Evaluation of Nasal and Soft Tissue Angular Measurements Across Class I, Class II, and Class III Orthodontic Patients: A Cross-Sectional Cephalometric Study
DOI:
https://doi.org/10.52206/jsmc.2026.16.1.1373Abstract
Background: Facial aesthetics is a fundamental component of orthodontic diagnosis and treatment planning, with increasing emphasis on soft tissue harmony rather than dental alignment alone. Angular soft tissue measurements of the nose, lips, and chin play a pivotal role in evaluating sagittal facial balance. Given the influence of ethnicity on facial morphology, population-specific reference values are essential to guide clinical decision-making.
Objective: To evaluate nasal and soft tissue angular measurements among Class I, Class II, and Class III orthodontic patients and to assess potential gender-based differences within a Pakistani population.
Methodology: This cross-sectional study was conducted at the Department of Orthodontics, Saidu College of Dentistry, Swat, from September 2024 to February 2025. A total of 109 adult patients with pre-treatment lateral cephalometric radiographs were included. Participants were classified into sagittal skeletal groups using ANB angle values. Five soft tissue angles nasolabial, nasomental, labiomental, chin-throat, and lip-chin-throat were manually traced and measured by a single calibrated examiner.
Results: Mean values of all evaluated soft tissue angles were generally within accepted aesthetic ranges. Class II subjects demonstrated higher angular values, indicative of a more convex soft tissue profile, while Class III subjects exhibited comparatively lower values consistent with straighter or mildly concave profiles. A statistically significant difference was observed only for the nasolabial angle across sagittal skeletal classes (p = 0.036). No significant gender-based differences were identified for any angular measurement.
Conclusion: Soft tissue angular measurements vary according to sagittal skeletal classification but are not influenced by gender in this population. The nasolabial angle emerged as a key diagnostic parameter, underscoring the importance of incorporating comprehensive soft tissue evaluation into orthodontic treatment planning.
Keywords: Cephalometry, Facial Aesthetics, Nasolabial Angle, Orthodontic Diagnosis.
References
Yunus O, Orhan Ç, Nurhat Ö, Hande E. Investigation of the Relationship between Sagittal Skeletal Nasal Profile Morphology and Malocclusions: A Lateral Cephalometric Film Study.
Akter L, Hossain MZ. Angular photogrammetric soft tissue facial profile analysis of Bangladeshi young adults. APOS Trends in Orthodontics. 2017 Nov 1; 7(6):279. https://doi.org/10.4103/2321-1407.219434
Proffit W, White RP, Sarvar DM. Psychosocial aspects of dentofacial deformity and its treatment. In: Contemporary treatment of Dentofacial Deformity. St. Louis Missouri: Mosby; 2003. P.70–3.
Graber TM, Vanarsdall RL, Vig KWL. Special considerations in diagnosis and treatment planning. In: Orthodontics current principles and techniques. 4th ed. St Louis, Missouri: Elsevier; 2005.p. 24.
Reyneke JP, Ferretti C. Diagnosis and planning in orthognathic surgery. Oral and maxillofacial surgery for the clinician. 2021:1437-62. https://doi.org/10.1007/978-981-15-1346-6_66
Ocak Y, Cicek O, Ozkalayci N, Erener H. Investigation of the relationship between sagittal skeletal nasal profile morphology and malocclusions: a lateral cephalometric film study. Diagnostics. 2023 Jan 27;13(3):463. https://doi.org/10.3390/diagnostics13030463
Gupta S, Bajjad AA, Sharma A, Hani SU, Kumar A, Pandey V, et al. Correlation of the Upper Nasolabial Angle With Skeletal Patterns and Nasal Morphology in Indian Adults: An Observational Study. Cureus. 2024 Sep 7;16(9). https://doi.org/10.7759/cureus.68857
Perovi? TM, Blažej Z, Jovanovi? I. The influence of antero-posterior dentoskeletal pattern on the value of nasal soft tissue angles: A cephalometric study. Folia Morphologica. 2021;80(3):657-64. https://doi.org/10.5603/FM.a2020.0087
Quinzi V, Paskay LC, D’Andrea N, Albani A, Monaco A, Saccomanno S. Evaluation of the nasolabial angle in orthodontic diagnosis: a systematic review. Applied Sciences. 2021 Mar 12;11(6):2531. https://doi.org/10.3390/app11062531
Javed M, Hamid MW. Perception of effect of nasolabial angle alteration on facial attractiveness comparing female profile modifications of class ii div i malocclusion. Journal of Medical & Health Sciences Review. 2025 Jan 30;2(1). https://doi.org/10.62019/zjx7g505
Powell N. Aesthetic evaluation of nasal contours. Othlaryngology Head and Neck Surgery, MO: the CV Mosby Co. 1986.
Jacobson A, Vlachos C. Soft tissue evaluation. In: Jacobson A, Jacobson RL. Radiographic Cephalometry: from basic to 3D imaging. 2nd ed. Chicago: Quint Publishing Co Inc;2006
Go??biowski M, ?wi?tkowska A, Pastuszak P, Rahnama M. Relationship between selected cephalometric parameters, nasolabial angle and its components in adolescent females. Diagnostics. 2023 Mar 22;13(6):1199. https://doi.org/10.3390/diagnostics13061199
Enlow DH, Hans MG. (Eds). Essentials of facial growth. Philadelphia: WB Saunders;1990
Naini FB, Gill DS. Facial aesthetics: 2. Clinical assessment. Dent Update. 2008;35(3):159–70. https://doi.org/10.12968/denu.2008.35.3.159
Arshad M, Mushtaq F, Abbas A. Comparison of soft tissue cephalometric norms among different ethnic groups in Pakistan. Pak Oral Dent J. 2017;37(2):281–5.
Choi SY, Kim SJ, Lee HY, Chang DS, Choi MS. Asthetic nasolabial angle according to the degree of upper lip protrusion in an Asian population. American journal of rhinology & allergy. 2018 Jan;32(1):66-70. https://doi.org/10.2500/ajra.2018.32.4485
Ani?-Milosevi? S, Lapter-Varga M, Slaj M. Analysis of the soft tissue facial profile by means of angular measurements. Eur J Orthod. 2008;30(2):135–40. https://doi.org/10.1093/ejo/cjm116
Hossain Z, Alam MK, Basri R, Haque S. Gender differences in soft tissue facial profile among Bangladeshi adult subjects with Class I occlusion. Bangladesh J Orthod Dent Pract. 2015;5(1):15–21.
Zubair T. Angular Photogrammetric Analysis of Nasiolabial and Mentolabial Angle in Pakistani Adults. Pakistan Journal of Medical and Health Sciences. 2021 Dec 31.
Nanda R, Meng H, Kapila S, Goorhuis J. Growth changes in the soft tissue facial profile. Angle Orthod. 1990;60(3):177–90.
Scavone H Jr, Trevisan H Jr, Gari DG, Ferreira FV. Facial profile evaluation in Japanese- Brazilian adults with normal occlusions and well-balanced faces. Am J Orthod Dentofacial Orthop 2006; 129:721.e1–5. https://doi.org/10.1016/j.ajodo.2005.10.018
Aljabaa AH. Lateral cephalometric analysis of the nasal morphology among Saudi adults. Clinical, Cosmetic and Investigational Dentistry. 2019 Jan 15:9-17. https://doi.org/10.2147/CCIDE.S190230
Adil S, Islam ZU, Jan G, Subhan F, Naz S. Evaluation of Nose Morphology in Different Skeletal Patterns in Patients Reporting to Tertiary Care Hospital at Peshawar, Pakistan: A Cross-Sectional Study. Journal of Postgraduate Medical Institute. 2024 Sep 30;38(3). https://doi.org/10.54079/jpmi.38.3.3356
Pop SI, Bud E, Mártha K, Mure?an IÉ, Jánosi KM, Dósa B, et al. Cephalometric and Photographic Evaluation of the Nasolabial Angle in Orthodontically Treated Patients: An Observational Cohort Study. Diagnostics (Basel). 2025 Jan 8;15(2):132. https://doi.org/10.3390/diagnostics15020132
Al-Mashhadany YI, Al-Khannaq MJ, Al-Basrawy AA. Comparative Evaluation of Soft Tissue Angles in Different Sagittal Malocclusions: A Cephalometric Study. J Contemp Orthod. 2023;7(1):12–18.
Shastri D, Tandon P, Singh A. Nasal changes in different age groups. National Journal of Maxillofacial Surgery. 2021 Sep 1;12(3):367-71. https://doi.org/10.4103/njms.NJMS_246_20
Jankowska A, Janiszewska-Olszowska J, Grocholewicz K. Nasal morphology and its correlation to craniofacial morphology in lateral cephalometric analysis. International Journal of Environmental Research and Public Health. 2021 Mar 16;18(6):3064.
https://doi.org/10.3390/ijerph18063064
Powell N, Humphrevs B. Proportions of the Aesthetic Face. New York: Thieme medical pub; 1984.
Begg RJ, Harkness M. A lateral cephalometric analysis of the adult nose. J Oral Maxillofac Surg. 1995 Nov 1;53(11):1268–1274. https://doi.org/10.1016/0278-2391(95)90582-0
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