Introduction 

An appealing and balanced face is one of the main objectives of orthodontic diagnostic and treatment planning.1 The age of cephalometric dominance, in which the profile as seen on a lateral cephalogram was primarily used to define beauty, endured for a long time. 2

The new paradigm, however, is soft tissue-based diagnostic and treatment planning. Despite a paradigm shift toward soft tissue-based diagnosis and treatment planning as well as result evaluation, there have been relatively few studies on photographs despite the fact that lateral cephalograms are not taken as required records during the pre-treatment stage, post-treatment stage, and retention phase of orthodontic treatment. 3

This soft tissue envelope is based on foundation of hard tissue skeletal component which is reflected on profile images typically the hard tissue (skeletal) can be measured on lateral and frontal cephalogram. However, several soft tissue measurements can be done directly on profile images as well. 4

As a result, a photograph-based cephalometric study may be useful for planning orthodontic treatment, especially in situations when a cephalometric radiograph is expressly avoided. To analyse soft tissue cephalometric characteristics in participants from Central India is what we thus propose as the goal of our study.5, 6, 7, 8

Materials and Methods

The lateral profile photos (n = 40) of central Indian participants meeting the inclusion criteria are analysed in this study. After getting their permission, standardised subject profile photos were obtained, then manually analysed. Standardized profile pictures were shot for the records using camera Canon 1500D and a 55-200mm macro lens.

The tripod is used to position the camera correctly vertically based on the height of the participants. The camera's focal length was 5.6 mm, the shutter speed was 100, and the separation between the operator and subject was 8 feet. Two umbrella flashes and an illuminated white backdrop are employed for excellent lighting and shadow-free pictures. (Figure 1A-C)

Following angular were measured on soft tissue photographs–

Exclusion criteria

1. Antero-posterior or vertical dysplasia that is syndromic and severe.

2. Any facial injuries or surgery.

3. Lip and palate deformities.

Figure 1

A: Adobe photoshop, B: Photographic setup; C: Camera canon EOS 1500; D: Angles were measured on soft.

Results

The excel page was filled out with the data. The data were analysed using the statistical software for social sciences (SPSS) 20.0 version. Using Kolmogorov-Smirnov test to determine the probability distribution of the data, it was determined that the data were not normally distributed (p value.05). It was done using descriptive statistics. The Spearman's correlation coefficient was used to evaluate the correlation between the variables. Statistical significance was determined by the p value of less than.05. The 95% confidence level was used.

Table 1 shows the mean (SD) and median (inter-quartile range) of the N'-Trg' -Sn', N'-Trg'-Me', Sn'-Trg'-Me', and N'-Trg'-Mp' angles. These angles are only faintly connected with one another, and the association that was discovered was statistically insignificant.

Table 2 1). N'-Trg'-Sn' & N'-Trg'-Me' are correlated with one another. 2). Sn'-Trg'-Me' & N'-Trg'-Sn'. Three) N'-Trg' -Sn' &Trg'-Me'-Mp' N'-Trg'-Me' and Sn'-Trg'-Me'. 5). &Trg'-Me'-Mp' N'-Trg-Me. 6). Sn'-Trg'-Me' and Trg'-Me'-Mp'

There was no statistically significant correlation between the different angles

Discussion

Different racial and ethnic group have different soft-tissue analysis standards. However, there is lack of data in this field specially for Indian population and we could not find specific data for Central India population. Therefore, standards for central Indian subjects' soft-tissue photographic norms are need of the hour.

Vahid Moshkelgosha et al 9 study, in an Adolescent Persian Population, found that the male mean and SD for the medium facial third (N'- Trg'- Me') are 27.01 and 2.33, while the value mean and SD are 28.99 and 2.4. Show by our study, which focused on the people of central India.

Angle of the lower third of the face in men is 37.44°, in women it is 35.3°, and in both cases the standard deviation is 2.61°. Angle of inferior facial third (SN'-Trg'-Me') SD 2.9, Mean 29.6 was the results of our investigation.

Saravana Pandian K and Sindhuja Krishnan Aravind kumar 3 discovered in their study on angular photogrammetric examination of Indian population's soft tissue face profile, the Angle of inferior facial third in males was Mean SD 29.610 and the Angle of inferior facial third in females was Mean SD 29.5. The value of Angle of inferior facial third (SN'-Trg'-Me') Mean 29.7, with SD 2.9 10 was found in our study, which was conducted on a population in central India.

Also medial third angle of the face in men the standard deviation is 25.4. Women's typical middle-face angles were 26.6 degrees on average, with a standard variation of 2.4 degrees. In our study, which was done on a population in central India, the angle of the medium facial third (N'-Trgh'-Sn') had a mean of 30.7 and an SD of 3.5.

Yusra A. M. Almansob 11 conducted their research on comparison of the soft tissue of the face before orthodontic treatment in Chinese patients having Angle’s class I, they reported angle of the middle part of the face with value of 27.6. (N'-Trg'-Sn') and SD of 3.5. 11 They reported angle of the lower portion of the face to be SD mean 36.7 ^ο.

In our study, N’-Trg'-Me' mean value of 59.08^ο with SD 4.6^ο. Trg'-Me'-MP' mean value of 27.8^ο with SD. 7.8^ο. which was conducted on a population in central India.

Conclusion

Therefore, this recommended to used soft tissue photographic norms for central India subjects while diagnosis, treatment planning as well as evaluation of results in subjects of central India origin. Further multicentric studies involving larger sample size with gender segregation of subjects will be needed to provide better floating norms for central India subjects.

Conflict of Interest

None.

Source of Funding

None.