The relationship of the forehead to the maxillary central incisor in adult white females: An evaluation of Andrews Element II analysis

Background. Facial esthetics is an important motivating factor for many patients seeking orthodontic treatment. Traditionally in orthodontics, facial profiles have been evaluated using cephalometrics and repose soft-tissue analysis. In this study we want to evaluate the significance of the profile soft-tissue analysis when the patient is smiling. Purpose: Our purpose is to evaluate and compare the anteroposterior relationship of the maxillary central incisors to the forehead in adult white females with harmonious profiles versus adult white female orthodontic patients.;Methods. 94 photographic images of adult white females with good facial harmony (control sample) were compared with 150 photographs of adult white females seeking orthodontic treatment from 3 separate offices (study sample). All images smiling profile images had the maxillary central incisors and the forehead in full view. The images were adjusted and rotated to the upright head position. Reference lines were drawn to measure the anteroposterior positions of the maxillary central incisors as well as forehead inclinations.;Results. Our results indicate that there is a significant difference in anteroposterior position of maxillary central incisor between the control sample (harmonious profiles) and each office [control and office 1 (p=.002), control and office 2 (p=.000), and control and office 3 (p=.004)]. ANOVA and Nonparametric analysis indicate that our results are significant. Also there was a significant correlation in the control sample (R2 = 0.641) between anteroposterior incisor position and forehead inclination, however none in the study samples. The most esthetic maxillary central incisor position, between FFA point and glabella, was highest in the control sample (94%), but much less in the three offices (Office 1 = 22%, Office 2 = 30%, Office 3 = 30%).;Conclusion. The forehead can be confirmed as a reliable landmark for assessing the facial profile for adult white females as it relates to anteroposterior maxillary central incisor position relative to FFA. Treatment goals should include a harmonious relationship between the anteroposterior position of maxillary central incisors and the forehead for adult white female patients.