• Waqar Jeelani Section of Dentistry, Department of Surgery, Aga Khan University Hospital, Karachi
  • Mubassar Fida Section of Dentistry, Department of Surgery, Aga Khan University Hospital, Karachi
  • Attiya Shaikh Section of Dentistry, Department of Surgery, Aga Khan University Hospital, Karachi


Background: The emergence of soft tissue paradigm in orthodontics has made various soft tissue parameters an integral part of the orthodontic problem list. The purpose of this study was to determine and compare various facial soft tissue parameters on lateral cephalograms among patients with short, average and long facial patterns. Methods: A cross-sectional study was conducted on the lateral cephalograms of 180 adult subjects divided into three equal groups, i.e., short, average and long face according to the vertical facial pattern. Incisal display at rest, nose height, upper and lower lip lengths, degree of lip procumbency and the nasolabial angle were measured for each individual. The gender differences for these soft tissue parameters were determined using Mann-Whitney U test while the comparison among different facial patterns was performed using Kruskal-Wallis test. Results: Significant differences in the incisal display at rest, total nasal height, lip procumbency, the nasolabial angle and the upper and lower lip lengths were found among the three vertical facial patterns. A significant positive correlation of nose and lip dimensions was found with the underlying skeletal pattern. Similarly, the incisal display at rest, upper and lower lip procumbency and the nasolabial angle were significantly correlated with the lower anterior facial height. Conclusion: Short facial pattern is associated with minimal incisal display, recumbent upper and lower lips and acute nasolabial angle while the long facial pattern is associated with excessive incisal display, procumbent upper and lower lips and obtuse nasolabial angle.


Peck S, Peck H. The aesthetically pleasing face. Trans Eur Orthod Soc 1971;175–84.

Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970;40(4):284–318.

Ricketts RM. Divine proportion in facial esthetics Clin Plast Surg 1982;9(4):401–22.

da Vinci PCL. Notebook of a Genius. Milan: Powerhouse Publishing, 2001.

Sassouni V. A classification of skeletal facial types. Am J Orthod 1969;55(2):109–23.

Opdebeeck H, Bell WH. The short face syndrome. Am J Orthod 1978;73(5):499–511.

Taibah SM, Feteih RM. Cephalometric features of anterior openbite. World J Orthod 2007;8(2):145–52.

Tsai HH. Cephalometric studies of children with long and shortfaces. J Clin Pediatr Dent 2000;25(1):23–8.

Johnston DJ, Hunt O, Johnston CD, Burden DJ, Stevenson M, Hepper P. The influence of lower face vertical proportion on facial attractiveness. Eur J Orthod 2005;27(4):349–54.

Vaden JL. Nonsurgical treatment of the patient with vertical discrepancy. Am J Orthod Dentofacial Orthop 1998;113(5):567–82.

Falconer DS, Waite PD. Surgical management of skeletal vertical facial problems. Semin Orthod 2013;19(4):293–304.

Ackerman JL, Proffit WR, Sarver DM. The emerging soft tissue paradigm in orthodontic diagnosis and treatment planning. Clin Orthod Res 1999;2(2):49–52.

Silberberg N, Goldstein M, Smidt A. Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence Int 2009;40(10):809–18.

Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent 1999;11(2):265–72.

Konstantonis D, Anthopoulou C, Makou M. Extraction decision and identification of treatment predictors in Class I malocclusions. Prog Orthod 2013;14:47.

Anwar N, Fida M. Compensation for vertical dysplasia and its clinical application. Eur J Orthod 2009;31(5):516–22.

Anwar N, Fida M. Evaluation of dentoalveolar compensation in skeletal class II malocclusion in a Pakistani University Hospital setting. J Coll Physicians Surg Pak 2009;19(1):11–6.

Ku SJ, Lee SJ, Chang YI. Dentoalveolar compensation according to skeletal pattern of normal ooclusion. Korea J Orthod 2002;32(2):91–105.

Feres MF, Hitos SF, Sousa HI, Matsumoto M. Comparison of soft tissue size between different facial patterns. Dent Press J Orthod 2010;15(4):84–93.

Sayagh NM, Saleem NR, Abdul–Qadir MY. Analysis of soft tissue facial profile in different vertical growth patterns. Al–Rafidain Dent J 2011;11(2):346–56.

Bravo LA. Soft tissue facial profile changes after orthodontic treatment with four premolars extracted. Angle Orthod 1994;64(1):31–42.

Kocadereli I. Changes in soft tissue profile after orthodontic treatment with and without extractions. Am J Orthod Dentofacial Orthop 2002;122(1):67–72.

Lee YT, Chen MC, Chen HL, Wu CB. Vertical skeletal and facial profile changes after surgical correction of mandibular prognathism. Chang Gung Med J 2009;32(3):320–9.

Steiner CS. Cephalometrics in clinical practice. Angle Orthod. 1959;29:8–29.

Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme variation in vertical facial growth and associated variation in skeletal and dental relations. Angle Orthod 1971;41(3):219–29.

Lai J, Ghosh J, Nanda RS. Effect of orthodontic therapy on the facial profile in long and short vertical facial patterns. Am J Orthod Dentofacial Orthop 2000;118(5):505–13.

Blanchette ME, Nanda RS, Currier GF, Ghosh J, Nanda SK. A longitudinal cephalometric study of the soft tissue profile of short- and long-face syndromes from 7 to 17 years. Am J Orthod Dentofacial Orthop 1996;109(2):116–31.

Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning - Part I. Am J Orthod Dentofacial Orthop 1993;103(4):299–312.

Al-Habahbeh R, Al-Shammout R, Al-Jabrah O, Al-Omari F. The effect of gender on tooth and gingival display in the anterior region at rest and during smiling. Eur J Esthet Dent 2009;4(4):382–95.

Jensen J, Joss A, Lang NP. The smile line of different ethnic groups in relation to age and gender. Acta Med Dent Helv 1999;4(2):38–46.

Ferrario VF, Sforza C. Size and shape of soft-tissue facialprofile: effects of age, gender, and skeletal class. Cleft Palate Craniofac J 1997;34(6):498–504.

Stark WJ, Epker BN. Cephalometric analysis of profile nasal aesthetics. Part 1. Methods and normative data. Int J Adult Orthod Orthognath Surg 1996;11(2):91–103.

Tanikawa C, Nakamura K, Yagi M, Takada K. Lip vermilion profile patterns and corresponding dentoskeletal forms in female adults. Angle Orthod 2009;79(5):849–58.




Most read articles by the same author(s)

1 2 > >>