Rev Odontol UNESP
Revista de Odontologia da UNESP
Rev. Odontol.
UNESP
0101-1774
1807-2577
Universidade Estadual Paulista Júlio de Mesquita
Filho
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.
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 stereophotogrammetry1.
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 obtained2,3.
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 measures4,5. 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 results5.
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.6 and Sforza et al.1.
•
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).Figure
1Reference Points marked facial in
the midline and bilaterally in the face prior to the
acquisition of three-dimensional
images.
•
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).
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).
Table 1
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)
T-Go-Pg
C-Sn-Ls
N-Prn-Pg
N-Sn-Pg
Li-Sl-Pg
Men
121.6 (±5.5)
117.5 (±5.1)
129.1 (±3.8)
161.9 (±3.8)
131.5 (±9.7)
Women
122 (±5.2)
116.5 (±7.5)
134.0 (±5.1)
166 (±4.0)
128.3 (±9.9)
Class I
121.8 (±5.3)
117 (±6.3)
131.5 (±4.4)
163.9 (±3.9)
129.9 (±9.8)
*p
0.92
0.78
0.54
0.23
0.36
*
T-Student test, comparison between genres, adopting a 5% significance
level.
Table 2
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
Cheek D
Cheek E
Hemiface D
Hemiface E
Lip D
Lip E
Men
74.75 ( ± 8.1)
72.4 (± 7.3)
171.5 (± 13.2)
168.75 (± 11.6)
3.8 (±0.95)
3.75 (±1.1)
Women
64.45 (±8.1)
61.18 (± 4.1)
153.09 (± 9.3)
150.27 (± 7.8)
2.9 (±0.7)
3 (±0.7)
Class I
69.6 (± 8.1)
66.79 (± 6.2)
165 (± 10,2)
159,30 (± 8,3)
3.4 (±0.8)
3.3 (±0.8)
*p
0.09
0.08
0.98
0.65
0.31
0.19
*
Students T Test, comparison between genders, adopting a 5% significance
level.
Table 3
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)
Superior D
Superior E
Inferior D
Inferior E
LML
Ls-Cph
Cph-Ch
Sum
Ls-Cph
Cph-Ch
Sum
Ch-Li
Ch-Li
Ls-Li
Men
6.7(±1.2)
28.35(±2.4)
35.8(±3)
6.6(±1.1)
28.2(±2.1)
35.4(±2.5)
30.55(±2.9)
30.4(±2.8)
17.3(±3.3)
Women
5.45(±0.9)
27.36(±1.9)
33(±2)
5.45(±0.8)
26.9(±1.9)
32.89(±2)
29.1(±1.8)
28.81(±1.4)
16.27(±2.9)
Class I
6(±1)
27.85(±2.1)
34.4(±2.4)
6.02(±0.9)
27.55(±2)
34.14(±2.2)
29.82(±2.4)
29.60(±2.2)
16.7(±3.1)
Table 4
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
Go-Gn (D)
Go-T (D)
Sum
Go-Gn (E)
Go-T (E)
Sum
Men
100.9 (± 5.7)
66.22 (± 5.4)
167.89 (± 7.7)
99.85 (± 5.5)
66 (± 4.8)
166.74 (± 6.9)
Women
97 (± 5.1)
53.45 (± 5)
150.81 (±6.8)
94.9 (± 3.4)
54.18 (± 4.7)
149.54 (± 5.3)
Class I
98.95 (± 5.4)
60.33 (± 5.2)
159.35 (± 7.3)
97.37 (± 4.6)
60.9 (± 4.7)
158.14 (± 6.3)
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
analysis5,7,8..
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
professionals2,5,9-11. Stereophotogrammetry is a conservative method for
individuals submitted to imaging, not to issue any type of radiation12. 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 children13.
In several clinical applications, virtual reproductions of morphology can help
professionals during the diagnosis and planning of medical procedures and
treatments12. 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.14 and Schendel et al.15 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.16 e Tzou et
al.17 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 centers8,18.
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 surgery14,15,19-23.
According to Brons et al.24 and
Metzler et al.16 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 measurement2,7.
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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Autoria
Ana Maria Bettoni Rodrigues da Silva **CORRESPONDING AUTHOR: Ana Maria Bettoni Rodrigues
da Silva, Departamento de Odontologia Restauradora, Faculdade de Odontologia,
USP - Universidade de São Paulo, Av. do Café, s/n, Bairro Monte Alegre,
14040-904 Ribeirão Preto - SP, Brasil, e-mail:
bettoniana@yahoo.com.br
Faculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, BrasilUniversidade de São PauloBrasilRibeirão Preto, SP, BrasilFaculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
Laís Valencise Magri
Faculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, BrasilUniversidade de São PauloBrasilRibeirão Preto, SP, BrasilFaculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
Álvaro Augusto Junqueira Júnior
Faculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, BrasilUniversidade de São PauloBrasilRibeirão Preto, SP, BrasilFaculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
Marco Antônio Moreira Rodrigues da Silva
Faculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, BrasilUniversidade de São PauloBrasilRibeirão Preto, SP, BrasilFaculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
CONFLICT OF INTEREST: The authors declare no conflicts of interest.
*CORRESPONDING AUTHOR: Ana Maria Bettoni Rodrigues
da Silva, Departamento de Odontologia Restauradora, Faculdade de Odontologia,
USP - Universidade de São Paulo, Av. do Café, s/n, Bairro Monte Alegre,
14040-904 Ribeirão Preto - SP, Brasil, e-mail:
bettoniana@yahoo.com.br
SCIMAGO INSTITUTIONS RANKINGS
Faculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, BrasilUniversidade de São PauloBrasilRibeirão Preto, SP, BrasilFaculdade de Odontologia, USP -
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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.
Table 1
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)
Table 2
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
Table 3
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)
Table 4
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
imageFigure
1 Reference Points marked facial in
the midline and bilaterally in the face prior to the
acquisition of three-dimensional
images.open_in_new
imageFigure 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.
open_in_new
imageFigure
1 Reference Points marked facial in
the midline and bilaterally in the face prior to the
acquisition of three-dimensional
images.open_in_new
table_chartTable 1
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)
T-Go-Pg
C-Sn-Ls
N-Prn-Pg
N-Sn-Pg
Li-Sl-Pg
Men
121.6 (±5.5)
117.5 (±5.1)
129.1 (±3.8)
161.9 (±3.8)
131.5 (±9.7)
Women
122 (±5.2)
116.5 (±7.5)
134.0 (±5.1)
166 (±4.0)
128.3 (±9.9)
Class I
121.8 (±5.3)
117 (±6.3)
131.5 (±4.4)
163.9 (±3.9)
129.9 (±9.8)
**
T-Student test, comparison between genres, adopting a 5% significance
level.
p
0.92
0.78
0.54
0.23
0.36
table_chartTable 2
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
Cheek D
Cheek E
Hemiface D
Hemiface E
Lip D
Lip E
Men
74.75 ( ± 8.1)
72.4 (± 7.3)
171.5 (± 13.2)
168.75 (± 11.6)
3.8 (±0.95)
3.75 (±1.1)
Women
64.45 (±8.1)
61.18 (± 4.1)
153.09 (± 9.3)
150.27 (± 7.8)
2.9 (±0.7)
3 (±0.7)
Class I
69.6 (± 8.1)
66.79 (± 6.2)
165 (± 10,2)
159,30 (± 8,3)
3.4 (±0.8)
3.3 (±0.8)
**
Students T Test, comparison between genders, adopting a 5% significance
level.
p
0.09
0.08
0.98
0.65
0.31
0.19
table_chartTable 3
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)
Superior D
Superior E
Inferior D
Inferior E
LML
Ls-Cph
Cph-Ch
Sum
Ls-Cph
Cph-Ch
Sum
Ch-Li
Ch-Li
Ls-Li
Men
6.7(±1.2)
28.35(±2.4)
35.8(±3)
6.6(±1.1)
28.2(±2.1)
35.4(±2.5)
30.55(±2.9)
30.4(±2.8)
17.3(±3.3)
Women
5.45(±0.9)
27.36(±1.9)
33(±2)
5.45(±0.8)
26.9(±1.9)
32.89(±2)
29.1(±1.8)
28.81(±1.4)
16.27(±2.9)
Class I
6(±1)
27.85(±2.1)
34.4(±2.4)
6.02(±0.9)
27.55(±2)
34.14(±2.2)
29.82(±2.4)
29.60(±2.2)
16.7(±3.1)
table_chartTable 4
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
Go-Gn (D)
Go-T (D)
Sum
Go-Gn (E)
Go-T (E)
Sum
Men
100.9 (± 5.7)
66.22 (± 5.4)
167.89 (± 7.7)
99.85 (± 5.5)
66 (± 4.8)
166.74 (± 6.9)
Women
97 (± 5.1)
53.45 (± 5)
150.81 (±6.8)
94.9 (± 3.4)
54.18 (± 4.7)
149.54 (± 5.3)
Class I
98.95 (± 5.4)
60.33 (± 5.2)
159.35 (± 7.3)
97.37 (± 4.6)
60.9 (± 4.7)
158.14 (± 6.3)
Como citar
Silva, Ana Maria Bettoni Rodrigues da et al. Análise facial de sujeitos Classe I de Angle por meio da estereofotogrametria 3D: comparação entre gêneros. Revista de Odontologia da UNESP [online]. 2015, v. 44, n. 3 [Acessado 12 Abril 2025], pp. 137-142. Disponível em: <https://doi.org/10.1590/1807-2577.0039>. Epub May-Jun 2015. ISSN 1807-2577. https://doi.org/10.1590/1807-2577.0039.
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