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Clinical facial analysis (CFA) for orthodontists and maxillofacial surgeons
By Mohammed AlmuzianUniversity of Glasgow, 2012
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What is Clinical Facial Analysis?It is the method utilized by clinician for evaluating and judging the patient‘s face; to define its proportions, volume, appearance, symmetry, and visible
deformities. (Biondi, 2005)
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To whom CFA might be beneficial?
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Methods of CFA
Direct examination
Clinical photographs
Non Radiographical 3D imaging methods
Conventional & 3D x-ray imaging.
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Is CFA parameters are standard?
Racial background
Cultural difference
Gender
Personal preference
Clinician philosophy
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Importance of CFA
• To diagnose and classify the deformities especially for border line cases.
• To plan the treatment approach that mainly addresses the patient concerns and complaints.
• To predict the treatment outcomes, stability & prognosis.
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When CFA should be performed?
Thorough CFA Initial CFA
Observation stage
Questionnaire stage
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Steps in CFA
Positioning the patient • NHP (developed by.., tested by…, described by…. • Centric relation• Relaxed lip position, BOWB (bite opening wax bite)
indicated in………• First tooth contact (wax bite , deprogramming splint)Then 1. Frontal view analysis, 2. Profile view analysis, 3. 45 degree view analysis for profile-frontal shared features.
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Frontal view analysis
Vertical analysis of the frontal viewFacial typeVertical heightsLip assessment
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Facial type
(Naini 2008)
Vertical analysis of the frontal view
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Vertical heights
Vertical analysis of the frontal view
1. upper third 2. middle third 3. lower third • Upper lip• Lower lip and chin• Interlabial gap
Bell et al 1980 Fish and Epker 1981Ricketts et al 1979Farkus 1984
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Lip assessment (LAMP),
miniesthetic analysis
• Line, • Activity• Morphology• Position
Mossy 1981Fish & Epker 1981Naini 2008
Vertical analysis of the frontal view
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Frontal view analysis
Transverse analysis of frontal viewVertical reference lines (Facial midline, Rule of fifths)Skeletal base assessment(Maxillary & Mandibular)Smile analysis
Dental factors
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Transverse analysis of frontal view
Vertical reference linesFacial midlineRule of fifths
Naini 2008Arnett and McLaughlin 2004Sheen, 1978
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Transverse analysis of frontal view
Skeletal base assessment
Mandibular assessment Chin jaw line
Maxillary assessment Sclera show
Paranasal hollowing
Naini 2008Hunt & Ruge 1983
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Transverse analysis of frontal view
Smile analysis
• The smile arc• Width of smile• Incisor and
gingival show (Posed, social smile)
Naini 2008
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Transverse analysis of frontal view
Dental factors
• Overbite• Occlusal plane
(Upper, lower, anterior posterior)
• Maxillary dental midline
• Mandibular dental midline
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Profile analysis
Total soft tissue profile analysisAnalysis of the high midfaceAnalysis of the maxillary areaAnalysis of the mandibular area
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Facial profile analysis
Total soft tissue profile analysis
Angle of convexity , Burstone 1968, 11-30 degree .
Nasomental angle (Total facial angle) 160 degree
Burstone 1965Moshiri et al, 1982Powell et al 1984
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Facial profile analysis
Analysis of the high midface
• Soft tissue glabella • Orbital rim • Check bone contour
Fish & Epker 1981
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Facial profile analysis
Analysis of the maxillary area
• Nasal base (Meridian line)
• Nasal projection (TVL)Anteroposterior lip position (TVL, E line, S line, H line) • Relationship of upper
lip to nose
Gonzales-Ulloa 1966Arnett & Bergman 1993
Ricketts 1979Steiner 1966Holdaway 1983Fish & Epker 1981
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Facial profile analysis Analysis of the mandibular area
1 .Anteroposterior lip position (TVL, E line, S line)
2 .Relationship of lower lip to chin
3. Anteroposterior chin positionBass aesthetic analysis Facial vertical
Holdaway angleProfile line or Z angle
4. Relationship of chin to submental area• Lip-chin-submental plane • Submental plane length
Gonzales-Ulloa 1966Arnett & Bergman 1993
Ricketts 1979Steiner 1966Bass, 2003Merrifield, 1966Moshiri et al, 1982
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Dental Appearance: Micro-Esthetics.
Tooth ProportionsWidth Relationships and the "Golden Proportion "
Height-Width RelationshipsGingival Heights, Shape and Contour
ConnectorsEmbrasures: Black TrianglesTooth Shade and Color
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Thank you