Rajiv Gandhi University OF HEALTH SCIENCES, KARNATAKA
Bangalore
Annexure-II
Proforma For Registration of Subjects for Dissertation
1. / Name of the candidate(in block letters)
/ Dr. CHAWLA GOLDIE JAGDISH
Permanent Address
/ SUGAN TOWER, JAIRAM NAGAR, NEAR RAJAPETH, AMRAVATI. 4446062. / Name of the Institution / H.K.E. SOCIETY’s S.NIJALINGAPPA INSTITUTE OF DENTAL SCIENCES AND RESEARCH, GULBARGA.
3. / Course of study and Subject / MASTER OF DENTAL SURGERY - ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS.
4. / Date of admission to the Course / 29th MAY 2012
5. / Title of Topic / “perception of preffered lip position
in varying chin prominences by
orthodontic patients, parents and
professionals of gulbarga.”
6. /
Brief resume of intended work:
6.1 / Need of study :Physical appearance influences an individual’s integration and self-esteem and
may become critical to their psychological well-being.1 Therefore, many patients
seek orthodontic treatment motivated by the desire to improve their facial
appearance2, and minimize aesthetic related psychosocial problems.3
Perception of beauty depends upon individual preference but is influenced by
ethnic and cultural experiences as well as by family beliefs.4These different
aspects underlie certain claims that the perception of beauty changes with time
and place.
Early studies illustrate attempts to find the ideal dental and skeletal cephalometric
relationships to produce balanced, stable results. However, early analyses paid
little attention to the importance of the soft tissues of the face in maximizing facial
harmony and esthetics.5
In recent times, there is a paradigm shift and many orthodontists believe that soft-
tissue profile analysis should be an important consideration in orthodontic
treatment planning5. It has also been stated that lip posture is a critical element not
only for overall facial aesthetics but also for post treatment stability and
function 5.
The concept of facial aesthetics is bound in many aspects on subjective judgement.
Facial attractiveness might be related to several factors: ethnic group, age, sex,
region and professional background.
So, it is important to consider the perception of non orthodontists in determining
the most pleasant profile because the goals of orthodontic treatment are not only to
achieve a functional occlusion, but also to create an aesthetic profile.
Thus the purpose of this study is to determine specifically the influence of varying
Chin prominence on preferred lip position in Gulbarga population.
6.2 / Review of Literature
1. Foster EJ (1973)7: studied six diverse groups of thirty people to evaluate seven silhouette facial profiles. Each silhouette drawing unchanged with the exception of the lips which were advanced in 2mm stages so that full face had lips 12 mm protrusive to the straight face. Results indicated that diversified groups in the study do seem to share a common aesthetic standard for posture of lips. All groups were consistent for assigning fuller lips in younger ages.
2. Barrer JG and Ghafari J. (1985)8: compared silhouette profiles to determine the effects of orthodontic treatment on facial esthetics. Forty-eight white patients with Class II, Division 1 malocclusions and mandibular retrognathism were treated. One hundred first-year dental students selected the profile which they estimated had the best facial esthetics and then evaluated this preferred profile as “satisfactory” or “unsatisfactory.” The results support the use of the silhouette in the evaluation of profiles. Also, they show the advantage of determining, in surveys of facial esthetics, whether or not preferred profiles or faces are “satisfactory” to the viewers.
3. Czarnecki ST, Nanda RS, Currier GF. (1993)9: assesed the role of the nose, lips and chin in achieving a balanced facial profile. A survey instrument of constructed androgynous facial silhouettes was evaluated by 545 professionals. The silhouettes had varied nose, lips, and chin relationships, as well as changes in facial angle and angle of convexity. The varied facial profiles were graded on the basis of most preferred to least preferred. The data was computed, and it was found that in males, a straighter profile was preferred in comparison with a slightly convex profile for the females. It is suggested that orthodontic treatment goals should be attuned to the achievement of balanced and harmonious facial features rather than rigid adherence to standard average dental and skeletal parameters.
4. Nanda RS, Ghosh J. (1995)10 refocused the attention of the orthodontists on the consideration of harmonized facial structures as a primary goal of treatment. Balancing the position of the lips in relation to the nose and chin has a direct relationship with esthetic preference and this concept was critical for extraction versus non extraction decision making.
5. Hier LA, et. al (1999)11: examined the aesthetic preferences of lip position in males and females and to compare each other with common orthodontic standard using a custom computer animation program. The sample consisted of 53 young adult subjects, 25 males and 28 females. The samples were divided into orthodontically treated and untreated cases. The results indicated sex effect with females preferring fuller lips and untreated cases preferring fuller lips.
6. Ioi H, Nakata S, Nakasima A. (2005)12: Assessed the average female and male profiles of 30 Japanese men and women with normal occlusions. The lips in each average profile were protruded or retruded in 1mm increments and 13 images were arranged with the average profile in the center. 42 orthodontists and 42 dental students were asked to select the 3 most-favored, well-balanced profiles for each sex and rank them in order of preference. The results showed that orthodontists and the students preferred a profile with slightly retruded lips. The dental students favored a more retruded lip position for women. The least-favored profile was the most protrusive.
7. Nomura M. (2009)13 :Four independent panels each consisting of 30 lay judges viewed pretreatment silhouette profiles of 10 European American, 10 Japanese, and 10 African American Angle Class I and Class II orthodontic patients. Profiles were traced from lateral cephalograms and manipulated so that the lip profile lay on the Ricketts' E-line or at various distances from the E-line from −8 to +4 mm in 2-mm increments. The judges selected the profile that they considered the most attractive and then classified the remaining 6 profiles as either acceptable or unacceptable. It was concluded that Judge race or ethnicity and patient race or ethnicity and sex significantly influence laypersons standards for lip profile esthetics.
6.3 / Objectives of the study
This study will be undertaken in Gulbarga population to achieve the following
objectives:
1. To evaluate lip position/fullness preferences in relation to different chin prominences.
2. To understand the lip fullness preferences among orthodontists, patients and parents of patients.
3. To evaluate lip position preferences between male and female profiles.
4. To compare the differences in lip position preferences (if at all present) between the silhouettes and natural photographs of the same patient.
7. / Materials and Methods
7.1 /
Source of Data
1. For Subjects whose photos and Cephalometric soft tissue profiles need to bephotoshoped :
Patients visiting the department of Oral Medicine and diagnosis at H.K.E. Society’s S. Nijalingappa Institute Of Dental Sciences And Research, Gulbarga, Karnataka.
2. For Patients and Parents of Patients as Evaluators :
Patients and Parents of Patients visiting the Department of Orthodontics at H.K.E. Society’s S. Nijalingappa Institute Of Dental Sciences And Research, Gulbarga, Karnataka.
3. For Orthodontists as Evaluators :
Orthodontists present in Gulbarga.
7.2 / Study Design: It is a Cross-Sectional Study.
7.3 / Methods of collection of Data
1.
I. For Subjects whose photos and Cephalometric soft tissue profiles need to
be photoshoped :
Two patients , one Male and one female in the age group
of 15 to 25 yrs displaying a Class I skeletal and dental
pattern with vertical and sagittal measurements within the
range of normal will be selected.
II. For subjects as Evaluators:
1.Patients :
With the help of simple random sampling technique about 50 patients seeking or willing to seek orthodontic treatment will be selected from the patients visiting the department of Orthodontics.
2.Parents of Patients :
With the help of simple random sampling technique about 50 parents accompanying patients seeking or willing to seek orthodontic treatment will be selected.
3.Orthodontists :
Almost all Orthodontists residing in and or practicing in Gulbarga (about 15) will be approached personally.
Inclusion Criteria
I. For Subjects whose photos and Cephalometric soft tissue profiles need to be photoshoped:
1. They should have Class I skeletal and dental pattern with vertical and sagittal measurements within the range of normal.
2. They should be in age group of 15-25 years.
3. They should be preferably of normal Indian colour (wheatish).
4. They should be co–operative and must be ready to participate in the study by letting their lateral profile photos clicked and lateral cephalograms done.
5. They should be the one who give consent to let their original photographs and silhouettes be photoshoped.
II. For Subjects as Evaluators:
1. They should be co-operative and must be ready to participate in the study by calm headedly giving their time to evaluate the photoshoped photos and silhouettes.
2. In case of Patient evaluators they should be in the age group of 15 to 25 years and they should be strictly those who are seeking or willing to seek orthodontic treatment.
3. In case of Parents of Patients they should be the ones whose children are or who are willing to seek orthodontic treatment.
Exclusion Criteria
I. For Subjects whose photos and Cephalometric soft tissue profiles need to be photoshoped :
1. Patients other than class I skeletal and dental pattern
2. Vertical and sagittal measurements not in the normal range.
3. Uncooperative patients.
4. Not willing to participate in the study.
5. Not providing consent to let their photos and silhouettes be Photoshoped.
II. For Subjects as Evaluators:
1. Uncooperative evaluators.
2. Evaluators having lack of time.
3. Not willing to participate in the study.
4. In case of Patient Evaluators: Patients not seeking or not willing to seek orthodontic treatment.
5. In case of Parent Evaluators :
a. Parents not in favor of Orthodontic treatment
b. Parents not accompanying their children who are seeking or willing to seek orthodontic treatment
6. In case of Orthodontists residing in and or practicing in Gulbarga: Orthodontists having extremely busy schedule and or reluctant to give their time for evaluation of photographs.
7.4 / Procedure
1. From the patients coming to the department of Oral Medicine And Diagnosis , few [preferably normal indian coloured (wheatish)] patients exhibiting Class I dental pattern and visually Class I skeletal pattern will be randomly selected and lateral cephalogram of these patients will be taken and cephalograms will be traced.
2. Out of these patients, 1 male and 1 female patients cephalograms which show Class I Dental and Skeletal pattern with vertical and sagittal measurements within the range of normal will be selected.
3. Of the same male and female patient lateral photographs showing their lateral profile will be taken.
4. Now the traced cephalometric soft tissue profiles (male and female each) will be cut out of black paper and scanned into the computer and thus converted into a Black “silhouette” to reduce the influence of any distracting features.6 All vertical relationships will be unaltered to evaluate only the anteroposterior aspects of the profile.6
5. To create a range of mandibular positions representing what might be encountered in clinical practice, the area from subnasale to soft tissue B point will be erased, and the mandibular portion of the silhouette from soft tissue B point to soft tissue
menton will be cut out. To establish a middle “normal” mandibular position, the
mandibular cut-out will be positioned sagittally to create a normal Facial contour
angle(G-Sn-Pg) of -11degree5,6.
6. From this point, the mandible will be moved horizontally differing in 7° to create a series of profiles with Facial Contour angles of -25°, -18°, -4°, and +3°, representing severe and moderate Class II profiles, and moderate and severe Class III profiles respectively.
7. Using Ricketts’ E-plane as reference, upper and lower lips will be drawn for each profile at -4mm, -2mm, 0mm, +2 mm and +4mm from Ricketts’ E-plane. The images for each profile will be scanned and prepared on a computer using Adobe Photoshop6. Thus the upper and lower lips will be positioned together from the most retruded to the most protruded positions.
8. The same procedure will be carried out for the lateral photographs of both the male and female patient (no silhouette will be made here). Natural lateral photographs will be processed as above. During editing of photographs in adobe photoshop attention will be paid that if at all some colour difference exists between male and female photographs we should bring it to normal Indian colour (wheatish) to avoid evaluation bias because of colour difference.
9. Following the above procedure we will get 50 profiles of male patient (25 silhouettes, 25 lateral photographs) and 50 profiles of female patient (25 silhouettes , 25 lateral photographs)
10. A hard copy of each of the above created profiles will be generated for the evaluators to give their opinion.
11. The profiles will be presented to all the 3 groups of evaluators in 4 sets, the first set will include 25 “silhouettes” of female patient: 5 silhouettes of 5 different lip position of one respective angle on a single page, thus creating 5 pages, arranged from severe Class II to severe Class III based on different facial contour angles (-250, -180, -110, -40 and +30), second set will include similarly arranged silhouettes of male patient. Third and fourth set will include similarly arranged lateral photographic sets of female and male patients respectively.
12. Each evaluator will have to visualize the profiles and select one profile from each page which he/she feels with the most pleasing appearance.
7.5 / Statistical analysis: The data collected will be analyzed using ANOVA test.
7.6 / Does the study require any investigation to be carried out in humans?
Yes
· Lateral Cephalograms of both the male and female patient will be taken
· Lateral photographs of both the male and female patient will be taken
7.7 / Has ethical clearance have been obtained from college?
Yes. Ethical clearance is taken from the ethical clearance committee at H.K.E Society’s S. Nijalingappa Institute Of Dental Sciences And Research, Gulbarga, Karnataka.
8. /
List of References
1. Knight H, Keith O. Ranking facial attractiveness. Eur J Orthod. 2005 Aug; 27(4):340-8.2. Wilmot JJ, Barber HD, Chou DG, Vig KW. Associations between severity of dentofacial deformity and motivation for orthodontic-orthognathic surgery treatment. Angle Orthod. 1993 Winter; 63(4):283-8.
3. Proffit WR. Ortodontia contemporanea. 3a ed. Rio de Janeiro: Guanabara Koogan; 2002.
4. Arpino VJ, Giddon DB, BeGole EA, Evans CA. Presurgical profile preferences of patients and clinicians. Am J Orthod Dentofacial Orthop. 1998 Dec; 114(6):631-7.
5. Grant G. Coleman, Steven J. Lindauer, EserTüfekçi. Influence of chin prominence on esthetic lip profile preferences. Am J Orthod Dentofacial Orthop 2007; 132:7:36-42
6. Johar Rajvinder Singh. Preference of lip profile in varying mandibular sagittal Position. JIOH Volume 3; Issue 5: October 2011
7. Foster EJ. Profile preferences among diversified groups. Angle Orthod 1973; 43:34-40.
8. Barrer JG and Ghafari J. Silhouette profiles in the assessment of facial esthetics: A comparison of cases treated with various orthodontic appliances. Am J Orthod Dentofacial Orthop 1985; 87: 385-391.
9. Czarnecki ST, Nanda RS, Currier GF. Perceptions of a balanced profile. Am J Orthod Dentofacial Orthop 1993; 104:180-7.
10. Nanda RS, Ghosh J. Facial soft tissue harmony and growth in orthodontic treatment. Semin Orthod 1995; 1:67-81.
11. Hier LA, Evans CA, BeGole EA, Giddon DB. Comparison of preferences in lip position using computer animated imaging. Angle Orthod 1999; 69:231-8.
12. Ioi H, Nakata S, Nakasima A. Anteroposterior lip positions of the most favored Japanese facial profiles. Am J Orthod Dentofacial Orthop 2005; 128:2:206-11.
13. Nomura M. Esthetic preferences of European American, Hispanic American, Japanese, and African judges for soft-tissue profiles. Am J Orthod Dentofacial Orthop 2009; 135: 4:S 87-95.
9. /
Signature of Candidate
10. /Remarks of guide
11 / 11.1 / Name and Designation of the Guide (in block letters) / Dr. M. SURESH(Proff. & Head )
Dept of Orthodontics and Dentofacial Orthopedics.
HKE’s S.N Dental College, Gulbarga.
11.2 / Signature
11.3 / Head of the Department / Dr. M. SURESH,
(Proff. & Head )
Dept of Orthodontics and Dentofacial Orthopedics
HKE’s S.N Dental College, Gulbarga.
11.4 / Signature
12 / 12.1 / Remarks of Chairman and Principal / Dr.Smt. Jayashree A. Mudda
(Principal)
HKE’s S.N Dental College , Gulbarga
12.2 / Signature
1