The maxillary incisor labial face tangent: clinical evaluation of maxillary incisor inclination in profile smiling view and idealized aesthetics

Naini, Farhad B.,Manouchehri, Shaadi,Al-Bitar, Zaid B.,Gill, Daljit S.,Garagiola, Umberto,Wertheim, David Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Background: To test the hypothesis that in profile smiling view, for ideal aesthetics, a tangent to the labial face of the maxillary central incisor crowns should be approximately parallel to the true vertical line and thereby perpendicular to the true horizontal line. Methods: An idealized female image was created with computer software and manipulated using the same software to construct an "ideal" female profile image with proportions, and linear and angular soft tissue measurements, based on currently accepted criteria for idealized Caucasian profiles. The maxillary incisor labial face tangent was altered in 5° increments from 70 to 120°, creating a range of images, shown in random order to 70 observers (56 lay people and 14 clinicians), who ranked the images from the most to the least attractive. The main outcome was the preference ranks of image attractiveness given by the observers. Results: The most attractive inclination of a tangent to the labial face of the maxillary incisor crowns in profile view in relation to the true horizontal line was 85°, i.e. 5° retroclined from a perpendicular 90° inclination. The most attractive range appears to be between 80 and 90°. Excessive proclination appeared to be less desirable than retroclination. Beyond 105° most observers recommend treatment. Conclusion: In natural head position, the ideal inclination of the maxillary incisor crown labial face tangent in profile view will be approximately parallel to the true vertical line and thereby approximately perpendicular to the true horizontal line.

Mentolabial angle and aesthetics: a quantitative investigation of idealized and normative values

Naini, Farhad B.,Cobourne, Martyn T.,Garagiola, Umberto,McDonald, Fraser,Wertheim, David Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: This study is a quantitative evaluation of the influence of the mentolabial angle on perceived attractiveness and threshold values of desire for surgery. Methods: The mentolabial angle of an idealized silhouette male Caucasian profile image was altered incrementally between $84^{\circ}$ and $162^{\circ}$. Images were rated on a Likert scale by pretreatment orthognathic patients (n = 75), lay people (n = 75) and clinicians (n = 35). Results: A mentolabial angle of approximately $107^{\circ}$ to $118^{\circ}$ was deemed the most attractive, with a range of up to $140^{\circ}$ deemed acceptable. Angles above or below this range were perceived as unattractive, and anything outside the range of below $98^{\circ}$ or above $162^{\circ}$ was deemed very unattractive. A deep mentolabial angle ($84^{\circ}$) or an almost flat angle ($162^{\circ}$) was deemed the least attractive. In terms of threshold values of desire for surgery, for all groups, a threshold value of ${\geq}162^{\circ}$ and ${\leq}84^{\circ}$ indicated a preference for surgery, although clinicians were least likely to suggest surgery. The clinician group was the most consistent, and for many of the images, there was some variation in agreement between clinicians and lay people as to whether surgery is required. There was even more variability in the assessments for the patient group. Conclusions: It is recommended that in orthognathic and genioplasty planning, the range of normal variability of the mentolabial angle, in terms of observer acceptance, is taken into account as well as threshold values of desire for surgery. The importance of using patients as observers in attractiveness research is stressed.

Chair side measuring instrument for quantification of the extent of a transverse maxillary occlusal plane cant

Naini, Farhad B.,Messiha, Ashraf,Gill, Daljit S. Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Background: Treatment planning the correction of a transverse maxillary occlusal plane cant often involves a degree of qualitative "eyeballing", with the attendant possibility of error in the estimated judgement. A simple chair side technique permits quantification of the extent of asymmetry and thereby quantitative measurements for the correction of the occlusal plane cant. Methods: A measuring instrument may be constructed by soldering the edge of a stainless steel dental ruler at 90° to the flat surface of a similar ruler. With the patient either standing in natural head position, or alternatively seated upright in the dental chair, and a dental photographic retractor in situ, the flat under-surface of the horizontal part of this measuring instrument is placed on a unilateral segment of a bilateral structure, e.g. the higher maxillary canine orthodontic bracket hook. The vertical ruler is held next to the contralateral canine tooth, and the vertical distance measured directly from the canine bracket to the flat under-surface of the horizontal part of the measuring instrument. Results: This vertical distance quantifies the overall extent of movement required to level the maxillary occlusal plane. Conclusions: This measuring instrument and simple chair side technique helps to quantify the overall extent of surgical levelling required and may be a useful additional technique in our clinical diagnostic armamentarium.

Validation of a new three-dimensional imaging system using comparative craniofacial anthropometry

Naini, Farhad B.,Akram, Sarah,Kepinska, Julia,Garagiola, Umberto,McDonald, Fraser,Wertheim, David Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: The aim of this study is to validate a new three-dimensional craniofacial stereophotogrammetry imaging system (3dMDface) through comparison with manual facial surface anthropometry. The null hypothesis was that there is no difference between craniofacial measurements using anthropometry vs. the 3dMDface system. Methods: Facial images using the new 3dMDface system were taken from six randomly selected subjects, sitting in natural head position, on six separate occasions each 1 week apart, repeated twice at each sitting. Exclusion criteria were excess facial hair, facial piercings and undergoing current dentofacial treatment. 3dMDvultus software allowed facial landmarks to be marked and measurements recorded. The same measurements were taken using manual anthropometry, using soluble eyeliner to pinpoint landmarks, and sliding and spreading callipers and measuring tape to measure distances. The setting for the investigation was a dental teaching hospital and regional (secondary and tertiary care) cleft centre. The main outcome measure was comparison of the craniofacial measurements using the two aforementioned techniques. Results: The results showed good agreement between craniofacial measurements using the 3dMDface system compared with manual anthropometry. For all measurements, except chin height and labial fissure width, there was a greater variability with the manual method compared to 3D assessment. Overall, there was a significantly greater variability in manual compared with 3D assessments (p < 0.02). Conclusions: The 3dMDface system is validated for craniofacial measurements.

Perception of frontal facial images compared with their mirror images: chirality, enantiomorphic discrimination, and relevance to clinical practice

Zaid B. Al-Bitar,Ahmad M. Hamdan,Abedalrahman Shqaidef,Umberto Garagiola,Farhad B. Naini 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background What we think we see consists of models constructed in our brains, which may be constrained, limited and perhaps modified at a cerebral level. Patients may view their mirror image differently to how others and the clinical team view them. Understanding potential variations in perception between real and mirror images is important in clinical practice. The aims were to assess differences in self-perception between frontal facial and mirrored photographs, comparing the results with selfie photographs. Methods Facial photographs were taken by one investigator under standardized conditions for preclinical and clinical students. Each student took a selfie photograph at rest and smiling using his/her smartphone. A mirror image was generated for each image. Each student was shown his/her original and mirror image, without being informed which was which. For each pair of images, students were asked to choose which photograph they perceived as more attractive. A set of photographs of a male volunteer was shown to all participants, to choose either the original or mirror image as the more attractive. Results Most observers preferred the true image of the volunteer (P < 0.05), which may be evidence that most people prefer the true image of others, which is how they normally view them. Most observers preferred their own original photograph in frontal view at rest and smiling (P < 0.05), but preferred the mirror image of their selfie photograph at rest and smiling (P < 0.05). Conclusions Significant differences in perceptions of attractiveness between true and mirror-reversed frontal and selfie images were found. Observers preferred their image the way they view themselves in a mirror. The selfie is how other people view an individual. If a selfie is flipped horizontally, that is how an individual sees themselves in a mirror. Most observers preferred the mirror image of their selfie, which is how they would view themselves in a mirror.

Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon

Elif Keser,Farhad B. Naini 대한악안면성형재건외과학회 2022 Maxillofacial Plastic Reconstructive Surgery Vol.44 No.-

Background: Techniques to accelerate tooth movement have been a topic of interest in orthodonticsover the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increaseddecalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment timein orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in acceleratedtooth movement has been the increased interest in adult orthodontics. Review: This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. Italso describes the advantages and limitations of these techniques, including guidance for future investigations. Conclusions: Optimization of the described techniques is still required, but some of the techniques appear to offerthe potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.

Zonal analysis in contemporary aesthetic orthognathic surgical planning

Mehmet Manisali,Farhad B. Naini 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background The purpose of this article is to introduce the concept of zonal analysis in orthognathic surgical planning. Case presentation The importance of developing this concept of facial zonal analysis is because grouping together elements of aesthetic importance in a region in a systematic manner allows for accurate diagnosis and logical treatment planning. An orthognathic case presentation is described to demonstrate this concept. Discussion The three facial zones described are related in terms of the presenting problem and in relation to the changes envisaged with each planned surgical movement. The importance of developing this concept of facial zonal analysis is because grouping together elements of aesthetic importance in a region in a systematic manner allows for accurate diagnosis and logical treatment planning. Consideration is given to the negative features that require improvement and the positive features that the clinician and patient would prefer not to alter. It also provides an organised tool for postoperative comparison of results. The analysis and synthesis of the information provided from this approach can aid contemporary orthognathic surgical planning.

Exosomes in craniofacial tissue reconstruction

Muhja Salah,Farhad B. Naini 대한악안면성형재건외과학회 2022 Maxillofacial Plastic Reconstructive Surgery Vol.44 No.-

Background: Mesenchymal stem cell (MSC) therapy gained interest among scientists following the discovery of its therapeutic potential. However, their clinical use has been hindered due to their immunogenicity and tumorigenicity. Relatively recently, it has been unveiled that the mechanism by which MSC promote healing is by secreting exosomes. This raised the interest in developing cell-free therapy, avoiding the obstacles that deterred the translation of MSC therapy into clinical practice. Review: This comprehensive narrative review summarises the current understanding of exosome biogenesis and content. Moreover, the existing research on exosome use in bone tissue engineering is discussed. Conclusions: Exosome-based therapy may provide excellent potential in the field of bone tissue engineering and craniofacial reconstructive surgery. Further investigation is required before the technology can be translated into clinical practice.

Coronoid impingement syndrome: literature review and clinical management

Acharya, Priti,Stewart, Andrew,Naini, Farhad B. Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: This case report discusses the unusual presentation of limited mouth opening as a result of bilateral coronoid process hyperplasia. Case presentation: A 14.5-year-old male patient of white Caucasian ethnicity presented with limited mouth opening, mandibular asymmetry, and dental crowding. Investigations confirmed bilateral coronoid process hyperplasia and management involved bilateral intraoral coronoidectomy surgery under general anaesthesia, followed by muscular rehabilitation. Mouth opening was restored to average maximum opening within 4 months of surgery. Conclusion: Limited mouth opening is a common presentation to medical and dental professionals. The rare but feasible diagnosis of coronoid impingement syndrome should not be overlooked.

Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness

Mantelakis, Angelos,Iosifidis, Michalis,Al-Bitar, Zaid B.,Antoniadis, Vyron,Wertheim, David,Garagiola, Umberto,Naini, Farhad B. Korean Association of Maxillofacial Plastic and Re 2018 Maxillofacial Plastic Reconstructive Surgery Vol.40 No.-

Background: In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding "ideal" facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion. Methods: Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models' facial ratios were calculated and compared with the golden proportion. Results: Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion. Conclusions: Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.