68 -0.17 0.35 –0.500 0.618 NS
(ULA-LLA)
Orbital rim-soft tissue point A (OR-A') 22.64 1.98 20.21 2.03 2.44 0.40 6.087 0.000 ***
Orbital rim-pogonion’ (OR-Pog') 18.18 4.43 16.43 3.92 1.75 0.84 2.094 0.039 *
Glabella-soft tissue point A (G'-A') 8.37 3.72 7.60 3.70 0.77 0.74 1.040 0.301 NS
Glabella-pogonion’ (G'-Pog') 4.12 5.39 4.30 4.71 –0.18 1.01 –0.176 0.861 NS
Facial angle 165.21 6.14 165.74 5.94 –0.53 1.21 –0.439 0.662 NS
NS: Nonsignificant (p > 0.05); *Significant (p < 0.05); **Highly significant (p < 0.01); ***Very highly significant (p < 0.001);
Mx: Maxillary; Md: Mandibular

230

Arnett’s Soft-tissue Cephalometric Analysis Norms for the North Indian Population: A Cephalometric Study
was found that all the parameters showed significantly
lower values for the North Indian population in the present
study. Similar results were found by Lalitha and Kumar.14
On comparing the males and females of the North Indian
population it was found that the males had significantly
higher values for N’-Me’, Sn-Me’, Sn-ULI, LLS-Me’,
Sn-Mx1 and Md1-Me’ than females which agreed with the
results of Kalha et al,15 Arnett et al,8 Uysal et al,11 Kadhom
and Al-Janabi16 and Lalitha and Kumar.14 This suggests
that males generally have larger values for the parameters
measured in vertical plane.
The reference line which was used in the present study
was true vertical line (TVL) (see Fig. 2C), and was used to
asses parameters related to nose, lip, chin and teeth. When
comparing the results of the present study with the Arnett’s
results, it was found that orbital rim (OR), cheek bone
(CB), subpupil (SP) and nasal tip (NT) were significantly
less prominent, AB was significantly more prominent
and B’, Pog’ were significantly posteriorly placed with
respect to TVL for the North Indian population of present
study whereas upper lip anterior and lower lip anterior
were significantly less prominent in females of the present
study. This suggests that the North Indian population has
a depressed midface and retruded soft tissue structures
which was also observed by Uysal et al11 and Kalha et al.15
In the present study the linear measurement of the orbital
rim, cheek bone, subpupil, alar base, soft tissue point B,
maxillary and mandibular incisor tip from the TVL were
significantly less prominent in males than females of the
North Indian population. Similar results were found in the
previous studies.8,11,16
Harmony is the position of each landmark relative to
other landmarks that determines facial balance and the
harmony of various structures. In the present study, the
horizontal distance between mandibular incisor to Pog’
and facial angle showed significantly higher values for
Caucasian males and females whereas distance of subnasale
to Pog’, upper lip anterior to lower lip anterior and orbital
rim to A’ showed significantly higher values only for females
of North Indian population in comparison to Caucasian
females. The chin projection relative to lower incisor and
soft tissue point B showed significantly higher values for
males than females of the North Indian population. Similar
results were observed in other studies by Kalha et al,15 Arnett
et al,8 Kadhom and Al-Janabi,16 Uysal et al11 and Lalitha and
Kumar.14 The horizontal distance between A’ and B’and the
horizontal distance between soft-tissue orbital rim to upper
and lower jaw showed significantly higher value for males
than females in the North Indian population which indicates
The Journal of Indian Orthodontic Society, October-December 2014;48(4):224-232
JIOS
increased maxillary advancement in males than females. No
significant difference was found for parameters of total face
between males and females which is in agreement with the
studies of Kalha et al,15 Arnett et al,8 Uysal et al,11 Kadhom
and Al-Janabi16 and Lalitha and Kumar.14
The results of the present study suggested that the
differences exist in the facial structures of two ethnic
groups (North Indian and Caucasian). So separate norms
for distinctive populations are necessary and that one set
of norms cannot be applied to patients of different races
and ethnic origin. Thus, the results of the present study
suggests that these racial differences should be considered
during diagnosis and orthodontic and orthognathic treatment
planning.
A bigger panel of judges including other professionals
and lay persons for selection of samples of pleasing profile
and a larger sample size makes the scope for future studies
in establishing Arnett’s soft tissue analysis norms for the
North Indian population.
Conclusion
Based on the present study, it can be concluded that stati­
s­tically significant differences in certain parameters were
found between the subjects of the North Indian population
and the Caucasian population and also between the males
and females of the North Indian population.
• In dentoskeletal factors, only overjet was found to be
significantly higher in the North Indian population as
compared to Arnett’s norms. No significant difference
for males and females of North Indian population were
observed.
• Soft-tissue structures were thicker in the Caucasian
population than the North Indian population when com­
pared with Arnett’s norms for the Caucasian population.
Upper lip, lower lip and submental region were thicker
in males than females of North Indian population.
• For facial lengths, it was found that the North Indian
population had less facial lengths than the Caucasian
population. Males of North Indian population had more
facial lengths than females except the interlabial gap and
maxillary incisor exposure.
• Projections to TVL showed that the midface and lower
face structures were more retruded in the North Indian
population than the Caucasian population. Midface
structures were more depressed and mandible was more
retrognathic in males than females of North Indian popu­
lation whereas maxillary and mandibular incisors were
more protruded in females than males of North Indian
population.
231
Tripti Tikku et al
• Harmony values showed that the profile was more convex
in the North Indian population as compared to Caucasian
population. The maxilla is slightly more anteriorly placed
in males of North Indian population as compared to
females of North Indian population.
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