2015 CEO

Published by / Edite par Elsevier Masson SAS

Original Article All rights reserved / Tous droits reserves

Article original

Soft tissue cephalometric norms of Iranian

Class I adults with good occlusions and
balanced faces
Normes ce
phalome
triques chez les adultes

sentant une bonne
iraniens en Classe I pre
occlusion et un visage e
quilibre

Fariborz AMINIa, Zeinab Sadat RAZAVIANb,*, Vahid RAKHSHANb,c

a
Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
b
Dentist in Private Practice, Tehran, Iran
c
Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University,
Tehran, Iran

Available online: 4 February 2016 / Disponible en ligne : 4 fe
vrier 2016

Summary
sume
Re

Aim: The aim of this study was to assess the soft tissue measure-

Objectif : Lobjectif de cette etude

etait

devaluer les valeurs
ments of Iranians with good occlusion and to compare the des tissus mous chez des Iraniens presentant
une bonne
Iranian norms with other ethnicities. occlusion et de comparer les normes iraniennes avec celles
dautres ethnies.
Materials and methods: A total of 25 anthropometric variables

Materiels

et methodes : Vingt-cinq variables ont et
e

were measured by a dentist in 50 Iranian Class I subjects (25 mesurees
par un dentiste chez 50 sujets iraniens en Classe
males, 25 females) with good occlusion and well-balanced I (25 hommes, 25 femmes) presentant
une bonne occlusion
faces. The differences between the two genders, as well as the

et un visage equilibr
Les differences
e.
entre les deux sexes,
differences between Iranian norms and the Holdaway and de meme ^

que les differences entre les normes iraniennes et
Burstone analyses, were statistically analyzed using a t-test celles des analyses de Holdaway et de Burstone, ont et
e

(a = 0.05). analysees
statistiquement a` laide dun test t (a = 0,05).
Results: The subjects mean age was 21.6 W 4.1 years. There

Resultats : La moyenne dage ^

des sujets etait de 21,6 W
were significant differences between males and females regard-

4,1 ans. Des differences significatives ont et
e
relevees

entre
ing the mentocervical angle, the nasolabial angle, Merrifields les hommes et les femmes concernant : langle cervicomen-
Z-angle, the angle of facial convexity, soft tissue chin thickness, tonnier, langle nasolabial, langle Z de Merrifield, langle de
and upper lip thickness (P < 0.05). The Holdaway norms can convexite
faciale, lepaisseur

des tissus mous mentonniers et
be used for the Iranian population, except for the following

lepaisseur 
de la levre

superieure (p < 0,05). Les normes de
measurements which might be significantly different: facial Holdaway peuvent etre ^ utilisees
sur une population iranienne
convexity angle, nasolabial angle, interlabial gap, soft tissue a` lexception des mesures suivantes qui peuvent differer
de
facial angle, skeletal profile convexity, H-angle, lower lip to fac on significative : langle de convexite
faciale, langle naso-
H-line, lower sulcus depth, and soft tissue chin thickness labial, la distance interlabiale, langle des tissus mous faciaux,
(P < 0.05). la convexite
du profil squelettique, langle H, la distance levre 

* Correspondence and reprints / Correspondance et tire
s a` part :

Zeinab Sadat RAZAVIAN, Islamic Azad University, Dental Branch, PO Box 19585-175,
Tehran, Iran.
e-mail address / Adresse e-mail : zsr.dentist@gmail.com (Z.S. RAZAVIAN)

108 International Orthodontics 2016 ; 14 : 108-122

http://dx.doi.org/10.1016/j.ortho.2015.12.003
 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

inferieure

a` la ligne H, la profondeur du sulcus inferieur, et


lepaisseur des tissus mous mentonniers (p < 0,05).
Conclusions: There was a considerable sex dimorphism in the

Conclusions : Il existe un dimorphisme considerable au sein
Iranian population. The Holdaway norms are not useful for the de la population iranienne. La plupart des normes de
Iranian population regarding most measurements. Holdaway ne peuvent etre ^

utilisees pour une population
iranienne.
2015 CEO. Published by Elsevier Masson SAS. All rights 2015 CEO. Edite par Elsevier Masson SAS. Tous droits
reserved reserves

Key-words
s
Mots-cle
Anthropometry.
Ethnic groups.
Anthropome
trie.
Groupes ethniques.
Orthodontic photography.
Sexual dimorphism.
Photographie orthodontique.
Dimorphisme sexuel.

Introduction Introduction

Orthodontic treatment will not be successful if we do not take Un traitement orthodontique ne peut re
ussir que si lon tient
into account the soft tissue, which needs to be normalized [1]. compte des tissus mous, qui ont besoin de ^tre normalise
s [1].
Defining norms and assessing any departures from the norms La de
finition de normes et le
valuation des e
carts par rapport
thus defined are two of the main tasks of orthodontic therapy a` ces normes sont deux des ta ^ches les plus importantes de la
[15]. Sound knowledge of the normal dentofacial pattern the
rapie orthodontique [15]. Une bonne connaissance des
increases the treatment success rate by ensuring facial har- sche
mas dentofaciaux normaux favorise le taux de re
ussite
mony [6,7]. There is a pressing need, therefore, to determine des traitements en garantissant lharmonie faciale [6,7]. Il est
the orthodontic norms of different ethnic groups in order to urgent, par conse
quent, de de
terminer les normes orthodon-
provide better treatment addressing both the functional and tiques de diffe
rents groupes ethniques afin dame
liorer le trai-
esthetic needs of patients from, or residing within, different tement en fonction des besoins esthe
tiques et fonctionnels de
regions [3,5,6,8]. patients originaires de re
gions diffe

rentes, ou habitant des
re
gions diffe
rentes [3,5,6,8].
Facial esthetics is receiving ever-increasing notice in ortho- Lesthe
tique faciale est lobjet dun inte
re
^ t croissant en ortho-
dontics [9]. Holdaway stressed the implementation of proper dontie [9]. Holdaway a souligne
limportance dutiliser des
soft tissue relations to establish the best possible facial har- relations approprie
es pour les tissus mous afin dobtenir une
mony [10,11]. Today, the facial soft tissue profile is one of the harmonie faciale optimale [10,11]. De nos jours, le profil des
most vital norms for orthodontists and maxillofacial/plastic tissus mous faciaux constitue lune des normes les plus
surgeons and has recently been a center of attention through essentielles en orthodontie et en chirurgie maxillofaciale/
soft tissue analyses by practitioners, such as Holdaway, cosme
tique et a attire
lattention par le biais danalyses des
Steiner, and Burstone [5,7,11,12]. tissus mous re
alise
es par des praticiens, tels que Holdaway,
Steiner et Burstone [5,7,11,12].
Most classical profile norms were derived from European/ La plupart des normes de profil classiques sont base
es sur
American populations [4,6,12]. These standards may not nec- des populations europe
ennes et ame
ricaines [4,6,12]. Ces
essarily be relevant to the diagnosis and treatment planning of normes ne sont pas ne
cessairement pertinentes pour le diag-
patients from other ethnic backgrounds, as findings in the nostic et le traitement de patients issus dautres horizons eth-
literature suggest a marked difference between populations niques, puisque les re
sultats dans la litte

rature sugge  rent des
[2,4,5,6,8,1219]. Since, ethnicity can affect the soft tissue diffe
rences prononce
es entre des populations diffe
rentes
features [2,4,5,8,13,14,2025], studies of different popula- [2,46,8,1219]. Vu que lorigine ethnique peut influer sur
tions can be of significant value. les tissus mous [2,4,5,8,13,14,20,21,2125], des e
tudes de
populations varie
es peuvent apporter une contribution
significative.
It was previously thought that, by aligning the teeth and skel- Pre
ce

demment, il e
tait convenu que lalignement des dents et
etal structures, soft tissue would be guided into a balanced and des structures squelettiques guidait les tissus mous faciaux
harmonious profile. However, since skeletal analyses are not vers une relation e
quilibre

e et harmonieuse. Cependant, e
tant
highly correlated with soft tissue measurements, this strategy donne
que les analyses squelettiques nont pas une relation
can lead to esthetic failure [5,2629]. Orthodontics is placing forte avec les valeurs des tissus mous, cette strate
gie peut

International Orthodontics 2016 ; 14 : 108-122 109

 Fariborz AMINI et al.

ever more emphasis on soft tissue [9,30,31]. Despite the
chec esthe
aboutir a` le
tique [5,2629]. De
sormais, lorthodon-
importance of soft tissue in the success of orthodontic treat- tie met de plus en plus laccent sur les tissus mous [9,30,31].
ment [5,7], soft tissue measurements have played a small part Malgre
limportance des tissus mous dans la re
ussite du trai-
in the literature, and substantial studies on this issue are tement orthodontique [5,7], les e
valuations des tissus mous
lacking. Moreover, this field has not been previously assessed nont occupe
quune place limite
e dans la litte

rature, et il y a
in an Iranian population. Furthermore, comparison of the pe
nurie de
tudes substantielles a` ce sujet. Par ailleurs, ce
norms of one population with other ethnicities can be of clin- domaine na jamais e
te

e
tudie
sur une population iranienne.
ical and anthropological value [4,5]. Nevertheless, very little Qui plus est, des comparaisons des normes dun groupe eth-
research has been done on this issue and none of the few nique avec dautres groupes peuvent save
rer dun inte
re
^t
existing studies has evaluated more than two ethnicities clinique et anthropologique certain [4,5]. Ne
anmoins, tre s
[2,4,18,19]. peu de recherches ont e
te

effectue
es a` ce sujet et aucune
des quelques e
tudes existantes na e
value
plus de deux
groupes ethniques [2,4,18,19].
Furthermore, sex dimorphism of soft tissue measurements has Dautre part, le dimorphisme sexuel relatif aux valeurs des
been insufficiently evaluated [9] except in a few studies tissus mous a e
te

insuffisamment e
value
[9], sauf dans de
[4,7,9,32], probably because conventional measurements are rares e
tudes [4,7,9,32], probablement parce que les mesures
not appropriate for shape assessment [9]. conventionnelles ne se pre ^ tent pas a` le

valuation de formes [9].
Few studies have evaluated the cephalometric soft tissue Peu de
tudes ont e
value
les normes des tissus mous
norms in Iranian children despite the increase in the number ce
phalome
triques chez les enfants iraniens malgre
le nombre
of subjects in the Iranian population seeking orthodontic treat- croissant dindividus en Iran faisant appel au traitement ortho-
ment [25]. All the few studies on Iranians and most of the other dontique [25]. Les quelques e
tudes portant sur des Iraniens et
studies globally were entirely limited to the Holdaway mea- la plupart des autres e
tudes internationales se sont limite
es
surements. Therefore, in order to further explore the above- exclusivement aux mesures de Holdaway. Par conse
quent,
mentioned issues and complement the very few studies on soft afin dexplorer ces proble mes et de comple
ter le tres petit
tissue norms and soft tissue gender dimorphism, we aimed to nombre de
tudes sur les normes des tissus mous et sur le
measure multiple items using three soft tissue tracing analyses dimorphisme sexuel associe
aux tissus mous, nous avons
in a uniform sample of Iranian orthodontic patients presenting voulu mesurer de nombreux e
le

ments a` laide de trois ana-
Class I occlusions. Subsequently, we compared our results lyses de trace
s des tissus mous sur un e
chantillon uniforme de
with the published norms. patients orthodontiques iraniens pre
sentant des occlusions de
Classe I. Ulte
rieurement, nous avons compare
nos re
sultats
avec les normes publie
es dans la litte
rature.

Materials and methods
riels et me

Mate
thodes

Out of more than 300 attendees at the Department of
Orthodontics, at the Islamic Azad University, Tehran, 90 par-
ticipants were selected by two orthodontists and a dentist,
using the following inclusion criteria: agreement to partici-
pate, dental Class I (canine and molar), full dentition (exclud-
ing third molars), normal overbite (12 mm) and overjet (0.5
1 mm), crowding < 6 mm, good physical, visual, auditory and
balance-related health, and a regular and well-balanced pro-
file (subjectively evaluated by two experienced orthodontists
and a dentist). In addition, the included subjects and their
parents all had to be born in Tehran, in order to ensure an
ethnically uniform sample.
The exclusion criteria were: presence of disharmony between
facial components (subjectively assessed by two orthodontists
and a dentist), discrepancy in the vertical, transverse, and
horizontal dimensions, midline shifts, proximal or large fill-
ings, and a history of orthodontic or plastic surgery treatment,
trauma, pathologies and systemic diseases or syndromes.
Sur plus de 300 patients traite
s au de
partement dorthodontie
de luniversite
Islamique Azad a` Te
he

ran, 90 ont e
te

se

lec-
tionne
s par deux orthodontistes et un dentiste utilisant les
res dinclusion suivants : accord de participation, Classe I
crite
dentaire (canine et molaire), denture comple te (a` lexception
des troisiemes molaires), supraclusion normale (12 mm) et
overjet normal (0,51 mm), encombrement < 6 mm, bonne
sante
physique, visuelle et auditive, bon e
quilibre, et un profil

gulier et e
re
quilibre

(e

value
subjectivement par deux orthodon-
tistes expe
rimente
s et un dentiste). De plus, tous les sujets
inclus et leurs parents devaient e ^tre originaires de Te
he
ran afin
de garantir luniformite
ethnique de le
chantillon.
Les criteres dexclusion e
taient : pre
sence de dysharmonie
entre les composantes faciales (e
value
e subjectivement par
deux orthodontistes et un dentiste) ; dysharmonie dans les
sens vertical, transversal et horizontal, de
viations des milieux,
amalgames importants ou proximaux, et un historique de trai-
tement orthodontique, de chirurgie plastique, de trauma-
tismes, de pathologies, et de maladies ou de syndromes
syste
miques.

110 International Orthodontics 2016 ; 14 : 108-122

 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

The ethics of the study protocol were approved by the univer- Le protocole de le
tude a e
te

approuve
par le comite
de
sity research committee. Patients were selected among those recherche universitaire. Les patients ont e
te

se
lectionne
s
undergoing pretreatment lateral cephalographs. All were parmi ceux qui devaient subir une ce
phalographie late
rale
informed about the study, and written consents were taken de pre
-traitement. Tous e
taient informe
s du protocole de
from them.
tude et un consentement e
le
claire
ae
te

obtenu de chacun
dentre eux.
A pilot study comprising 20 randomly selected patients (10 Une e
tude pilote comprenant 20 patients se
lectionne
s au
men and 10 women) was conducted to pre-determine the hasard (10 hommes et 10 femmes) a e
te

entreprise pour
sample size, which was estimated at 50 subjects (25 men, 25 de
terminer la taille de le
chantillon, qui a e
te

estime
e
women) including the pilot study population. The remaining a` 50 sujets (25 hommes et 25 femmes), la population de
subjects (30 patients) were selected randomly.
tude pilote comprise. Les participants restants (30 patients)
le
ont e
te

se
lectionne
s de facon randomise
e.
A total of 90 selected patients were subsequently referred to a Ensuite, 90 patients ont e
te

adresse
s a` un seul centre de
single radiology center equipped with digital lateral cephalo- radiologie e
quipe
dun appareil pour la prise de ce
pha-
graphy equipment (Promax, Planmeca, Finland) until the lographies late
rales (Promax, Planmeca, Finlande) jusqua`
desired sample size was achieved. Lateral cephalographs were obtention de la taille de
chantillon de
sire
e. Des ce
phalogra-
taken in the natural head position, from a distance of 180 cm. phies late
rales ont e
te
re
alise
es dans une position de te ^te
The screens were situated 30 cm away from the patients naturelle, a` une distance de 180 cm. Les e
crans e
taient
midsagittal plane, and all measured 25  20 cm. The voltage positionne
s a` une distance de 30 cm du plan sagittal me
dian
and exposure time were 76 kVp and 12 seconds, respectively. du patient, et tous mesuraient 25  20 cm. La tension et
These could be adjusted according to the patients age and lexposition e
taient de 76 kVp et 12 secondes, respectivement.
size. The magnification factor of each cephalograph was deter- Ces valeurs pouvaient e ^tre ajuste
es en fonction de la ^ge et de
mined by hanging a ring from the right ear of each patient, and la taille du patient. Le facteur de grossissement de chaque
dividing its diameter by the width of the image. Magnification ce
phalographie a e
te

de
termine
en accrochant une boucle
was less than 0.9. a` loreille droite de chaque patient et en divisant le diame tre
par la largeur de limage. Le grossissement e
tait infe

rieur a` 0,9.
ANB angle and Wits analyses were performed on each radio- Langle ANB et lanalyse Wits ont e
te

re
alise
s sur chaque
graph in order to confirm patients skeletal Class I relation- radiographie afin de confirmer la relation de Classe I des
ship. As a first inclusion criterion, only patients with an ANB patients. Comme premier crite re dinclusion, seuls les patients
angle between 1 and 2 and a Wits analysis of W 1 were avec un angle ANB entre 1 et 2 et un Wits de W 1 ont e
te


included. As a second inclusion criterion, only images accu- inclus. Comme deuxie me crite re dinclusion, seules les images
rately showing the quality of soft tissue were included. reproduisant de facon exacte la qualite
des tissus mous ont e
te


Otherwise, they were replaced by new patients (if the other incluses. En cas de rejet, ces sujets e
taient remplace
s par de
radiographic inclusion criterion had been met). This proce- nouveaux patients (a` condition que lautre crite re dinclusion
dure was carried out until 25 males and 25 females had been soit respecte
). Cette proce
dure a e
te

respecte
e jusqua`
recruited. lobtention de 25 patients et de 25 patientes.
Considering the magnification factor of the cephalography

Etant donne
le facteur de grossissement de lappareil de
appliance, 15 linear and 7 angular measurements (accuracy: ce
phalome
trie, 15 mesures line
aires et 7 mesures angulaires
0.5 mm and 0.5 , respectively) were performed manually, (pre
cision : 0,5 mm et 0,5 , respectivement) ont e
te


according to the Burstone, Steiner, and Holdaway analyses. effectue
es manuellement, selon les analyses de Burstone,
The true horizontal line (THL) and true vertical line (TVL) Steiner et Holdaway. La ligne vraie horizontale (LVH) et la ligne
were taken as the horizontal and vertical references, vraie verticale (LVV) ont e
te
prises comme re
fe

rences hori-
respectively. zontale et verticale, respectivement.
Linear measurements (mm) were made for: upper lip curva- Les mesures line
aires (mm) ont e
te

re
alise
es pour :
ture, nose prominence, chin prominence, skeletal profile con- la courbure de la le vre supe
rieure, la proe
minence du nez, la
vexity, upper lip thickness, soft tissue subnasale to H-line, convexite
du profil squelettique, le
paisseur de la le vre
lower lip to H-line, pronasale to H-line, lower lip to E-line, supe
rieure, le subnasal du tissu mou a` la ligne H, la
upper lip to E-line, soft tissue chin thickness, lower sulcus vre infe
le
rieure a` la ligne H, le pronasal a` la ligne H, la le vre
depth, interlabial gap, upper lip prominence, lower lip prom- infe
rieure a` la ligne E, la le vre supe
rieure a` la ligne E,
inence, lower lip to S-line, upper lip to S-line. Angular mea-
paisseur des tissus mous mentonniers, la profondeur du
le
surements (in degrees) comprised Merrifields Z-angle, H-line sulcus infe
rieur, la distance interlabiale, la proe
minence de la
angle, nasolabial angle, angle of facial convexity (lower), men- vre supe
le
rieure, la le vre infe
rieure a` la ligne S, et la le vre
tocervical angle, facial angle, and nasomental angle. supe
rieure a` la ligne S. Les angles mesure
s (en degre
s)

taient : langle Z de Merrifield, langle de la ligne H, langle
e
nasolabial, langle de convexite
faciale (infe
rieur), langle cer-
vicomentonnier, langle facial, et langle nasomentonnier.

International Orthodontics 2016 ; 14 : 108-122 111

 Fariborz AMINI et al.

Method error
thode

Erreur de me

A week after completion of all tracings, 10 radiographs were Une semaine apre s lache vement de tous les trace
s,
selected randomly and traced again by the same person. The 10 radiographies ont e
te

se

lectionne

es au hasard et retrace
es
error variance was calculated at 0.03 using Dahlbergs for- par le me^me ope
rateur. La variance des erreurs a e
te

calcule

e
mula, (Table I). Intra-evaluator concordance was calculated at a` 0,03 utilisant la formule de Dahlberg (Tableau I). La concor-
95% (P = 0.000). dance intra-e
valuateur a e
te

estime

e a` 95 % (p = 0,000).

Statistical analyses Analyses statistiques

Descriptive statistics were calculated for each sex and for Les statistiques descriptives ont e
te

calcule

es pour chaque
both combined (Table II). Sex dimorphism was evaluated sexe et pour les deux sexes combine
s (Tableau II). Le dimor-
by comparing the above-mentioned measurements in men phisme sexuel a e
te

e

value

en comparant les mesures
versus women using an independent-samples t-test mentionne
es ci-dessus entre les hommes et les femmes en
(Table III). The findings were compared with published norms
chantillons inde
utilisant un test t a` e
pendants (Tableau III). Les
(Tables IV and V).
sultats ont e
re
te
compare
s avec les normes publie
es
(Tableaux IV et V).

Results
sultats
Re

The difference between the mean ages of males and females La diffe
rence entre la moyenne da ^ges des hommes et des
was not significant (P = 0.5), according to the t-test. femmes e
tait non significative (p = 0,5), selon le test t.
Descriptive statistics for the whole sample are presented in Les statistiques descriptives pour lensemble de le
chantillon
Table II. There were significant differences between males sont donne
es au Tableau II. Il existait des diffe
rences signifi-
and females in terms of mentocervical angle, nasolabial angle, catives entre les hommes et les femmes concernant langle
Merrifields Z-Angle, angle of facial convexity, soft tissue chin cervicomentonnier, langle nasolabial, langle Z de Merrifield,
thickness, and upper lip thickness (Table III). langle de convexite
faciale, le

paisseur des tissus mous men-

paisseur de la le
tonniers et le vre supe
rieure (Tableau III).
Comparison between Iranian norms (both sexes combined) La comparaison entre les normes iraniennes (les deux sexes
and the Burstone published norms showed a significant dif- combine
s) et la norme publie
e par Burstone montrait une
ference in terms of facial convexity angle and interlabial gap
rence significative concernant langle de convexite
diffe
faciale
(Table IV). Most of the Holdaway analysis measurements were et la distance interlabiale (Tableau IV). La plupart des valeurs
different in the Persian population from the published norms de lanalyse de Holdaway montraient une diffe
rence entre la
(Table V). population persane et la norme publie
e (Tableau V).

Discussion Discussion

The findings of this study indicated that most Iranian soft Les re
sultats de cette e
tude ont montre
que la plupart des
tissue norms were significantly different from the published normes iraniennes de tissus mous e
taient significativement
norms. The only measurements for which Holdaway and
rentes des normes dans la litte
diffe
rature. Les seules valeurs
Burstone analyses might still be useful were upper lip curva- pour lesquelles les analyses de Holdaway et Burstone pour-
ture, soft tissue subnasale to H-line, upper lip thickness, and raient encore rendre service e
taient la courbure de la le vre
nasolabial angle. The latter was not significantly different supe
rieure, le subnasal du tissu mou a` la ligne H, le
paisseur
from the Burstone norm, but was still considerably different vre supe
de la le
rieure et langle nasolabial. Ce dernier ne
tait
with a rather small P value. Therefore, it remains inconclusive pas significativement diffe
rent de la norme de Burstone, mais
awaiting future studies to confirm or invalidate our findings.
tait ne
e
anmoins conside
rablement diffe
rent avec une valeur p
Nevertheless, the upper lip thickness was similar to the ^t petite. Ce re
pluto
sultat reste peu concluant, par conse
quent,
Holdaway norm, and thus probably within the ranges of the a` moins quil ne soit confirme
ou invalide
par des e
tudes
published norm. Our findings contrasted with another study futures. Ne
anmoins, le
paisseur de la le vre supe
rieure e
tait
that found most Iranian norms to be consistent with the similaire aux normes de Holdaway et, de ce fait, rentrait dans
Holdaway standards, except skeletal profile convexity, H- la fourchette de la norme publie
e. Nos re
sultats contrastent
angle, basic upper lip thickness and soft tissue chin thickness avec une autre e
tude qui a trouve
une correspondance entre la
[25]. The differences might be due to sampling from different plupart des normes iraniennes et les normes de Holdaway,
cities (Tehran versus Isfahan cities). Our results were more mis a` part la convexite
du profil squelettique, langle H,

112 International Orthodontics 2016 ; 14 : 108-122

 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

Table I Tableau I
The method error for each of the soft tissue measurements.
thode pour chacune des mesures de tissus
Lerreur de me
mous.

Indices Method error Significance

Error of method / P value /


Erreur de methode Significativite

Nasofacial angle / Angle nasofacial 0.0230 NS
Naso mental angle / Angle nasomentonnier 0.0559 NS
Mentocervical angle / Angle mentocervical 0.0230 NS
Nasolabial angle / Angle nasolabial 0.0000 NS
Z-Merrifield angle / Angle Z de Merrifield 0.0000 NS
H-angle / Angle H 0.0000 NS
Angle of facial convexity / Angle convex. faciale 0.0900 NS
Facial angle / Angle facial 0.0212 NS
Upper lip curvature / Courbure lev. sup. superieure



susuperieurecurvature 0.0661 NS


Nose prominence / Proeminence nez 0.0210 NS


Chin prominence / Proeminence menton 0.0500 NS


Upper lip prominence / Proeminence  sup.
lev. 0.0000 NS


Lower lip prominence / Proeminence lev. inf. 0.0000 NS
 sup. ligne E
Upper lip to E-line / Lev. 0.0500 NS
 inf. ligne E
Lower lip E-line / Lev. 0.0250 NS
 sup. ligne S
Upper lip to S-line / Lev. 0.0000 NS
 inf. ligne S
Lower lip to S-line / Lev. 0.0353 NS
 inf. ligne H
Lower lip to H-line / Lev. 0.0000 NS
Pronasale to H-line / Pronasal a` ligne H 0.0000 NS
Soft tissue subnasale to H-line / Subnasal Tiss. mous 0.0000 NS
Soft tissue chin thickness / Tissus mous menton 0.0250 NS
Skeletal profile convexity / Profil squelettique 0.0500 NS
Upper lip thickness / Epaisseur lev. sup. 0.0250 NS
Lower sulcus depth / Prof. sillon inf 0.0250 NS
Interlabial gap upper lip / E
cart interlab. sup 0.0623 NS

similar to another study on Iranians, which found a greater
paisseur de la base de la le

le vre supe
rieure et le

paisseur des
number of differences between Iranian norms and Holdaway tissus mous mentonniers [25]. Les diffe
rences sont peut-e ^tre
norms [1]. They reported that upper lip sulcus depth, soft dues a` un e
chantillon compose
de sujets provenant de villes
tissue subnasale to H-line, skeletal convexity, H-angle, and
rentes (Te
diffe
he

ran versus les villes dIsfahan). Nos re
sultats
inferior sulcus to H-line were non-significantly different from
taient plus proches de ceux dune autre e
e
tude sur les Iraniens
Holdaway standards, and still in the normal range [1]. qui a trouve
un plus grand nombre de diffe
rences entre les
Therefore, they suggested the possibility of using the measure- normes iraniennes et les normes de Holdaway [1]. Cette e
tude
ments presented by Holdaway for Iranians [1]. Persian adults a rapporte
des diffe
rences non significatives par rapport aux
evaluated in another study [33] had four soft tissue features normes de Holdaway pour la profondeur du sulcus de la le vre
different from the Holdaway standards: a larger skeletal pro- supe
rieure, le subnasal du tissu mou a` la ligne H, la convexite

file convexity, basic upper lip thickness, H-angle, and soft squelettique, langle H, et le sulcus infe
rieur a` la ligne H et a
tissue chin thickness [11]. This indicates that Iranians have a
tabli que ces e
e
le

ments rentraient tout de me ^me dans la four-
slightly more convex profile compared with the Holdaway chette des normes [1]. Ces re
sultats sugge  rent, par conse
-
norms [11]. Arab populations seemed to share more features quent, la possibilite
dutiliser les valeurs avance
es par

International Orthodontics 2016 ; 14 : 108-122 113

 Fariborz AMINI et al.

Table II Tableau II
Descriptive statistics for the measured soft tissue indices in
s
Statistiques descriptives des indices de tissus mous mesure
the sample.
chantillon.
dans le

Index / Indice Mean W SD / CV Maximum Minimum 95% CI /

Moyenne W E-T (%) 95 % IC
Nasofacial angle / Angle nasofacial 35 W 2.9 8.1 43 31 34.7936.40
Naso mental angle / Angle nasomentonier 123 W 4 8.2 136 115 121.9124.1
Mentocervical angle / Angle mentocervical 115 W 13 12.3 195 104 111.39118.60
Nasolabial angle / Angle nasolabial 105 W 11 10.5 130 80 101.9108.04
Z-Merrifield angle / Angle Z de Merrifield 70 W 6.5 2.3 82 57 69.9870.017
H-angle / Angle H 13.7 W 4.6 33.6 23 5 12.4214.97
Angle of facial convexity / Angle de convexite
faciale 6.39 W 3.4 53.2 12 0 5.447.33
Facial angle / Angle facial 86 W 3.5 4.1 92 80 85.0286.97
Upper lip curvature / 2.8 W 1.1 39.3 5 0 2.493.10

Courbure levre

superieure curvature


Nose prominence / Proeminence nez 0.31 W 0.01 3.2 0.40 0.14 0.3020.312


Chin prominence / Proeminence menton 9.9 W 4.2 42.4 15 1.5 8.7311.064


Upper lip prominence / Proeminence  sup.
lev. 3.5 W 1.9 54.3 8 0 2.974.02


Lower lip prominence / Proeminence lev. inf.  2.6 W 2 76.9 9 0 2.043.12

Upper lip to E-line / Levre sup. a` ligne E 4.8 W 3.3 55.2 12 0 3.885.71

Lower lip E-line / Levre inf. a` lignre E 3 W 2.9 70.5 9 0 2.663.339

Upper lip to S-line / Levre sup. a` ligne S 2.1 W 2.6 80.0 7 0 1.3792.820

Lower lip to S-line / Levre inf. a` ligne S 1.8 W 2.6 87.3 5 0 0.9972.603

Lower lip to H-line / Levre inf. a` ligne H 0.4 W 1.6 118 16 0 0.0430.843
Pronasale to H-line / Pronasal a` ligne H 8.5 W 4.8 56.5 19 0 7.1899.810
Soft tissue subnasale to H-line / 4.9 W 2.6 53.1 23 5 4.545.26
Subnasal tiss. mous a` ligne H tissue to H-Line
Soft tissue chin thickness / 13.5 W 3.2 23.7 31 4 12.2014.387
E
paisseur tiss. mous menton tissue
Skeletal profile convexity / 14.9 W 5.8 38.9 30 5 13.2916.50
Convexite
profil squelettique squelettisquelettique
Upper lip thickness / E
paisseur levre


superieure 15.2 W 4.00 26.3 20 9 14.116.30


Lower sulcus depth / Profondeur sillon inferieur 6.6 W 3.1 0.5 12 3 6.0347.16
Interlabial gap upper lip / E
cart interlabial lev.
 sup. 0.41 W 0.7 0.7 170 1 0 0.1320.687
SD: standard deviation; CV: coefficient of variation; CI: confidence interval / E
-T : ecart-type

; CV : coefficient de variation ; IC : intervalle de confiance.

with the published norms. Yemeni people showed three Holdaway pour les Iraniens [1]. Les adultes persans e
value

s
increased features relative to the Holdaway norms (skeletal dans une autre e
tude [33] ont montre
quatre e
le

ments de tissu
profile convexity, basic upper lip thickness, and H-angle) mou qui se
cartaient des normes de Holdaway : une convexite

[18], while Jordanian norms were similar to Holdaway and du profil squelettique plus prononce
e, le

paisseur de la base
Ricketts norms, apart from skeletal convexity and the vre supe
de la le
rieure, langle H, et le
paisseur des tissus
H-angle, which were greater in Jordanians [6,11]. mous mentonniers [11]. Cette observation laisse entendre
que les Iraniens ont un profil le
ge
 rement plus convexe par
rapport aux normes de Holdaway [11]. Les populations arabes
semblent partager davantage de
le

ments avec les normes

es. Les Ye
publie
me
nites pre
sentent trois e
le

ments plus
grands par rapport aux normes de Holdaway (la convexite

114 International Orthodontics 2016 ; 14 : 108-122

 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

Table III Tableau III

Soft tissue cephalometric indices in men and women, and their Indices ce
phalome
triques des tissus mous chez les hommes
comparison using the t-test. et les femmes, et la comparaison entre eux en utilisant le test t.

Index / Indice Men / Women / Significance /

Hommes Femmes Significativite

Nasofacial angle / Angle nasofacial 36.04 W 3.4 35.4 W 2.9 0.4
Naso mental angle / Angle nasomentonnier 123 W 4.07 123 W 4.17 0.9
Mentocervical angle / Angle mentocervical 118 W 17.4 112 W 4.03 0.03
Nasolabial angle / Angle nasolabial 131 W 10.3 105 W 11.2 0.0001
Merrifields Z-angle / Angle Z de Merrifield 64.1 W 6.3 71.9 W 6.1 0.0001
H-angle / Angle H 13.8 W 5.2 13.6 W 4.1 0.9
Angle of facial convexity / Angle de convex. faciale 5.43 W 3.35 7.23 W 3.21 0.008
Facial angle / Angle facial 85.1 W 3 86.3 W 3.9 0.09
Upper lip curvature / Courbure levre 

superieure 2.7 W 1.1 2.8 W 1.2 0.7


Nose prominence / Proeminence nez 0.3 W 0.05 0.31 W 0.7 0.9


Chin prominence / Proeminence menton 10.1 W 4.8 9.3 W 3.2 0.4


Upper lip prominence / Proeminence lev.  sup. 4.2 W 3.1 3.6 W 1.9 0.5


Lower lip prominence / Proeminence  inf.
lev. 2.5 W 3.5 2.8 W 1.9 0.6

Upper lip to E-line / Levre sup. a` ligne E 4.7 W 2.2 4.9 W 3.2 0.8

Lower lip to E-line / Levre inf. a` ligne E 2.8 W 3.2 2.9 W 2.9 0.9

Upper lip to S-line / Levre sup. a` ligne S 2.2 W 2.3 2.1 W 2.8 0.9

Lower lip to S-line / Levre inf. a` ligne S 1.1 W 2.7 0.8 W 2.8 0.6

Lower lip to H-line / Levre inf. a` ligne H 0.34 W 1.9 0.44 W 1.4 0.8
Pronasale to H-line / Pronasal a` ligne H 8.3 W 4.3 8.5 W 4.3 0.9
Soft tissue Subnasale to H-line / Subnasal tiss. mous a` ligne H 4.8 W 2.7 5.2 W 2.5 0.4
Soft tissue chin thickness / E
paisseur tiss. mous menton 14.9 W 3.2 12.3 W 2.8 0.0001
Skeletal profile convexity / Convexite
profil squelettique 15.7 W 6.7 14.5 W 4.1 0.3
Upper lip thickness / E
paisseur levre 

superieure 17.4 W 0.7 13.3 W 3.1 0.0001
Lower sulcus depth / Profondeur sillon inferieur
6.9 W 2.8 6.2 W 3.5 0.3
Interlabial gap upper lip / E
cart interlabial lev. sup. 0.4 W 3.8 0.4 W 0.5 0.9

Table IV Tableau IV
Comparison of Burstone analysis versus our findings on Comparaison de lanalyse Burstone versus nos propres
Persian norms.
sultats concernant les normes persanes.
re

Persian Burstone
Index / Indice Mean W SD / CV Mean W SD / CV Significance /


Moy. W E-T

Moy. W E-T Significativite

Facial convexity angle / Angle de convexite
faciale 6.39 W 3.4 2.35 12 W 4 33.3 0.0001
Nasolabial angle / Angle nasolabial 105 W 11 10.5 102 W 8 7.8 0.2
Interlabial gap / E
cart interlabial 0.41 W 0.7 170 2W2 100 0.0001
SD: standard deviation; CV: coefficient of variation / E
-T : ecart-type

; CV : coefficient de variation.

International Orthodontics 2016 ; 14 : 108-122 115

 Fariborz AMINI et al.

Table V Tableau V
Comparison of Holdaway analysis versus our findings on Comparaison de lanalyse de Holdaway versus nos propres
Persian norms.
sultats concernant les normes persanes.
re

Persian norm / Holdaway norm /

Norme persane Norme
Holdaway
Index / Indice Mean / CV Mean / CV Significance /
Moyenne Moyenne Significativite

Soft tissue facial angle / Angle des tissus mous faciaux 86 W 3.5 4.1 91 W 7 7.7 0.0001


Nose prominence / Proeminence nasale 31 W 1 3.2 19

Upper lip curvature / Courbure levre

superieure 2.8 W 1.1 39.3 2.5 W 1.5 60 0.2
Soft tissue subnasale to H-line / Subnasal tissus mous a` ligne H 4.9 W 2.6 53.1 5W2 40 0.8
Skeletal profile convexity / Convexite
du profil squelettique 6.4 W 3.4 53.1 3.5 W 0.5 14.3 0.0001
Upper lip thickness / E
paisseur levre


superieure 15.2 W 4 26.3 15 W 0 0 0.7
H-angle / Angle H 13.7 W 4.6 33.6 0 0.0001

Lower lip to H-line / Levre

inferieure a` ligne H 0.4 W 1.6 400 0.5 W 1.5 300 0.005


Lower sulcus depth / Profondeur sillon inferieur 6.6 W 3.1 47 5W0 0 0.0005
Soft tissue chin thickness / E
paisseur tissus mous menton 13.5 W 3.2 23.7 11 W 1 9.1 0.0001
SD: standard deviation; CV: coefficient of variation / E
-T : ecart-type

; CV : coefficient de variation.

du profil squelettique, le
paisseur de la base de la le vre

supe
rieure, et langle H) [18], alors que les normes jorda-
niennes sont similaires aux normes de Holdaway et de
Ricketts, a` lexception de la convexite
squelettique et de langle
H, qui sont plus grands chez les Jordaniens [6,11].
Previous studies found that most linear measurements were Des e
tudes ante
rieures ont trouve
que la plupart des mesures
larger in males compared to females [32,34,35]. Alessandra line
aires e
taient plus importantes chez les hommes que chez
and Barnett [36] concluded that the superior sulcus, upper lip, les femmes [32,34,35]. Alessandra et Barnett [36] ont
inferior sulcus and chin integuments were significantly rapporte
que le sulcus supe
rieur, la le
vre supe
rieure, le sulcus
thicker in males compared to females [32]. Chin soft tissue infe
rieur et les tissus mous mentonniers e
taient significative-
was as found to be much thicker in males in previous reports ment plus e
pais chez les hommes que chez les femmes [32].
[32,34]. The same was observed in this study and two other Les tissus mous mentonniers e
taient plus e
pais chez les
studies on Iranians [1,33] and studies on Turks [37] and Iraqis hommes dans plusieurs e
tudes ante
rieures [32,34]. La me ^me
[38] in terms of chin thickness and upper lip thickness in chose a e
te

observe
e dans la pre
sente e
tude et dans deux
Iranian men versus women. Another study on Iranians showed autres e
tudes sur les Iraniens [1,33] ainsi que dans des e
tudes
that chins were thicker in Iranian men compared to Iranian portant sur les Turcs [37] et sur les Iraquiens [38] en ce qui
women [39]. However, only 6 out of 25 measurements in this concerne le
paisseur mentonnie re et le
paisseur de la le vre
study showed gender dimorphism. This finding was similar to supe
rieure, plus importantes chez les Iraniens que chez les
another study on Iranians, which showed not only a lack of sex femmes. Une autre e
tude sur une population iranienne a mon-
dimorphism for lip prominence, but also showed that, among tre
que le menton e
tait plus e

pais chez les Iraniens par rapport
their 11 measurements, only 2 were significantly different aux Iraniennes [39]. Cependant, seulement 6 des 25 mesures
between boys and girls [1]. American Caucasians also had dans cette e
tude ont affiche
un dimorphisme sexuel. Ce
few items related to sex dimorphism [2]. In the present study, re
sultat e
tait similaire a` lobservation dune autre e
tude sur
as well as in another Iranian study, [1] nose prominence was les Iraniens qui a re
ve

le

non seulement une absence de dimor-
not significantly different between men and women. However, phisme sexuel relatif a` la proe
minence labiale mais qui a
in two other studies on Iranians, noses were more prominent in
galement montre
e
, parmi 11 mesures, que seulement
Iranian men compared to women [33,39]. In Saudis, males 2e
taient significativement diffe
rentes chez les garcons par
showed significant upper lip thickness and non-significant rapport aux filles [1]. Les Caucasiens ame
ricains ont

116 International Orthodontics 2016 ; 14 : 108-122

 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

increased lip prominence as reflected by the soft tissue sub-
galement pre
e
sente
peu de diffe
rences lie
es au dimorphisme
nasale to H-line measurement as well as greater nose prom- sexuel [2]. Dans notre e
tude, ainsi que dans une autre e
tude
inence compared to females [11]. iranienne [1], la proe
minence nasale ne
tait pas significative-
ment diffe
rente entre les hommes et les femmes. Cependant,
dans deux autres e
tudes portant sur une population iranienne,
le nez e
tait plus proe
minent chez les hommes que chez les
femmes [33,39]. Chez les Saoudiens, les hommes ont montre

une e
paisseur plus importante de la le vre supe
rieure et une
augmentation non significative de la proe
minence labiale,

ve
re
le

e par la valeur du subnasal du tissu mou a` la ligne H,
de me ^me quune proe
minence nasale plus forte chez les
hommes par rapport aux femmes [11].
Nose prominence is considered a recognizable individual La proe
minence nasale est conside
re

e comme un trait facial
facial trait [11]. The amount of prominence could influence individuel reconnaissable [11] dont lampleur peut influer sur le
treatment planning since it affects the presentation of adjacent plan de traitement puisquelle affecte laspect des structures
circumoral and facial structures [11]. According to Holdaway, pe
ribuccales et faciales avoisinantes [11]. Selon Holdaway,
a value less than 14 mm indicates a small nose [10,11]. une valeur infe
rieure a` 14 mm indique un petit nez [10,11].
Chinese subjects might have less prominent noses and more Les sujets chinois auraient un nez moins proe
minent et un
acute nasolabial angles [11,19]. Iranians noses were more angle nasolabial plus aigu [11,19]. Le nez des Iraniens est
prominent than the published norms. It was previously sug- plus proe
minent que les normes publie
es. Il a e
te

sugge
re


gested that Iranians might have more prominent noses than do pre
ce
demment que les Iraniens auraient un nez plus proe
mi-
white Americans, Turks, and Brazilians [2,5,7]. However, nent que les blancs ame
ricains, les Turcs et les Bre
siliens
noses might be as prominent in Turks as in the published [2,5,7]. Il se peut, cependant, que le nez des Turcs soit aussi
norms [2]. It was interesting that nose prominence of Iranian proe
minent que dans les normes publie
es [2]. Il e

tait inte

res-
men and women did not differ in this study and in another sant de relever que la proe
minence nasale chez les hommes
study on Iranians [1]. Nose growth shows fluctuations that et femmes iraniens na pas montre
de diffe
rence significative
differ between same-aged girls and boys. However, eventually, par rapport a` une e
tude pre
ce

dente sur une population irani-
boys noses can become slightly but statistically non-signifi- enne [1]. La croissance nasale subit des fluctuations
cantly more prominent than girls noses at the age of 14 to
rentes chez les garcons par rapport aux filles du me
diffe ^me
15 years old [25]. Other studies on various populations sug- ^ge. Ne
a
anmoins, le nez des garcons peut e
voluer pour devenir
gested that the nose might be more prominent in boys com- plus proe
minent, de facon mode
re

e mais statistiquement non
pared to girls [11,25,33,37,39,4042]. Saudis might have a significative, par rapport au nez des filles entre 14 et 15 ans
reduced nose prominence in comparison with Turkish norms, [25]. Dautre e
tudes sur des populations diverses sugge  rent
[11,37] but they tend to show sex dimorphism in favor of males que le nez des garcons est plus proe
minent que celui des filles
[11]. The soft tissue angle in the Iranian population was smal- [11,25,33,37,3942]. Les Saoudiens auraient un nez moins
ler than the Holdaway standard. A smaller facial angle indi- proe
minent que les normes turques [11,37], mais auraient
cates a backward-inclining profile. Facial convexity angle tendance a` pre
senter un dimorphisme sexuel en faveur des
presented both sex dimorphism and interethnic differences. hommes [11]. Langle des tissus mous dans la population
It was smaller in women compared to men, and was also iranienne e
tait infe

rieur a` la norme de Holdaway. Un angle
smaller in Iranians than the Burstone norms. This indicates facial re
duit indique un profil convexe. Langle de convexite

more convex profiles in Iranian women compared to men, and faciale indiquait la pre
sence dun dimorphisme sexuel et de
in Iranians compared to Caucasians of European ancestry.
rences interethniques. Il e
diffe
tait plus petit chez les hommes
Other studies on Iranians [43] and Iranian females [44] que chez les femmes, et il e
tait plus petit chez les Iraniens par
showed that Iranians have more convex soft tissue profiles rapport aux normes de Burstone. Ces re
sultats indiquent la
[1]. The sex dimorphism in facial convexity was not observed pre
sence de profils plus complexes parmi les femmes ira-
in white Americans [2]. Some study populations also showed niennes compare
s aux hommes iraniens, et chez les
sex dimorphism in terms of facial convexity, with women Iraniens compare
s aux Caucasiens dorigine europe
enne.
showing more convex profiles [2,12,19]. Dautres e
tudes sur les Iraniens [43] et les Iraniennes [44]
ont montre
que les Iraniens, dans leur ensemble, ont un profil
des tissus mous plus convexe [1]. Le dimorphisme sexuel au
niveau de la convexite
faciale na pas e
te

observe
chez les
Ame
ricains blancs [2]. Dans plusieurs populations de
tude, on
ae
galement observe
un dimorphisme sexuel en termes de
convexite
faciale, avec les femmes pre
sentant un profil plus
convexe [2,12,19].

International Orthodontics 2016 ; 14 : 108-122 117

 Fariborz AMINI et al.

Although the H-angle might vary between the sexes at the age Malgre
de
ventuelles diffe
rences de langle H entre les sexes
of 1112 (with boys having more obtuse angles), due to a (en faveur des garcons qui ont un angle plus obtus) a` la ^ge de
growth spurt in boys, it becomes similar between boys and 1112 ans, en raison de la pousse
e de croissance chez les
girls aged 14 to 15 years old [25]. The H-angle can be affected garcons, la disparite
garcons/filles sestompe aux alentours de
by the mandibular and chin positions [11]. The ideal value for 14 a` 15 ans [25]. Langle H peut e ^tre affecte
par la position de
the H-angle is 10 when the skeletal profile convexity is 0 . As la mandibule et du menton [11]. La valeur ide
ale de langle H
skeletal convexity increases, the H-angle also increases to est de 10 quand la convexite
du profil squelettique est de 0 .
maintain facial harmony [1,10,25]. Iranian skeletal convexity Au fur et a` mesure de laugmentation de la convexite
squelet-
was 1.01 W 2.23 and the H-angle also increased to tique, langle H augmente aussi pour maintenir lharmonie
14.36 W 3.53 [1]. Our findings concorded with the other faciale [1,10,25]. La convexite
squelettique iranienne e
tait de
two studies on Iranians that showed an increased H-angle 1,01 W 2,23 et langle H a e
galement augmente
a` 14,36
together with increased skeletal profile convexity in Iranians (W 3,53) [1]. Nos observations e
taient en accord avec les deux
compared to Holdaway norms [1,33]. This was similar to other autres e
tudes sur les Iraniens qui ont fait e
tat dun angle H
studies on Iraqi adults [38], Yemenis, [18] Saudis, [11] accru de me ^me que dune augmentation de la convexite
du
Kuwaiti adolescents (only the H-angle), [45] and Jordanians profil squelettique chez les Iraniens par rapport aux normes de
(only the H-angle) [1,6]. Indians also had increased facial Holdaway [1,33]. Ces re
sultats e
taient similaires a` ceux
convexity according to the Burstone analysis [1,46]. dautres e
tudes sur des adultes iraquiens (40), ye
me
nites
However, Turks showed a straighter profile with a tendency [18], saoudiens [11], sur des adolescents kowetiens (langle
to slight concavity [11,37]. Japanese subjects also had less H seulement) [45], et jordaniens [1,6] (langle H seulement).
convex skeletal profiles [47]. Saudis have a retruded mandible Les Indiens ont e
galement affiche
une convexite
faciale
compared to European-American norms [48], which was con- accrue par rapport a` lanalyse de Burstone [1,46]. Les Turcs,
firmed by the increased H-angle in Saudis compared to both cependant, ont montre
un profil plus droit avec une le
ge
 re
Anatolian Turkish and Holdaway standards [11]. Compared to tendance a` la concavite
[11,37]. Les sujets japonais avaient
the Holdaway norms, Japanese adults might have more obtuse aussi un profil squelettique moins convexe [47]. Les
H-angles with the lower lip being positioned more anteriorly Saoudiens avaient une mandibule re
trusive compare
s aux
than the H-line with a thicker soft tissue chin [11,47]. normes ame
ricano-europe
ennes [48], ce qui e
tait confirme

par langle H plus important chez les Saoudiens par rapport
aux Turcs anatoliens et aux normes de Holdaway [11].
Compare
s aux normes de Holdaway, les adultes japonais
auraient un angle H plus obtus avec une position de la le vre

rieure plus ante
infe
rieure que la ligne H et avec une e
paisseur
de tissus mous plus conse
quente [11,47].
In the present study, Iranians exhibited thicker soft tissue Dans la pre
sente e
tude, les Iraniens ont pre
sente
des
chins compared to Holdaway standards, similar to earlier
paisseurs de tissus mous mentonniers plus importantes
e
studies on Iranians [25], Turks [37], Iraqis [38] and compare
es aux normes de Holdaway, en accord avec des
Japanese males and females that showed thicker chins
tudes ante
e
rieures sur les Iraniens [25], les Turcs, les
[47,49]. On the other hand, Chinese subjects and a group of Iraquiens [38], les hommes japonais et les femmes japonaises
Turks had thinner chins [2,11,19]. Increased soft tissue chin qui ont montre
un menton plus e
pais [47,49]. Dun autre co ^ te

,
thickness might compensate for a retrusive skeletal chin and les sujets chinois et un groupe de Turcs avaient un menton
help achieve harmony [1,25]. Soft tissue chin was greater in plus mince [2,11,19]. Une e
paisseur des tissus mous menton-
males compared to females in this sample. Another study on niers augmente
e peut compenser un menton squelettique
Iranians showed a non-significant relative thickness in 14- or
trusif et re
re
aliser lharmonie [1,25]. Les tissus mous menton-
15-year-old boys compared to girls [25]. The difference might niers e
taient plus e
pais chez les hommes dans notre
be due to the sampling ages, as it has been shown that soft
chantillon que chez les femmes. Une autre e
e
tude sur les
tissue chin is initially thinner in boys, but with growth and Iraniens a trouve
une e
paisseur relative non significative chez
development it grows thicker than that of girls [25]. Therefore, les garcons de 14 ou 15 ans compare
s aux filles [25]. La
it might be possible for it to become significantly thicker at
rence peut sexpliquer, peut-e
diffe ^tre, par la^ge des sujets
older ages. In Indians, the nasomental angle and mandibular dans le
chantillon puisquil a e
te

de
montre
que, initialement,
sulcus contour angle were more obtuse in men while the total les tissus mous mentonniers sont plus minces chez les
facial contour angle was more obtuse in women, which might garcons mais quils e
paississent en cours de croissance pour
be attributed to greater chin soft tissue thickness in men [32]. finalement de
passer le
paisseur de ceux des filles [25]. Il se
peut, par conse
quent, quils soient significativement plus

pais a` un a
e ^ge plus avance
. Chez les Indiens, langle nasome-
ntonnier et langle du contour du sulcus mandibulaire e
taient
plus obtus chez les hommes alors que langle du contour facial

tait plus obtus chez les femmes, ce qui sexplique peut-
total e

118 International Orthodontics 2016 ; 14 : 108-122

 Soft tissue cephalometric norms of Iranian Class I adults with good occlusions and balanced faces

phalome
Normes ce
triques chez les adultes iraniens en Classe I pre

sentant une bonne occlusion et un visage e

quilibre

^tre par le
e
paisseur plus importante des tissus mous menton-
niers chez les hommes [32].
Lip prominence is defined by lines, such as H, S1, S2, E, or B La proe
minence labiale est de
finie par des lignes, telles que
in various analyses [2,5,12,13,17,50]. Lip position is much les lignes H, S1, S2, E, et B dans diverses analyses
more protrusive in Chinese subjects, and is slightly more [2,5,12,13,17,50]. La position des le vres est beaucoup plus
protrusive in Turks than in Americans, Yemenis, and protrusive dans la population chinoise et est le
ge
 rement plus
Iranians [2,5,12,1820]. In this study, upper lip thickness protrusive chez les Turcs que chez les Ame
ricains, les
was shown to differ between sexes but not between ethnic Ye
me
nites et les Iraniens [2,5,12,1820]. Dans notre e
tude,
groups. Also, lower lip-chin length and the lip length ratio
te
il a e
de

montre
que le

paisseur de la le vre supe
rieure e

tait
were significantly greater in males compared to females in diffe
rente entre les deux sexes mais non pas entre les diffe
r-
some studies [32,51,52]. Nevertheless, unlike many previous ents groupes ethniques. Aussi, dapre s certaines e
tudes, la
studies [2,5,18,20,22], in this sample, lips were not more longueur le vre infe
rieure-menton et le ratio longueur des
prominent in women compared to men. The lower lip was vres e
le
taient significativement plus e
leve
s chez les hommes
retrusive in our sample compared to the Holdaway standards, que chez les femmes [32,51,52]. Ne
anmoins, a` la diffe
rence
unlike Chinese people in which both lips were more protrusive de nombreuses recherches [2,5,18,20,22], dans notre e
tude
than in Caucasians [11,19]. Similar to previous reports, no les levres e
taient plus proe
minentes chez les femmes que
significant difference between boys and girls in terms of lower chez les hommes. La le vre infe

rieure e
tait re

trusive dans notre
lip to H-line was found in this sample [25,41]. In Saudis
chantillon, compare
e
e aux normes de Holdaway, a` la diffe
-
[11,53] also, the lower lip was more protrusive than the norms rence de la population chinoise chez qui les deux le vres
reported by Holdaway, estimating an ideal lower lip position to
taient plus protrusives que chez les Caucasiens [11,19].
e
be between 0 and 0.5 mm from the H-line. In the Japanese Comme dans des e
tudes ante
rieures, aucune diffe
rence sig-
population, the lower lip was also protrusive relative to the nificative na e
te

trouve
e dans notre e
chantillon entre les
Holdaway norms, in keeping with their greater skeletal con- garcons et les filles en ce qui concerne la le vre infe
rieure
vexity [11,47]. There was no difference in upper lip thickness a` la ligne H [25,41]. Chez les Saoudiens [11,53] e
galement,
between Iranians and the Holdaway standards. This was in la le vre infe
rieure e
tait plus protrusive que les normes
contrast to the Saudi population, which showed reduced upper rapporte
es par Holdaway qui situent la position ide
ale de la
lip thickness compared with many other ethnicities [11], but vre infe
le
rieure entre 0 et 0,5 mm de la ligne H. Dans la popu-
was similar to Turks who showed increased thickness of the lation japonaise, la le vre infe

rieure e
tait e

galement plus pro-
upper lip [37]. trusive que les normes de Holdaway, en accord avec la con-
vexite
squelettique plus marque
e [11,47]. Il ny avait pas de
diffe
rence au niveau de le
paisseur de la le vre supe
rieure
entre les Iraniens et les normes de Holdaway, a` la diffe
rence
de la population saoudienne qui montrait une e
paisseur de la
vre supe
le
rieure re
duite compare
e a` beaucoup dautres
groupes ethniques [11], mais similaire aux Turcs qui ont mon-
tre
une e
paisseur accrue de la le vre supe
rieure [37].

Limitations
tude
Limites de le

In terms of limitations, the intermixture of different ethnicities En ce qui concerne les limites de notre e
tude, le me
lange de
precludes drawing clear distinctions. Also, Iran hosts different
rents groupes ethniques nous empe
diffe ^che de de
gager des
ethnic populations and it is unlikely that a group drawn from
rences nettes. De plus, lIran accueille divers groupes
diffe
one city will reflect all the ethnicities living throughout the ethniques et il est peu probable quun groupe recrute
dans
country. This seems to have been a limitation of almost every une ville donne
e puisse refle
ter toutes les ethnicite

s pre

sentes
other similar study so far. However, Tehran possesses a blend dans lensemble du pays. Cette limitation semble sappliquer
of different ethnicities from all over Iran, which might com- aussi a` presque toutes les autres e
tudes similaires re
alise

es
pensate partly for this shortcoming. In addition, well-balanced
sent. Cependant, Te
jusqua` pre
he
ran possede une mixite
de
faces were determined subjectively, as there is no objective groupes ethniques varie
s provenant de partout dans le pays,
way of identifying such faces. Similar to earlier research ce qui compense en partie cette lacune. Par ailleurs, des
[2,8,1219], this study was done on cephalograms, which visages e
quilibre

s ont e

te

se
lectionne
s de facon subjective,
might raise X-ray exposure and ethical concerns [5,54]. puisquil nexiste pas de technique objective pour identifier de
However, we avoided using too large a sample by incorporat- tels visages. Semblable a` la plupart des e
tudes pre
ce

dentes
ing the results of a pilot study, which minimized X-ray expo- [2,8,1219], cette e
tude a e
te

re

alise

e en utilisant des
sure to the population for research purposes. Moreover, the ce
phalogrammes, ce qui pourrait augmenter lexposition aux
included patients needed lateral cephalographs as a routine rayons X et provoquer des proble mes e
thiques [5,54].

International Orthodontics 2016 ; 14 : 108-122 119

 Fariborz AMINI et al.

part of their diagnosis and treatment at the department. Our Cependant, nous avons e
vite

dutiliser un e
chantillon trop
sample size was within the range of many previous studies important en incorporant les re
sultats dune e
tude pilote, ce
adopting samples with as many as 41 [6], 62 [13] or 60 subjects qui a minimise
lexposition aux rayons X a` la population utilise

e
[4]. a` des fins de recherche. De plus, les patients inclus avaient
besoin de ce
phalogrammes late
raux dans le cadre de leur
diagnostic routinier et de leur traitement dans notre
de
partement. La taille de notre e
chantillon e
tait dans la four-
chette de celles de beaucoup de
tudes ante
rieures, qui ont
adopte
des e
chantillons avec jusqua` 41 [6], 62 [13] ou
60 sujets [4].

Conclusions Conclusions

The current study demonstrated that the Holdaway norms can La pre
sente e
tude a de

montre
que les normes de Holdaway
be used for the Iranian population except for the following sont utilisables pour une population iranienne a` lexception
measurements which can be significantly different: facial con- des mesures suivantes, qui peuvent diffe
rer de manie re sig-
vexity angle, nasolabial angle, interlabial gap, soft tissue nificative : langle de convexite
faciale, langle nasolabial, la
facial angle, skeletal profile convexity, H-angle, lower lip to distance interlabiale, langle des tissus mous faciaux, la con-
H-line, lower sulcus depth, and soft tissue chin thickness. vexite
du profil squelettique, langle H, la levre infe

rieure a` la
Gender dimorphism was observed in the mentocervical angle, ligne H, la profondeur du sulcus infe
rieur et le

paisseur des
nasolabial angle, Merrifields Z-angle, the angle of facial tissus mous mentonniers. Le diphormisme sexuel a e
te


convexity, soft tissue chin thickness, and upper lip thickness. observe
pour langle cervicomentonnier, langle nasolabial,
langle Z de Merrifield, langle de convexite
faciale, le

paisseur
des tissus mous mentonniers et le
paisseur de la le vre
supe
rieure.

Disclosure of interest
claration de liens dinte

De
re
^ts

The authors declare that they have no competing interest.
clarent ne pas avoir de liens dinte
Les auteurs de
re
^ ts.

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