Craniofacial features and incisor position design of esthetics population after orthodontic treatment

doi:10.7518/hxkq.2024.2023443

Abstract

Abstract:

Objective This study aims to provide craniofacial features and incisor position prediction models among esthetics population after orthodontic treatment. Methods A total of 338 patients with esthetic profiles were selected from 1 055 post-orthodontic adults based on inclusion and exclusion criteria and scored by five dental students. Mean values of cephalometric measurement were demonstrated with gender and sagittal skeletal pattern (ANB) differences assessed by generalized estimating equation. Correlations among age, skeletal, and soft tissue variables in different genders were determined. Multivariate analysis was used to assess the influence of skeletal and soft tissue variables on orthodontic incisor position. Results Within the esthetic cohort after orthodontic treatment, gender differences existed in cranial and mandibular length, mandibular rotation, protrusion of pogonion, inclination of maxillary incisors, upper lip thickness, lower 1/3 face height, and nose protrusion. However, in class Ⅰ malocclusion, the development of the chin showed no significance, whereas the protrusion of the lower lip significantly differed between genders, with less protrusion in males. In males, the protrusion of lip and chin varied among groups, with thinner basic upper lip thickness of class Ⅱ than class Ⅰ and greater lower lip height of class Ⅲ than class Ⅰ. In females, the protrusion and height of the upper lip and chin varied in groups, with thicker basic upper lip thickness of class Ⅲ than class Ⅰ. Upper lip thickness, female basic upper lip thickness, and female lower lip height were correlated with age. The protrusion of the upper lip was mainly correlated with posterior cranial base, mandibular body length, ANB in male and SNA, ANB, sagittal maxillary length, mandibular rotation, and protrusion of pogonion in female. The protrusion of the lower lip in males was mainly correlated with ramus height, mandibular rotation, protrusion of pogonion in male and ANB, mandibular rotation, and protrusion of pogonion in females. After employing skeletal variables to fit dental parameters, optimal results were achieved in male IMPA (adjusted R²=0.712) and female G Vert-U1 (adjusted R²=0.795). After employing skeletal and soft tissue variables simultaneously, optimal results were achieved in male and female G Vert-U1, which was mainly influenced by the protrusion of the chin and nasal base in males (adjusted R²=0.836) and the protrusion of the nasal base as well as ANB in females (adjusted R²=0.842). Conclusion This study demonstrated the craniofacial features of esthetics population after orthodontic treatment and revealed the correlation of gender, age, skeleton, and soft tissues to provide reliable prediction models for aesthetic orthodontic incisor position.

Key words: aesthetics, orthodontics, craniofacial feature, incisor position design, cephalometric standard

CLC Number:

R783.5

Cheng Junxin, Zhu Yujie, Li Yuelin, Zheng Yingcheng, Wang Jun. Craniofacial features and incisor position design of esthetics population after orthodontic treatment[J]. West China Journal of Stomatology, 2024, 42(5): 609-623.

Figures/Tables 18

Fig 1

Tab 1

Definition of cephalometric measurements

测量指标	定义
骨性指标
S-N	前颅底长度，从蝶鞍点（S）到鼻根点（N）的距离
S-Ar	后颅底长度，从蝶鞍点（S）到关节点（Ar）的距离
Ar-Go’	下颌升支高度，从关节点（Ar）到下颌角点（Go’）的距离
Go’-Me	下颌体长度，从下颌角点（Go’）到颏下点（Me）的距离
Na-S-Ar	鞍角，S-N和S-Ar之间的夹角
S-Ar-Go’	关节角，S-Ar和Ar-Go’之间的夹角
Ar-Go’-Me	下颌角，Ar-Go’和Go’-Me之间的夹角
SNA	上颌骨矢状向关系，S-N和N-A之间的夹角
SNB	下颌骨矢状向关系，S-N和N-B之间的夹角
ANB	上下颌骨矢状向关系，N-A和N-B之间的夹角
A-N perp	上颌骨矢状向长度，N-A的连线投影到FH平面的长度
SN-MP	下颌骨顺旋情况，SN平面和MP平面的夹角
FMA	下颌骨顺旋情况，FH平面和MP平面的夹角
PP-MP	下颌骨顺旋情况，PP平面和MP平面的夹角
Pog-NB	骨性颏部突度，颏前点和N-B之间的距离
牙性指标
G Vert-U1	上颌切牙矢状向位置，U1到从软组织额点（G’）做眶耳平面（FH）垂线的距离
U1-NPog	上颌切牙矢状向位置，U1到面平面（N-Pog）之间的距离
L1-NPog	下颌切牙矢状向位置，L1到面平面（N-Pog）之间的距离
U1-NA	上颌切牙矢状向位置，U1到NA之间的距离
L1-NB	下颌切牙矢状向位置，L1到NB之间的距离
U1-SN	上颌切牙唇倾度，U1-U1A和SN平面形成的后下角
U1-PP	上颌切牙唇倾度，U1-U1A和PP平面形成的后下角
IMPA	下颌切牙唇倾度，L1-L1A和MP平面形成的后上角
FMIA	下颌切牙唇倾度，L1-L1A和FH平面形成的后下角
U1-L1	上下颌切牙夹角，U1-U1A和L1-L1A形成的夹角
OP-FH	平面倾斜度，OP平面和FH平面之间的夹角
软组织指标
UL-EP	上唇突度，上唇突点（Ls）点到审美线（EP平面）的距离
LL-EP	下唇突度，下唇突点（Li）点到审美线（EP平面）的距离
Z角	软组织颏前点（Pog’）和唇最突点的连线与FH平面的夹角
上唇基底部厚度	A点向下3 mm上颌骨边缘的位置与鼻底点的距离
上唇厚度	U1最突点和上唇最突点（Ls）的距离
Sn-Stms	上唇面高，鼻底点（Sn）和上唇下缘最低点（Stms）的连线投影到FH垂线的距离
Stmi-Me’	下唇面高，下唇上缘最高点（Stmi）和软组织颏下点（Me’）的连线投影到FH垂线的距离
Sn-Me’	下面高，鼻底点（Sn）和软组织颏下点（Me’）的距离
Prn-Sn Vert	鼻尖突度，鼻尖点（Prn）到鼻底点（Sn）做FH平面垂线的距离
G Vert-Sn	鼻底突度，鼻底点（Sn）到软组织额点（G’）做FH平面垂线的距离
G Vert-Pog’	软组织颏部突度，软组织颏前点（Pog’）到软组织额点（G’）做FH平面垂线的距离

Tab 1

Tab 2

Tab 3

Tab 4

Cephalometric measurement results of aesthetics male population after orthodontic treatment with different sagittal skeletal pattern

测量指标	骨性Ⅰ类	骨性Ⅱ类	骨性Ⅲ类		P值
测量指标	骨性Ⅰ类	骨性Ⅱ类	骨性Ⅲ类	整体	Ⅱ-Ⅰ	Ⅲ-Ⅰ
骨性指标
S-N/mm	65.6±3.8	66.3±3.6	67.1±5.7	0.651	-	-
S-Ar/mm	36.5±3.0	37.3±3.4	39.1±5.7	0.324	-	-
Ar-Go’/mm	51.8±6.2	50.0±5.5	54.2±5.2	0.081	-	-
Go’-Me /mm	73.5±5.2	71.1±3.3	78.5±9.2	0.007	0.040	0.091
Na-S-Ar/°	123.9±5.2	125.3±4.9	123.2±5.6	0.445	-	-
S-Ar-Go’/°	152.1±5.1	152.0±5.8	150.1±4.5	0.435	-	-
Ar-Go’-Me/°	113.0±8.7	115.2±6.4	118.4±5.1	0.050	0.310	0.016
SNA/°	81.3±3.2	81.6±3.7	80.8±3.5	0.809	-	-
SNB/°	78.8±3.4	76.3±3.6	81.7±4.9	0.001	0.009	0.077
ANB/°	2.5±0.8	5.3±1.0	-1.0±1.8	<0.001	<0.001	<0.001
A-N perp/mm	-1.0±2.8	0.2±3.1	-2.6±1.6	0.001	0.153	0.025
SN-MP/°	29.4±7.1	32.9±6.0	31.9±6.1	0.152	-	-
FMA/°	21.7±6.3	24.3±5.9	25.0±3.2	0.091	-	-
PP-MP/°	19.6±6.0	22.3±5.7	22.9±5.2	0.143	-	-
Pog-NB/mm	2.1±1.5	1.8±1.3	1.9±1.2	0.748	-	-
牙性指标
G Vert-U1/mm	-4.0±3.9	-3.7±3.7	-1.2±3.1	0.041	0.753	0.017
U1-NPog/mm	6.5±2.3	9.6±2.2	5.8±3.1	<0.001	<0.001	0.483
L1-NPog/mm	3.6±2.1	6.4±2.1	3.5±1.8	<0.001	<0.001	0.860
U1-NA/mm	4.4±1.5	3.0±2.1	8.5±3.0	<0.001	0.008	<0.001
L1-NB/mm	4.9±2.0	7.5±2.0	4.4±1.7	<0.001	<0.001	0.446
U1-SN/°	105.0±7.1	100.6±5.6	111.1±8.7	<0.001	0.012	0.040
U1-PP/°	114.9±6.7	111.2±6.3	120.1±7.8	0.002	0.041	0.051
IMPA/°	98.9±9.8	104.1±7.3	89.6±7.4	<0.001	0.029	0.001
FMIA/°	59.4±6.4	51.7±7.6	65.5±6.3	<0.001	<0.001	0.007
U1-L1/°	126.6±9.7	122.4±9.5	127.5±8.4	0.170	-	-
OP-FH/°	8.2±3.9	10.7±3.7	6.4±3.6	0.002	0.016	0.156
软组织指标
UL-EP/mm	-1.3±1.6	-0.2±1.6	-2.3±1.6	0.001	0.014	0.082
LL-EP/mm	-0.4±1.8	1.3±2.0	1.0±1.4	0.002	0.001	0.011
Z角/°	71.3±5.8	64.7±6.0	72.5±4.2	<0.001	<0.001	0.505
上唇基底部厚度/mm	16.5±1.5	15.2±1.6	17.0±2.0	0.002	0.002	0.415
上唇厚度/mm	16.4±1.6	16.2±1.9	16.8±1.9	0.685	-	-
Sn-Stms/mm	22.6±2.3	23.2±2.2	23.8±2.7	0.366	-	-
Stmi-Me’/mm	45.0±4.3	45.3±3.7	51.0±5.5	0.004	0.808	0.001
Sn-Me’/mm	73.8±4.3	76.1±4.6	79.7±7.4	0.017	0.061	0.012
Prn-Sn Vert/mm	13.6±1.7	14.2±1.6	14.7±1.6	0.187	-	-
G Vert-Sn/mm	7.7±2.2	7.8±2.7	7.5±1.7	0.889	-	-
G Vert-Pog’/mm	0.7±5.4	-2.6±5.7	3.9±3.7	<0.001	0.028	0.038

Tab 4

Tab 5

Cephalometric measurement results of aesthetics female population after orthodontic treatment with different sagittal skeletal pattern

测量指标	骨性Ⅰ类	骨性Ⅱ类	骨性Ⅲ类		P值
测量指标	骨性Ⅰ类	骨性Ⅱ类	骨性Ⅲ类	整体	Ⅱ-Ⅰ	Ⅲ-Ⅰ
骨性指标
S-N/mm	62.6±3.5	63.0±3.8	62.5±4.1	0.612	-	-
S-Ar/mm	33.1±2.9	33.3±3.3	32.8±3.0	0.714	-	-
Ar-Go’/mm	46.0±3.9	44.2±4.7	46.8±3.9	0.001	0.002	0.269
Go’-Me/mm	69.9±4.1	69.0±4.7	71.0±4.5	0.054	-	-
Na-S-Ar/°	124.9±4.7	124.8±5.0	125.4±5.0	0.802	-	-
S-Ar-Go’/°	151.8±10.8	154.5±6.1	149.5±4.3	<0.001	0.015	0.040
Ar-Go’-Me/°	115.4±6.1	116.4±6.0	116.5±5.4	0.358	-	-
SNA/°	80.7±3.0	81.8±3.0	79.4±3.0	<0.001	0.003	0.032
SNB/°	77.9±3.0	76.3±3.1	80.0±3.3	<0.001	<0.001	0.001
ANB/°	2.7±0.9	5.6±1.1	-0.6±1.5	<0.001	<0.001	<0.001
A-N perp/mm	-0.7±2.9	0.2±3.3	-1.7±2.4	0.002	0.030	0.038
SN-MP/°	33.2±5.1	35.8±4.8	31.7±5.6	<0.001	<0.001	0.130
FMA/°	24.5±5.4	27.4±5.7	22.8±4.8	<0.001	<0.001	0.057
PP-MP/°	23.0±5.1	25.6±4.8	22.0±4.7	<0.001	<0.001	0.286
Pog-NB/mm	1.7±1.2	1.3±1.0	1.7±1.2	0.042	0.022	0.825
牙性指标
G Vert-U1/mm	-2.5±4.0	-3.4±4.8	-0.5±3.7	0.001	0.119	0.005
U1-NPog/mm	7.1±2.3	9.6±2.3	6.0±2.8	<0.001	<0.001	0.040
L1-NPog/mm	4.1±2.2	6.4±2.3	3.3±2.5	<0.001	<0.001	0.072
U1-NA/mm	4.4±1.8	2.6±1.6	7.6±2.7	<0.001	<0.001	<0.001
L1-NB/mm	5.1±1.7	7.0±1.8	3.9±2.2	<0.001	<0.001	0.002
U1-SN/°	101.9±6.0	97.7±6.3	110.2±6.5	<0.001	<0.001	<0.001
U1-PP/°	112.1±5.9	108.0±6.1	119.8±6.5	<0.001	<0.001	<0.001
IMPA/°	97.2±7.5	100.8±6.7	92.5±7.1	<0.001	<0.001	0.001
FMIA/°	58.3±6.7	51.8±6.4	64.8±7.1	<0.001	<0.001	<0.001
U1-L1/°	127.7±8.7	125.6±8.4	125.7±9.6	0.141	-	-
OP-FH/°	10.1±3.8	12.5±4.2	6.7±4.1	<0.001	<0.001	<0.001
软组织指标
UL-EP/mm	-1.1±1.7	0.0±1.7	-2.0±2.0	<0.001	<0.001	0.010
LL-EP/mm	0.5±1.9	1.0±2.1	0.2±2.0	0.058	-	-
Z角/°	71.4±6.0	66.4±6.6	75.6±6.1	<0.001	<0.001	<0.001
上唇基底部厚度/mm	14.0±1.4	13.8±1.9	14.8±1.3	0.001	0.440	0.001
上唇厚度/mm	14.8±2.0	14.7±2.4	14.7±2.5	0.829	-	-
Sn-Stms/mm	21.4±1.7	22.5±2.2	20.4±1.9	<0.001	<0.001	0.008
Stmi-Me’/mm	42.2±3.2	42.0±3.4	42.8±3.3	0.531	-	-
Sn-Me’/mm	69.5±4.4	71.9±5.0	68.0±4.3	<0.001	<0.001	0.067
Prn-Sn Vert/mm	12.4±1.6	12.8±2.2	12.6±1.9	0.288	-	-
G Vert-Sn/mm	6.6±3.0	7.2±3.4	6.5±2.3	0.204	-	-
G Vert-Pog’/mm	0.8±5.5	-2.7±6.8	4.8±4.8	<0.001	<0.001	<0.001

Tab 5

Fig 2

Tab 6

Fig 3

Fig 4

Tab 7

Tab 8

Tab 9

Tab 10

Tab 11

Tab 12

Tab 13

Tab 14

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测量指标	女性（277例）	男性（61例）	合计（338例）	P值
骨性指标
S-N/mm	62.7±3.7	66.1±4.0	63.4±4.0	<0.001
S-Ar/mm	33.2±3.0	37.2±3.8	33.9±3.5	<0.001
Ar-Go’/mm	45.5±4.3	51.5±5.9	46.5±5.2	<0.001
Go’-Me /mm	69.7±4.4	73.4±5.9	70.4±4.9	<0.001
Na-S-Ar/°	124.9±4.8	124.3±5.1	124.8±4.9	0.392
S-Ar-Go’/°	152.5±8.8	151.7±5.3	152.4±8.3	0.346
Ar-Go’-Me/°	115.9±6.0	114.8±7.5	115.7±6.3	0.251
SNA/°	80.9±3.1	81.4±3.4	81.0±3.1	0.378
SNB/°	77.6±3.3	78.3±4.1	77.7±3.5	0.169
ANB/°	3.4±2.2	3.0±2.4	3.3±2.3	0.302
A-N perp/mm	-0.5±3.0	-0.8±2.9	-0.5±3.0	0.460
SN-MP/°	34.0±5.3	31.2±6.6	33.5±5.6	0.002
FMA/°	25.4±5.7	23.2±5.8	25.0±5.8	0.009
PP-MP/°	23.8±5.1	21.2±5.9	23.3±5.4	0.001
Pog-NB/mm	1.5±1.2	2.0±1.4	1.6±1.2	0.023
牙性指标
G Vert-U1/mm	-2.6±4.4	-3.4±3.8	-2.7±4.3	0.119
U1-NPog/mm	7.9±2.7	7.6±2.9	7.8±2.7	0.506
L1-NPog/mm	4.9±2.6	4.7±2.4	4.8±2.5	0.640
U1-NA/mm	4.1±2.4	4.5±2.7	4.2±2.5	0.298
L1-NB/mm	5.7±2.1	5.9±2.3	5.7±2.1	0.552
U1-SN/°	101.4±7.3	104.3±7.7	101.9±7.4	0.006
U1-PP/°	111.6±7.0	114.3±7.3	112.1±7.1	0.007
IMPA/°	97.9±7.6	99.4±9.8	98.2±8.0	0.263
FMIA/°	56.7±7.9	57.3±8.5	56.8±8.0	0.589
U1-L1/°	126.7±8.7	125.1±9.6	126.4±8.9	0.226
OP-FH/°	10.6±4.4	8.9±4.0	10.3±4.4	0.003
软组织指标
UL-EP/mm	-0.8±1.8	-1.0±1.8	-0.9±1.8	0.475
LL-EP/mm	0.6±2.0	0.5±2.0	0.6±2.0	0.711
Z角/°	70.1±7.0	68.9±6.5	69.9±6.9	0.202
上唇基底部厚度/mm	14.0±1.6	16.0±1.8	14.4±1.8	<0.001
上唇厚度/mm	14.7±2.2	16.4±1.8	15.0±2.3	<0.001
Sn-Stms/mm	21.7±2.1	23.0±2.3	21.9±2.2	<0.001
Stmi-Me’/mm	42.2±3.3	46.1±4.7	42.9±3.9	<0.001
Sn-Me’/mm	70.2±4.8	75.6±5.4	71.2±5.3	<0.001
Prn-Sn Vert/mm	12.6±1.9	14.0±1.7	12.9±1.9	<0.001
G Vert-Sn/mm	6.8±3.1	7.7±2.3	7.0±3.0	0.008
G Vert-Pog’/mm	0.0±6.4	-0.1±5.7	0.0±6.3	0.918

测量指标		男性			女性
测量指标	相关系数	P值	斜率	相关系数	P值	斜率
UL-EP	-0.106	0.417	-	-0.052	0.389	-
LL-EP	-0.150	0.247	-	-0.023	0.707	-
Z角	0.005	0.971	-	0.029	0.628	-
上唇基底部厚度	-0.242	0.061	-0.098	-0.225	<0.001	-0.073
上唇厚度	-0.385	0.002	-0.157	-0.267	<0.001	-0.119
Sn-Stms	-0.136	0.294	-	0.063	0.294	-
Stmi-Me’	-0.077	0.556	-	-0.136	0.024	-0.089
Sn-Me’	-0.137	0.291	-	-0.063	0.299	-
Prn-Sn Vert	0.151	0.246	-	0.073	0.228	-
G Vert-Sn	-0.054	0.678	-	0.078	0.194	-
G Vert-Pog’	-0.054	0.680	-	0.076	0.207	-

项目	骨性指标	骨性+软组织矢状向指标	骨性+软组织指标
G Vert-U1	0.795	0.840	0.842
U1-NPog	0.515	0.515	0.541
L1-NPog	0.533	0.544	0.585
U1-NA	0.521	0.530	0.531
L1-NB	0.421	0.438	0.458
U1-SN	0.516	0.528	0.554
U1-PP	0.493	0.507	0.534
IMPA	0.559	0.572	0.572
FMIA	0.581	0.594	0.594

项目	骨性指标	骨性+软组织矢状向指标	骨性+软组织指标
G Vert-U1	0.800	0.838	0.838
U1-NPog	0.384	0.384	0.384
L1-NPog	0.417	0.426	0.450
U1-NA	0.157	0.187	0.187
L1-NB	0.181	0.222	0.228
U1-SN	0.348	0.351	0.376
U1-PP	0.316	0.324	0.348
IMPA	0.526	0.551	0.551
FMIA	0.421	0.441	0.441

项目	骨性指标	骨性+软组织矢状向指标	骨性+软组织指标
G Vert-U1	0.825	0.859	0.859
U1-NPog	0.323	0.352	0.457
L1-NPog	0.377	0.438	0.527
U1-NA	0.057	0.083	0.083
L1-NB	0.221	0.305	0.317
U1-SN	0.334	0.367	0.410
U1-PP	0.187	0.187	0.256
IMPA	0.417	0.436	0.436
FMIA	0.439	0.494	0.494