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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 52  |  Issue : 1  |  Page : 17-21

Device to take facial photographs in frankfort horizontal plane in a standardized manner at repeated intervals


1 Prof. and HOD, Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
2 Prof, Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
3 Reader, Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
4 Senior Lecturer, Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
5 PG Student, Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India

Date of Submission25-Aug-2015
Date of Acceptance21-Nov-2017
Date of Web Publication18-Jan-2018

Correspondence Address:
Dr. Gorantla Suresh
Department of Orthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jios.jios_167_15

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  Abstract 

Introduction: Very little attention has been given in orthodontic diagnosis and treatment planning regarding appropriate facial orientation during photographic recordings. Analysis of facial profile using standardized photographs is a valuable tool for orthodontic diagnosis. Materials and Methods: We have worked on a new way to position the patient's head with Frankfort horizontal parallel to the floor by use of a a specially fabricated device. It consists of a vertically adjustable scale attached to metal framework. The shadow of the scale is projected as a horizontal line onto the face by means of a light source. The patient's head is positioned such that the Frankfort horizontal lies along the projected line. Twenty-five (13 males and 12 females) people aged between 15 and 25 years were photographed using the above method with a digital single-lens reflex camera. The photographs were taken again after a 15-day interval using the same protocol and checked for reliability. Results: Statistical analysis was done using paired student t-test and Kappa test. The results showed that there was no statistically significant difference between the mean angles at the initial (76.92 ± 4.77) and 15-day interval (76.72 ± 4.67) in profile view and between the mean angles at the initial (90.88 ± 2.06) and 15-day interval (90.96 ± 1.96) in the frontal view. Conclusion: This method allows us to take facial photographs by positioning the patient’s head such that the FH plane is parallel to the floor. This method also helped us in standardization of facial photographs when photographs are taken in successive visits.

Keywords: Frankfort horizontal plane, horizontal orientation tool, reproducibility, standardization


How to cite this article:
Suresh G, Anil C, Chakravarthy VG, Vizia M, Kishore T. Device to take facial photographs in frankfort horizontal plane in a standardized manner at repeated intervals. J Indian Orthod Soc 2018;52:17-21

How to cite this URL:
Suresh G, Anil C, Chakravarthy VG, Vizia M, Kishore T. Device to take facial photographs in frankfort horizontal plane in a standardized manner at repeated intervals. J Indian Orthod Soc [serial online] 2018 [cited 2019 May 21];52:17-21. Available from: http://www.jios.in/text.asp?2018/52/1/17/223652


  Introduction Top


Photographs taken in standardized manner and proper orientation are excellent tools in orthodontic diagnosis, treatment planning, pre- and post-treatment comparisons, and documentation of the records.

Very less attention has been given in orthodontic diagnosis and treatment planning regarding appropriate facial orientation during photographic recordings. Many investigators oriented the individual's head in natural head position (NHP). NHP is a standardized, reproducible position, with the head in an upright posture and eyes focused on a point in the distance at eye level such that the visual axis is horizontal.[1] To take the photographs in NHP, there should be trained technicians during orthodontic examinations.[2],[3]

The advantage of Frankfort horizontal plane (FH plane) is that it can be projected onto the patient's face and the patient can be oriented to this plane in a standardized manner in successive visits. There are studies which suggest that FH plane is closely oriented to NHP among all the horizontal reference planes.[4],[5]

The present study was done with an aim to:

  1. Take facial photographs in a standardized manner
  2. Eliminate the intraobserver errors
  3. Observe the reliability and reproducibility of the same in successive visits.


Photographic device preparation

Equipment positions used in this study are set up as seen in [Figure 1]. A Portable device called as Horizontal orientation tool (HOT) [Figure 1]a was fabricated which consists of a metal framework to which a stiff metal scale was attached [Figure 2]. The shadow of this metal scale was projected onto the patient's face with the help of light source attached behind the metal scale. The light source can be adjusted on a horizontal sliding rack so that we get a sharp line projected onto the patient's face. This whole assembly was mounted on a vertical sliding rack [Figure 2], which can be adjusted and locked into any position with the help of screws, according to the height of the patient. A fluid level device [6] [Figure 3] was placed on the scale after it was adjusted to the patient's height, to make sure that the scale was parallel to the floor. Parallelism can be achieved by making adjustments to the height-adjustable screws on the base of the metal framework. The metal scale bisects the center of high-intensity light source [Figure 4] so that the projection of metal scale will fall on the patient's face as a thin horizontal shadow.
Figure 1: Equipment positions used in this study (A) horizontal orientation tool (B) patient (C) photographic camera (D) background light source (E) auxiliary light source

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Figure 2: Horizontal orientation tool

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Figure 3: Fluid level device placed on the scale to make sure that the scale is parallel to the floor

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Figure 4: Metal scale bisects the center of high-intensity light source

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The patient was positioned at a distance of 30 cm from the background light source and in front of the HOT [Figure 1]b.

Photographic camera [Figure 1]c – A Nikon D5100 digital SLR camera with 18–55 mm zoom lens set at 55 mm in manual mode with aperture value of F11 and speed adjustment at 1/60th of a second was positioned on a tripod at a distance of 180 cm from the patient. All the photos were taken with the height of the camera adjusted such that the center of the camera lens coincided with the subnasale of the individual.

Background light source [Figure 1]d – As a background for the photographs, a light box with 100-watt incandescent bulb was used at a distance of 30 cm from the patient. A black string was attached to the light box with a plumb. This string was used as the vertical reference line.

Auxiliary light source [Figure 1]e – We have positioned two softboxes with umbrellas as auxiliary light source so as to eliminate the shadows.

The patient was positioned in this setup [Figure 1], and the shadow of the scale was projected onto the patient's face. The tilt of the head was adjusted such that the projected line coincides with the orbitale and porion in both lateral and frontal photographs.


  Materials and Methods Top


A sample of 25 adults (13 males and 12 females) aged 15–25 years were taken. Authorized participation was taken from the participants by signing terms of informed consent.

Once the patient was stabilized in the standardized position using the HOT, the first set of photographs were taken in both profile (P) [Figure 5] and frontal (F) [Figure 6] views. The line was not visible on the photograph because of the flash. Another set of photographs were taken after 15 days for the same patient in both Profile (P') and Frontal (F') views using the same protocol.
Figure 5: Profile of the individual with projection of metal scale and after click

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Figure 6: Frontal of the individual with projection of the metal scale and after click

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To check the reliability and reproducibility

Unaltered digital photographs were printed. The angle between vertical line (VL) and line joining soft tissue pogonion (pog') and upper lip (Ls) for profile photographs [Figure 7] was measured, labeled form P1 to P25 for all the patients, respectively, and tabulated [Table 1]. The angle between VL and the line joining outer canthi for frontal photographs [Figure 8] was measured, labeled form F1 to F25 for all patients respectively, and tabulated [Table 2]. The same operator did all measurements.
Figure 7: Measuring the angle P (initial) (between vertical line and line joining soft tissue pogonion [pog'] to upper lip [Ls]) and P' (after an interval of 15 days) on profile photographs

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Table 1: The angle measured between vertical line and line joining soft tissue pogonion and upper lip (labium superioris) on profile photographs taken initially (P1–P25) and taken after an interval of 15 days (P'1–P'25)

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Figure 8: Measuring the angle F (initial) (angle between vertical line and the line joining outer canthi) and F' (after an interval of 15 days) on frontal photographs

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Table 2: The angle measured between vertical line and the line joining outer canthi on frontal photographs taken initially (F1–F25) and taken after an interval of 15 days (F'1–F'25)

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To evaluate error of method

Unaltered digital photographs were printed for the second set of photographs, which were taken after 15 days for the same patients using the same criteria. We have tabulated the values obtained after measurements by the same operator to eliminate interobserver errors in both profile P'1–P'25 and frontal views F'1–F'25 in [Table 1] and [Table 2], respectively. Comparison between angles measured on profile photographs taken initially (P1–P25) and those taken after an interval of 15 days (P'1–P'25) on the same patients was done in [Table 3]. Comparison between angles measured on frontal photographs taken initially (F1–F25) and those taken after an interval of 15 days (F'1–F'25) on the same patients was done in [Table 4].
Table 3: Comparison of mean angles in profile view at initial (P) and 15-day interval (P')

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Table 4: Comparison of mean angles in frontal view at initial (F) and 15-day interval (F')

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Statistical analysis

Paired Student's t-test was done to compare the mean difference between P, P' values [Table 3] and F, F' values [Table 4] to evaluate the statistical significance of the difference in the angular measurements seen in the profile and frontal photographs. The mean value between P, P' and F, F' values was used for Kappa test. This test was done to measure the reliability of the study [Table 5].
Table 5: Symmetric measures

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  Results Top


In the profile view, the difference observed between the mean angles at the initial (76.92 ± 4.77) and 15-day interval (76.72 ± 4.67) was not significant [Table 3]. The difference observed between the mean angles at the initial (90.88 ± 2.06) and 15-day interval (90.96 ± 1.96) in the frontal view was also not significant [Table 4].

Kappa test on profile photographs gives a value of 0.628, which suggests substantial agreement [Table 5] and on frontal photographs gives the value of 0.698, which indicates substantial agreement [7] [Table 5].

These results showed that the above method could be successfully employed for the standardization of the facial photographs.


  Discussion Top


The importance of standardization of facial photographs is justified by the fact that facial analysis is essential to orthodontic diagnosis.[8],[9] According to Moorrees,[1] little attention has been given in orthodontic publications regarding the appropriate facial orientation during photographic recording. In some cases, patients with malocclusion Class II are documented before treatment with the head tilted down and after treatment with the head tilted up in order to highlight the correction of mandible retrognathia.[3]

NHP as a craniofacial reference system has been advocated because of its good intraindividual reproducibility; however, its use is not widespread perhaps due to practical constraints such as equipment and staff training.

The Frankfurt horizontal plane (parallel to soil) is the most commonly used reference for positioning patients during photographic or radiographic records, as recommended by Burstone.[5] Among all the reference planes studied, the FH plane was closest to the true horizontal and thus could be recommended as a reference plane, when radiographs were not recorded in NHP.[4] FH plane can be easily identifiable by locating porion and orbitale and can be reproducible in successive session. Thus, we have used FH plane because it is less variable and is oriented closely to true horizontal.[4]

It would be beneficial to take both lateral cephalograms and facial photographs with the head positioned along the FH plane so that it will be easier to superimpose the lateral cephalograms and facial photographs and can perform facial analyses. When lateral cephalograms are taken, the head is oriented to the FH plane by using a light guide built into the cephalometric machine. However, this machine cannot be used for orienting the head when taking facial photographs. Hence, we have devised this HOT to help orient the head with FH plane parallel to the floor. As seen in our study, this tool helps to take standardized facial photographs with minimal variability in successive visits.


  Conclusion Top


  • This method allowed us to take facial photographs with patient's head positioned with FH plane parallel to the floor
  • This method helped us in standardization of facial photographs when photographs are taken in successive visits.


Ethical approval

Ethical Approval was obtained from the Institutional Ethics Committee of Sree Sai Dental College & Research Institute, Srikakulam, Dr NTR University of Health Sciences, Vijayawada.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moorrees CF. Natural head position – A revival. Am J Orthod Dentofacial Orthop 1994;105:512-3.  Back to cited text no. 1
[PUBMED]    
2.
Rino Neto J, Freire-Maia BA, Paiva JB. Method of recording the natural position of the head to obtain the lateral cephalometric radiograph-considerations and importance of the method in orthodontic diagnosis. Rev Dent Press Ortod Ortop Facial 2003;8:61-71.  Back to cited text no. 2
    
3.
Pereira A, Manzotti L, Cabrini P, Luiz A. Reproducibility of natural head position in profile photographs of children aged 8 to 12 years with and without the aid of a cephalostat. Dent Press J Orthod 2010;15:65-73.  Back to cited text no. 3
    
4.
Shetty D, Bagga DK, Goyal S, Sharma P. A cephalometric study of various horizontal reference planes in Natural Head Position. J Ind Orthod Soc 2013;47:143-7.  Back to cited text no. 4
    
5.
Burstone CJ. The integumental profile. Am J Orthod Dentofacial Orthop 1958;44:1-25.  Back to cited text no. 5
    
6.
Showfety KJ, Vig PS, Matteson S. A simple method for taking natural-head-position cephalograms. Am J Orthod 1983;83:495-500.  Back to cited text no. 6
[PUBMED]    
7.
World Health Organization. Basic principles of clinical oral health surveys. In: Oral Health Surveys: Basic Methods. 5th ed. France: World Health Organization Publications; 2013. p. 27-8.  Back to cited text no. 7
    
8.
Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop 1993;103:299-312.  Back to cited text no. 8
[PUBMED]    
9.
Viazis AD. A cephalometric analysis based on natural head position. J Clin Orthod 1991;25:172-81.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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