HOLDAWAY ANALYSIS
HOLDAWAY ANALYSIS
The soft- tissue profile plays an important part inour orthodontic considerations.
Usually, as we correct malocclusions, we bring aobut changes in appearance that are
pleasing to all concerned. However, most orthodontists who have practiced fro even a
few years have had the unpleasant experience of finding that some patients faces looked
better before the orthodontic corrections were made. We should determine beforehand
that the proposed orthodontic treatment will not result in adverse facial change. This
analysis is an attempt to express quantitatively those soft- tissue relationships which are
peasing and harmonious as well as those which are not, to differentiate one from the other
and to explain how this information is used in orthodontic treatment planning.
SOFT- TISSUE ANALYSIS:
Soft- tissue facial angle. This is an angular measurement of a line drawn from
soft- tissue nasion. Where the sella- nasion line crosses the soft- tissue profile, to the
soft- tissue chin at a point overlying the hard- tissue suprapogonion of Ricketts measured
to the Frankfort horizontal plane. This chin point is chosen because of the bony stability
here during growth and because in cases in which there is hypementalis activity resulting
in an uneven distribution of the integumental covering of the bony chin it is a more
realistic point at which to measure the chin prominence.
A measurement of 91degrees is ideal, with an acceptable range of 7± degrees.
Nose prominence: Next in importance to variations in chin position are position
are variations in noses. Nose prominence can be measured by means of a line
perpendicular to Frankfort horizontal and running tangent to the vermilion border of the
upper lip. This measures the nose from its tip in front of the line and the depth of the
incurvation of the upper lip to the line. Arbitrarily, those noses under 14mm. are
considered small, while those above 24mm. are in the large or prominent range. Nasal
form should be judged on an individual basis.
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HOLDAWAY ANALYSIS
Superior sulcus depth measured to a perpendicular to Frankfort and tangent to
the vermilion border to the upper lip. Next let us consider the upper lip form or curl.
This is the superior sulcus depth measured to the same perpendicular to Frankfort. A
range of 1 to 4 mm. is acceptable in certain types of faces, with 3mm. being ideal. This
measurement is especially useful in cases found to be on either extreme of facial
convexity where a measurement to the H line (Harmony line) is misleading because of
the change in the cant of this line in highly convex or concave faces. This is a simple
way to quantitate the actual curl of the upper lip.
During orthodontic treatment or surgical orthodontic procedures, we should strive
never to allow this measurementto become less than 1.5mm.
Measurement of soft tissue subnasale to H line. Here the ideal is 5mm., with a
range of 3 to 7mm. when the skeletal convexity of a case will be from – 3 to +5 mm. at
retention, the lips can usually be aligned nicely along the H line when the superior sulcus
measurement is at or near 5mm. with short and/or thicker lips; 7mm. may be in
excellent balance.
Basic upper lip thickness. This is near the base of the alveolar process,
measured about 3mm. below point A. it is at a level just below where the nasal
structures influence the drape of the upper lip. This measurement is useful, when
compared to the lip thickness overlying the incisor crowns at the level of the vermilion
border. In determining the amount of lip strain or incompetency present as the patient
close his or her lips over protrusive teeth.
Upper lip strain measurement. The usual thickness at the vermilion border
level is 13 to 14mm. excessive taper is indicative of the thinning of the upper lip as it is
stretched over protrusive teeth; also excessive vertical height may produce more than
1mm of taper due to lip stretching. When the lip thickness at the vermilion border is
larger than the basic thickness measurement, this usually identifies a lack of vertical
growth of the lower face with a deep overbite and resulting lip redundancy. Lip strain
must be considered when one is doing a VTO if such an objective is to be realistic.
A angle. This is an angular measurement of the H line to the soft- tissue Na-Po line or
soft – tissue facial plane. Ten degrees is ideal when the convexity measurement is 0mm.
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HOLDAWAY ANALYSIS
However, measurements of 7 to 15 degrees are all in the best range as dictated by the
convexity present. Ideally, as the skeletal convexity increases, the H angle must also
increase if a harmonious drape of soft tissues is to be realized in varying degrees of
profile convexity.
Lower lip to H line. The ideal position of the lower lip to the H line is 0 to
0.5mm. anterior, but individual variations from 1mm. behind to 2mm. in front of the H
line are considered to be in a good range. When the lower lip is situated behind the H
line, the measurement is considered to be a minus figure. A lower lip measurements are
only reasonably good is indicative of lower incisors that are positioned too far lingually.
Inferior sulcus to the H line. The contour in the interior sulcus area should fall
into harmonious lines with the superior sulcus form. This is measured at the point of
greatest incurvation between the vermilion border of the lower lip and the soft- tissue
chin and is measured to the H line. It is an indicator of how well we manage axial
inclinations of the lower anterior teeth. Leveling procedures on round arch wires may
cause a lingual tipping of the lower incisor roots with point B following and thus
exaggerate and already excessive labiomental furrow and a prominent chin.
Soft tissue chin thickness (10 to 12 mm. average). This is recorded as a
horizontal measurement and is the distance between the two vertical lines representing
the hard- tissue and soft- tissue facial planes at the level of Ricketts’ suprapogonion.
Usually, these lines diverge only slightly from the area of nasion down to the chin.
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HOLDAWAY ANALYSIS
HOLDAWAY’S LIP ANALYSIS
Normal Patient values Inference
1) Facial Angle 91° + 7° 84° Normal
2) Nose Prominence 14-24 mm -8 mm backwardly placed
3) Superior Sulcus depth 3 mm 16 mm Increased
4) Soft tissue Subnasale 5 + 2 mm 11 mm Increased
to H-line angle
5) Skeletal profile 2.5 mm 9 mm convex profile
convexity
6) Upper lip thickness 15mm 10 mm Upper lip thickness
increased
7) Upper lip strain 13-14 mm 8.5 mm Thin upper lip
8) H-Angle 7-15° mm 290 Prominent upper lip
9) Lower lip to H- line 0-0.5 mm 5 mm Protrusive lower lip
10) Inferior sulcus to + 2mm 4 mm Deep mentolabial sulcus
H- line
11) Soft Tissue Chin 10-12 mm 9 mm Normal chin prominence
Thickness
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