Abstracts
Objective
The aim of this study was to establish reference parameters for facial analysis in subjects with Angle’s Class I occlusion by means of stereophotogrammetry, comparing men and women.
Material and method
Twenty-six healthy young adults with Angle’s Class I occlusion volunteered to participate in the study, 15 males and 11 females, ages between 18 and 30 years old (22 years ± 5). These subjects were clinically examined to verify their type of occlusion. Twenty-five landmarks were performed in soft tissue, and those subjects underwent image capturing by the stereophotogrammetry technique, using the apparatus Vectra (M3-Canfield®). The following variables were measured in those images: naso-labial angle (C-Sn-Ls); (N-Prn-Pg); (N-Sn-Pg); mentolabial (Li-Ps-Pg); growth angle (T-Go-Pg), cheek area (T, Zy, Chk, Ch, Gn, Go), hemifaces' areas (T, Zy, Ft, Tr, N, Prn, C, Sn, Ls, Sto, Li Ps, Gn, Go), lip area, bilaterally (Ls, Cph, Ch, Li, Sto), and linear measurements of the lips and jaw.
Result and conclusion
The data were compared between genders (Student's t-test), and no statistically significant differences between groups (p>0.05) were found. Despite the limitations of this study, it is possible to conclude that, as there were no differences between men and women for the studied variables (angular, linear, and area), the data of the total sample (Class I) should be used as reference parameters in future studies. Additionally, the 3D stereophotogrammetry technique has proven to be a new possibility for facial analysis, which might be employed in several areas of dentistry.
Photogrammetry; imaging three-dimensional; dental occlusion
Objetivo
O objetivo deste estudo foi estabelecer parâmetros de referência para análise facial de tecido mole de sujeitos Classe I de Angle por meio da técnica de estereofotogrametria 3D, comparando-se homens e mulheres.
Material e método
A amostra foi composta por 26 voluntários (11 mulheres e 15 homens), com idade entre 18 e 30 anos (22±5), em oclusão de Classe I. Estes sujeitos foram submetidos a um exame odontológico para verificação do tipo de oclusão. Foram então demarcados pontos de referência na face e realizada uma tomada fotográfica por meio do aparelho Vectra (M3-Canfield®) para a obtenção de imagens tridimensionais da face. Nas imagens 3D foram mensuradas as seguintes variáveis: ângulos naso-labial (C-Sn-Ls); (N-Prn-Pg); (N-Sn-Pg); mentolabial (Li-Sl-Pg); de crescimento (T-Go-Pg), área das bochechas (T, Zy, Chk, Ch, Gn, Go), hemifaces (T, Zy, Ft, Tr, N, Prn, C, Sn, Ls, Sto, Li, Sl, Gn, Go) e dos lábios bilateralmente (Ls, Cph, Ch, Li, Sto), além de medidas lineares dos lábios e da mandíbula.
Resultado e conclusão
Os dados foram comparados entre gêneros (T-student), sendo que não foram encontradas diferenças estatisticamente significantes entre-grupos (p>0,05). Considerando-se as limitações deste estudo, é possível concluir que como não houve diferenças entre homens e mulheres para as variáveis estudadas (angulares, lineares e de área), sugere-se a utilização dos dados da amostra total (Classe I) como parâmetros de referência para estudos futuros. A estereofotogrametria 3D se mostrou uma nova possibilidade de análise do tecido mole facial, que poderá ser empregada em diversas áreas da Odontologia.
Fotogrametria; imagem tridimensional; oclusão dentária
INTRODUCTION
Facial analysis is essential for the diagnosis and treatment planning of different
dental procedures, such as for example, orthognathic surgery and visualization of
craniofacial malformations. The development of techniques that seek to ensure this
type of analysis has been proposed, among them the one that stands out the most is
the 3D stereophotogrammetry11 Sforza C, Elamin F, Tommasi DG, Dolci C, Ferrario VF. Morphometry of
the soft tissues of the orbital region in Northern Sudanese persons. Forensic
Sci Int. 2013 May;228(1-3):180.e1-11.
http://dx.doi.org/10.1016/j.forsciint.2013.02.003.
PMid:23453642
http://dx.doi.org/10.1016/j.forsciint.20...
.
This technique consists of a rapid method for acquisition of images in a
non-invasive and safe manner, reducing the need for exposure to radiation. Image
acquisition is performed by cameras positioned at different angles, and a software
produces a three-dimensional digital image of the individual's face. These images
precisely represent the soft tissues of the face, since it is not necessary that
there is contact with the skin's surface. This technique can be widely used both in
the dental area, as well as in the medical field for the diagnosis, planning and
comparison of the results obtained22 Wong JY, Oh AK, Ohta E, Hunt AT, Rogers GF, Mulliken JB, et al.
Validity and reliability of craniofacial anthropometric measurement of 3D
digital photogrammetric images. Cleft Palate Craniofac J. 2008 May;45(3):232-9.
http://dx.doi.org/10.1597/06-175. PMid:18452351
http://dx.doi.org/10.1597/06-175...
,33 Menezes M, Rosati R, Allievi C, Sforza C. A photographic system for
the three-dimensional study of facial morphology. Angle Orthod. 2009
November;79(6):1070-7. http://dx.doi.org/10.2319/111008-570.
PMid:19852596
http://dx.doi.org/10.2319/111008-570...
.
The 3D image acquisition system and facial sculptor Vectra M3 (Canfield Scientific,
Fairfield, NJ) consists of two capsules including three cameras (one color and two
black and white) and a projector in each capsule. The system captures images in two
dimensions of the individual’s face and reconstructs them three-dimensionally. These
3D images can be processed, analyzed, manipulated and measures44 Khambay B, Nairn N, Bell A, Miller J, Bowman A, Ayoub AF. Validation
and reproducibility of a high-resolution three-dimensional facial imaging
system. Br J Oral Maxillofac Surg. 2008 January;46(1):27-32.
http://dx.doi.org/10.1016/j.bjoms.2007.04.017. PMid:17561318
http://dx.doi.org/10.1016/j.bjoms.2007.0...
,55 Menezes M, Rosati R, Ferrario VF, Sforza C. Accuracy and
reproducibility of a 3-dimensional stereophotogrammetric imaging system. J Oral
Maxillofac Surg. 2010 September;68(9):2129-35.
http://dx.doi.org/10.1016/j.joms.2009.09.036. PMid:20646812
http://dx.doi.org/10.1016/j.joms.2009.09...
. The possibility of handling the 3D image in different
directions (front, side, inferior-superior, superior-inferior) allows several types
of analysis of soft tissue are performed, among them we can highlight the
measurement of linear distances, angles and areas. Furthermore, it is possible to
superimpose these images before and after treatment, for example, orthognathic
surgery, which also allows the patient to view these results55 Menezes M, Rosati R, Ferrario VF, Sforza C. Accuracy and
reproducibility of a 3-dimensional stereophotogrammetric imaging system. J Oral
Maxillofac Surg. 2010 September;68(9):2129-35.
http://dx.doi.org/10.1016/j.joms.2009.09.036. PMid:20646812
http://dx.doi.org/10.1016/j.joms.2009.09...
.
Knowledge of the occlusion is of paramount importance for many areas in Dentistry, among which stand out the oral rehabilitation, restorative dentistry, orthodontics and functional orthopedics of the jaws. The majority of the analyses that are carried out for plans dental interventions are based on images of hard tissues (x-rays, computed tomography, cephalometries). However, it is important to point out also the importance of evaluating the soft tissue, because this represents the facial appearance of each individual.
Therefore, the objective of this study was to establish reference parameters for the analysis of facial soft tissue of subjects Class I Angle by means of the 3D stereophotogrammetry technique (Vectra M3 - Liphook, United Kingdom®), comparing men and women.
MATERIAL AND METHOD
Study Design
This was a cross-sectional observational study.
Research Participants
A group of 26 healthy volunteers (11 women and 15 men, were recruited for this study. Their ages ranged between 18 and 30 years (22 years ± 5). Inclusion criteria were: occlusion in Angle Class I and presence of at least 26 teeth in the mouth. We excluded individuals who had missing teeth, patients with central or peripheral neurological disorders, or who have suffered tumors, trauma in the region of head / neck and orthognathic or plastic surgery. Patients were also excluded who were undergoing orthodontic treatment, users of partial or full dentures, and subjects with presence of accentuated horizontal and/or vertical overlaps and maxilla-mandibular discrepancies.
All participants were informed about the ethical aspects related to this research and were asked to sign the Informed Consent. This study was approved by the Research Ethics Committee of School of Dentistry of Ribeirão Preto (FORP/USP), according the protocol 08874612.3.0000.5419.
Procedures Performed
The research participants were submitted to clinical dental care performed by a
dental surgeon trained and calibrated, with the objective to evaluate the
occlusal conditions and the verification of the existence of the Class I Angle.
Initially, a band was positioned on the participant's head with the purpose to
secure their hair and ensure better visualization of the face. The skin was
cleaned with sterile gauze soaked in 70% alcohol, in order to remove any
impurities, oiliness and makeup. Reference Points were marked on the facial
surface of the participants using black eyeliner (Boticário®), previously
established by Ferrario et al.66 Ferrario VF, Sforza C, Poggio CE, Cova M, Tartaglia G. Preliminary
evaluation of an electromagnetic three-dimensional digitizer in facial
anthropometry. Cleft Palate Craniofac J. 1998 January;35(1):9-15.
http://dx.doi.org/10.1597/1545-1569(1998)035<0009:PEOAET>2.3.CO;2.
PMid:9482218
http://dx.doi.org/10.1597/1545-1569(1998...
and Sforza et al.11 Sforza C, Elamin F, Tommasi DG, Dolci C, Ferrario VF. Morphometry of
the soft tissues of the orbital region in Northern Sudanese persons. Forensic
Sci Int. 2013 May;228(1-3):180.e1-11.
http://dx.doi.org/10.1016/j.forsciint.2013.02.003.
PMid:23453642
http://dx.doi.org/10.1016/j.forsciint.20...
.
-
•
Reference Points of the middle line: Tr, Trichion; N, Nasion; Prn, Pronasale; C, Columela; Sn, Subnasale; Ls, Labiale Superius; Sto, Stomion; Li, Labiale Inferius; Sl, Sublabiale; Gn, Gnation; Pg, Pogonion (Figure 1).
-
•
Bilateral reference points (right and left): Ftr and Ftl, Frontotemporale; Cphr and Cphl, Crista Philtri; Chr and Chl, Cheilion; Tr and Tl, Tragus; Gor and Gol, Gonion; Zyr and Zyl, Zygion; Chkr and Chkl, Cheek (Figure 1).
In the 3D image the cheek areas were measured bilaterally in cm2, between the points T, Zy, Chk, Ch, Ng, Go. The lip areas bilaterally (Ls, Cph, Ch, Li Sto), three distances above the lip (Ls-Cph and Cph-Ch); sum between these two distances), distance of lower lip (Li-Ch ), distance from the lip midline( Ls-Li ). The right and left areas between the points T, Zy, Ft, Tr, N, Prn, C, Sn, Ls, Sto, Li Sl, Gn, Go. In addition to two linear measurements of the mandible bilaterally (Go-T and Gn-Go). The following angles were also verified: naso-labial (C-Sb-Ls), angle of convexity of the facial soft tissue profile with nose (N-Prn-Pg), convexity angle of facial soft tissue profile without nose (N-Sn-Pg), mentolabial angle (Li-Ps-Pg), growth angle (T-Go-Pg) (Figure 2).
Marking of the hemiface area, growth angle T-Go-Pg, the lip area and linear distances of the lips for viewing of the Vectra®- 3D dimensional image processing software.
The data obtained were analyzed by means of descriptive statistics, in order to establish average and standard deviation of linear distances, angles and areas, the Students T Test was also employed for comparison between genders, after checking the normality of the data, in which a 5% level of significance (Bioestat 5.0).
RESULT
The values of the mean and standard deviation for each variable evaluated are distributed in Tables 1, 2, 3 and 4, and Table 1 shows the angles T- Go-Pg , C- sn , N- Prn-Pg , N- Sn-Pg and Li-Sl -Pg, Table 2 shows the values of the areas of the cheeks, facial hemispheres and lips, in Table 3 the values for the lips (upper and lower distances and distance from the lip midline) and in Table 4 the values of linear measurements of the mandible. It is important to point out that for all variables were considered each gender and the total sample (Class I).
Mean and standard deviation of angles T- Go-Pg (growth), C- Sb-Ls (nasolabial), N- Prn-Pg (convexity of soft profile facial with nose), N- Sn-Pg (convexity of soft profile face without nose) and Li-Sl -Pg (mentolabial) for both genders and total sample (Class I)
Mean and standard deviation of the areas of the cheeks, lips and hemifaces for both sides of the face (D for right and E for the left), considering men, women and total sample (Class I), measured in cm3
Mean and standard deviation of the variables related to his lips: upper right distance, distance upper left, lower right distance, left smaller distance and distance from the lip midline (LML), considering both genders and the total sample (Class I)
Mean and standard deviation of the variables concerning the linear distances of the mandible: Go-Gn, Go-T and the sum of Go-Gn and Go-T (D for right-hand side and E for the left-hand side), considering both genders and the total sample
Regarding the analyzed angles, the biggest difference observed between the mean values in the comparison between genders was for the convexity angle of facial soft tissue profile without the nose (N-Sn-Pg), for which men achieved an average of 161.9 (± 3.8) and 166 women (± 4.0), although not statistically significant. For the other values of angles was found great proximity between men and women, being that no statistically significant differences were obtained in the comparison between genders for any variable (p>0.05) (Table 1).
Considering Table 2, it is possible to check that there was no statistically significant difference between men and women in the areas of cheek and facial hemispheres. For the right hemiface, the p value was 0.98 and for the left hemiface was 0.65. While for the right cheek area of the p value was 0.09 and the left cheek was 0.08. As for the lip area, the p value for the right side was 0.31 and 0.19 for the left side.
Tables 3 and 4 contain data concerning the descriptive statistical analysis of the data of lips and linear measurements of the mandible (mean and standard deviation) for men, women, and total sample (Class I). The measures relating to the lips were considered: distance top right, distance top left, distance bottom right, distance bottom left and away from the lip midline and measures concerning the linear distances of the mandible are Go-Gn, Go-T and sum of Go-Gn and Go-T.
DISCUSSION
The scientific and technological advances, techniques such as laser scanning, MRI,
ultrasound, scan for contact and stereophotogrammetry offer significant changes in
the diagnostic process, because they are considered non-invasive methods of facial
analysis55 Menezes M, Rosati R, Ferrario VF, Sforza C. Accuracy and
reproducibility of a 3-dimensional stereophotogrammetric imaging system. J Oral
Maxillofac Surg. 2010 September;68(9):2129-35.
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,77 Weinberg SM, Naidoo S, Govier DP, Martin RA, Kane AA, Marazita ML.
Anthropometric precision and accuracy of digital three-dimensional
photogrammetry: comparing the Genex and 3dMD imaging systems with one another
and with direct anthropometry. J Craniofac Surg. 2006 May;17(3):477-83.
http://dx.doi.org/10.1097/00001665-200605000-00015.
PMid:16770184
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,88 Sforza C, Laino A, D’Alessio R, Dellavia C, Grandi G, Ferrario VF.
Three-dimensional facial morphometry of attractive children and normal children
in the deciduous and early mixed dentition. Angle Orthod. 2007
November;77(6):1025-33. http://dx.doi.org/10.2319/100206-400.1.
PMid:18004919
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..
The data previously analog have gone digital, and opened up the possibility of fast
acquisition, accurate and without radiation, with its information while being
archived for future analyzes, moreover can be shared easily with patients and other
professionals22 Wong JY, Oh AK, Ohta E, Hunt AT, Rogers GF, Mulliken JB, et al.
Validity and reliability of craniofacial anthropometric measurement of 3D
digital photogrammetric images. Cleft Palate Craniofac J. 2008 May;45(3):232-9.
http://dx.doi.org/10.1597/06-175. PMid:18452351
http://dx.doi.org/10.1597/06-175...
,55 Menezes M, Rosati R, Ferrario VF, Sforza C. Accuracy and
reproducibility of a 3-dimensional stereophotogrammetric imaging system. J Oral
Maxillofac Surg. 2010 September;68(9):2129-35.
http://dx.doi.org/10.1016/j.joms.2009.09.036. PMid:20646812
http://dx.doi.org/10.1016/j.joms.2009.09...
,99 Ferrario VF, Sforza C, Miani A, Tartaglia G. Craniofacial
morphometry by photographic evaluations. Am J Orthod Dentofacial Orthop. 1993
April;103(4):327-37. http://dx.doi.org/10.1016/0889-5406(93)70013-E.
PMid:8480698
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10 Germec-Cakan D, Canter HI, Nur B, Arun T. Comparison of facial soft
tissue measurements on three-dimensional images and models obtained with
different methods. J Craniofac Surg. 2010 September;21(5):1393-9.
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-1111 Gor T, Kau CH, English JD, Lee RP, Borbely P. Three-dimensional
comparison of facial morphology in white populations in Budapest, Hungary, and
Houston, Texas. Am J Orthod Dentofacial Orthop. 2010 March;137(3):424-32.
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. Stereophotogrammetry is a conservative method for
individuals submitted to imaging, not to issue any type of radiation1212 Rosati R, Menezes M, Rossetti A, Sforza C, Ferrario VF. Digital
dental cast placement in 3-dimensional, full-face reconstruction: a technical
evaluation. Am J Orthod Dentofacial Orthop. 2010 July;138(1):84-8.
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. Doctors and dental surgeons
must consider the risks and benefits to the patient in obtaining craniofacial
images, current research is attempting to reduce unnecessary x-ray exposure,
especially in children1313 Sforza C, Peretta R, Grandi G, Ferronato G, Ferrario VF. Soft tissue
facial planes and masticatory muscle function in skeletal Class III patients
before and after orthognathic surgery treatment. J Oral Maxillofac Surg. 2008
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.
In several clinical applications, virtual reproductions of morphology can help
professionals during the diagnosis and planning of medical procedures and
treatments1212 Rosati R, Menezes M, Rossetti A, Sforza C, Ferrario VF. Digital
dental cast placement in 3-dimensional, full-face reconstruction: a technical
evaluation. Am J Orthod Dentofacial Orthop. 2010 July;138(1):84-8.
http://dx.doi.org/10.1016/j.ajodo.2009.10.035. PMid:20620838
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. The system used
in this study enables the overlay of images captured from the individual with the
image obtained by means of computed tomography and, thus increasing the accuracy of
images and measurements. Naudi et al.1414 Naudi KB, Benramadan R, Brocklebank L, Ju X, Khambay B, Ayoub A. The
virtual human face: superimposing the simultaneously captured 3D photorealistic
skin surface of the face on the untextured skin image of the CBCT scan. Int J
Oral Maxillofac Surg. 2013 March;42(3):393-400.
http://dx.doi.org/10.1016/j.ijom.2012.10.032. PMid:23228692
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and Schendel et al.1515 Schendel SA, Jacobson R, Khalessi S. 3-dimensional facial simulation
in orthognathic surgery: is it accurate? J Oral Maxillofac Surg. 2013
August;71(8):1406-14. http://dx.doi.org/10.1016/j.joms.2013.02.010.
PMid:23642546
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verified this hypothesis and confirmed the great
applicability of 3D imaging, as well as their superposition. This new method is
promising, in that it can assist with more accuracy the planning of surgical
treatments..
Metzler et al.1616 Metzler P, Sun Y, Zemann W, Bartella A, Lehner M, Obwegeser JA, et
al. Validity of the 3D VECTRA photogrammetric surface imaging system for
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e Tzou et
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compared the validity
of three-dimensional stereophotogrammetry with other imaging systems, which proved
to be an effective reliable and fast method. The software allows for tissue
modifications to promote the planning and visualization of the possible
post-operative. The same can be found in this study, being that this method does not
provide any changes in soft tissues of the face, since the device does not come in
contact with the face of the individual to perform the image capture, which would
result in changes to the measurements. It also allows the measurement of linear
distances, area, and volume and it is possible view the images from different
angles.
The apparatus for facial analysis in 3D (Vectra M3) have a high cost and need for a
suitable location, with space reserved specially for their installation without
temporary changes. Thus, the facial analysis in 3D is still limited to laboratories
of universities and research centers88 Sforza C, Laino A, D’Alessio R, Dellavia C, Grandi G, Ferrario VF.
Three-dimensional facial morphometry of attractive children and normal children
in the deciduous and early mixed dentition. Angle Orthod. 2007
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.
The images obtained from individuals are standardized and can be saved for later
evaluation of cases and form a database for future comparisons. These images allow
modifications that facilitate preoperative planning, and a “vision” of
post-operative patients. Thus, it allows great applicability, especially in
Dentistry as in cases of orthognathic surgery1414 Naudi KB, Benramadan R, Brocklebank L, Ju X, Khambay B, Ayoub A. The
virtual human face: superimposing the simultaneously captured 3D photorealistic
skin surface of the face on the untextured skin image of the CBCT scan. Int J
Oral Maxillofac Surg. 2013 March;42(3):393-400.
http://dx.doi.org/10.1016/j.ijom.2012.10.032. PMid:23228692
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,1515 Schendel SA, Jacobson R, Khalessi S. 3-dimensional facial simulation
in orthognathic surgery: is it accurate? J Oral Maxillofac Surg. 2013
August;71(8):1406-14. http://dx.doi.org/10.1016/j.joms.2013.02.010.
PMid:23642546
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22 Verhoeven TJ, Coppen C, Barkhuysen R, Bronkhorst EM, Merkx MA, Bergé
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.
According to Brons et al.2424 Brons S, van Beusichem ME, Bronkhorst EM, Draaisma J, Bergé SJ, Maal
TJ, et al. Methods to quantify soft-tissue based facial growth and treatment
outcomes in children: a systematic review. PLoS ONE. 2012; 7(8):e41898.
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and
Metzler et al.1616 Metzler P, Sun Y, Zemann W, Bartella A, Lehner M, Obwegeser JA, et
al. Validity of the 3D VECTRA photogrammetric surface imaging system for
cranio-maxillofacial anthropometric measurements. Oral Maxillofac Surg. 2014
September;18(3):297-304. http://dx.doi.org/10.1007/s10006-013-0404-7.
PMid:23559195
http://dx.doi.org/10.1007/s10006-013-040...
the speed in the
pictures capture speed significantly reduces possible distortions due to the
individual drive, which facilitates work done with children. There is no need for
contact with the facial surface, thus prevents changes in soft tissues, which could
cause errors in direct measurement22 Wong JY, Oh AK, Ohta E, Hunt AT, Rogers GF, Mulliken JB, et al.
Validity and reliability of craniofacial anthropometric measurement of 3D
digital photogrammetric images. Cleft Palate Craniofac J. 2008 May;45(3):232-9.
http://dx.doi.org/10.1597/06-175. PMid:18452351
http://dx.doi.org/10.1597/06-175...
,77 Weinberg SM, Naidoo S, Govier DP, Martin RA, Kane AA, Marazita ML.
Anthropometric precision and accuracy of digital three-dimensional
photogrammetry: comparing the Genex and 3dMD imaging systems with one another
and with direct anthropometry. J Craniofac Surg. 2006 May;17(3):477-83.
http://dx.doi.org/10.1097/00001665-200605000-00015.
PMid:16770184
http://dx.doi.org/10.1097/00001665-20060...
.
In this sense, the 3D stereophotogrammetry brings a new possibility of soft facial tissue analysis, which may be employed in the most diverse situations, thus the establishment of parameters of measures, be they angular, linear or area for subjects with normal occlusion (Class I) is important, because it will serve as a reference for other studies that use the same technology, but with different samples.
CONCLUSION
Considering the limitations of this study, it is possible to conclude that there were no gender differences for the variables studied (angular, linear and area), it is suggested to use the data of the total sample (Class I) as benchmarks for future studies. The 3D stereophotogrammetry proved to be a new possibility of analysis of soft facial tissue, which can be used in many different areas of dentistry.
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Publication Dates
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Publication in this collection
June 2015
History
-
Received
29 Oct 2014 -
Accepted
02 Dec 2014