Skip to main content
NCBI home page
Journal of Maxillofacial & Oral Surgery logoLink to Journal of Maxillofacial & Oral Surgery
. 2014 Aug 21;14(2):271–277. doi: 10.1007/s12663-014-0636-6

“Are We Similar to Caucasians”: Orthognathic Surgery for North Indians

Ritesh Garg 1,✉, Mohan Alexander 1
PMCID: PMC4444660  PMID: 26028847

Abstract

Primary Aim

To establish the cephalometric standards for hard and soft tissues of the facial skeleton for north Indian population.

Methods

The sample comprised of lateral cephalograms taken in natural head position of 100 participants (50 men, 50 women). The cephalograms were traced, analyzed and interpreted using the landmarks and values given by Burstone’s analysis for hard tissue and Legan and Burstone analysis for soft tissue respectively. The Student’s t test, standard deviation and mean deviation were calculated to compare between the groups.

Results

Statistically significant results were found in various parameters between intra and inter group comparison.

Conclusion

The results obtained in the north Indian population can be used as cephalometric norms for orthognathic surgery.

Keywords: Cephalometric norms for North Indians, Burstone and Legan anaylsis, Orthognathic surgery for North Indians

Introduction

The specialty of oral and maxillofacial surgery has expanded its boundaries to a great extent in the last few decades. The subspecialty of orthognathic surgery which deals with the correction of disproportion of the facial skeleton has been at the forefront of this expansion and this has brought about dramatic changes in the lives of many patients. To get the proportions correct, various aids have been used, with cephalometric analysis being one of the main tools.

Two of the most accepted analysis norms have been the ones proposed by Burstone et al. [1] and Legan and Burstone [2] for hard tissues and soft tissues respectively. The problem facing the maxillofacial surgeon in India has been that these analyses are basically for the Caucasian population. Norms for the Indian population have also been put forth but again these have been mainly for the south Indian population [3]. So we decided to conduct a study to establish the cephalometric norms for ethnic north Indian population utilizing the widely accepted analyses given by Burstone et al. [1] and Legan and Burstone [2].

Materials and Methods

A total of 100 subjects (50 males and 50 females) were enrolled for the study consecutively who met inclusion and exclusion criteria. Lateral cephalogram was taken in normal head position with the teeth in the maximum intercuspation and lips in repose.

All radiographs were traced on 0.008 matte acetate sheets by a single individual and reviewed twice with another investigator for accurate landmark identification. The cephalometric landmark identification and analysis was done according to definitions used by Burstone et al. [1] and Legan and Burstone [2] in their articles.

Written consent was obtained from all the subjects and the study received ethical clearance from the institution’s ethical board.

Inclusion criteria:

  1. Person native to North India.

  2. Age group 18–25 years.

  3. Class I occlusion with well balanced facial profile.

  4. Full complement of permanent teeth with proper intercuspation.

  5. Absence of remarkably large overjet and overbite.

  6. Presence of only negligible crowding, rotations and spacing of the teeth.

Exclusion criteria

  1. Person with major dental and skeletal discrepancy.

  2. History of trauma in maxillofacial region.

  3. History of orthodontic treatment, orthognathic or plastic surgery in the maxillofacial region.

Results

The mean values with standard deviation of hard and soft tissues of north Indian male and female respectively are tabulated in Tables 1 and 2.

Table 1.

Hard tissue analysis—North Indian (male and female)

S. no. Variables Observed mean value
Male SD Female SD
Cranial base
1. Ar–Ptm (II HP) 38.53 3.16 35.69 2.84
2. Ptm–N (II HP) 53.94 4.12 51.10 3.88
Horizontal skeletal
3. N–A–Pg (angle) 5.96 4.32 6.98 7.19
4. N–A (II HP) 0.53 3.56 −0.46 4.03
5. N–B (II HP) −4.57 5.63 −5.33 7.32
6. N–Pg (II HP) −3.79 5.92 −4.88 8.31
Vertical (skeletal, dental)
7. N–ANS (perpendicular HP) 55.49 3.43 52.85 4.14
8. ANS–Gn (perpendicular HP) 70.55 5.94 66.11 5.93
9. PNS–N (perpendicular HP) 56.34 4.40 52.12 2.61
10. MP–HP (angle) 20.78 6.09 24.34 6.44
11. Upper 1—NF (perpendicular NF) 29.50 3.85 27.77 2.96
12. Lower 1—MP (perpendicular MP) 42.22 5.54 39.74 4.04
13. Upper 6—NF (perpendicular NF) 25.26 5.10 22.28 2.47
14. Lower 6—MP (perpendicular MP) 34.88 2.54 32.15 2.84
Maxilla–mandible
15. PNS–ANS (II HP) 58.33 3.73 54.77 3.56
16. Ar–Go (linear) 54.96 4.48 49.44 4.50
17. Go–Pg (linear) 80.86 4.15 75.07 4.16
18. B–Pg (II MP) 6.53 1.88 6.66 1.81
19. Ar–Go–Gn (angle) 121.26 6.23 125.34 5.37
Dental
20. OP upper (HP angle) 4.52 3.21 6.74 4.72
21. OP lower (HP angle) 4.52 3.21 6.74 4.72
22. A–B (II OP) −3.38 2.75 −2.16 1.93
23. Upper 1—NF (angle) 115.52 8.79 113.10 8.27
24. Lower 1—MP (angle) 101.76 7.34 98.90 7.00
Open in a new tab

p value <0.05

Table 2.

Soft tissue analysis—North Indian (male and female)

S. no. Variables Male SD Female SD
Facial form
1. Facial convexity angle G–Sn–Pg′ (angle) 15.36 5.52 13.24 5.15
2. Maxillary prognathism G–Sn (II HP) 8 4.05 5.39 4.62
3. Mandibular prognathism G–Pg′ (II HP) 0.63 5.92 −1.06 8.35
4. Vertical height ratio G–Sn/Sn–Me′ (Perp. HP) 1.00 0.10 1.06 0.11
5. Lower face throat angle Sn–Gn′–C (angle) 115.96 12.10 109.54 10.52
6. Lower vertical height- depth ratio Sn–Gn′/C–Gn′ 1.328 0.32 1.18 0.19
Lip position and form
7. Nasolabial angle Cm–Sn–Ls (angle) 113.74 11.88 110.54 9.58
8. Upper lip protrusion Ls–(Sn–Pg′) 2.53 3.40 2.65 2.11
9. Lower lip protrusion Li–(Sn–Pg′) 1.91 2.97 2.07 2.29
10. Mentolabial sulcus Si–(Li–Pg′) 4.85 4.47 5.08 1.94
11. Vertical lip chin ratio Sn–Stms/Stmi–Me (Perp. HP) 0.47 0.076 0.45 0.05
12. Maxillary incisor exposure Stms-1 2.87 2.27 2.03 1.58
13. Interlabial gap Stmi–Stms (Perp. HP) 0.56 1.07 0.31 0.66
Open in a new tab

p value <0.05

Tables 3, 4 and 5 shows the comparative result of hard and soft tissue analysis of North Indians with Caucasians.

Table 3.

Hard tissue analysis—male comparsion—Caucasians and North Indians

S. no. Variables Caucasian North indian p value
Mean SD Mean SD
Cranial base
1. Ar–Ptm (II HP) 37.1 2.8 38.53 3.16 0.13
2. Ptm–N (II HP) 52.8 4.1 53.94 4.12 0.37
Horizontal skeletal
3. N–A–Pg (angle) 3.9 6.4 5.96 4.32 0.16
4. N–A (II HP) 0.0 4.1 0.53 3.56 0.63
5. N–B (II HP) −5.3 6.7 −4.57 5.63 0.68
6. N–Pg (II HP) −4.3 8.5 −3.79 5.92 0.8
Vertical (skeletal, dental)
7. N–ANS (perpendicular HP) 54.7 3.2 55.49 3.43 0.44
8. ANS–Gn (perpendicular HP) 68.6 3.8 70.55 5.94 0.25
9. PNS–N (perpendicular HP) 53.9 1.7 56.34 4.40 0.047
10. MP–HP (angle) 23.0 5.9 20.78 6.09 0.23
11. Upper 1—NF (perpendicular NF) 30.5 2.1 29.50 3.85 0.36
12. Lower 1—MP (perpendicular MP) 45.0 2.1 42.22 5.54 0.07
13. Upper 6—NF (perpendicular NF) 26.2 2.0 25.26 5.10 0.5
14. Lower 6—MP (perpendicular MP) 35.8 2.6 34.88 2.54 0.24
Maxilla–mandible
15. PNS–ANS (II HP) 57.7 2.5 58.33 3.73 0.55
16. Ar–Go (linear) 52.0 4.2 54.96 4.48 0.004
17. Go–Pg (linear) 83.7 4.6 80.86 4.15 0.03
18. B–Pg (II MP) 8.9 1.7 6.53 1.88 <0.001
19. Ar–Go–Gn (angle) 119.1 6.5 121.26 6.23 0.26
Dental
20. OP upper (HP angle) 6.2 5.1 4.52 3.21 0.14
21. OP lower (HP angle) 6.2 5.1 4.52 3.21 0.14
22. A–B (II OP) −1.1 2.0 −3.38 2.75 0.005
23. Upper 1—NF (angle) 111 4.7 115.52 8.79 0.07
24. Lower 1—MP (angle) 95.9 5.2 101.76 7.34 0.007
Open in a new tab

Bold values signifies statistically significant values

p value <0.05

Table 4.

Hard tissue analysis—female comparison—Caucasians and North Indians

S. no. Variables Caucasian North Indian p value
Mean SD Mean SD
Cranial base
1. Ar–Ptm (II HP) 32.8 1.9 35.69 2.84 <0.001
2. Ptm–N (II HP) 50.9 3.0 51.10 3.88 0.85
Horizontal skeletal
3. N–A–Pg (angle) 2.6 5.1 6.98 7.19 0.03
4. N–A (II HP) −2.0 3.7 −0.46 4.03 0.18
5. N–B (II HP) −6.9 4.3 −5.33 7.32 0.42
6. N–Pg (II HP) −6.5 5.1 −4.88 8.31 0.46
lVertical (skeletal, dental)
7. N–ANS (perpendicular HP) 50.0 2.4 52.85 4.14 0.01
8. ANS–Gn (perpendicular HP) 61.3 3.3 66.11 5.93 0.003
9. PNS–N (perpendicular HP) 50.6 2.2 52.12 2.61 0.04
10. MP–HP (angle) 24.2 5.0 24.34 6.44 0.94
11. Upper 1—NF (perpendicular NF) 27.5 1.7 27.77 2.96 0.73
12. Lower 1—MP (perpendicular MP) 40.8 1.8 39.74 4.04 0.31
13. Upper 6—NF (perpendicular NF) 23.0 1.3 22.28 2.47 0.27
14. Lower 6—MP (perpendicular MP) 32.1 1.9 32.15 2.84 0.95
Maxilla–mandible
15. PNS–ANS (II HP) 52.6 3.5 54.77 3.56 0.037
16. Ar–Go (linear) 46.8 2.5 49.44 4.50 0.03
17. Go–Pg (linear) 74.3 5.8 75.07 4.16 0.56
18. B–Pg (II MP) 7.2 1.9 6.66 1.81 0.31
19. Ar–Go–Gn (angle) 122.0 6.9 125.34 5.37 0.048
Dental
20. OP upper (HP angle) 7.1 2.5 6.74 4.72 0.77
21. OP lower (HP angle) 7.1 2.5 6.74 4.72 0.77
22. A–B (II OP) −0.4 2.5 −2.16 1.93 0.004
23. Upper 1—NF (angle) 112.5 5.3 113.10 8.27 0.79
24. Lower 1—MP (angle) 95.9 5.7 98.90 7.00 0.12
Open in a new tab

Bold values signifies statistically significant values

p value <0.05

Table 5.

Soft tissue analysis—combined (male and female) comparison—Caucasians and North Indians

S. no. Variables Caucasian North Indian p value
Mean SD Mean SD
Facial form
1. Facial convexity angle G–Sn–Pg′(angle) 12 4 14.3 5.42 0.016
2. Maxillary prognathism G–Sn (II HP) 6 3 6.69 4.52 0.37
3. Mandibular prognathism G–Pg′ (II HP) 0 4 −0.21 7.25 0.86
4. Vertical height ratio G–Sn/Sn–Me′ (Perp. HP) 1 – 1.03 – –
5. Lower face throat angle Sn–Gn′–C (angle) 100 7 112.75 11.73 <0.001
6. Lower vertical height-depth ratio Sn–Gn′/C–Gn′ 1.2 – 1.25 – –
Lip position and form
7. Nasolabial angle Cm–Sn–Ls (angle) 102 8 112.14 10.85 <0.001
8. Upper lip protrusion Ls–(Sn–Pg′) 3 1 2.59 2.82 0.37
9. Lower lip protrusion Li–(Sn–Pg′) 2 1 1.99 2.64 0.98
10. Mentolabial sulcus Si–(Li–Pg′) 4 2 4.97 3.42 0.1
11. Vertical lip chin ratio Sn–Stms/Stmi–Me(Per HP) 0.5 – 0.45 – –
12. Maxillary incisor exposure Stms-1 2.0 2 2.45 1.99 0.23
13. Interlabial gap Stmi–Stms (Perp. HP) 2.0 2 0.43 0.89 <0.001
Open in a new tab

Bold values signifies statistically significant values

p value <0.05

Discussion

The improvement in facial aesthetics and functional occlusion are two desirable objectives for the success of various orthognathic surgical procedures. For proper planning and execution of these, various diagnostic procedures are used, cephalometric analysis being the most vital one. Various cephalometric norms for the analysis of hard and soft tissue discrepancies have been laid down, the Burstone’s analysis being the standard one which is based on Caucasians.

A thorough search of literature revealed difference in cephalometric values of dentofacial relationships of various ethnic groups [4, 5]. We conducted a study to know if there were any similarities or differences in cephalometric values of north Indian adults with class I occlusion and well balanced facial profile as compared to the values obtained by Burstone et al. [1] based on Caucasians. The findings are discussed under hard and soft tissue analysis respectively.

Hard Tissue Measurements

The total cranial base length (Ar–ptm–N) in north Indian population was similar to the Caucasian population in males but there was statistically significant increase in females. The contributing factor for this was the increase in Ar–ptm. Similar findings were found in south Indian (Karnataka) population [3] and in Egyptians [6]. The horizontal skeletal measurements for north Indian males were similar to Caucasian males but north Indian females had more convex profile compared to their Caucasian counterparts, this being true of Chinese [7], Egyptian [6], Kuwaiti [8] and Saudi [9] female profiles also. Thus north Indian females have marginally prognathic maxillary/mandibular apical base. Though the skeletal norms of north Indian females were protrusive when compared to Caucasians, they were retrusive when compared with Chinese [10], and Afro-American [11] females; however the mean values of the north Indian females were quite similar to Japanese [5].

The vertical skeletal measurements for north Indians of both sexes were increased compared to Caucasians. The contributing factor for the overall increase in length of both males and females was the increase in posterior middle third height, whereas in females there were other contributing factors also, like increase in upper third and lower third vertical facial height. A similar finding was found in Japanese females also [5].

The maxillo–mandibular relationship of our study group differed much from the Caucasians. Statistically significant differences were found in ramus length, relationship of maxilla and mandible apical base and retrusive chin in both sexes, whereas north Indian females tend to have increased ramal mandibular plane angle and males had short mandibular body length. Increased ramal mandibular plane angles in both sexes were reported in Kuwaitis [8] and Saudis [9] also. The dental relationship showed relatively proclined lower incisors in north Indian males. Similar findings were reported in the Nanda and Nanda’s study for north Indian population [12], south Indian (Karnataka) [3], Chinese [10], Egyptian [6], Kuwaiti [13], Japanese [5], Korean [9] and Saudi [14] populations also. This indicates that, while treating north Indian male subjects, a slight protrusion of teeth in comparison with Caucasian standards will be optimum for their features [12].

When the north Indian male profile was correlated with the Caucasian male’s, it was evident that the anterior maxilla is seen to be rotated counterclockwise for north Indians which substantiates the fact that for Caucasians an increased anterior facial height does not make the profile displeasing. The north Indian male has a retruded profile as evidenced by decrease in mandibular corpus length, increased ramal length and decreased chin prominence. To mask this the incisors procline, thus providing a pleasing profile.

In north Indian females it was evident that the profile tended towards more convexity (increased N–A–Pg and decreased A–B). An increase in the Ar–Go–Gn angle indicates that the north Indian females have a tendency towards hyperdivergence which is also supported by the fact that the anterior facial height is increased. This increase in facial height (compared to the Caucasian females) seems to sit well with this group.

But overall comparison of the skeletal patterns showed that skeletal morphology of north Indians were very similar to those of the Caucasians.

Soft Tissue Measurements

While planning and assessing the success of orthognathic treatment, soft tissue values are as important as hard tissue values. Therefore, soft tissue values must accurately reflect ideal norms throughout treatment. Soft tissue values of our study group were compared with the Caucasian norms and an inter-gender comparison was also done within this group itself.

The facial convexity angle was found to be greater in our study group, which implies a more convex profile in north Indians than in Caucasians. Our findings were similar to those of Jain and Kalra’s study involving north Indian population [15] as well as south Indian [7] and Kerala population [16], whereas less convex profile was reported in Japanese [17] and Black populations [8]. We found that north Indian males have more facial convexity than females. When the maxillary and mandibular prognathism values of our study group were compared to those of Caucasians, no statistically significant differences were seen. However, in our study group males had more maxillary prognathism when compared to females. South Indian [7] and Kerala population [16] were also reported to have midfacial prominence, when compared to Caucasians.

The lower face-throat angle was more obtuse compared to Caucasians. Since this angle is critical in treatment planning to correct anteroposterior dysplasias [1], our study suggests that procedures involving chin reduction should be undertaken with caution in north Indian population. The vertical height ratio, lower vertical height depth ratio, upper and lower lip protrusion, etc., were all similar in both our study group as well as the Caucasians. Upper lip protrusion was reported in Jain and Kalra’s study for north Indian population [15], lower lip protrusion in Kerala population [16] and both upper and lower lip protrusions were reported in south Indian [7], Japanese [17] and Korean [18] populations. When comparison was made gender-wise within the study group, males had more obtuse lower face height depth ratio than females.

Statistically significant difference was found in the nasolabial angle between our study group and the Caucasians. The comparison revealed it to be more obtuse in our study group. Similar findings were reported in Blacks [19], Japanese [17] and Koreans [18]. Obtuse nasolabial angle is suggestive of maxillary retrusion as per available literature but our study contradicts this view as our study group did not exhibit the latter even though, they had obtuse nasolabial angle. But it is most likely due to the anticlockwise roataion of the maxilla in north Indian males. The interlabial gap of our study group was shorter as compared to Caucasians, with statistical significance. Similar finding was reported in Jain and Kalra’s study for north Indian population also [15]. No difference was observed in the incisal show of our study group and the Caucasians. However, in our study group males had statistically more incisal show compared to females. Similar finding was reported when south Indian population was compared gender- wise [7].

Intergroup comparison of soft tissue profiles of north Indian males and females clearly indicated that soft tissue convexity (G–Sn–Pg′) in males is more in comparison to females (in compensation to the underlying skeletal base which is more convex in females). This is also supported by the fact that males exhibit a protrusive maxillary soft tissue profile (G–Sn) to give a convex appearance. In addition males also exhibited an increased distance between Stms-1 which shows that males have thick protrusive lips in comparison to females.

Overall, it was found that the soft tissue profiles of north Indians were very similar to those of the Caucasians.

Even though computerized cephalometric softwares are available, we have used manual cephalometric analysis because in manual tracing landmark identification is easier, more accurate and with less variation while duplicating [20].

Some the advantages of this study are:

  • More number of subjects were taken as compared to Burstone et al. [1] or Legan and Burstone [2] in their respective studies.

  • Both hard and soft tissue analyses were done by single examiner.

  • Hard and soft tissue analyses were done on the same samples.

  • Intra group comparison (male and female) was done for hard and soft tissue analyses.

  • In soft tissue analysis separate norms were established for males and females, as compared to Legan and Burstone’s [2].

Conclusion

Our findings suggest that:

  • Since north Indian males had increase in lower incisors proclination, pre-surgical orthodontic treatment should be done with caution as this might lead to cortical plate defect because this subset of patients already have proclined lower incisors.

  • Literature suggests that relapse rate is higher [21] with either mandibular advancement or setback in hyperdivergence patients and this might have to be taken into consideration while planning surgeries in north Indian females as they exhibit this feature commonly.

  • Obtuse nasolabial angle without maxillary-retrusion in north Indians males is most likely to be due to the anticlock-wise rotation of the maxilla. If Lefort I osteotomy with superior repositioning is planned in these patients, partial resection of anterior nasal spine with or without resection of caudal portion of the septum [22], might have to be considered.

  • As the north Indian males and females have obtuse soft tissue chin throat angle, mandibular set back surgery should be planned with caution especially if the patient also has a short heavy throat [2].

We are of the opinion that result values that we have obtained can be used as cephalometric norms for orthognathic surgery in north Indians.

Acknowledgments

The authors received the support in the form of Grants from D.J. College of Dental Sciences and Research.

References

  • 1.Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg. 1978;36(4):269–277. [PubMed] [Google Scholar]
  • 2.Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg. 1980;38:744–751. [PubMed] [Google Scholar]
  • 3.Arunkumar KV, Reddy VV, Tauro DP. Establishment of cephalometric norms for the south Indian (Karnataka) population based on Burstone’s analysis. J Maxillofac Oral Surg. 2010;9(2):127–133. doi: 10.1007/s12663-010-0039-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Garcia CJ (1975) Cephalometric evaluation of Mexican Americans using Downs and Steiner analyses. Am J Orthod 68(1):67–74 [DOI] [PubMed]
  • 5.Engel G, Sploter BM. Cephalometric and visual norms for a Japanese population. Am J Orthod. 1981;80(1):48–60. doi: 10.1016/0002-9416(81)90195-0. [DOI] [PubMed] [Google Scholar]
  • 6.Bishara SE, Abdalla EM, Hoppens BJ. Cephalometric comparisons of dentofacial parameters between Egyptian and North American adolescents. Am J Orthod Dentofac Orthop. 1990;97:413–421. doi: 10.1016/0889-5406(90)70113-Q. [DOI] [PubMed] [Google Scholar]
  • 7.Kalha AS, Latiff A, Govardhan SN. Soft tissue cephalometric norms in a south Indian ethnic population. Am J Orthod Dentofac Orthop. 2008;133:876–881. doi: 10.1016/j.ajodo.2006.05.043. [DOI] [PubMed] [Google Scholar]
  • 8.Connor AM, Moshiri F. Orthognathic surgery norms for American Black patients. Am J Orthod. 1985;87(2):119–133. doi: 10.1016/0002-9416(85)90021-1. [DOI] [PubMed] [Google Scholar]
  • 9.Park I, Bowman D, Klapper L. A cephalometric study of Korean adults. Am J Orthod Dentofac Orthop. 1989;96:54–59. doi: 10.1016/0889-5406(89)90229-1. [DOI] [PubMed] [Google Scholar]
  • 10.Cooke MS, Wei SHY. A comparative study of southern Chinese and British Caucasian cephalometric standards. Angle Orthod. 1989;59:2. doi: 10.1043/0003-3219(1989)059<0131:ACSOSC>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 11.Drummond RA. A determination of cephalometric norms for the Negro race. Am J Orthod. 1968;54(9):670–681. doi: 10.1016/0002-9416(68)90018-3. [DOI] [PubMed] [Google Scholar]
  • 12.Nanda R, Nanda RS. Cephalometric study of the dentofacial complex of North Indians. J Indian Dent Assoc. 1969;39(1):22–28. doi: 10.1043/0003-3219(1969)039<0022:CSOTDC>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 13.Behbehani F, Hicks P, Beeman C, Kluemper T, Rayens MK. Racial variation in cephalometric analysis between Whites and Kuwaitis. Angle Orthod. 2006;76:406–411. doi: 10.1043/0003-3219(2006)076[0406:RVICAB]2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 14.Hassan AH. Cephalometric norms for Saudi adults living in the western region of Saudi Arabia. Angle Orthod. 2006;76:109–113. doi: 10.1043/0003-3219(2006)076[0109:CNFSAL]2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 15.Jain P, Kalra JPS (2010) Soft tissue cephalometric norms for a north Indian population group using Legan and Burstone analysis. Int J Oral Maxillofac Surg [DOI] [PubMed]
  • 16.Valiathan A, John KK. Soft tissue cephalometric analysis of adults from Kerala. J Indian Dent Assoc. 1984;56:419–422. [PubMed] [Google Scholar]
  • 17.Alcalde RE, Jinno T, Orsini MG, Sasaki A, Sugiyama RM, Matsumara T. Soft tissue cephalometric norms in Japanese adults. Am J Orthod Dentofac Orthop. 2000;118:84–89. doi: 10.1067/mod.2000.104411. [DOI] [PubMed] [Google Scholar]
  • 18.Hawang HS, Kim WS, McNamara JA. Ethnic differences in the soft tissue profile of Korean and European–American adults with normal occlusions and well balanced faces. Angle Orthod. 2002;72:72–80. doi: 10.1043/0003-3219(2002)072<0072:EDITST>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 19.Bacon W, Girardin P, Turlot JC. A comparison of cephalometric norms for the African Bantu and a Caucasoid population. Eur J Orthod. 1983;5:233–240. doi: 10.1093/ejo/5.3.233. [DOI] [PubMed] [Google Scholar]
  • 20.Naornova J, Lindman R. A comparison of manual traced images and corresponding scanned radiographs digitally traced. Eur J Orthod. 2011;33(3):247–253. doi: 10.1093/ejo/cjn110. [DOI] [PubMed] [Google Scholar]
  • 21.Eggensperger N, Smolka W, Rahal A, Jizuka T. Skeletal relapse after mandibular advancement and setback in single-jaw surgery. J Oral Maxillofac Surg. 2004;62(12):1486–1496. doi: 10.1016/j.joms.2004.07.007. [DOI] [PubMed] [Google Scholar]
  • 22.Pearlman SJ. Surgical treatment of the nasolabial angle in balanced rhinoplasty. Fac Plast Surg. 2006;22:28–35. doi: 10.1055/s-2006-939949. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Maxillofacial & Oral Surgery are provided here courtesy of Springer

RESOURCES