Three-dimensional Facial Morphometry of Attractive Children and Normal Children in the Deciduous and Early Mixed Dentition

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1 Originl Article Three-dimensionl Fcil Morphometry of Attrctive Children nd Norml Children in the Deciduous nd Erly Mixed Dentition Chirell Sforz ; Alberto Lino b ; Roul D Alessio c ; Cludi Dellvi d ; Gi Grndi e ; Virgilio Ferruccio Ferrrio f ABSTRACT Objectives: To identify possible esthetic cnons in fcil size nd shpe of Itlin children. Mterils nd Methods: The three-dimensionl coordintes of 50 fcil lndmrks (forehed, eyes, nose, cheeks, mouth, jw, ers) were collected in 220 helthy reference children (4 9 yers old) nd in 89 ttrctive children of similr ge group selected by commercil csting orgniztion. Soft-tissue fcil ngles, distnces, nd volumes were computed. Comprisons were mde with the Student s t-test. Results: Attrctive children hd lrger fce thn the reference children, with lrger mxill nd forehed; overll, their fces were wider nd deeper, but less verticlly developed. Lips were more voluminous in ttrctive children, with higher mouth. The nose ws lrger in ttrctive children thn in reference children. The soft-tissue fcil profile ws more convex in ttrctive children, with more prominent mxill reltive to the mndible. Conclusions: Overll, considering tht in the nlyzed ges body growth nd dentl chnges re very fst nd individully determined, ll the mesurements ppered sufficiently homogenous, nd the quntittive chrcteristics of n ttrctive fce well defined. Esthetic reference vlues cn be used to determine optiml timing nd gols in orthodontic tretment. KEY WORDS: Fce; Children; Attrctiveness; Soft tissues INTRODUCTION The fce plys key role in communiction nd interction with the environment. 1 3 This prt of the body hs been extensively studied by scientists, clinicins, rtists, nd mny who hve tried to mesure nd re Professor, Functionl Antomy Reserch Center, Deprtment of Humn Morphology, University of Miln, Miln, Itly. b Associte Professor, Dentl, Orl, nd Mxillo-Fcil Sciences, Section of Orthodontics, University Federico II, Nples, Itly. c Privte Prctice, Rome, Itly. d Assistnt Professor, Deprtment of Humn Morphology, University of Miln, Miln, Itly. e Post doc, Deprtment of Humn Morphology, University of Miln, Miln, Itly. f Professor nd Deprtment Chir, Functionl Antomy Reserch Center, Deprtment of Humn Morphology, University of Miln, Miln, Itly. Corresponding uthor: Chirell Sforz, MD, Humn Morphology, University of Miln, vi Mngiglli 31, Miln, MI I-20133, Itly (e-mil: chirell.sforz@unimi.it) Accepted: December Submitted: October by The EH Angle Eduction nd Reserch Foundtion, Inc. produce some of the fcil chrcteristics, not the lest of which hs been beuty. 4,5 Esthetic criteri pper to hve been defined in lmost ll cultures, 2,5 8 but the ctul presence of codified fcil dimensions, ngles, nd rtios in ttrctive people is still mtter of debte. Scientific reserch on the quntittive, mesurble bses of fcil ttrctiveness is, therefore, still in progress. 2,4,9 13 Attrctiveness is lso becoming mtter of concern during childhood. Currently, children re widely employed in cinem nd television, in the fshion industry, nd in dvertising. Children with nonttrctive fce re considered less intelligent, nd re more likely to be isolted nd underscored thn children with n ttrctive fce, even by their peers. 1,14 A beutiful fce is often considered the key to success, nd prents nd children look for medicl modifictions of nonttrctive dentofcil physiognomies. 8,13 Orthodontists, therefore, fce n incresing demnd for tretments minly bsed on esthetic requests, 15 nd should pproch the problem with the most dvnced instruments nd methods for dignosis nd tretment plnning. Indeed, while technology tody offers very dvnced methods for tretment, orthodontic DOI: /

2 1026 SFORZA, LAINO, D ALESSIO, DELLAVIA, GRANDI, FERRARIO dignosis still remins n rt, widely relying on subjective evlutions of the fcil soft tissues. Conventionl two-dimensionl mesurements bsed on photogrphs or on rdiogrphic profile projections 16,17 should be supplemented by three-dimensionl nlyses Fcil three-dimensionl imging is novel field for dentistry, nd it is becoming useful tool for both clinicins nd reserchers. 17 For fruitful clinicl ppliction, ptient dt should be complemented with norml, reference dt. Indeed, conventionl two-dimensionl mesurements cnnot be completely pplied to the novel methods; dditionlly, in the field of fcil esthetics, the culturl bckground seems to prtilly determine wht is considered ttrctive nd beutiful, 2,6,8 nd new esthetic norms should be defined in n ever chnging society. In the current investigtion, the three-dimensionl fcil chrcteristics of children considered ttrctive were obtined. Dt were compred to those collected in helthy children of the sme ethnicity, selected using criteri of dentofcil normlity. 2,6,8 The presence of mesurble esthetic chrcteristics ws ssessed. If estheticlly plesing fces possess codified fcil dimensions, ngles, nd rtios, these mesurements could be used by orthodontists nd mxillofcil surgeons s reference for dentofcil modifictions. MATERIALS AND METHODS Subjects Two groups of white, Northern Itlin children ged 4 9 yers, ll with complete deciduous dentition or n erly mixed dentition (first permnent molrs; incisors in vrious stges of exfolition nd eruption), 23 were nlyzed. All children hd no previous crniofcil trum, orthodontics, surgery, or congenitl nomlies. The helthy, reference children included 121 boys nd 99 girls; they hd norml dentofcil dimensions nd proportions. They were ttending severl schools in Miln nd the surroundings. 3 Forty-two boys nd 47 girls were beutiful, ttrctive children selected by commercil csting gency. The gency ws sked to provide children with beutiful, ttrctive fce, considered positive nd cceptble for cinem, television, dvertising, nd the fshion industry. 15 All the nlyzed children nd their prents/legl gurdins gve their informed consent to the experiment. All procedures were noninvsive, did not provoke dmges, risks or discomfort to the subjects, nd were pproved by the locl ethics committee. Dt Collection nd Anlysis The procedure took plce in two seprte steps, 18 nd it ws followed by off-line clcultions. For ech Figure 1. Digitized fcil lndmrks. Midline lndmrks: tr, trichion; g, glbell; n, nsion; prn, pronsle; c, columell; sn, subnsle; ls, lbile superius; sto, stomion; li, lbile inferius; sl, sublbile; pg, pogonion; me, menton. Pired lndmrks: ex r,ex l, exocnthion; en r,en l, endocnthion; os r,os l, orbitle superius; or r,or l, orbitle; ft r, ft l, frontotemporle; chk r, chk l, cheek; zy r,zy l, zygion; t r,t l, trgion; l r,l l, lre; c r,c l, nsl lr crest; itn r, itn l, inferior point of the nostril xis; stn r, stn l, superior point of the nostril xis; cph r, cph l, crist philtri; ch r,ch l, cheilion; go r,go l, gonion; pr r, pr l, preurle; s r,s l, superurle; p r,p l, posturle; sb r, sb l, suburle. child, single experienced opertor locted nd mrked 50 soft-tissue lndmrks by inspection nd/or plption. 3 During lndmrk mrking, the children st relxed with nturl hed position. For ech child, this phse lsted less thn 5 minutes. Three-dimensionl coordintes of the fcil lndmrks were then obtined with computerized electromgnetic digitizer (3Drw, Polhemus Inc, Colchester, Vt). During dt collection, the children st in nturl hed position in chir with bckrest, where cephlostt fixed the child s hed. The children remined motionless, with closed eyes nd the mndible in rest position. The digitiztion of lndmrks took pproximtely 1 minute. Duplicte dt collections gve rndom errors corresponding to 1.2% of nsion-mid trgion distnce, without differences between reference nd ttrctive children. Files of the three-dimensionl coordintes were obtined, nd computer progrms were used for ll subsequent off-line clcultions. The fcil soft-tissue lndmrks collected re shown in Figure 1. The coordintes of the lndmrks were used to estimte severl liner distnces, ngles, nd fcil volumes, 18,19,21 s follows: distnces (unit, mm): fcil height (n-pg); nterior upper fcil height (n-sn); nterior lower fcil height (sn-pg); upper fcil width (ex-ex); middle fcil width (t-t); lower fcil width (go-go); middle fcil depth (sn-t); mndibulr corpus length (pg-go); mouth width (ch-ch); vermilion height (ls-li) ngles (unit, degrees): fcil convexity including the nose (n-prn-pg); mndibulr convexity (go-pg-go); mxillry prominence, soft-tissue nlog of skele-

3 FACIAL MORPHOMETRY OF ATTRACTIVE CHILDREN 1027 Tble 1. Soft Tissue Fcil Liner Distnces Mesured in 42 Beutiful nd 121 Reference Boys n-pg n-sn sn-pg sn-(t-t) pg-(go-go) ex-ex t-t go-go ch-ch ls-li Boys, 4 5 y Beutiful (n 8) Men SD Reference (n 19) Men SD P (Student s t) NS NS NS NS NS NS Boys, 6 7 y Beutiful (n 21) Men SD Reference (n 47) Men SD P (Student s t).015 NS.009 NS NS NS NS.007 NS NS Boys, 8 9 y Beutiful (n 13) Men SD Reference (n 55) Men SD P (Student s t) NS NS NS.011 NS.036 NS NS NS NS All vlues re mm. NS indictes not significnt, P.05. tl ANB ngle (sl-n-sn); nsolbil (prn-sn-ls); mentolbil (li-sl-pg); interlbil (sn-ls sl-li) volumes (unit, mm 3 ): totl fcil volume (ll fcil structures from the externl cutneous surfce up to plne pssing through trichion, trgi, nd goni); fcil upper third volume (forehed), mesured between the plne pssing through trichion, frontotemporle lndmrks, nd trgi, nd plne pssing through trgi nd exocnthi; fcil middle third volume (mxill), comprised between the plne pssing through trgi nd exocnthi, nd plne connecting cheilion lndmrks nd trgi; fcil lower third volume (mndible), comprised between the cheilion-trgi plne nd plne drwn between pogonion nd goni; nsl volume; lip volume (subdivided into the upper nd lower lip) Sttisticl Clcultions Reference nd ttrctive children were divided into three ge groups: 4 5 yers, 6 7 yers, nd 8 9 yers; ges were rounded to the nerest 6 months. The men ges did not differ within ech sex nd ge group. Descriptive sttistics were computed for ech group nd comprisons were performed within ech sex nd ge group using independent Student s t-tests with two-tiled distributions. Significnce ws set t 5% (P.05). RESULTS In both groups of children nd in both sexes, ll liner distnces incresed s function of ge (Tbles 1 nd 2). Overll, boys hd lrger fcil dimensions thn girls of the sme ge nd group. A notble exception ws nterior upper fcil height (n-sn) tht ws somewht lrger in girls thn in boys on lmost ll occsions. When compred to reference children, ttrctive children hd reduced totl fcil height (n-pg); the difference ws sttisticlly significnt in the 6- to 7- yer-old children. The difference ws minly found in the fcil lower third tht ws lwys lrger in the reference children, but the differences did not rech sttisticl significnce. Attrctive children hd deeper (middle fcil depth, sn-t; mndibulr corpus length, pg-go) nd wider (in ll fcil thirds, upper, ex-ex; middle, t-t; nd lower, go-go) fces thn reference children (Figure 2). Overll, these differences in the liner dimensions gve lrger fcil volumes in ttrctive children thn in reference children (Tbles 3 nd 4). Totl fcil volume nd the upper nd middle thirds were significntly

4 1028 SFORZA, LAINO, D ALESSIO, DELLAVIA, GRANDI, FERRARIO Tble 2. Soft Tissue Fcil Liner Distnces Mesured in 47 Beutiful nd 99 Reference Girls n-pg n-sn sn-pg sn-(t-t) pg-(go-go) ex-ex t-t go-go ch-ch ls-li Girls, 4 5 y Men SD Reference (n 11) Men SD P (Student s t) NS NS NS NS NS Girls, 6 7 y Beutiful (n 18) Men SD Reference (n 45) Men SD P (Student s t).035 NS NS NS NS Girls, 8 9 y Men SD Reference (n 43) Men SD P (Student s t) NS NS NS.016 NS NS NS NS NS NS All vlues re mm. NS indictes not significnt, P.05. lrger in both sexes nd in ll ges (P.05). The mndibulr/mxillry volume rtio ws significntly smller in the ttrctive children thn in the reference ge group (reltively lrger mxill together with reltively smller mndible). The difference ws prticulrly significnt in the youngest children, with n pproximte 20% reduction. The men fcil volumes were lrger in boys thn in girls of the sme ge, nd incresed s function of ge. At ll ges nd in both sexes, ttrctive children hd lrger nsl, upper, nd totl lip volumes thn reference children. The lrger lip volumes could be explined by trend in lrger vermilion height (ls-li); in girls, the dditionl contribution of mouth width (ch-ch) should be considered (Figure 3). In the ttrctive children, the modifictions in fcil dimensions were coupled with some vritions in the rrngement of fcil fetures tht were sometimes different in the two sexes t the vrious ges (Tbles 5 nd 6). For instnce, in the sgittl plne, fcil convexity including the nose (n-prn-pg) ws similr in ttrctive nd reference boys, but it ws reduced (more cute) in ttrctive girls. The nsolbil ngle (prn-snls) ws reduced in ttrctive boys, but it ws incresed (more obtuse) in ttrctive girls. In the first two ge groups, the interlbil ngle (sn-ls sl-li) ws reduced in ttrctive boys, but incresed in ttrctive girls. Other profile ngles hd similr trends in the two sexes: the mxillry prominence reltive to the mndible (sl-n-sn) ws significntly lrger in the 8- to 9- yer-old ttrctive children (more prominent mxill); in girls, there ws trend towrd lrger vlues t ll ges. The mentolbil ngle (li-sl-pg) ws more cute (reduced) in ttrctive children when compred to reference children (sttisticlly significnt in 6- to 7- nd 8- to 9- yer-old children). In the horizontl plne, the mndibulr convexity ngle (go-pg-go) ws significntly lrger (more obtuse) in the 6- to 7-yer-old ttrctive boys nd girls thn in their reference ge group. Overll, within group vribility ws similr in ttrctive nd reference children, with comprble coefficients of vrition (the percentge rtio of stndrd devition to men). Notble exceptions were mxillry nd nsl volumes (more homogenous in ttrctive children). DISCUSSION The nlysis of fcil soft tissues, from both quntittive nd qulittive (esthetic) point of view, is n essentil prt of orthodontic nd mxillofcil dignosis, tretment plnning, nd evlution of results. 16,23 While clssicl cephlometric ssessments llow the

5 FACIAL MORPHOMETRY OF ATTRACTIVE CHILDREN 1029 Figure 2. Men trcings of ttrctive nd reference girls in the 8- to 9-yer-old ge group. two-dimensionl mesurement of soft tissue profile only, 16 the new three-dimensionl instruments produce numericl evlutions in ll three sptil plnes Apprently, only two previous investigtions ssessed fcil esthetic chrcteristics in three dimensions 7,24 ; other studies were limited to two-dimensionl photogrphs or cephlometric films. 6,11,25 Overll, the current results re in good greement with previous findings on ttrctive women, 7 prt from lck of differences in the volume of the fcil lower third (mndible). This could be explined by reduced verticl dimension (sn-pg) coupled with n increment in the horizontl (go-go) nd sgittl (pg-go) dimensions in the ttrctive boys nd girls. The composite three-dimensionl volume gve similr results in the two groups of children. Additionlly, in the current children other chrcteristics in the fcil middle third were observed, with significntly lrger lip volumes (especilly the upper lip), n spect in good ccord with literture references. 11 The mouth width ws lrger in ttrctive girls thn in reference girls, s previously found in ttrctive women. 7 Frks 4 lso found lrger upper lip vermilion height in estheticlly plesing men, nd lrger upper

6 1030 SFORZA, LAINO, D ALESSIO, DELLAVIA, GRANDI, FERRARIO Tble 3. Fcil Volumes Estimted in 42 Beutiful nd 121 Reference Boys Forehed Mxill Mndible Totl Mndible/ Mxill Nose Totl Lip Upper Lip Lower Lip Boys, 4 5 y Beutiful (n 8) Men SD Reference (n 19) Men SD P (Student s t) NS NS NS NS NS Boys, 6 7 y Beutiful (n 21) Men SD Reference (n 47) Men SD P (Student s t) NS NS NS Boys, 8 9 y Beutiful (n 13) Men SD Reference (n 55) Men SD P (Student s t) NS NS All vlues re mm 3, except the mndibulr to mxillry volume rtio (%). NS indictes not significnt, P.05. vermilion rch with more protruding upper lip in women, s compred to persons with nonttrctive fces. In the middle nd lower third fcil profile, other differences from the reference children were observed (nsolbil, interlbil, nd mentolbil ngles), but the results were different in the two sexes nd did not show constnt trends. Considering the vritions in dentl formuls typicl of the children of this ge 23 nd the influence of incisor position on soft-tissue profile, 8 the results reltive to these ngles should be considered with cution. The results on nsl volume re contrsting: while the current ttrctive children hd lrger nose thn the reference children, the ttrctive women hd significntly smller nsl volumes. 7 Probbly, most of the ttrctive women underwent surgicl corrections of nsl dimensions (no ctul nmnesis ws collected), while this kind of intervention hd not been performed in children. Nevertheless, nsl volume ws reltively more homogenous in ttrctive children thn in reference children, s previously found in ttrctive women. 7 The increment in upper fcil height observed in severl of the current groups of ttrctive children my explin the incresed nsl volume. This verticl mesurement seems to be reltively constnt nd independent from seculr trends in esthetic opinions. 6 In previous three-dimensionl study performed on ttrctive children, 24 nonttrctive girls hd lrger lower fcil width, finding in contrst with the present findings. Indeed, the previous investigtion 24 contrsted two esthetic groups selected on the bsis of seprte frontl nd lterl photogrphs, nd cnnot be fully compred with the present nlysis. According to Ferrrio et l, 24 nonttrctive girls were on verge ftter thn ttrctive girls, nd the lrger intergonil width ws result of dipose tissue deposition. Overll, when mesured in three dimensions, ttrctive fces of Itlin children with deciduous nd erly mixed dentition s well s young Itlin women, pper to shre severl chrcteristics, notwithstnding the ge differences, nd the time spn (pproximtely 10 yers). Indeed, time-relted modifictions of esthetic cnons hve been reported by severl investigtors, s reviewed by Auger nd Turley, 6 who found tht in the first 90 yers of the lst century Americn femle models were preferred with more nd more prominent nd full lips. Apprently, in these lst few decdes, ttrctive fces hve mintined similr lip chrcteristics. 11 The culturl bckground of the observer seems to

7 FACIAL MORPHOMETRY OF ATTRACTIVE CHILDREN 1031 Tble 4. Fcil Volumes Estimted in 47 Beutiful nd 99 Reference Girls Forehed Mxill Mndible Totl Mndible/ Mxill Nose Totl lip Upper lip Lower lip Girls, 4 5 y Men SD Reference (n 11) Men SD P (Student s t) NS NS NS NS NS Girls, 6 7 y Beutiful (n 18) Men SD Reference (n 45) Men SD P (Student s t) NS NS Girls, 8 9 y Men SD Reference (n 43) Men SD P (Student s t) NS All vlues re mm 3, except the mndibulr to mxillry volume rtio (%). NS indictes not significnt, P.05. Figure 3. Middle nd lower fcil thirds, profile view. Attrctive nd reference girls in the 8- to 9-yer-old ge group. influence esthetic choices in the dentofcil region 1,2,6,8 : in prticulr, dentl nd surgicl professionls pper to be more criticl in their ssessment of fcil esthetic thn nonprofessionls. 1,8,15,17 Additionlly, it is felt tht esthetics should be evluted by the lypersons who ctully seek orthodontic or mxillofcil tretment. 13,17 The use of pnel of judges seemed to be the only scientific mens of mesuring fcil beuty, 9,12 but the process is very complex nd time consuming for its ctul ppliction in clinicl prctice. 12,24 In the current study, n externl pnel of judges ws chosen: the children were independently selected by professionls in csting gency who were unwre of the ctul scope of the investigtion. They were sked to provide ttrctive children of both sexes within well-defined ge rnge nd ethnicity. These fces were to be considered positive nd cceptble for mss medi. 15 This kind of selection ppers to hve never been used before in the scientific literture for children; similr selections were mde for dults only: television ctresses 7 ; winners in beuty competitions, professionl models, nd performing ctors 25 ; nd photogrphs of professionl models published in fshion mgzines. 6,11 The procedure my pper unusul, but the selected children re those tht pper in television, on mgzines, nd vi the mss medi. Their fcil chrcteristics re lso likely to be considered ttrctive by lypersons. 5,6

8 1032 SFORZA, LAINO, D ALESSIO, DELLAVIA, GRANDI, FERRARIO Tble 5. Soft Tissue Fcil Angles Mesured in 42 Beutiful nd 121 Reference Boys n-prn-pg go-pg-go sl-n-sn prn-sn-ls li-sl-pg sn-ls sl-li Boys, 4 5 y Beutiful (n 8) Men SD Reference (n 19) Men SD P (Student s t) NS NS NS NS NS NS Boys, 6 7 y Beutiful (n 21) Men SD Reference (n 47) Men SD P (Student s t) NS.027 NS NS.019 NS Boys, 8 9 y Beutiful (n 13) Men SD Reference (n 55) Men SD P (Student s t) NS NS.040 NS.014 NS All vlues re degrees. NS indictes not significnt, P.05. Tble 6. Soft Tissue Fcil Angles Mesured in 47 Beutiful nd 99 Reference Girls n-prn-pg go-pg-go sl-n-sn prn-sn-ls li-sl-pg sn-ls sl-li Girls, 4 5 y Men SD Reference (n 11) Men SD P (Student s t).018 NS NS NS NS NS Girls, 6 7 y Beutiful (n 18) Men SD Reference (n 45) Men SD P (Student s t) NS NS NS NS Girls, 8 9 y Men SD Reference (n 43) Men SD P (Student s t) NS NS NS NS NS NS All vlues re degrees. NS indictes not significnt, P.05.

9 FACIAL MORPHOMETRY OF ATTRACTIVE CHILDREN CONCLUSIONS When compred to reference, helthy children, Itlin ttrctive children in the deciduous nd erly mixed dentition hd : Lrger fce, with n incresed development of the fcil middle (mxill) nd upper thirds (forehed); the fce ws wider nd deeper (dimensions nd horizontl convexity), but less verticlly developed in the lower third Lrger lips, with n incresed verticl dimension; in girls, lso lrger mouth width Lrger nose More convex profile, with more prominent mxill reltive to the mndible ACKNOWLEDGMENTS The uthors re gretly indebted to ll the Stff of the Lbortorio di Antomi Funzionle dell Apprto Stomtogntico, Università degli Studi di Milno, who prticipted in dt collection nd nlysis (Drs Frncesc Ctti, Veronic Cius, Ann Colombo, Frncesc R. Dimggio, Silvi Floren, Fbrizio Min, Ginluc M. Trtgli). Dr Ptrizi Frngell orgnized the dt collection in ttrctive children. The finncil support of the Consiglio Direttivo of the Società Itlin Di Ortodonzi (SIDO) is lso grtefully cknowledged. REFERENCES 1. Johnson N, Sndy J. An esthetic index for evlution of cleft repir. Eur J Orthod. 2003;25: Mtoul S, Pncherz H. Skeletofcil morphology of ttrctive nd nonttrctive fces. Angle Orthod. 2006;76: Ferrrio VF, Sforz C, Serro G, Cius V, Dellvi C. Growth nd ging of fcil soft-tissues: computerised three-dimensionl mesh digrm nlysis. Clin Ant. 2003; 16: Frks LG. Anthropometry of the ttrctive North Americn Cucsin fce. In: Frks LG, ed. Anthropometry of the Hed nd Fce. 2nd ed. New York, NY: Rven Press; 1994: Peck S, Peck L. Selected spects of the rt nd science of fcil esthetics. Semin Orthod. 1995;1: Auger TA, Turley PK. The femle soft tissue profile s presented in fshion mgzines during the 1900s: photogrphic nlysis. Int J Adult Orthodon Orthognth Surg. 1999;14: Ferrrio VF, Sforz C, Poggio CE, Trtgli G. Fcil morphometry of television ctresses compred with norml women. J Orl Mxillofc Surg. 1995;53: Isiksl E, Hzr S, Akylcin S. Smile esthetics: perception nd comprison of treted nd untreted smiles. Am J Orthod Dentofcil Orthop. 2006;129: Mew J. Suggestions for forecsting nd monitoring fcil growth. Am J Orthod Dentofcil Orthop. 1993;104: Ricketts RM. Perspectives in the clinicl ppliction of cephlometrics. The first fifty yers. Angle Orthod. 1981;51: Bisson M, Grobbelr A. The esthetic properties of lips: comprison of models nd nonmodels. Angle Orthod. 2004; 74: Edler R, Agrwl P, Wertheim D, Greenhill D. The use of nthropometric proportion indices in the mesurement of fcil ttrctiveness. Eur J Orthod. 2006;28: Kiekens RM, Mlth JC, vn t Hof MA, Kuijpers-Jgtmn AM. Objective mesures s indictors for fcil esthetics in white dolescents. Angle Orthod. 2006;76: Shw WC. The influence of children s dentofcil ppernce on their socil ttrctiveness s judged by peers nd ly dults. Am J Orthod. 1981;79: Orsini MG, Hung GJ, Kiyk HA, Rmsy DS, Bollen AM, Anderson NK, Giddon DB. Methods to evlute profile preferences for the nteroposterior position of the mndible. Am J Orthod Dentofcil Orthop. 2006;130: Bergmn RT. Cephlometric soft tissue fcil nlysis. Am J Orthod Dentofcil Orthop. 1999;116: Todd SA, Hmmond P, Hutton T, Cochrne S, Cunninghm S. Perceptions of fcil esthetics in two nd three dimensions. Eur J Orthod. 2005;27: Ferrrio VF, Sforz C, Poggio CE, Cov M, Trtgli G. Preliminry evlution of n electromgnetic three-dimensionl digitizer in fcil nthropometry. Cleft Plte Crniofc J. 1998;35: Ferrrio VF, Sforz C, Trtgli GM, Sozzi D, Crù A. Three-dimensionl lip morphometry in dults operted on for cleft lip nd plte. Plst Reconstr Surg. 2003;111: Hjeer MY, Mo Z, Millett DT, Ayoub AF, Siebert JP. A new three-dimensionl method of ssessing fcil volumetric chnges fter orthognthic tretment. Cleft Plte Crniofc J. 2005;42: Sforz C, Perett R, Grndi G, Frronto G, Ferrrio VF. Three-dimensionl fcil morphometry in ptients with skeletl Clss III mlocclusion. A non-invsive study of softtissue chnges before nd fter orthognthic surgery. Br J Orl Mxillofc Surg [seril online]. Februry 14, Soncul M, Bmber MA. Evlution of fcil soft tissue chnges with opticl surfce scn fter surgicl correction of Clss III deformities. J Orl Mxillofc Surg. 2004;62: Dimggio FR, Cius V, Sforz C, Ferrrio VF. Photogrphic soft tissue profile nlysis in children of 6 yers of ge. Am J Orthod Dentofcil Orthop.In press. 24. Ferrrio VF, Sforz C, Poggio CE, Colombo A, Trtgli G. The reltionship between fcil 3-D morphometry nd the perception of ttrctiveness in children. Int J Adult Orthodon Orthognth Surg. 1997;12: Peck S, Peck L, Ktj M. Skeletl symmetry in estheticlly plesing fces. Angle Orthod. 1991;67:43 48.