Computer-assisted development of age- and sex-specific cephalometric templates for evaluating facial profiles: A cross-sectional study

Objectives: Cephalometric analysis requires time and expertise, making it difficult for non-specialists. Existing templates lack anatomical design for hard and soft tissues, focusing only on landmarks without considering standard deviations (SDs). This study aimed to develop age- and sex-specific cephalometric templates by integrating means and SDs from the most attractive segment of the population, providing a more refined approach for evaluating facial profiles. Material and Methods: In this cross-sectional study, 400 Iranian subjects (equal by sex) were divided into four age groups: 7–10, 11–14, 15–18, and >18 years. Standardized profile photos and lateral cephalograms were collected. Attractiveness was rated by 26 laypeople using Visual Analog Scale, and the top 20% per age-sex group were selected. Using Dolphin Imaging software, 40 landmarks were identified per image. Mean positions and SDs were calculated to generate three superimposed templates per group, each varying by ±1 SD in anteroposterior and vertical dimensions. Results: A total of 400 images yielded 24 facial profile templates, incorporating means and SDs for each age–sex group. In males, preferred features included prominent chins, fuller upper lips, and angular lower faces. In females, greater facial convexity, softer contours, and less nasal projection were favored. Hard tissue analysis showed a mild skeletal retrusion in attractive females, while attractive males resembled normative skeletal patterns. Age-related trends included increased nasal prominence, vertical growth, and lip retrusion. Conclusion: Digital templates offer quick visual references for parents, patients, students, and general dentists. However, further validation is needed to confirm their clinical applicability and diagnostic reliability.