Professional Documents
Culture Documents
Andrews - Angle Orthod08 - AP Relationship of The Maxillary Central Incisors To The Forehead in Adult White Females
Andrews - Angle Orthod08 - AP Relationship of The Maxillary Central Incisors To The Forehead in Adult White Females
ittal plane of the head. Three vertical reference lines means, standard deviations, and ranges were calcu-
were constructed: line 1 through the FFA point, line 2 lated for maxillary central incisor position relative to the
through glabella, and line 3 through the maxillary cen- forehead and for forehead inclination in both samples.
tral incisors FA point. A fourth reference line (line 4) The means for both samples were compared using a
for assessing forehead inclination was constructed by paired two-tailed t-test. P values of .05 or less indi-
connecting glabella to the uppermost point of the clin- cated significant differences. A simple second-order
ical forehead (superion point or trichion) as described regression analysis was performed between the max-
by Andrews35 (Figure 6). Forehead inclination was de- illary central incisor position and forehead inclination
fined as the angle between line 1 and line 4. for both samples. Confidence intervals were set at
The photographic image was deleted from each 95%.
PowerPoint slide, leaving only the constructed refer-
ence points and lines. The slides were then printed on Error Analysis
8½⬙ ⫻ 11⬙ standard white paper (Figure 7). All mea-
surements were made on the printed paper by one All measurements were repeated by the same ex-
examiner. The AP relationship of the maxillary central aminer on a random sample of 20 subjects (10 from
incisors to the forehead was measured as the distance the study sample, 10 from the control sample). The
between line 1 and line 3 using a metric ruler to the systematic error between the first and second mea-
closest 0.5 mm. A positive value was assigned when surements was calculated using a paired t-test, for P
the maxillary central incisors (line 3) were anterior to ⬍ .05. The error variance was calculated according to
the forehead’s FFA point (line 1) and negative when the Dahlberg formula.37
posterior. Forehead inclination was measured as the
angle between line 4 and line 1 using a protractor to RESULTS
the closest 0.5⬚.
Table 1 shows the results of the measurement error
analysis. The systematic errors were statistically insig-
Statistical Analysis
nificant for both incisors position (P ⫽ .157) and fore-
Descriptive and comparative statistical analyses head inclination (P ⫽ .453). The error variance (Dahl-
were performed using StatView Student computer berg formula) was .842 for forehead inclination and
software (Abacus Concepts Inc, Berkeley, Calif). The .367 for incisor position.
the incisors tended to be directly below the forehead’s Table 4. Forehead Inclination (Angle Between Line 4 and Line 1, ⬚)
FFA point (0 mm). For each degree the forehead was Mean SD Minimum Maximum
inclined greater than 7.5⬚, the incisors were corre-
Control sample (n ⫽ 94) 13.7 4.7 2 26
spondingly 0.5 mm more anterior to the forehead’s
Study sample (n ⫽ 94) 12.5 4.5 2 27
FFA point (Figure 10). In the study sample, the AP
positions of the maxillary central incisors were poorly
correlated with the inclinations of the forehead (r 2 ⫽
were strongly associated with the forehead landmarks
.094; Figure 11).
used in this study and strongly correlated with fore-
head inclination in adult white females with good facial
DISCUSSION
harmony (control sample). These findings support An-
If the maxillary incisors are considered a part of the drews’ observations.35 The study sample, which rep-
face, then orthodontists should evaluate the facial pro- resents a typical orthodontic patient population of adult
file with the maxillary incisors bared. Facial landmarks white females, exhibited characteristics distinctly dif-
other than the lips, nose, and chin are needed for as- ferent from the control sample. Most (64%) of the
sessing their position in profile when those teeth are study sample had maxillary central incisors positioned
displayed. The results of this study indicate that the posterior to the forehead’s FFA point, compared with
forehead can be used as such a landmark. Using the only 4% of the controls. Those in the study sample
forehead as a primary landmark for AP incisor posi- were also much more likely (15%) to have maxillary
tioning avoids the potential pitfalls of relying on ceph- central incisors anterior to glabella than those in the
alometric analysis or repose soft tissue analysis. control sample (3%). Furthermore, AP maxillary incisor
The AP positions of the maxillary central incisors position was not correlated with forehead inclination in
Table 5. Correlations Between Incisor Position and Forehead In- forehead’s FFA point and glabella and correlated with
clination forehead inclination. Additional studies are needed to
Sample Position, mm Inclination, ⬚ r2 extend these findings to other racial, age, and gender
Control (n ⫽ 94) 2.5 13.75 .642 groups.
Study (n ⫽ 94) ⫺1.2 12.5 .094
CONCLUSIONS
REFERENCES
1. Dorsey J, Korabik K. Social and psychological motivations
for orthodontic treatment. Am J Orthod. 1977;72:460–467.
2. Kilpelanien P, Phillips C, Tulloch JFC. Anterior tooth posi-
tion and motivation for early treatment. Angle Orthod. 1993;
63:171–174.
Figure 11. Change in anteroposterior maxillary central incisor posi- 3. McKiernan EXF, McKiernan F, Jones ML. Psychological
tion vs change in forehead inclination for the study sample, r 2 ⫽ profile and motives of adults seeking orthodontic treatment.
.094. Int J Adult Orthod Orthognath Surg. 1992;7:1887–1898.
4. Baumrind S, Frantz RC. The reliability of head film mea-
surements. 1. Landmark identification. Am J Orthod. 1971;
the study sample, despite the fact that forehead incli- 60:111–127.
nation was not found to be statistically different be- 5. Baumrind S, Frantz RC. The reliability of head film mea-
tween the two samples. surements. 2. Conventional angular and linear measures.
Am J Orthod. 1971;60:505–517.
The findings from this study can be incorporated into 6. Kvam E, Krogstad O. Variability in tracings of lateral head
routine orthodontic records, diagnosis, and treatment plates for diagnostic orthodontic purposes. Acta Odont
planning. The addition of a smiling profile photograph Scand. 1969;27:359–369.
with the forehead and maxillary incisors fully bared to 7. Richardson A. An investigation into the reproducibility of
diagnostic records as well as a clinical evaluation of some points, planes, and lines used in cephalometric anal-
ysis. Am J Orthod. 1966;52:637–651.
the smiling facial profile will allow the orthodontist to 8. Sandler PJ. Reproducibility of cephalometric measure-
document the orientation of the patients’ maxillary cen- ments. Brit J Orthod. 1988;1:105–110.
tral incisors to the forehead. The findings from the con- 9. Tourne LPM, Bevis RL, Cavanaugh G. A validity test of
trol sample can be applied as a treatment goal for cephalometric variables as a measure of clinical applicabil-
adult white female patients seeking improved facial ity in antero-posterior profile assessment. Int J Adult Orthod
Orthognath Surg. 1993;8:95–112.
harmony. Treatment goals for adult white females 10. Tulloch C, Phillips C, Dann C. Cephalometric measures as
should include the condition that the maxillary central indicators of facial attractiveness. Int J Adult Orthod Or-
incisors be positioned somewhere at or between the thognath Surg. 1993;8:171–179.
11. Cox NH, van der Linden FPGM. Facial harmony. Am J Or- 25. Spradley FL, Jacobs JD, Crowe DP. Assessment of the an-
thod. 1971;60:175–183. tero-posterior soft-tissue contour of the lower facial third in
12. Moss JP, Linney AD, Lowey MN. The use of three-dimen- the ideal young adult. Am J Orthod. 1981;79:316–325.
sional techniques in facial esthetics. Semin Orthod. 1995;1: 26. Fields HW, Vann WF, Vig KW. Reliability of soft tissue pro-
94–104. file analysis in children. Angle Orthod. 1982;52:159–165.
13. Arnett GW, Bergman RT. Facial keys to orthodontic diag- 27. Kuyl MH, Verbeek RMH, Dermaut LR. The integumental
nosis and treatment planning—part I. Am J Orthod Dento- profile: a reflection of the underlying skeletal configuration?
facial Orthop. 1993;103:299–312. Am J Orthod Dentofacial Orthop. 1994;106:597–604.
14. Arnett GW, Bergman RT. Facial keys to orthodontic diag- 28. Kasai K. Soft tissue adaptability to hard tissues in facial
nosis and treatment planning—part II. Am J Orthod Dento- profiles. Am J Orthod Dentofacial Orthop. 1998;113:674–