Mirjam Berneburg

Beauty lies in the eye of the beholder? Aspects of beauty and attractiveness

Discussing aesthetic issues and their management with patients is a growing area of dermatologic practice. Sometimes treatment options within ones own discipline are rapidly discussed, without a clear idea of the various aspects of the face which all combine to produce beauty and attractiveness. We review various features leading to the impression of beauty and attractiveness. Familiarity with these concepts should facilitate a broader discussion with the patient on the aspects of beauty and attractiveness beyond the borders of ones own discipline and also lead to multidisciplinary treatment options. We also examine the question how much the personality of the beholder himself is involved in the perception of attractiveness and beauty (of the person sitting opposite to him).

Changes in esthetic standards since 1940

INTRODUCTION The goals of this study were to investigate differences between the most popular female and male faces, past and present, and to determine whether they had changed over time and, if so, to what extent. METHODS Internet film databases were searched for photographs of men and women who were considered attractive between 1940 and 2008. Images meeting defined inclusion criteria were compared. Measurements were taken on a minimum of 20 images per sex per decade. Intersex facial differences were grouped by decades, and we examined whether these differences remained stable or whether and how they changed over time. RESULTS The women had fuller and more protrusive lip profiles than did the men, particularly during the first decade of the 21st century. Significant sex-specific developments were noted over time with respect to chin lengths, frontonasal angles, and total face angles. The men had decreases in chin size and length, but a small opposite trend was observed in the womens faces. During the observation period, female and male faces considered highly attractive became slightly more similar in terms of chin position and size. CONCLUSIONS Notions of facial attractiveness might be influenced by developments in society.

Reference values for three-dimensional surface cephalometry in children aged 3-6 years.

OBJECTIVE This prospective cross-sectional study design was performed to define reference values for the facial surfaces of 3-6-year-old boys and girls using three-dimensional surface cephalometry. MATERIAL AND METHODS A total of 2290 standardized three-dimensional facial images from 3 to 6-year-old preschool children were separated by gender and assigned to four age categories. All children were Caucasian and revealed no evidence of dentofacial abnormalities. On each image, 31 cephalometric landmarks were marked, resulting in 35 (19 frontal, six lateral, 10 paired) distances and eight angles. Differences between age groups and genders were calculated and significances detected. RESULTS A base table with reference values was compiled, which indicated that boys showed higher values than age-matched girls and that measured distances increased with age. CONCLUSION The mean values from this study could be compiled as a reference table for three-dimensional facial analysis in Caucasian children aged 3-6 years. Such a reference table could be used in comparative studies with other populations or children with craniofacial malformations.

The Reproducibility of Landmarks on Threedimensional Images of 4- to 6-year-old Children

Objective:The objective of this study was to check the reproducibility and influencing parameters of landmarks on three-dimensional images of 4- to 6-year-old Caucasian children.Probands and Methods:We examined the reproducibility of 22 landmarks on six three-dimensional facial scans of 4- to 6-yearold randomly-selected kindergarten children. The 3D scans were taken by the digital system faceSCAN II® under standardized conditions. One specially-trained investigator marked all landmarks on each of the six 3D scans a total of ten times. Ten different orthodontic residents also placed all landmarks on each of these scans. Standard deviations from the mean were then calculated from the data for each individual landmark on the x-, y- and z-axes.Results:The specially-trained investigator who had placed all landmarks on each of the six 3D scans a total of ten times found 15 of 22 landmarks to be reproducible well to within a standard deviation of less than 1 mm on each spatial plane. For the ten orthodontic residents, only three landmarks were found to be reproducible to within a standard deviation of under 1 mm for each spatial plane.Conclusion:Familiarity with 3D facial scans and their corresponding software programs, together with good image quality, improve the reproducibility of the analysis. Landmarks revealing poor reproducibility should be used, if at all, with due caution for analysis. It remains to be seen whether they can be omitted altogether, or whether they should be re-set.ZusammenfassungZielsetzung:Ziel dieser Studie war es, auf dreidimensionalen Fotos die Reproduzierbarkeit von Messpunkten und deren Einflussfaktoren für 4–6-jährige kaukasische Kinder zu prüfen.Probanden und Methodik:Auf sechs zufällig ausgesuchten 3DScans von 4–6-jährigen Kindergartenkindern wurden 22 Messpunkte auf ihre Reproduzierbarkeit hin untersucht. Die 3D-Scans wurden unter standardisierten Bedingungen mit dem Digitalisierungssystem faceSCAN II® fotografiert. Ein geeichter Untersucher zeichnete auf allen sechs 3D-Scans alle Punkte insgesamt zehnmal ein. Weitere zehn kieferorthopädische Assistenten zeichneten ebenfalls alle Messpunkte auf diesen Scans ein. Anschließend wurde für die x-, y- und z-Koordinaten eines jeden Punktes die Standardabweichung zu den Mittelwerten bestimmt.Ergebnisse:Die Auswertung des geeichten Untersuchers, der auf allen 3D-Scans die Messpunkte zehnmal eingezeichnet hatte, ergab, dass 15 von 22 Punkten in allen drei Raumebenen mit einer Standardabweichung von unter 1 mm gut reproduzierbar waren. Bei den zehn kieferorthopädischen Assistenten gab es nur drei Punkte, bei denen die Standardabweichung in allen drei Raumebenen unter 1 mm betrug.Schlussfolgerung:Routine im Umgang mit 3D-Scans und den dazugehörigen Programmen sowie eine gute Bildqualität steigern die Reproduzierbarkeit von Messungen. Punkte, die schlecht reproduzierbar waren, sollten für Auswertungen wenn überhaupt, dann nur mit Vorsicht verwendet werden. In Zukunft muss noch geklärt werden, ob man auf sie vollständig verzichtet oder ob sie rekonstruiert werden müssen.

Lip and tongue movements during phonetic sequences: analysis and definition of normal values

Precise knowledge of lip and tongue movements is limited. Conventional investigative methods do not allow for their precise representation and analysis. In the present study, electromagnetic articulography (EMA) was used to define normal values for lip movements based on consonant-vowel-consonant (CVC) sequences and for tongue movements based on vowel-consonant-vowel (VCV) sequences. The study population included 25 volunteers (11 males and 14 females) with a median age of 26 (23 to 29) years. An EMA unit was used to conduct the measurements. For this purpose, the volunteers repeated a number of VCV and CVC text sequences 10 times each during two different body positions (upright and relaxed). Statistical analysis (including Bland and Altmans measurement error, non-parametric Wilcoxon rank score testing, and analysis of variance) of distance and time variables resulted in a small measurement error. There was no effect of different body positions on measurement error. Gender was found to have a significant effect on the values measured (67 versus 17 per cent of variables related to distances in CVC versus VCV sequences and 38 versus 75 per cent of variables related to intervals in CVC versus VCV sequences). This finding did not, however, hold true for any of the other parameters investigated as potential influencing factors. EMA is capable of providing valuable information about lip and tongue movements and any pathological dysfunctions involved.

Correlation between occlusal abnormalities and parameters investigated by three-dimensional facial photography

OBJECTIVE To clarify, by three-dimensional (3D) facial scans, if 4- to 6-year-old children with intraoral sagittal discrepancies and open-bite occlusion show differences in facial morphology when compared to children without anomalies. MATERIALS AND METHODS Scans of 290 children presenting with occlusal abnormalities were compared to 1772 face scans of age-matched individuals photographed with a faceSCAN II® 3D data acquisition system. From these, three study groups were formed comprising 188 children with distal occlusion/increased overjet (Class II), 37 with mesial occlusion/inverse overjet (Class III), and 65 with open-bite occlusion. These groups were evaluated by age and gender for each group compared to the control individuals. RESULTS The Class II group showed statistically significant reduced dimensions of head width, upper face width, and midface length. In addition, the mean values for mouth width and lip thickness were higher, and their upper lips were located more anteriorly than in the control group. The Class III group exhibited more markedly retruded upper lips. The facial profile of female 5-year-old Class III patients was significantly more concave. Patients in the open-bite group showed reduced upper lip length, with differences only being statistically significant in male 4-year-olds. CONCLUSION Dental Class II with increased overjet and dental Class III with decreased overjet influence soft tissue morphology and are represented on 3D facial scans.

Effect of cephalograms on decisions for early orthodontic treatment

OBJECTIVE To assess the extent to which cephalograms modify therapeutic decisions related to early orthodontic treatment. MATERIALS AND METHODS Diagnostic records of six patients requiring early treatment were digitized for this purpose. A total of 234 orthodontists were then asked to select therapeutic measures on a treatment-planning sheet at two different times (T1 and T2). Three groups of orthodontists were formed and were provided with case-specific records either including or not including cephalograms and the appended tracing values. Forty-seven orthodontists completed all phases of the questions. RESULTS Statistical analysis revealed only two statistically significant differences between the first (T1) and second (T2) treatment plans, both concerning options of transverse treatment. None of the other results showed any significant changes from T1 to T2 treatment planning. CONCLUSION It follows that cephalograms did not influence therapeutic decisions for early orthodontic treatment and should not be routinely used in very young patients.

Orthodontic Findings in 4- to 6-year-old Kindergarten Children from Southwest Germany

Objective:The objective of this epidemiologic study was to make basic data available on the age dependence of malocclusions and their developmental tendency in 4- to 6-year-old kindergarten children so as to define the optimum time to start early treatment.Materials and Methods:In this study 2015 kindergarten children (1048 male, 967 female) aged between 4 and 6 years were examined and divided into three age groups. The anteroposterior, transverse and vertical occlusion of the anterior and posterior teeth was assessed and analyzed.Results:Increased overjets and open bites showed significant self-regulation with increasing age. There were no significant differences among the age groups with regard to anteroposterior and transverse occlusion of the posterior teeth. Only mesioclusion deteriorated with increasing age. According to statistical analysis of the findings, 61.6% of the 4-year-olds, 58.4% of the 5-year-olds and 50.9% of the 6-year-old children had one or two malocclusions.Conclusion:As increased overjets and open bites often diminish spontaneously with increasing age, it is sufficient to start treating these malocclusions at the end of 5 years of age once dysfunctions have been eliminated. This in turn enhances children’s ability to cooperate and reduces the duration of their early treatment.ZusammenfassungFragestellung:Ziel dieser epidemiologischen Studie war es, Basisdaten über die Altersabhängigkeit und Entwicklungstendenz von Gebissanomalien bei 4- bis 6-jährigen Kindergartenkindern zu ermitteln, um den idealen Zeitpunkt für den Beginn von Frühbehandlungsmaßnahmen festzulegen.Material und Methodik:In dieser Studie wurden 2015 Kindergartenkinder (1048 Jungen, 967 Mädchen) im Alter zwischen 4 und 6 Jahren untersucht und in drei Altersgruppen eingeteilt. Erhoben und ausgewertet wurden sagittale, transversale und vertikale Okklusionsbefunde im Front- und Seitenzahnbereich.Ergebnisse:Der vergrößerte Overjet und der offene Biss zeigten eine signifikante Selbstausheilungstendenz mit zunehmendem Alter. Beim sagittalen und transversalen Okklusionsbefund im Seitenzahnbereich waren keine wesentlichen Unterschiede zwischen den Altersgruppen zu beobachten. Einzig die Mesialbissstellung verschlechterte sich leicht mit höherem Alter. Die statistische Auswertung der Gesamtbefunde ergab: Ein oder zwei Anomalien wiesen 61,6% der 4-jährigen, 58,4% der 5-jährigen und 50,9% der 6-jährigen Kinder auf.Schlussfolgerung:Aufgrund häufiger Spontanreduktionen beim vergrößerten Overjet und dem offenen Biss scheint es nach der Beseitigung von Dysfunktionen bei diesen Anomalien auszureichen, die Therapie erst ab Ende des 6. Lebensjahres zu beginnen, um die Kooperationsbereitschaft der Kinder zu steigern und die Frühbehandlungszeit zu verkürzen.