Farhad B. Naini

The influence of craniofacial to standing height proportion on perceived attractiveness

An idealised male image, based on Vitruvian Man, was created. The craniofacial height was altered from a proportion of 1/6 to 1/10 of standing height, creating 10 images shown in random order to 89 observers (74 lay people; 15 clinicians), who ranked the images from the most to the least attractive. The main outcome was the preference ranks of image attractiveness given by the observers. Linear regressions were used to assess what influences the choice for the most and the least attractive images, followed by a multivariate rank ordinal logistic regression to test the influence of age, gender, ethnicity and professional status of the observer. A craniofacial height to standing height proportion of 1/7.5 was perceived as the most attractive (36%), followed by a proportion of 1/8 (26%). The images chosen as most attractive by more than 10% of observers had a mean proportion of 1/7.8(min=1/7; max=1/8.5). The images perceived as most unattractive had a proportion of 1/6 and 1/10. The choice of images was not influenced by the age, gender, ethnicity or professional status of the observers. The ideal craniofacial height to standing height proportion is in the range 1/7 to 1/8.5. This finding should be considered when planning treatment to alter craniofacial or facial height.

Canine substitution for missing maxillary lateral incisors: The influence of canine morphology, size, and shade on perceptions of smile attractiveness

INTRODUCTION This study was conducted to determine whether variations in the morphology, size, or shade of maxillary canines would influence perceptions of smile attractiveness in patients with canines substituted for missing maxillary lateral incisors. METHODS A smiling photograph of a hypodontia patient who had had orthodontic space closure with maxillary canines replacing the lateral incisors was digitally modified to create a bilaterally symmetrical image. Four groups of images were created, digitally altering canine gingival height, crown tip height, canine width, and canine shade. Three groups of judges (40 orthodontists, 40 dentists, and 40 laypeople) ranked the images for smile attractiveness, also scoring the most and the least attractive of each of the 4 groups, and the most and least attractive of all images. RESULTS Canine gingival height was the most attractive 0.5 mm below the gingival margin of the maxillary central incisor and progressively less attractive with increasing gingival height. Increasing canine width, increased canine tip height, and pointed canines were perceived to be unattractive. Brighter than normal shades of canines were preferred to darker shades. Narrow canine crowns were most frequently ranked as the most attractive overall, 1.5 mm narrower was preferred by the orthodontists and dentists, and 3.0 mm narrower was preferred by the laypeople. All 3 groups ranked the darkest image, 20 times darker than the original, most frequently as the least attractive image overall. There was good general agreement between orthodontists, dentists, and laypeople for all 4 parameters of smile attractiveness, although laypeople demonstrated greater intragroup variations. CONCLUSIONS The morphology, size, and shade of the maxillary canine in patients having orthodontic space closure and lateral incisor substitution can have a marked effect on perceived smile attractiveness.

Retrospective analysis of nasal soft tissue profile changes with maxillary surgery.

PURPOSE The aim of this study was to analyze the changes in the position of the nasal and labial soft tissue profile of patients undergoing bimaxillary orthognathic surgery, with special emphasis on the effect on the nasal tip projection. MATERIALS AND METHODS The lateral cephalometric radiographs of 27 consecutive patients (16 female and 11 male patients; mean age, 22 years) who had undergone maxillary advancement and mandibular setback were studied. The pretreatment and end-of-treatment lateral cephalometric radiographs were selected. The pretreatment and end-of-treatment radiographs were superimposed on the sella-nasion plane, and the case was only included if there had been no change in sella-nasion length (ie, no growth). Analyses of Pearson correlation coefficient and stepwise linear regression tests were used to compare the cephalometric measurements at the beginning and at the end of treatment. Paired-sample t tests were also performed to analyze changes in nasolabial angle (NLA) and columella-lobular angle (CLA). RESULTS The correlations between vertical movement of nasal tip, A-point, and maxillary incisal tip were important. Although there was an important correlation between nasal and incisal tip, interestingly, there was no correlation between nasal tip and A-point in horizontal movement. According to stepwise linear regression analysis, the best model for horizontal movement of nasal tip was as follows: Nasal anteroposterior movement = 0.241 + 0.188 × Incisal tip anteroposterior movement + 0.153 × Incisal tip superoinferior movement. For vertical movement of nasal tip, the best model was as follows: Nasal superoinferior movement= -1.117 + 0.399 × Incisal tip superoinferior movement + 0.323 × A-point anteroposterior movement. There was no significant relation in angular measurements of NLA and CLA before and after treatment. CONCLUSION The results of our study suggest that both horizontal and vertical movements of nasal tip were related to incisal tip and A-point movements; however, angular changes in CLA and NLA did not affect the nasal tip.

Systematic review of changes in maxillary incisor exposure and upper lip position with Le Fort I type osteotomies with or without cinch sutures and/or VY closures.

The aim was to systematically review the maxillary incisor exposure and upper lip position changes with Le Fort I type osteotomies for advancement ± impaction with rigid internal fixation, taking into account the use of cinch sutures and VY closures. Electronic databases (Cochrane Library, Medline, Embase, and Web of Science) were searched using medical subject headings (MeSH), key words, truncations, and Boolean operators. Hand searching was also undertaken. Of 979 articles identified, 15 were included (11 retrospective, two prospective, and two unspecified). Relevant study details and outcomes were recorded on a spreadsheet, along with an assessment of their quality. In total, these studies assessed 419 patients (266 female, 118 male) with a mean age of 26.4 years (range 14-57 years). Soft tissue changes were assessed on lateral cephalometric radiographs. The mean maxillary hard tissue advancement and impaction ranged between 0.94 and 8.77 mm and -0.56 and 4.2 mm, respectively. The ranges of ratios demonstrated that from pronasale (0.24-0.35) to labrale superius (0.36-1.43), the soft tissues followed the underlying horizontal hard tissue movement increasingly more closely. Alar base cinch sutures and VY closures tended to increase these ratios. The soft tissue response was more variable vertically. None of the studies reported on maxillary incisor exposure change. More good quality prospective studies are needed.

Avicenna and the Canon Medicinae

Congratulations should be extended to Sharma and Minhas for their interesting article debating evidence in medicine.1 Unfortunately, the article contains a factual error, albeit unintentional, which requires elaboration. The authors state, ‘Arabic physician Ibn Sina (known as Avicenna in the West) is the first physician to recommend that practice should be evidence based and to set out a summary of current evidence in his “Canon of Medicine”.’1 The statement regarding the Canon is correct; however, Avicenna was a Persian physician and polymath.2 Pur Sina, or Ibn Sina (meaning ‘son of Sina’), known in the West by his Latinized name Avicenna, was born c. 980 in Bukhara and died in 1037 in Hamadan, both in Persia. Avicenna spent his entire life in the eastern and central regions of Iran; his lifetime coincided with one of the most tumultuous periods in Iranian history. The turbulent politics of the time and Avicennas secular nature kept him permanently unsettled. Other than brief periods of relative tranquillity, it led to a life of wandering and turmoil, which was to last to the end of his days.2 However, his powers of concentration were such that he was able to continue his scientific work with remarkable consistency. Avicenna wrote a number of works, including The Book of Healing, a vast philosophical and scientific encyclopaedia. However, in the West his fame is above all based on The Canon of Medicine.3 This vast tome, consisting of more than a million words, surveyed the entire field of medical knowledge from ancient times to the most up-to-date techniques. Its comprehensive and systematic approach meant that when it was translated into Latin in the 12th century, it became the standard medical textbook for seven centuries throughout Europe.4 Sir William Osler described Avicenna as the ‘author of the most famous medical textbook ever written,’ noting that Avicennas Canon of Medicine remained ‘a medical bible for a longer time than any other work.’4 The reason for Sharma and Minhass error is to an extent understandable, though not acceptable. The Canon was written in Arabic, as it was unlawful, and dangerous, for Persians to write in their native language while under Arab rule. Despite this, Persian polymaths of the time, such as Avicenna, Biruni, Razi (Latin Rhazes) and Khayyam wrote many of their works in Persian. Clearly, the great men and women of history belong to all mankind. The unsurpassed beauty of Shakespeares Sonnets are as inspiring to a German as they are to us, and Leonardo da Vincis paintings and notebooks are as enlightening to the French as to the Italians; yet, Shakespeare was not German and Leonardo was not French. This is not an issue of nationalizm, which Einstein rightly noted was ‘an infantile disease’ and ‘the measles of mankind’.5 Medicine rises above such conceptions. This is simply a point of historical accuracy.

Prospective assessment of maxillary advancement effects: maxillary incisor exposure, and upper lip and nasal changes.

INTRODUCTION Our aim was to assess changes in maxillary incisor exposure, and upper lip and nasal soft tissues with maxillary advancement with or without impaction, accounting for the use of cinch sutures and VY closures. METHODS This was a prospective study of 41 consecutive patients undergoing maxillary advancement with or without impaction. Lateral cephalometric radiographs and clinical measurements were taken preoperatively and up to 6 months postoperatively by 1 examiner. RESULTS Thirty-one patients (19 female, 12 male) with a mean age of 25.5 years (range, 16.9-49.9 years) completed the study. Twenty-six received bimaxillary surgery. Fifteen had simple closures, 6 had cinch sutures, and 10 had alar base cinch and VY closures. The mean amounts of maxillary advancement and impaction were 3.34 and 1.6 mm, respectively. Soft tissues followed increasingly more closely the hard tissue advancement from pronasale to stomion superius. Mean maxillary incisor exposure increased at rest (0.5 mm) and on smiling (1.0 mm). The nasolabial angle increased (1.88°) because of columella upturning. Alar base width (3.09 mm) significantly increased. CONCLUSIONS Soft to hard tissue horizontal ratios increased progressively from pronasale to stomion superius. Alar base cinch and VY closures increased these further. Maxillary incisor display changes were partly explained by presurgical upper lip thickness and soft tissue manipulation. Nasolabial angle increased, and cinch sutures seemed to increase this further. Alar base width increased significantly, and the cinch sutures did not significantly limit this.

The origin of the zero-degree meridian used in facial aesthetic analysis.

The roots of clinical facial aesthetic analysis stem from the theoretical musings of pioneering artists and sculptors, stretching back to antiquity. The use of such analyses in clinical practice has been modified in accordance with changing cultural perceptions and better understanding of age-, sex-, and ethnicity-specific anthropometric and cephalometric normative data for various craniofacial parameters. Nevertheless, the work of the great artists and sculptors of past ages remains inherent in our ability to accurately diagnose variations in facial appearance. The objective of this letter is to delve into the origin of one of the most widely used facial aesthetic analyses, the zero-degree meridian of the facial profile, based on 2 images recently detected within the Leonardo da Vinci archives of the Royal Collection (Windsor Castle, England), which is the largest Leonardo da Vinci collection in the world. The zero-degree meridian was described and named by the Mexican plastic surgeon Mario Gonzalez-Ulloa as a …

The ‘acrylic technique’ to check arch coordination in orthognathic surgery patients

t p o t i m s b r rch coordination is one of the most important preparatory equirements for orthognathic surgery, the objective being o make certain that the maxillary and mandibular dental rches will fit together well at the time of surgery, with coresponding arch forms and good labial and buccal segment nterdigitation. Inadequate arch coordination can jeopardize he quality of the surgical result. Clinical evaluation of arch coordination can be difficult. n Class II malocclusions, the patient may be asked to posture

So, those who can't do it, teach it?

It has been said that “He who can, does. He who cannot, teaches.” I have often wondered whether there is any truth behind this frequently quoted expression, which surgical students hear from the early days of their clinical training. To find the answer, one must look at the origin …

Cotton Wool Roll Technique in Orthognathic Planning

It is said that hindsight is always 20/20. As such, nothing is as important as the actual result of an orthognathic surgical procedure in demonstrating the appropriateness of the original treatment plan. Therefore, any diagnostic modality that permits simulation of a potential final operated result is extremely useful in the treatment planning stages of orthognathic surgery. This is part of the reason so many different treatment planning software modalities are now available on the market. In some patients, the degree of relative movement of the maxilla, mandible, and chin required to provide ideal facial soft tissue profile esthetics can be rather