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The accuracy and reliability of a novel smartphone application for orthodontic soft tissue analysis: A pilot study Cover

The accuracy and reliability of a novel smartphone application for orthodontic soft tissue analysis: A pilot study

Australasian Orthodontic Journal
Volume 41 (2025): Issue 1 (January 2025)
By: Mahmoud A. Elfeky,  Amira A. Aboalnaga,  Faten H. Eid and  Yehya A. Mostafa  
Open Access
|Nov 2025

Figures & Tables

Figure 1.

The Camera setup used in the study; The distance between the two soft boxes arms is (1.78 m), the distance between the arm of the soft box and the chair position is (1.16 m), the distance between the tripod holding camera and the chair position is (4.94 m).
The Camera setup used in the study; The distance between the two soft boxes arms is (1.78 m), the distance between the arm of the soft box and the chair position is (1.16 m), the distance between the tripod holding camera and the chair position is (4.94 m).

Figure 2.

The newly designed SOFTBLINK banner used in the study.
The newly designed SOFTBLINK banner used in the study.

Figure 3.

Soft tissue measurements calculated using the SOFTBLINK application; A&B showing the profile angle, C showing the mandibular plane angle and D showing the nasolabial angle.
Soft tissue measurements calculated using the SOFTBLINK application; A&B showing the profile angle, C showing the mandibular plane angle and D showing the nasolabial angle.

Descriptive statistics (MANOVA) and multiple pairwise comparison tests of the soft tissue measurements using the three comparative methods of the study

Profile Facial Thirds
Mean ± SD
Dolphin 51.90 ± 2.221
Web Ceph 50.83 ± 1.772
SOFTBLINK 50.500 ± 2.664
Repeated measure MANOVA (within subject effect) F = 1.836
P = 0.209
Multiple pairwise Comparison test
Mean differenceStd. error P value
Dolphin Vs. Web Ceph1.0670.630 0.454
Dolphin Vs SOFTBLINK1.4000.986 0.645
Web Ceph Vs. SOFTBLINK0.3330.615 1.000
Profile angle
Mean ± SD
Dolphin 163.00 ± 4.604
Web Ceph 165.166 ± 2.714
SOFTBLINK 165.166 ± 2.857
Repeated measure MANOVA (within subject effect) F = 6.450
P = 0.016*
Multiple pairwise Comparison test
Mean differenceStd. error P value
Dolphin Vs. Web Ceph-2.1670.792 0.123
Dolphin Vs SOFTBLINK-2.1670.833 0.145
Web Ceph Vs. SOFTBLINK0.0010.356 1.000
Nasolabial angle
Mean ± SD
Dolphin 105.33 ± 14.094
Web Ceph 97.33 ± 17.385
SOFTBLINK 98.00 ± 17.515
Repeated measure MANOVA (within subject effect) F = 5.624
P = 0.060
Multiple pairwise Comparison test
Mean differenceStd. error P value
Dolphin Vs. Web Ceph8.0003.296 0.179
Dolphin Vs SOFTBLINK7.333.116 0.196
Web Ceph Vs. SOFTBLINK-0.6670.667 1.000
Mentolabial angle
Mean ± SD
Dolphin 129.83 ± 25.119
Web Ceph 127.600 ± 19.258
SOFTBLINK 125.00 ± 22.226
Repeated measure MANOVA (within subject effect) F = 0.729
P = 0.507
Multiple pairwise Comparison test
Mean differenceStd. error P value
Dolphin Vs. Web Ceph2.2333.868 1.000
Dolphin Vs SOFTBLINK4.8335.089 1.000
Web Ceph Vs. SOFTBLINK2.6002.709 1.000
Mandibular plane angle
Mean ± SD
Dolphin 26.31 ± 8.196
Web Ceph 19.833 ± 2.786
SOFTBLINK 22.833 ± 2.639
Repeated measure MANOVA (within subject effect) F = 2.930
P = 0.100
Multiple pairwise Comparison test
Mean differenceStd. error P value
Dolphin Vs. Web Ceph6.4833.476 0.364
Dolphin Vs SOFTBLINK3.4832.912 0.856
Web Ceph Vs. SOFTBLINK-3.0001.000 0.090

Soft tissue landmarks and measurements used in the study

LandmarkAbbreviationDefinition
TrichionTrPoint of intersection of the normal hairline and the middle line of the forehead.
GlabellaG’Most anterior soft tissue point on the frontal bone.
Soft tissue NasionN’The soft tissue point which is located in front of the bony Nasion at the midline of both the nasal root and the nasofrontal suture.
Soft tissue OrbitaleOrThe soft tissue point located at the most inferior level of each infraorbital rim, located at the level of the hard tissue cephalometric Orbitale landmark.
PorionPoThe highest point of the ear canal; most superior point of the external auditory meatus.
ColumellaCThe line that links the nasal tip to the nasal base. It is the inferior margin of the nasal septum.
SubnasaleSnThe midpoint of the angle at the columella base where the lower border of the nasal septum and the surface of the upper lip meet.
Upper lipULThe most anterior point on the curve of the upper lip.
Lower lipLLThe most anterior point on the curve of the lower lip.
Soft tissue B pointB’The soft tissue point located in front of (B point) which is the most concave point between lower lip and the soft tissue chin.
Soft tissue pogonionPg’The most anterior point on the curve of the soft tissue chin.
Soft tissue MentonMe’The most inferior point of the soft tissue chin.
GonionGoThe most convex point where the posterior and inferior curves of the ramus meet.
MeasurementDescription
Facial thirdsUpper third; Trichion (Tr) to soft tissue nasion (N’). Middle third; Soft tissue nasion (N’) to subnasal (Sn).Lower third; Subnasal (Sn) to Soft tissue menton (Me’).
Profile angleThe angle between Soft tissue glabella (G’), subnasal (Sn) and Soft tissue pogonion (Pg’).
Nasolabial AngleIntersection of upper lip (UL) and columella (C) at subnasal (Sn).
Mentolabial AngleIntersection of lower lip (LL) and soft tissue pogonion (Pg’) at soft tissue B point (B’).
Mandibular plane angleThe angle between Frankfurt plane (Line between orbitale (Or) and Porion (Po)) and Mandibular plane (Line between menton (Me) and gonion (Go)).

Diagnostic chart of linear and angular soft tissue measurements

Soft Tissue MeasurementNormDiagnosisClinical Indication
Profile Angle165-175°

  • Class I soft tissue (straight profile)

  • Class II soft tissue (Convex profile)

  • Class III soft tissue (Concave profile)

  • Normal soft tissue profile

  • Skeletal class II (maxillary protrusion – vertical maxillary excess – mandibular retrusion)

  • Skeletal Class III (maxillary retrusion – vertical maxillary deficiency – mandibular protrusion)

Facial thirds (Profile)Lower third to Middle third55 ± 12%

  • Normal

  • Increased lower facial height more than 67%

  • Decreased lower facial height less than 43%

  • Normal

  • Vertical maxillary excess

  • Vertical maxillary deficiency

Mandibular plane angle30.5 ± 6°

  • Normal mandibular plane

  • Increased mandibular plane

  • Decreased mandibular plane

  • Normal

  • Increased lower vertical height – vertical maxillary excess –downward and backward rotation of the mandible

  • Decreased lower facial height – vertical maxillary deficiency – forward and upward rotation of the mandible.

Nasolabial angle102 ± 8°

  • Normal

  • Increased

  • Decreased

  • Normal

  • Avoid retraction of upper maxillary incisors and avoid extraction in maxillary arch

  • Proclination of upper incisors and extraction of upper premolars are recommended

Mentolabial Angle120 ± 10°

  • Normal

  • Increased

  • Decreased

  • Normal chin

  • Flat chin

  • Protruded chin

DOI: https://doi.org/10.2478/aoj-2025-0021 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472
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Language: English
Page range: 346 - 356
Submitted on: Dec 1, 2024
Accepted on: May 1, 2025
Published on: Nov 4, 2025
Published by: Australian Society of Orthodontists Inc.
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2025 Mahmoud A. Elfeky, Amira A. Aboalnaga, Faten H. Eid, Yehya A. Mostafa, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution 4.0 License.

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