CENTER FOR STUDIES OF

ANÁHUAC VALLEY POSTGRADUATE

DIAGNOSIS IN ORTHODONTICS
II.
FACIAL ANALYSIS
C.D. Nancy Ríos Alemán

INTRODUCTION

In order to talk about facial analysis, one must remember what beauty is.
the background resides in the eye of the observer and it is impossible to formulate a concept
beauty objective that has a universal character. Subjectivity linked to its
idiosyncrasy, personality, age, culture, religion, race, philosophy of the time and
even motivated by the globalized media that try to
imposing aesthetic patterns Each person has their own concept of
beauty

HISTORY

The Egyptians discovered the divine proportions through analysis and observation.
seeking measures that would allow him to divide the land precisely

Round and wide faces

Regular ovals with soft contours
Inclined fronts
Bulging eyes
Softly contoured nose
Thick-prominent lips
Soft but defined chin
Light biprotrusions
 In Greek times, great importance was given to the
proportionality and balance. They were the ones
they introduced the term aesthetics

Oval face that narrows towards the chin.

Well-defined mentolabial sulcus and a full chin
convex.
Straight nose.
Curved upper lip and slightly lower lip
rolled and somewhat more prominent.

In medieval times, the Greek standards of beauty and

Romans were condemned by religious fanatics.
as pagan and mythical. The faces no longer show
voluptuous losing the sensuality it provides
the prominence of the mouth and the contour of the chin.

Flat faces.
Small mouth, not very pronounced.
Thin lips.
Small teeth.

In the Renaissance, classicism was recovered.

Greek and Roman Leonardo Da Vinci, draw the
man with ideal mathematical proportions in
his body and his face, studied the face from all
the angles to come up with some formula
magic arithmetic of form and facial beauty
In the 16th century, a current of thought develops according to which a
An "ugly" individual could be a mentally ill person or a criminal.

In the current era, a beautiful and attractive face is

those who have an oval face do not
rounded, with cheekbones and chin
marked, lips prominent
partially open, large and striking teeth.

Straighter profiles:

Stronger and more angular complexions

Smaller and sunken eyes
Forehead and more pronounced nose: Nose
proportionally greater
More prominent supraorbital arch
Eyebrows over the supraorbital ridge

More convex profiles:

Rounder face with curved lines.

Eyebrows above the supraorbital ridge.
More pronounced cheekbones and upper jaw
 More protruding eyes and closer to the "front" of the face
Forehead and nose less protruding.

FACIAL CLINICAL ANALYSIS

Doctors William Arnett and Robert Bergman propose a clinical analysis

from the face to identify asymmetries and facial disproportion in the three
space plans

NATURAL POSITION OF THE HEAD

The position in which the patient places their head at

moment of clinical observation, determines in
largely the clinician's appreciation.

This is due to the line of sight of all the

mammals are parallel to the floor, being this a
necessary characteristic to be located in
time and space.

Other conditions that the patient must meet in order to apply it properly.
A correct clinical analysis of the face involves the lips at rest and the position.
mandible at rest.
Four steps are suggested:

The patient is asked to relax the lips.

2. With the fingers, the patient's lips are pressed until they relax.
The lips are observed repeatedly, to ensure that
they were evaluated in a relaxed position
4. The patient is casually observed while they are distracted.

To carry out the facial clinical analysis, 2 views of the patient are evaluated.
evaluate the patient from the front view and the lateral view.

FRONTAL VIEW

Face contour
Their height and width are evaluated, these two measurements always maintain a
relationship between each other, and allow categorizing the artistic form of the outline of the
man, according to this relationship, different types can be observed
facial features such as wide or thin, short or long, round or
oval, square or rectangular.
The widest dimension of the face corresponds to the bi- distance
Sigomatica, the bigoneal distance is approximately 30% shorter than the
interciliary distance.

2. Level of the face

It is necessary to have a reliable horizontal reference plane.

the bipupilar plane (PP) is used as the horizontal reference plane. The
structures that are compared with this horizontal plane are, 1 canine level
superior (Ncs), 2nd level lower canine (Nci) and 3rd level of the chin and the
jaw (Nmm).
Facial symmetry
Although there is a slight difference in all individuals
discrepancy between the right and left facial sides,
considered normal, when these asymmetries leave
To be subtle, it can be said that there is an asymmetry.
facial. To measure facial symmetry, a
imaginary midline that divides the face into two
hemispheres.
To obtain it, the points of the nasal bridge (Pn) are connected and
the filter (F) on a vertical plane, based on this plane the evaluations are made
dorsum and the nasal tip, the upper dental midline, the lower dental line and
the soft tissue chin. The nasal bridge and the labial philtrum are taken.
superior as reference points since they are stable structures within
the facial midline.

If it is observed that the nose is located

deviated from the midline is advisable
that the dentist suggests to the patient a
evaluation by the otolaryngologist.

In a symmetrical patient, the midlines

upper and lower dental areas must match
with the facial midline. If the midlines
 Dental structures are misaligned, which may be the result of an alteration.
dental or skeletal.

If the alteration is dental, the displacement can be corrected.

orthodontically. However, if the alteration is skeletal, it must be
surgically corrected.

When the dental midlines and their

Bone bases are found shifted together.
it is of skeletal etiology, if the
deviation affects the chin and the line
the lower dental media can be thought of as
the jaw is displaced
What does it mean that it is a skeletal problem.

4. FACIAL THIRDS.

Another important consideration is the ratio between the cranial components.

upper, middle, and lower facial thirds, which are known as thirds
facials.
Upper third

It is marked above by the triquet.

(Tr) (Deployment line of
hair) and below by the brow (Ec).
The middle third is delimited above.
through the glabella (ec) and below by the
subnasal point (Sn) and the chin of
soft tissues (Me'). On a face
harmonious and balanced the three thirds
facials present a ratio of 1 to 1, which indicates that the
skeletal components are balanced.
 There may be slight facial disproportions that can be
considered normal in pediatric patients.

Lower third.

The lower third (comprised between

the subnasal point and chin) is
special importance, since the
changes in the dimensions of this
third reflect possible alterations
of growth, it also reflects
changes in the orofacial function e
even presents a big
vulnerability to induced changes
due to environmental influences such as habits
adverse.

This third is composed of the lip

superior, the lower lip and the space
interlabial. To evaluate, the lips must be in position
relaxed.

The upper lip is measured from the

subnasal point (Sn) to the most
inferior of the upper lip in its part
average dimension
this measurement is between 16 and
22 mm.

The lower lip is measured from the highest point.

superior to the soft tissue chin. This
the measurement is considered normal when it measures
between 38 and 44 mm. These measurements can
vary with age and sex.

5. DENTOLABIAL RELATIONSHIP

With it, the distance that

exists between the incisal edge of the
upper incisors and the edge more
inferior of the upper lip. A value
too increased reflects a
severe skeletal alteration and of
difficult correction, the most frequent is
that said increase is presented by a
exaggerated vertical growth of the maxilla.
 The conditions that can produce a
disharmony can be the product of 4
variables:

Increase or decrease in length

anatomy of the upper lip (rare).

2. Increase or decrease in length

skeletal of the maxilla (common).

A thick upper lip is less

incisive than a thin upper lip,
as long as everyone else
factors are similar.

4. The angle of vision changes the amount

visible from the incisor to the sight of
observer.

6. INTERLABIAL DISTANCE.

Distance between the upper lip and the lower lip To measure it, the
lips must be at rest and that space should measure from
A 1 to 5 mm increase in the interlabial space may be associated with
a short lip, vertical maxillary excess, and mandibular protrusion
 Position with closed lips

It can also reveal disharmonies in the lengths of the tissues.

soft like in that of the hard. An increase in the contraction of
chin, lip tension, and narrowing of the alar base are characteristics
what is observed in skeletal vertical excess.

Lip level during the smile

The ideal exposure with the smile fluctuates between ¾ of the crown up to 2 mm
from the gum. Excessive exposure of the gum may be caused by
a short upper lip, excessive vertical maxillary. A poor exposure
it can be caused by a long lip, a maxillary vertical deficiency.

7. PROFILE VIEW

Profile angle
Represents the measure most
important of the soft profile, already
that is located anteroposteriorly the maxilla and
the jaw, with which one can classify the
patients within a class relationship 1,11 or
1:11 skeletal, this angle is
formed by the imaginary plans glabella
(most prominent point of the forehead), subnasal (most posterior point of the
nasal columella) (Gl-Sn) and subnasal-pogonion (most prominent point of
(chin)(Sn-Pg).

In a normal patient (skeletal Class I), these planes should form a

The angle that goes from 165° to 175° is almost a straight line, those
angles that tend to close, reflect a skeletal Class II and a profile
convex while angles greater than 175° reflect a class III and
a concave profile.

nasolabial angle

The angle formed by the C-Sn plane and the Sn- plane
Lsa, a normal angle has a range between 85° and
105°, in women the angles are more accepted.
more open than in men.

It is a very important indicator of the position and

inclination of the upper incisors. It determines in
large measure the treatment plan, since the therapies
Orthodontics easily modify them.
 The open angles reflect retroversion in
of the upper incisors, in this type of cases
to correct this malocclusion it is necessary
to procline the incisors, which in turn will evert
the lip to achieve a harmonious profile.

Outline of the cheek

It becomes a very comprehensive map of the

location of the maxillae. It consists of
two segments, a corresponding superior
on the edge of the cheekbone and one lower
corresponding to the contour of the nasal base and the lip (Bn-L).

The contour of the cheekbone begins at the arch.

zygomatic (ac), in front of the ear pavilion,
about a horizontal tangent to the lower eyelid of the
eye. This outline subtly descends and crosses the
pupillary point (Pp), which is located 20 to 25 mm
below and from 5 to 100 mm in front of the edge
external of the eye. Its descent continues forward and
down and mischievous the maxillary point.

In order to evaluate the contour of the cheek, it is necessary to analyze both the
front view like the profile.
The outline of the nasal base and the lip begins at the maxillary point (Pm) and at
from this point gently descends down and back, until
end behind the labial commissure. When the contour descends in
a subtle and continuous line from the zygomatic arch to the commissure
labial it can be said that the intermaxillary relationship is correct and the profile is
harmonic.