Original Research Article DOI: 10.18231/2455-6785.2017.0019 Indian Journal of Orthodontics and Dentofacial Research, April-June 2017;3(2):92-97 92 Comparative evaluation of hard and soft tissue mid-face dimensions of Class I and Class III Individuals using CBCT Raghu Devanna 1,* , Yousef Althomali 2 , Nayef H. Felemban 3 , Bheema S. Manasali 4 , Prashant M. Battepati 5 1,2 Associate Professor, 3 Assistant Professor, Orthodontic Division, Dept. of Preventive, 4 Assistant Professor, Dept. of Prosthodontics, 5 Assistant Professor, Pediatric Dentistry, Dept. of Preventive, Faculty of Dentistry, Taif University, Taif, KSA *Corresponding Author: Email: drraghu@tudent.edu.sa Abstract Introduction: Augmenting the malar area enhances the angularity and fullness of the mid face. Pop culture portrays people with high malar prominence and angular faces as beautiful and exotic. (1) On the other hand, people with mid face deficiency tend to have a gaunt or hollow mid face leading to increased show of the sclera inferior to the pupil. Materials and Method: Thirty Class I and 30 Class III CBCT images (16 male, 14 female - each group) between the age group of 14-20 years were included in the study. Data collected from the patients reporting to the Insight CBCT Center, Pune. The CBCT images were analyzed with creation of hard and soft tissue slices for PPA and results were drawn with statistical analysis. Results: The Class I male horizontal slices had smaller measurements (P<.05) in both the soft and hard tissue than Class III by 0.4 to 1.5 mm at nearly nine measurements of PPA. The Class III sample pattern profile measurements were larger by 0.6 to 1.7 mm. The laterality measurements also found to be larger for the Class III as compared to Class I. Discussion & Conclusion: Class III males found to have a larger mid face deficiency than Class I male. Anterior component of the Class III male’s mid face showed posterior positioning. Class I and Class III female sample showed similar size and position of the mid facial complex (Statistically Insignificant). Class III male’s mid facial deficiency was more, mid face complex positioned further laterally and elongated more anteriorly as compared to the Class I male and female Class III. Keywords: Malar Area, Mid Face Deficiency, Class I, Class III Introduction Malar augmentation is a common procedure among plastic surgeons and otolarygologists. (1) Oral surgeons use different designs of Le Fort I, II, and III surgical procedures to help increase malar projection during orthognathic surgery. (2-4) Increasing the malar area enhances the angularity and fullness of the mid face. Pop culture portrays people with high malar prominence and angular faces as beautiful and exotic. (1) On the other hand, people with mid face deficiency tend to have a gaunt or hollow mid face leading to increased show of the sclera inferior to the pupil. (5,6) The hollow mid face creates a perpetually tired, worn out, older and sad appearance. (1,7) Aging augments the hollowness as soft tissue atrophy and sagging reduce malar soft tissue prominence and move it more inferior. (8) To achieve facial beauty there must be balance among the facial promontories. (9) The nose, lips, chin, glabella, and malar prominence related to each other and they create a positive perspective within the face. (10) Any single promontory out of proportion with the rest makes the other promontories more or less protrusive. A large nose decreases the apparent size of the chin and malar prominences. Flat malar areas make the nose large and unseemly. Likewise, a large nose masked by augmenting the malar prominences and chin. (11) Orthodontists are concerned with establishing facial beauty and balance. In particular, they diagnose and treat according to the facial profile and the effects that treatment will have on the facial profile. (12,13) The lips move in proportion to the amount of tooth movement and lip fullness can be increased or decreased with orthodontic treatment. (14,15) Additionally, the relationship of the maxilla and mandible and their relationship to the profile of the patient given utmost consideration. (16) In patients with retrognathic mandibles, treatment plans are created to advance the mandible or reduce the prominence of the maxilla to mask the mandibular retrusion. (17) Mandibular advancement decreases the perception of mid face fullness or increases the hollowness of a patient already deficient. Mandibular setback would increase the perception of the malar fullness. In three dimensions, the malar prominence becomes more important. The prominence creates width to the anterior face and cheek fullness. The orthodontic treatments affecting the mandible and lips also affect the perception of the nose and malar prominence. (18) Skeletally Class III individuals have maxillae that are by definition behind the mandible and thus should appear to have increased incidence of malar deficiency. Misdiagnosis of facial asymmetry can result in inaccurate orthodontic treatment plans. Precise evaluation of facial asymmetry is a key step in orthodontic diagnosis. (19) Consequently, in recent years, the use of CBCT for evaluation of facial asymmetry has become more common. CBCT not only overcomes the disadvantages of 2D radiographs without exposing the patient to high levels of radiation and great expense (20,21) but also improves the ability to understand the 3D nature of facial asymmetry, enabling the