soft tissue analysis - Copy.pptx

PRESENTED BY:
DR. MOHIT MAKKAR
DEPARTMENT OF
ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS
SOFT TISSUE CEPHALOMETRIC
ANALYSIS

CONTENTS
1. Areas of analysis
2. Need for soft tissue analysis
3. Profile analysis
4. Lip analysis
5. Tongue analysis
6. Cephalometric analysis
7. Conclusion
8. References

AREAS OF ANALYSIS
Area of
analysis
Dentoskeletal
analysis
Soft tissue
analysis
Functional
analysis

SOFT TISSUE ANALYSIS
Soft
tissue
analysis PROFILE
ANALYSIS
LIP ANALYSIS
TONGUE
ANALYSIS

NEED FOR SOFT TISSUE ANALYSIS
1) Dynamic entity of soft tissue behaviour
2) Growth is independent of hard tissue of face

PROFILE ANALYSIS
 Reference points
1. Tr - trichion
2. N - skin nasion
3. No - tip of nose
4. Sn - subnasale
5. Ss - subspinale
6. Ls - labrale superius (border of upper lip)
7. Sto - stomion (central point of interlabial gap)
8. Li - labrale inferius (border of lower lip)
9. Sm - submentale (labiomental fold)
10. Pog - skin pogonion
11. Gn - skin gnathion

SOFT TISSUE POINTS FOR PROFILE
ANALYSIS

SOFT TISSUE CEPHALOMETRIC LANDMARKS

ASSESSMENT OF TOTAL PROFILE
1. PROPORTIONAL ANALYSIS –
A. Frontal third tr-n 1/3 Upper one third
B. Nasal third n-sn 1/3 Middle one third
C. Gnathic third sn-gn 1/3 Lower one third

ANTERIOR FACE HEIGHT
PROPORTIONS
MID FACE 45%
LOWER FACE
55%

ANGULAR PROFILE ANALYSIS
 Convexity of profile
 By J. D. Subtelny & M. S. Rochester in 1959
 Analysis of convexity of the profile amongst –
1. The Skeletal profile
2. The Soft tissue profile
3. The Full or total soft tissue profile (including nose)
Subtenly jd. A longitudinal study of soft tissue facial structures and their profile
characteristics, defined in relation to underlying skeletal structures. Am j orthod
dentofacial orthop 1959;45:41-507

SKELETAL SOFT TISSUE FULL OR TOTAL SOFT TISSUE
PROFILE PROFILE PROFILE

SKELETAL PROFILE
 Landmarks –
1. N
2. Pt. A
3. Pog
 mean value is 175 deg.
 At age 12 is 177.5 deg
convexity decreases with age.

SOFT TISSUE PROFILE
 Landmarks –
1. N’
2. Sn
3. Pog
 mean value is 161 deg.
 Convexity does not change
with age.

FULL OR TOTAL SOFT TISSUE PROFILE
 Landmarks –
1. N’
2. No
3. Pog
Convexity of nose influences
cosmetics.
Avg value 137 deg(m) and 133
deg(f).
Bishara found convexity
increases with age because of
anterior growth of the nose.

MEAN VALUES OF CONVEXITY
Profile Class I CLASS II CLASS III
SKELETAL
PROFILE
174 deg 178 deg 181 deg
SOFT TISSUE
PROFILE
159 deg 163 deg 168 deg
TOTAL PROFILE 133 deg 133 deg 139 deg

SOFT TISSUE PROFILE THICKNESS
 Acc to subtelny
a) The thickness of soft tissue nasion was practically
constant
b) The thickness at the sulcus lab. Sup. Increased by
approx 5 mm
c) The thickness of the soft tissue chin increased by
approx 2 mm

SOFT TISSUE PROFILE THICKNESS
 Acc to burstone analysis ref pts –
i. Skeletal points :
1. Subspinale
2. Incisio sup
3. Pro section of pt b
4. Inciso inf
5. Supramentale
6. pogonion

 Soft tissue points :
A. Subnasale
B. Sulcus labialis sup
C. Labrale sup
D. Labrale inf
E. Sulcus labialis inf
F. Menton
G. Glabella
Boys girls
mm mm
Glabella 7 6.6
Subnasale 18.7 16.9
Sulcus lab.
Sup
16.2 14.7
Sulcus lab. Inf. 12.9 11.6
Soft tissue
chin
12.8 12.2

 Bowker and merdith analysis
 Soft tissue thickness irt N-Pog line in boys & girls
 Analysis show growth related changes in soft tissue
profile during course of treatment

ACC TO BOWKER & MEREDITH MEAN VALUES
Age 5 Age 14 Gain
mm mm mm
Nasion B
G
6.3
6.3
6.6
7.1
0.3
0.8
Tip of nose B
G
23.8
24.8
30.9
32.0
7.7
7.5
Convexity of
upper lip
B
G
14.5
14.7
16.3
17.5
1.8
2.8
Labiomental
fold
B
G
9.7
9.5
9.9
9.5
0.2
0.0
Soft tissue
pogonion
B
G
11.3
11.4
12.3
12.4
1.0
1.0

PROFILE ANALYSIS AFTER A.M. SCHWARZ
 Three ref lines for profile
analysis
1. The H line
2. The Pn line
3. The Po line
GPF is gnathic profile field
which permits profile
assessment.

 Width of gpf 13-14
mm in children &
15-17 mm in adults
 T angle

BASED ON POSITION OF SN IRT NA
a) Average face – Sn lying on the Na perp.
b) Retroface – Sn behind Na perp
c) Anteface – Sn in front of the Na perp
when pog id displace proportionately to the subnasale
in cases of retro or anteposition is known as straight
retroface or balanced or straight average face.

Average face Retroface Anteface

Straight profiles Oblique profiles
a) average face
b) straight anteface
c) straight retroface
a1. retroclination
b1. ante inclination
a2. average face,gnathic
profile slanting backward
b2. average face, gnathic
profile slanting backward
a3. anteface, gnathic profile
slanting backward
b3. retroface, gnathic profile
slanting forward

RETROPOSITION AVG TYPE ANTEPOSITION
GNATHIC GNATHIC GNATHIC
SLOPING BACKWARD

ANTEPOSITION AVG TYPE RETROPOSITION
GNATHIC GNATHIC GNATHIC
SLOPING FORWARD

LIP ANALYSIS
 Metric determinations
1. Length of upper lip (sn-
stm)
Avg is 24 mm for boys and 20
mm for girls
2. Length of lower lip (stm –
gn)
Avg is 50mm in boys and 46.5
mm

3.THICKNESS OF UPPER LIP
Labial surface of most labial
incisor to the most anterior
point on the red part of upper
lip.
Avg is 11.5 mm.
thickness increases with age 6
to 12 by 1.4 mm

4.THICKNESS OF LOWER LIP
Labial surface of the lower
incisors to the most anterior
point of the red part of lower lip.
Avg is 12.5 mm.
Lower lip thickness increases
only minimally from 6 to 12 1.2
mm in class II and 0.8 mm in
class III

RICKETT’S E LINE – AESTHETIC PLANE
 From tip of nose to soft tissue
chin.
 Lip position should be analysed
with the nose-chin reference.
 Normal values for caucasians –
upper lip 4 mm & lower lip 2 mm
behind e line.
 Varies with age & sex.
 Ricketts RM. Planning treatment on the basis of the facial
pattern and an estimate of its growth. Angle Orthod 1957;27:14–
37.
 Ricketts RM. Cephalometric analysis and synthesis. Angle
Orthod 1961;31:141–156.

STEINER’S S LINE
 By cecil steiner in 1962
 From soft tissue pogonion to
midpoint of s shaped curve
between subnasale and nasal
tip.
 Normally upper & lower lips
touch S line and tip of nose is
9mm anterior.
 Lips can be retrusive or
protrusive
 Ref-Steiner CC. Cephalometrics as a clinical tool. In: Kraus
BS, Riedel RA (eds). Vistas in Orthodontics. Philadelphia:
Lea & Febiger, 1962.

HOLDAWAY’S ANALYSIS
 By Reed A. Holdaway in 1983 and 1984
 Harmony line or H line – tangent to chin and
upper lip.
 With an ANB angle of 1-3 deg H angle shd be
7-8 deg.
 Holdaway defines perfect profile as
a) ANB angle 2 deg,h angle 7-8 deg
b) Lower lip touching the soft tissue line
c) The relative proportions of nose and upper
lip are balanced
 Holdaway RA. A soft-tissue cephalometric analysis and its use in orthodontic
treatment planning. Part I. Am J Orthod 1983;84: 1–28.
 Holdaway RA. A soft-tissue cephalometric analysis and its use in orthodontic
treatment planning. Part II. Am J Orthod 1984;85: 279–293.

TONGUE ANALYSIS
 Ref points :
1) I = incisal edge of lower CI
2) M = cervical, distal 3rd of last erupted molar
3) V = most caudal point on shadow of the soft palate
these points form the ref line
Total 7 lines are formed

TONGUE PARAMETERS
1. Assessment of tongue
position
 Line 1 – dist b/w soft
palate and roof of tongue
 Lines 2-6 – relation of
the dorsum of the tongue
to the roof of the mouth
 Line 7 position of the tip
of the tongue relative to
the lower incisors
2. Assessment of tongue
mobility
 Template is used to
determine the height of
the dorsum of the tongue
on all seven lines
 Difference in occlusion
and rest position is
calculated

CEPHALOMETRIC ANALYSIS
1. E line ( ricketts analysis)
2. Holdaway’s analysis
3. Subtelny angular profile analysis
4. Merrifield z angle
5. Steiner’s S line
6. Inclination of nasal bone
7. Mentocervical angle
8. Submental – neck angle
9. Arnett’s soft tissue cephalometric analysis(STCA)
10. Cogs soft tissue analysis

MEASUREMENTS OF HOLDAWAY’S ANALYSIS
1. Soft tissue facial angle
2. Skeletal profile convexity
3. H angle
4. Nose prominence
5. Superior sulcus depth
6. Soft tissue chin thickness
7. Upper lip thickness
8. Upper lip strain
9. Upper lip to sulcus depth
10. Lower lip to h line
11. Inferior sulcus to h line

SOFT TISSUE FACIAL ANGLE
 Landmarks
1. Fh plane
2. N’
3. Pog’
Ideal values are 91+/- 7
deg

SKELETAL PROFILE CONVEXITY
 Landmarks –
1. Pt A
2. N
3. Pog
4. Ideal measurement
range is -2 to +2 mm

H ANGLE/ HOLDAWAY ANGLE
 Landmarks –
1. N’
2. Pog’
3. Ls
Ideal is 7- 15 deg
This angle measures
prominence of the upper
lip irt the overall soft tissue
profile
H angle increases with
convexity

NOSE PROMINENCE
 Landmarks-
1. Fh plane
2. Vermilion border of
upper lip
Tip of nose in front of line
Less than 14 is small
More than 24 is large

SUPERIOR SULCUS DEPTH
 Landmarks-
1. FH plane
2. Tangent to upper lip
Range 1-4 mm
Decreased value suggests
upper lip strain

SOFT TISSUE CHIN THICKNESS
 Land marks-
1. Skeletal facial plane
2. Soft tissue facial plane
Hard tissue pog to soft
tissue pog.
Ideal is 10 to 12 mm

UPPER LIP THICKNESS
 Landmarks –
1. 3 mm below Pt A
2. Alveolar process
Usual thickness at
vermilion border level is 13
to 14 mm

UPPER LIP STRAIN
 Landmarks-
1. Vermilion border of
upper lip
2. Labial surface of
maxillary central
incisor
 Ideally shd be same as
upper lip thickness if its
less then lip is strained

UPPER LIP SULCUS DEPTH
 Landmarks-
1. Sn
2. H line
Ideal 5 mm with range of
3-7 mm

LOWER LIP TO H LINE
 Landmarks –
1. Li
2. H line
Ideal 0 – 0.5 mm anterior
to h line with range of -1 to
+2 mm.

INFERIOR SULCUS TO THE H LINE
 Landmarks-
1. pt of greatest
incurvation at the
vermilion border of the
lower lip
2. soft tissue chin,
measure to h line.
 Contour should fall into
harmonious lines with
the superior sulcus form.

MERRIFIELD Z ANGLE
 By L Levern Merrifield in
1966.
 Landmarks –
1. FH plane
2. Pog’
3. Most protrusive lip point
 Merrifield LL. The profile line as an aid in critically
evaluating facial esthetics. Am J Orthod 1966;52:804–
822.

INCLINATION OF NASAL BONE
 Landmarks –
1. True vertical line
2. Long axis of nostrils
90 deg in men to 105 deg in
women

MENTOCERVICAL ANGLE
 By sommerville in 1988
 Landmarks –
1. Tangent to submental
area
2. E line
Ranges from 110 to 120deg
 Sommerville JM, Sperry TP, BeGole EA. Morphology of the submental and neck
region. Int J Adult Orthod Orthognathic Surg 1988;3:97–106.

SUBMENTAL NECK ANGLE
 Landmarks
1. Submental tangent
2. Neck tangent

CEPHALOMETRICS FOR ORTHOGNATHIC
SURGERY
 By C J BURSTONE in 1980
 Developed at univ of connecticut
 Called as facial form analysis
 Used landmarks &
measurements that can be
altered by common surgical
procedures
 C J BURSTONE. Soft tissue cephalometric analysis for
orthognathic surgery. J Oral Surg. 1980 Oct;38(10):744-51

FACIAL FORM ANALYSIS
1. FACIAL CONVEXITY ANGLE
2. MAXILLARY PROGNATHISM
3. MANDIBULAR PROGNATHISM
4. VERTICAL HEIGHT RATIO
5. LOWER FACE THROAT ANGLE
6. LOWER VERTICAL HEIGHT DEPTH RATIO

1. FACIAL CONVEXITY ANGLE
 Landmarks
1. G
2. Sn
3. Pg’
Mean value is 12 +/- 4
+ve value indicates a convex
profile
-ve value indicates concave
profile

2. MAXILLARY PROGNATHISM
 Landmarks
1. G
2. Sn
Mean value 6+/-3 mm
Describes max excess/deficiency in
AP.
+ve maxillary retrusion
-ve maxillary procumbency

3. MANDIBULAR PROGNATHISM
 Landmarks
1. G
2. Pg’
Mean value 0 +/- 4
Inference –
 Mandibular
prognathism/retrognathism
 Increase –ve value indicates
mandibular deficiency

4. VERTICAL HEIGHT RATIO
 Landmarks
1. G
2. Sn
3. Me
4. HP plane
Ratio of middle 3rd to lower 3rd
facial height
Ratio must be 1:1

5. LOWER FACE THROAT ANGLE
 Landmarks
1. Sn
2. Gn
3. C
Application is critical in
treatment planning to correct
anteroposterior facial dysplasia
Mean is 100+/- 7

6. LOWER VERTICAL HEIGHT DEPTH RATIO
 Landmarks
1. Sn- Gn’
2. C - Gn’
Useful for determining feasibility
of reducing or increasing the
prominence of chin
Mean is 1:2

LIP POSITION
A. NASOLABIAL ANGLE
B. UPPER LIP PROTRUSION
C. LOWER LIP PROTRUSION
D. MENTOLABIAL SULCUS
E. VERTICAL CHIN LIP RATIO
F. MAXILLARY INCISAL EXPOSURE
G. INTERLABIAL GAP

B.NASOLABIAL ANGLE
 Landmarks
1. Cm
2. Sn
3. Ls
Mean is 100+/-8
Obtuse angle indicates maxillary
hypoplasia and calls for
maxillary proclination or
advancement

C. UPPER LIP PROTRUSION
 Landmarks
1. Ls
2. Sn
3. Pg’
Mean is 3+/-1 mm

D.LOWER LIP PROTRUSION
 Landmarks
1. Li
2. Sn
3. Pg’
Mean 2+/-1 mm

E. MENTOLABIAL SULCUS
 Landmarks
1. Sl
2. Li
3. Pg’
Measured from depth of sulcus
perpendicular to the li – pg’ line.
Mean is 4+/-2 mm
factors

F. VERTICAL CHIN LIP RATIO
 Landmarks
1. Sn
2. Stms
3. Stmi
4. Me’
Lower 3rd of face can be divided into
3rds
1. Length of upper lip
2. Distance stmi-Me’ shd be 2/3rd
Ratio should be 1:2

G.MAXILLARY INCISAL EXPOSURE
 Landmarks
1. Stms
2. I
2 mm of exposure at rest is
desirable

H.INTERLABIAL GAP
 Landmarks
1. Stms
2. Stmi
3. Vertical distance b/w upper &
lower lip at rest
4. Mean 2+/- 2

ARNETT & BERGMANN ANALYSIS
 DENTOSKELETAL FACTORS
 SOFT TISSUE STRUCTURE
 FACIAL LENGTH
 PROJECTION TO TVL
 ARNETT GW, BERGMANN RT.SOFT TISSUE CEPHALOMETRIC ANALYSIS: DIAGNOSIS AND TREATMENT
PLANNING OF DENTOFACIAL DEFORMITY.AM J ORTHOP AND DENTOFACIAL ORTHOD1999;116:239-53)

DENTOSKELETAL FACTORS
1. U1 to max occlusal
plane
2. L1 to mand occlusal
plane
3. Maxillary occlusal
plane
4. Overbite
5. overjet

SOFT TISSUE STRUCTURES
1. Upper lip thickness
2. Lower lip thickness
3. Pogonio-pogonion’
4. Menton-menton’
5. Nasolabial angle
6. Upper lip angle

FACIAL LENGTH
1. Facial height (na’-me)
2. Lower 1/3rd height (sn-
me’)
3. Upper lip length(sn to
upper lip inferior)
4. Lower lip length(lower
lip superior to me’)
5. Interlabial gap

FACIAL LENGTH
6. U1 exposure (soft to
hard tissue, upper lip
inferior to max incisor
tip)
6. Maxillary height(sn to
maxillary incisor tip)
6. Mandibular
height(mandibular
incisor tip to me’)

PROJECTIONS TO TVL
1. GLABELLA
2. ORBITAL RIMS
3. CHEEK BONE
4. SUBPUPIL
5. ALAR BONE
6. NASAL PROJECTION
7. SUBNASALE
8. A POINT’
9. UPPER LIP ANTERIOR
10. U1
11. L1
12. LOWER LIP ANTERIOR
13. B POINT’
14. POGONION’

ARNETT SOFT TISSUE ANALYSIS
 19 TRAITS IN 2 VIEWS
1. FRONTAL
2. PROFILE
 ARNETT GW,BERGMANN RT. FACIAL KEYS TO ORTHODONTIC DIAGNOSIS AND TREATMENT
PLANNING.PART II. AJO/DO 1993;103:299-312.

 FRONTAL VIEW
A. OUTLINE FORM
B. FACIAL LEVEL
C. MIDLINE ALIGNMENTS
D. FACIAL ONE THIRDS
E. LOWER 1/3RD
EVALUATION
1. UPPER AND LOWER LIP
LENGTHS
2. INCISOR TO RELAXED
UPPER LIP
3. INTELABIAL GAP
4. CLOSED LIP POSITION
5. SMILE LIP LEVEL
 PROFILE VIEW
A. PROFILE ANGLE
B. NASOLABIAL ANGLE
C. MAXILLARY SULCUS
CONTOUR
D. MANDIBULAR SULCUS
CONTOUR
E. ORBITAL RIM
F. CHEEKBONE CONTOUR
G. NASAL BASE LIP
CONTOUR
H. NASAL PROJECTION
I. THROAT LENGTH
J. SUBNASALE POGONION
LINE

A.OUTLINE FORM AND SYMMETRY
 FACIAL HEIGHT –
HAIRLINE(H) TO SOFT
TISSUE MENTON(Me’)
 FACIAL WIDTH –
ZYGOMATIC ARCH (ZA)
TO ZYGOMATIC
ARCH(ZA),
GONION(Go’) TO
gonion (Go’).
 Height to width ratio
1.3:1 for f
 1.35:1 for m

B.FACIAL LEVEL
 Pupil plane (PP) also
called frontal postural
horizontal.
 Upper dental arch(UDA)
 Lower dental arch(LDA)
 Chin jaw line (CJL)
drawn under surface of
chin at maximum tissue
contact

CONSTRUCTED POSTURAL HORIZONTAL
REFEFENCE LINE
 If pupil in head position
not at level of horizon
then a constructed
horizontal reference line
is used
 Contructed Postural
Horizontal Reference
line – line through pupil
area parallel to floor.

C. MIDLINE ALIGNMENTS
 NASAL BRIDGE(NB)
 NASAL TIP(NT)
 FILTRUM(F)
 UPPER INCISOR
MIDLINE(UIM)
 LOWER INCISOR
MIDLINE(LIM)
 CHIN MIDLINE(Me’)
 Points shd be ona line
perpendicular to the
frontal postural
horizontal

D.FACIAL ONE THIRDS
 Lines through
A. HAIRLINE (H)
B. MIDBROW (Mb)
C. SUBNASALE(Sn)
D. SOFT TISSUE
MENTON(Me’)

E. LOWER ONE THIRDS EVALUATION
1. UPPER AND LOWER
LIP LENGTHS
 With relaxed lips line through
a) SUBNASALE(Sn)
b) UPPER LIP INFERIOR(ULI
c) LOWER LIP
SUPERIOR(LLS)
d) SOFT TISSUE
MENTON(Me’)
e) UPPER LIP IS HALF THE
LENGTH OF LOWER LIP
LIP REDUNDANCY

2. INCISOR TO RELAXED UPPER LIP
 LIPS RELAXED
 UPPER LIP
INFERIOR(ULI)
 MAXILLARY INCISOR
EDGE(MxIE)
 UPPER TOOTH TO
LIP(UTTL) is the vertical
dimensionof exposed
incisor b/w ULI and
MxIE

3. INTERLABIAL GAP
 UPPER LIP
INFERIOR(ULI)
 LOWER LIP
SUPERIOR(LLS)

PROFILE VIEW
 MAXILLARY
SULCUS CONTOUR
 INFROMS ABOUT
UPPER LIP TENSION
 CAN BE –
ACCENTUTATED,
GENTLE OR FLAT
 MEASUREMENT IS
IMPRACTICAL

 MANDIBULAR
SULCUS CONTOUR
 INDICATES LIP
TENSION
 CAN BE
ACCENTUATED,
GENTLE OR FLAT

 ORBITAL RIM
 MEASUREDFROM
ANTERIOR MOST
GLOBE(Gb) TO
ORBITAL RIM POINT
(Or)
 Subjectively can be
normal, flat or protruded

CHEEKBONE CONTOUR
 Is anteriorly facing
 Starts anterior to ear
extending fwd through
cheekbone
point(CP),then antero
inferiorly at maxilla
point(MxP) adjacent to
alar base of nose.
 Divided into 3 reas
1. Zygomatic arch
2. Middle contour area
3. Subpupil area

MANDIBULAR AND MAXILLARY RETRUSION

NASAL PROJECTION
 FROM Sn to NT.
 NORMALLY 16 TO 20
mm
 Indicator of maxillary
anteroposterior position

THROAT ANGLE
 TL – throat length
 From NTP to Me’
 Described as normal long
or short
 Pt with sagging throat
length is not not a good
candidate for mandibular
setback.

SUBNASALE POGONION LINE
 Lip projections evaluated
with this line

CONCLUSION
 Orthodontists use dental, skeletal and facial keys to
diagnose and to treat malocclusions.
 Dental keys include overjet, canine occlusion &
molar occlusion.
 The dental keys are given much weight in the
determination of treatment, facial keys used by
orthodontist include relative positions of the upper
lip, lower lip & chin these give information but very
less insight into comprehensive diagnosis.

CONCLUSION
 In contrast with the help of soft tissue
cephalometrics an organized, comprehensive
approach to facial analysis can be done with analysis
normal facial traits can be maintained and
abnormals can be corrected with orthodontics and
surgery.

REFERENCES
 RADIOGRAPHIC CEPHALOMETRY – ALEXANDER
JACOBSON
 AN ATLAS AND MANUAL OF CEPHALOMETRIC
RADIOGRAPHY – THOMAS RAKOSI 1982
 LEGAN HL, BURSTONE CJ. SOFT TISSUE CEPHALOMETRIC
ANALYSIS FOR ORTHODONTIC SURGERY. J ORAL SURG
1980: 38: 81-87.
 MERRIFIELD LL. THE PROFILE LINE AS AN AID IN
CRITICALLY EVALUATING FACIAL ESTHETICS. AM J
ORTHOD 1966;52:804–822.
 ARNETT GW,BERGMANN RT. FACIAL KEYS TO
ORTHODONTIC DIAGNOSIS AND TREATMENT
PLANNING.PART II. AJO/DO 1993;103:299-312.

REFERENCES
 ARNETT GW, BERGMANN RT.SOFT TISSUE CEPHALOMETRIC
ANALYSIS: DIAGNOSIS AND TREATMENT PLANNING OF
DENTOFACIAL DEFORMITY.AM J ORTHOP AND DENTOFACIAL
ORTHOD1999;116:239-53).
 SUBTELNY JD. A LONGITUDINA; STUDY OF SOFT TISSUE FACIAL
STRUCTURES AND THEIR PROFILE CHARACTERISTICS,
DEFINED IN RELATION TO UNDERLYING SKELETAL
STRUCTURES. AM J ORTHOD DENTOFACIAL ORTHOP 1959;45:41-
507.
 RICKETTS RM. PLANNING TREATMENT ON THE BASIS OF THE
FACIAL PATTERN AND AN ESTIMATE OF ITS GROWTH. ANGLE
ORTHOD 1957;27:14–37.
 RICKETTS RM. CEPHALOMETRIC ANALYSIS AND SYNTHESIS.
ANGLE ORTHOD 1961;31:141–156.

 STEINER CC. CEPHALOMETRICS AS A CLINICAL TOOL. IN:
KRAUS BS, RIEDEL RA (EDS). VISTAS IN ORTHODONTICS.
PHILADELPHIA: LEA & FEBIGER, 1962.
 HOLDAWAY RA. A SOFT-TISSUE CEPHALOMETRIC ANALYSIS
AND ITS USE IN ORTHODONTIC TREATMENT PLANNING. PART I.
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 HOLDAWAY RA. A SOFT-TISSUE CEPHALOMETRIC ANALYSIS
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