Antropometry survey methods orthodontic patients

Antropometry survey methods orthodontic patients. Photometry in orthodontics.

ANTHROPOMETRIC METHODS OF INVESTIGATION

During the first visit of the patient jaw impresses are obtained with the help of impress mass. This is done to see clearly the alveolar processes, apical bases, palatine vault, sublingual region, frenula of tongue and lips. Models are cast in gypsum or supergypsum. Models bases can be shaped with the help of special devices, rubber moulds, or cut in such a way that the socle angles correspond to the line of canine teeth, the bases are parallel to the mastication surfaces of teeth. The patient’s name, surname and age, the date of obtaining impresses are marked on the models. Such models are called control or diagnostic.

To study the dimensions of teeth, dental arches, apical bases of jaws it is expedi­ent to use a meter or a special slide gauge, and also different devices like orthocross, symmetroscope, orthometer.

Models study is conducted in three mutually perpendicular axes: sagittal, occlu-sive, frontal, and corresponding to them directions: sagittal, transversal, and vertical (Fig. 38).

Teeth Measuring

The width, height, and thickness of the coronal part of tooth are measured. The width is detected in the widest part of the tooth — in all teeth at the level of equator, and in lower incisors — at the level of scalprum (Fig. 39). For the frontal group of teeth it is the mediolateral dimension of tooth, for lateral — mesiodistal; though in contemporary literature, both domestic and foreign, the width of the coronal part of all teeth is spoken of as the mesiodistal dimension.

The height of the coronal part of permanent teeth is measured from the cutting edge of tooth to its border with the gingival margin: of the frontal teeth — along the middle of the vestibular surface, of the lateral ones — along the middle of the buc-cal tubercle.

The thickness of the coronal part of tooth is its mesiodistal dimension for the incisors and canine teeth and mesiolateral dimension for the premolars and molars.

The data of average value of the coronal part of milk teeth is shown in the table by Wetzel, and permanent — in the table by V.D. Ustymenko (Table 5).

 

Fig. 38. Planes for the study of jaw models: a — tuberal; b — sagittal; c — occlusal

Fig. 39. Tooth width measuring with the help of the caliper

Table 5. Permanent Teeth Crowns Data (according to V.D. Ustymenko)

 

Jaw	Tooth name	Width, mm		Height, mm		Thickness, mm
		Average variant	Basic variant	Average variant	Basic variant	Average variant	Basic variant
Upper	LL1	8.5	8.0-9.0	8.9	8.2-9.7	7.2	7.7-7.7
	2.L2	6.5	6.0-7.1	7.8	7.1-8.5	6.3	5.7-6.7
	3J.3	7.6	7.1-8.1	8.9	8.0-9.6	8.2	7.7-8.7
	4.L4	6.7	6.2-7.2	7.3	6.6-8.0	9.0	8.5-9.5
	5.L5	6.4	6.0-7.0	6.1	5.3-6.9	9.2	8.6-9.9
	6-L6	9.4	8.7-10.0	5.2	4.5-5.9	10.9	10.4-11.2
	7.L7	9.4	8.7-10.0	5.2	4.5-5.9	10.9	10.4-11.2
Lower	1T1	5.3	4.9-5.6	7.8	7.0-8.6	6.1	5.6-6.6
	2T2	6.0	5.6-4.6	7.9	7.2-8.7	6.3	5.8-6.8
	3T3	6.7	6.3-7.2	9.4	8.5-10.2	7.5	7.0-8.0
	4T4	6.8	6.4-7.3	7.8	7.2-8.5	7.6	7.1-8.1
	5T5	7.0	6.5-7.4	6.7	6.0-7.3	8.1	7.6-8.6
	6T6	10.0	10.3-11.7	5.5	4.4-6.1	10.3	9.7-10.8
	7r7	10.2	9.6-10.8	5.2	4.5-5.9	10.1	9.6-10.6

Teeth Dimensions Correlation

Dimensions correlation of the upper and lower permanent incisors is defined by P. Tonn’s index, which normally equals 1.33:

4 upper incisors width total _ 4    , -, 4 lower incisors width total     3

Z.I. Dolhopolova studied the correlation of the totals of the milk upper and lower incisors width by Tonn’s method and confirmed their interconnection at phys­iological occlusion. Z.I. Dolhopolova’s index makes 1.30.

Dental Arches Measurements

Dental arches measurements are performed in the transversal (cross) and sagittal (longitudinal) directions. In the transversal direction the width of dental arches is studied, in the sagittal — their length.

Transversal Dimensions of Dental Arches

Z.I. Dolhopolova offered to measure the width of dental arches on the upper and lower jaws between the central and lateral incisors, canine teeth, the 1^st and 2^nd milk molars in children in the period of milk teeth occlusion. The measuring points in the central and lateral incisors and canine teeth are located on the apices of teeth tu­bercles, in the 1^st and 2^nd milk molars — on the masticatory surfaces in the frontal recess in the intersection point of the longitudinal and transversal sulci (Fig. 40; Table 6).

Table 6. Average Dimensions of Dental Arches in Children Aged 3—6 years (according to Z.I. Dolhopolova)

 

Upper dental arch	Age, years	Interdental width, mm				Length, mm
		II II	III III	IV IV	V V	From I to V
	3	17.6±0.2	26.4±0.3	26.4±0.2	40.8±0.2	30.0±0.2
	4	17.6±0.2	27.2±0.2	36.6±0.3	41.0±0.3	30.4±0.2
	5	18.1±0.2	27.1±0.2	35.5±0.2	41.0±0.2	30.2±0.2
	6	18.8±0.2	27.9±0.2	35.3±0.2	40.4±0.2	30.5±0.1
	Difference	1.2	1.5	0.2	0.1	0.5
	Average dimensions	17.2—18.8	26.3—27.8	35.0—35.3	40.8—40.9	30.0—30.5
Lower dental arch	Age, years	Interdental width, mm				Length, mm
		II II	III III	IV IV	VJ.V	From I to V
	3	13.3±0.14	21.1±0.2	29.8±0.2	35.6±0.2	26.2±0.2
	4	13.4±0.14	21.4±0.2	30.6±0.2	36.2±0.3	27.0±0.2
	5	I3.8±0.21	21.7±0.2	30.2±0.2	36.1±0.2	26.6±0.2
	6	I4.6±0.17	22.7±0.2	30.5±0.2	36.2±0.2	26.5±0.2
	Difference	1.28	1.2	0.7	0.69	0.32
	Average dimensions	13.3—14.6	21.0—22.2	From 29.7	35.5—36.2	26.2—26.5

Fig. 40. Detecting transversal dimensions of dental arches in children in the period of milk occlusion

In the period of permanent teeth occlusion Font’s technique is used for detecting the transver­sal dimensions of dental arches. The technique is based on the dependence between the mesiodistal dimensions total of the 4^th upper incisors and the distance between the 1^st premolars and the 1^st mo­lars on the upper and lower jaws. With this pur­pose Pont offered measuring points, which coin­cide at the closure of the upper and lower teeth. So, their dental arches width is identical.

In the region of the 1^st premolars dental arch width is measured, according to Pont:

• on the upper jaw — between points in the middle of the intertubercular fissure;

•   on the lower jaw — between distal contact points on the clivus of the buccal tubercles.

In the region of the 1^st permanent molars dental arch width is measured: « on the upper jaw — between points in the frontal recesses of the longitudinal fissure;

 

 

Fig. 41. Font’s measurement points and dental arches width measurement: a — upper jaw; b — lower jaw; c — measuring instruments

•  on the lower jaw — between the posterior buccal tubercles (Fig. 41).

In the period of transitional dental arch the distal foveolae of the upper 1^st milk molars or their posterior buccal tubercles on the lower jaw are taken instead of the measuring points (by Korkhaus).

Pont derived the premolar and molar indices, by which the indices of dental arches width in the region of premolars and molars within the mark can be detected depending on the total of the mesiodistal dimensions of the 4^th upper incisors:

4^Ih upper incisors transversal dimensions total

Premolar index =   —               —x 100 = 80.

Distance between premolars

4^th upper incisors transversal dimensions total

Molar index =                 —xlOO = 64.

Distance between molars

H. Under and G. Harth checked Font’s method and made corrections in the index figures. According to the scholars, the premolar index equals 85, and the molar one — 65. These indices can be used in the period of transitional dentition and in the period of permanent occlusion. In practical work it is recommended to use their table (Table 7).

Except for studying dental arches width in the region of premolars and molars it is expedient to study dental arches width in the region of canine teeth, which is mea­sured between the apices of their cutting edge (Fig. 42).

 Fig. 42. Dental arches width detection in the region of canine teeth

 

In the Table 8 average indices of denti­tions width in the region of canine teeth, of­fered by A.B. Slabkovska, are given on the ba­sis of mesiodistal dimensions total of the 4^lh lower incisors, because their dimensions are less variable.

Table 7. Dental Arches Width Indices

 

(according to H. Linder and G. Harth)

 

4* upper incisors width total, nun	Width in premolars region, mm	Width in molars region, mm
27.0	“        32.0	41.5
27.5	32.5	42.3
28.0	33.0	43.0
28.5	33.5	43.8
29.0	34.0	44.5
29.5	34.7	45.3
30.0	35.5	46.0
30.5	36.0	46.8
31.0	36.5	47.5
31.5	37.0	48.5

 

Table 7 continued

 

4* upper incisors width total, mm	Width in premolars region, mm	Width in molars region, mm
32.0	37.5	49.0
32.5	38.2	50.0
33.0	39.0	51.0
33.5	39.5	51.5
34.0	40.0	52.2
34.5	40.5	53.0
35.0	41.2	54.0
35.5	42.0	54.5
36.0	42.5	55.5

Table 8. Dental Arches Width Indices in the Region of Canine Teeth

(according to A.B. Slabkovska)

 

4* lower incisors width total, mm	Dental arches width in the region of canine teeth, mm
	Upper	Lower
20.3	29.3	21.3
20.7	39.9	21.9
21.1	30.4	22.4
21.4	31.0	23.0
21.8	31.5	23.5
22.2	32.1	24.1
22.6	32.6	24.6
23.0	33.2	25.2
23.3	33.7	25.7
23.7	34.2	26.2
24.1	34.8	26.8
24.5	35.4	27.4
24.8	35.9	27.9
25.2	36.4	28.4
25.6	37.0	29.0
25.9	37.5	29.5
26.3	38.1	30.0
26.7	38.6	30.6
27.1	39.1	31.1

 

Sagittal Dimensions of Dental Arches

Sagittal dimensions of dental arches in children at the age from 3 till 6—7 years (in the period of milk teeth occlusion) are measured by Z.I. Dolhopolova’s method. At that, the length of the anterior part and the total sagittal dental arch length are detected.

The length of the anterior dental arch part is measured from the middle of the distance between the mesial angles of the central incisors from their vestibular surface on sagittal plane to the point of intersection with the line joining the distal surfaces of the milk canine teeth crowns; the total sagittal length — to the point of intersection with the line joining the distal surfaces of the 2^nd milk molars (Fig. 43).

The average data of sagittal dimensions of dental arches in children with milk teeth are given in the Table 9.

 

Table 9. Sagittal Dimensions of Dental Arches in Children Aged 3—7 Years at Physiological Occlusion (according to Z.I. Dolhopolova)

 

Measuring in the region of	Age, years
	3	4	5	6-7
Upper jaw, mm (M ± m)
I-III	9.9+0.1	10.0±0.1	10.6±0.1	10.3±0.1
I-V	29.8±0.1	29.7±0.2	30.1 ±0.1	30.7+0.1
Lower jaw, mm (M ± m)
I-III	6.5±0.1	6.9+0.1	7.2±0.1	7.1±0.1
I-V	26.3±0.1	26.5±0.5	26.9±0.1	27.3±0.1

In the period of permanent occlusion the length of the anterior part of the upper and lower dental arches in the sagittal direction is measured by G. Korkhaus’ method. G. Korkhaus supplemented Font’s method, having offered to measure the length of the anterior dental arch part depending on the sum of mesiodistal dimensions of the 4^th upper incisors. The measurement is conducted from the contact point on the su­perior surface of central incisors sculpri to the point of intersection with the line drawn through Font’s points in the region of the 1^st premolars. Korkhaus comprised a table of the values of the length of the anterior upper dental arch part at different totals of the 4^th upper incisors width. These figures, reduced by 2 mm (according to the upper incisors thickness), may be used to detect the length of the anterior lower dental arch part (Table 10, Fig. 44).

Measuring the Longitudinal Length of Dental Arches

Measuring the longitudinal length of dental arches is conducted by N. Nance’s method with a ligature wire by means of locating it from the distal surface of the 1^st molar to the distal surface of the 1^st molar of the opposite side, shaping the wire in

 

Table 10. Indices of the Length of the Anterior Part of the Upper and Lower Dental Arches

(according to G. Korkhaus)

 

Total of the 4″1 upper incisors width, mm	Length of the anterior part of the upper dental arch, mm	Length of the anterior part of the lower dental arch, nun	Total of the 4* upper incisors width, mm	Length of the anterior part of the upper dental arch, mm	Length of the anterior part of the lower dental arch, mm
27.0	16.0	14.0	32.0	18.5	16.5
27.5	16.3	14.3	32.5	18.8	16.8
28.0	16.5	14.5	33.0	19.0	17.0
28.5	16.8	14.8	33.5	19.3	17.3
29.0	17.0	15.0	34.0	19.5	17.5
29.5	17.3	15.3	34.5	19.8	17.8
30.0	17.5	15.5	35.0	20.0	18.0
30.5	17.8	15.8	35.5	20.5	18.5
31.0	18.0	16.0	36.0	21.0	19.0
31.5	18.3	16.3	36.5	21.5	19.5

the form of the dental arch. In the region of lateral teeth the wire is located along the middle of the masticatory surface, of frontal teeth — along the cutting edges. The longitudinal length of dental arch normally equals to the total of the mesiodistal di­mensions of the 12 teeth

 

 

Fig. 43. Detection of the sagittal di­mensions of dental arch in children in the period of milk occlusion

Fig. 44. Detection of the length of the anterior part of the dental arch

 

Diagnostics of Dental Arches Symmetry and Lateral Teeth Displacement

To detect the inadequacy of lateral teeth location in the dental arch in the sagittal and transversal directions Fuss’ technique is used, which allows correlating the dimen­sions of the right and left dental arch halves and detect the unilateral shift of the lateral group of teeth on plaster jaws models (Fig. 45). For this purpose right triangles are built, one cathetus of which will be the median palatine suture, the other — the perpendicular from it to Font’s points on the I^s1 premolars and 1^st molars, and hypote­nuse — the line between the contact points of the central incisors and Font’s points.

Mesial dislocation of lateral teeth can be detected on plaster jaw models by means of comparing the distances from the interincisor papilla to the apices of canine teeth or Font’s points on the 1^st premolars and 1^st molars on the right and on the left. On the side of predictable mesial displacement of lateral incisors this distance will be reduced if compared to the opposite side and norm (Fig. 46).

It is Schwarz’ opinion that the difference of tangents to the distal surface of the 1^st permanent molars, drawn at right angle to the median palatine suture, will point at the unilateral mesial displacement of lateral teeth.

G.P. Schmuth offered to use for diagnostics the raphe-papilla tangent (RPT), which is drawn through the posterior margin of the incisive papilla and the first pair of transversal palatine folds. RPT is to cross the middle of canine teeth crowns (Fig. 47).

Also, lateral teeth position can be estimated relative to the point 0, located on the intersection of the median palatine suture and a tangent to the distal surfaces of the I^st permanent molars. The distance from this point to Font’s measuring points on the 1^st premolars (line b) and 1^st molars (line a), and also the distance along the median palatine suture from the point O to the apex of the interincisor papilla (line c). The distance from the point O to the measuring points to the right and to the left is to be identical (Fig 48).

Studying Dental Arches Segments by Gerlach

Gerlach offered to study the proportionality of the dental arches of the upper and lower jaws by the correlation of segments, which were singled out by him: anterior, which includes 4 incisors, and two lateral (right and left), which include a canine

 

 

Fig. 45. Studying dental arches symmetry by Fuss’ technique

Fig. 46. Studying the shift of the mesial-lateral teeth on plaster

jaw casts:

a — by the distance from the interincisor papilla to the canine teeth, pre­molars, and molars; b — by the location of perpendiculars from the distal surfaces of molars on the median palatine suture

Chapter 4. Auxiliary Methods of Examining Patients with Dentognathic Anomalies…

tooth, premolars and a 1^st permanent molar. The anterior upper segment (SI) and the anterior lower segment (Si) are detected by the sum of the mesiodistal dimensions of the upper and lower incisors. The lateral segments of both upper (Lor and Lof) and lower (Lur and Lul) jaws on the right and on the left are measured by the size of a cord — the line, which joins the mesial surface of canine teeth in the point of contact with the lateral incisors and the distal surface of 1^st molars in the point of their con­tact with the 2^nd molars (Fig. 49).

Gerlach’s formula for studying dental arches segments correlation:

Lor> SI<Lol, Lr = LI (±3 %),

where L — lateral segment: the sum of the canine tooth, both premolars and the 1^st molar (r — right, / — left).

SI = L — 0.1 (±3 %) (straight occlusion),

57 = L (±3 %) (normal overbite), where / — upper incisors, L — lateral segment.

Palatine Vault Measuring

On plaster models of the upper jaw such parameters of the palatine vault are detected: depth (height), width, length, and palate angle.

In children aged 3—7 years the study of hard palate parameters is conducted by Z.I. Dolhopolova’s method. Palate circuits are obtained with the help of Korkhaus’ symmetrograph with a cutting grid (Fig. 50).

In the transversal direction palatine vault circuits are obtained at the level of the milk lateral incisors, canine teeth, 1^st and 2^nd milk molars, on which the palate width and depth are studied. In the sagittal direction palatine vault circuits are detected from the apex of the interincisor papilla along the palatine suture to the point of intersection with the tangent joining the distal surfaces of 2^nd milk molars, and the length of the palate is measured. The average values of palatine vault parameters in children aged 3—7 years with physiological occlusion of dental arches are given in the Table 11.

Table 11. Palatine Vault Dimensions in Children Aged 3—7 Years with Physiological Occlusion of Dental Arches (according to Z.I. Dolhopolova), mm

 

Parameters	Measuring in the region		Age, years
			3	4	5	6-7
Width	II	II          1	15.3+0.1	14.7±0.1	15.5±0.1
	III	III	22.7±0.2	22.4+0.2	23.1+0.2	24.7+0.2
	IV	IV	26.1±0.2	25.8±0.2	26.4±0.2	27.9±0.2
	V	V	29.0±0.2	29.1±0.2	29.7±0.2	31.0±0.2
Height	II	II	0.8+0.1	0.8±0.1	0.8+0.1	1.0+0.1
	III	III	4.2+0.1	4.0±0.1	3.8+0.1	3.9±0.1
	IV	IV	9.0±0.1	9.5±0.1	9.6±0.1	9.7±0.1
	V	V	10.8+0.1	11.4+0.1	11.5±0.1	11.8±0.1
Length	From I to III		10.1±0.1	10.0+0.1	10.2±0.1	10.4+0.0
	From I to V		28.5±0.1	28.3±0.1	28.5±0.1	28.7±0.1

 

 

Fig. 47. Studying dental arch symmetry by Schmuth’s      Fig. 48. Studying dental arch symmetry

technique:    with the help of the point O

RPT— the raphe-papilla tangent

Lur

Lul

 Fig. 49. Measurement of lateral segments by Gerlach

In the period of transitional dentition and in the period of permanent teeth oc­clusion palatine vault circuits in the sagittal and transversal directions are also ob­tained with the help of Korkhaus’ symmetrograph. The values of palatine vault pa­rameters (length, height, width, and palate angle) are detected by the following technique:

•    the palatine vault length is measured from the apex of the interincisor papilla
(lateral approximal surfaces of central incisors) along the median palatine suture to
the line joining the distal surfaces of the 1^st permanent molars;

•    the palatine vault depth is detected by the value of the perpendicular from the
deepest point on the drawn circuit of the palate on the line joining the apices of the
interdental papillae between the 2^nd premolars and 1^st molars;

•    the palatine vault width is measured along the line joining the apices of the
interdental papillae between the 2^nd premolars and 1^st molars;

PHOTOMETRIC METHODS OF INVESTIGATION

Anthropometric investigation is based on the regularities of the structure of the facial and cerebral parts of the skull, proportionality of the correlation of different parts of head and their relations to certain planes.

The study is conducted on the head of the patient, on photographs of the face, teleroentgenograms.

To characterize the dimensions of the patient’s head and face the following pa¬rameters are determined: width, length and depth.

The width of head is studied in its upper, middle, and lower parts (Fig. 56):

•        the head width (eu—eu) — between laterally prominent points (eu) on the lat¬

eral surface of head on the right and on the left;

•        the morphological width of head (zy—zy) – – between the most protruding

points (zy) of the temporal arch on the left and on the right;

•        the face width (go—go) — between the inferior and downwards located points

(go) of the lower jaw angles on the right and on the left (the upper jaw width is mea¬

sured similarly).

The head length (gl~op) is measured between the most protruding point on the lower part of forehead along the medial-sagittal plane above the root of nose between the eyebrows and the most backwards protruding point (op) of the occiput on the medial-sagittal plane (Fig. 57).

The head height (t—v) is detected from the point (?), located on the hircus of ear, along the perpendicular to the line gl—op to the protruding point (v) on head circum¬ference.

Except for the head height, the face height is also studied: morphological (upper, lower, and full) and physiognomic.

•        The upper morphological height efface (n—pf) is measured between the point

(«) located on the intersection of the median plane with the nasofrontal suture and

the most anterior point (pr) of the alveolar crest of the upper jaw in the median in¬

tersection at the orientation of the skull by the Frankfort plane.

•        The lower morphological height of face (pr—gri) is detected between the points

(pr) and (gri) of the joining of the circuit of the lower jaw inferior margin and the

external circuit of symphysis.

cu

gt

Fig. 56. Measuring the head width (eu—eu), morpho­logical   face   width   (zy—zy),    face   width   (go—go) (L.S. Persin, 2004)

Fig. 57 Measuring the length (gl-₀p) and height (f-v) of head (L.S. Persin, 2004)

 

gn

 

Fig. 58. Measuring the upper (n—pr), low­er (pr-gri), and full morphological (n—gn) and physiognomic (tr—gn) height of face (L.S. Persin, 2004)

Fig. 59. Measuring the face depth (/-« t-sn, r-pg, t-gn) (L.S. Persin, 2004)   ‘

Fig.  60.  Detecting the facial  Izard  index

(L.S. Percin, 2004):

oph-gn —  face  height;  zy-zy —  morphological width

• The full morphological face height (n—gn) is measured between the points n and gn.

The physiognomic face height (tr—gn) is detected between the point (tr), located on the sagittal plane be­tween the forehead and the pilary part of head, and the point gn (Fig. 58).

The face depth is estimated by four dimensions (Fig. 59), detected from the point / to the point n, cuta­neous, the most posteriorly located point in the place of lower circuit of nose transition to the upper lip (sn), the most anterior point of the mental protuberance (pg) in the median inter­section at the orientation of head by the Frankfort plane, the point gn.

To characterize the form of head and face there are used the indices, which are a percentage ratio of one head and face dimension to another.

The head shape is detected by cross-longitudinal, height-longitudinal, and altitude-transversal indices. The most important and the most often used in practical work is the cross-longitudinal (cranial, head) index — percentage ratio of the head width to its length. If this value is less than 75.9, the head has dolichocephalic shape, 76.0—80.9 — mesocephalic, 81.0—85.4 — brachycephalic, 85.5 and more — hyperbrachycephalic.

The face form can be determined with the help of the facial indices, offered by Kollman, I.I. Uzhumetskene, Garson, G. Izard. The facial index by Garson is de­tected by the percentage ratio of the morphological height of face (n—gn) to the width of face in the region of temporal arches (zy—zy). By this index value the following types of face are singled out: very wide, wide, average, narrow, very narrow.

Izard offered the index of facial morphology (IFM), which equals to the percent­age ratio of the distance from the point (oph) of the intersection of the median face line and the tangent to the superciliary arches to the point gn to the width of face in the region of temporal arches (zy—zy)- Index value from 104 and more characterizes a narrow face, from 97 to 103 — average, from 96 and less — wide face (Fig. 60).

oph

-xlOO.

IFM =

zy-zy

The patient’s face is studied en face and in profile. En face the symmetry of the right and left halves is estimated, and also the proportionality of the upper, middle, and lower thirds efface (Fig. 61).

Fig. 61. Studying the face fullface (a) and in profile (b)

Fig. 62. Face profile types: a — straight; b — convex; c — concave

Face profile is estimated by its appearance: it can be concave, straight and convex depending on the correlation of the position of the points n, sn, and pg (Fig. 62).

When estimating face profile lips position relative to the esthetic plane, of­fered by Ricketts, is taken into account; it goes through the point (EN) on the apex of nose and the point (DT), which corresponds to the point pg (Fig. 63).

Face profile is detected by means of estimating the position of the upper lip (UL) and the lower lip (LL) relative to the esthetic plane. Protruding of the low­er lip corresponds to the convex profile of face. Concave face profile is marked by the reclinate lower lip by more than 2.0 mm relative to the esthetic plane.

Fig. 63. Face profile estimation by Ricketts