Evaluation of Nasal and Soft Tissue Angular Measurements Across Class I, Class II, and Class III Orthodontic Patients: A Cross-Sectional Cephalometric Study

Background: Facial aesthetics is a fundamental component of orthodontic diagnosis and treatment planning, with increasing emphasis on soft tissue harmony rather than dental alignment alone. Angular soft tissue measurements of the nose, lips, and chin play a pivotal role in evaluating sagittal facial balance. Given the influence of ethnicity on facial morphology, population-specific reference values are essential to guide clinical decision-making. Objective: To evaluate nasal and soft tissue angular measurements among Class I, Class II, and Class III orthodontic patients and to assess potential gender-based differences within a Pakistani population. Methodology: This cross-sectional study was conducted at the Department of Orthodontics, Saidu College of Dentistry, Swat, from September 2024 to February 2025. A total of 109 adult patients with pre-treatment lateral cephalometric radiographs were included. Participants were classified into sagittal skeletal groups using ANB angle values. Five soft tissue angles nasolabial, nasomental, labiomental, chin-throat, and lip-chin-throat were manually traced and measured by a single calibrated examiner. Results: Mean values of all evaluated soft tissue angles were generally within accepted aesthetic ranges. Class II subjects demonstrated higher angular values, indicative of a more convex soft tissue profile, while Class III subjects exhibited comparatively lower values consistent with straighter or mildly concave profiles. A statistically significant difference was observed only for the nasolabial angle across sagittal skeletal classes (p = 0.036). No significant gender-based differences were identified for any angular measurement. Conclusion: Soft tissue angular measurements vary according to sagittal skeletal classification but are not influenced by gender in this population. The nasolabial angle emerged as a key diagnostic parameter, underscoring the importance of incorporating comprehensive soft tissue evaluation into orthodontic treatment planning. Keywords: Cephalometry, Facial Aesthetics, Nasolabial Angle, Orthodontic Diagnosis.