Original article
Self-perception of facial esthetics by patients with different profiles compared with assessments of orthodontists and lay people

https://doi.org/10.1016/j.ajodo.2019.10.027Get rights and content

Highlights

  • •

    Perceptions of facial esthetics were evaluated in facial photographs.

  • •

    Profile convexity did not affect the esthetic perceptions of patients or lay people.

  • •

    Orthodontists assessed facial esthetics more critically, especially in profile.

  • •

    Discrepant profiles did not influence frontal view evaluation.

Introduction

This study evaluated the perception of facial esthetics of patients with different profiles as assessed by orthodontists, lay people, and patients.

Methods

The sample comprised 120 patients (81 females, 39 males; mean age, 26.3 years) selected from private practices at the onset of orthodontic treatment. The patients were divided into 3 groups of 40 according to the type of facial profile. The groups were composed of straight, concave, and convex profiles, on the basis of the facial convexity angle (G.Sn.Pog’) measured on the initial cephalometric tracings. Patients analyzed only their frontal (smiling and at rest) and profile facial photographs and evaluated the pleasantness of these images on a 5-point Likert scale. A group of 30 orthodontists and 30 lay people also evaluated the patients’ facial pleasantness, using the same scale. Factorial analysis of variance (convexity and sex) was used to evaluate the differences between the convexities, and analysis of variance mixed model (type of evaluator and sex) to compare the 3 categories of evaluators, using the aligned rank transform technique. The correlation between the convexity angle and facial pleasantness was assessed by the Spearman correlation coefficient.

Results

Patients and lay people assigned higher pleasantness scores than orthodontists, with statistically significant differences for all evaluations, except for the frontal analysis of the convex group. The correlation coefficients regarding profile convexity and facial pleasantness were negative, indicating a tendency that more convex or concave facial profiles received lower pleasantness scores; however, this correlation was only significant in the evaluation of profile photographs by orthodontists.

Conclusions

Patients with different profiles were scored with acceptable faces by lay people and patients themselves. Orthodontists’ perceptions were different; they attributed lower pleasantness scores. Discrepant profiles affect facial esthetics in the profile view when judged by orthodontists.

Section snippets

Material and methods

The Research Ethics Committee of the University of North Paraná, Londrina, Paraná, Brazil, under protocol number 2.359.615, approved this study.

The sample calculation was based on the study of McKeta et al.18 To compare straight, convex, and concave profiles—considering an average standard deviation of 0.669, at a significance level of 5% and power of 80%—we determined that a total of 38 subjects should be included in each group. For comparison between lay people and orthodontists, the same

Results

The intraexaminer error for patients, lay people, and orthodontists was evaluated by the weighted kappa, and the results were interpreted using the classification proposed by Landis and Koch.21 The kappa ranged from 0.77 to 0.83, 0.75 to 0.76, and 0.62 to 0.71 for patients, lay people, and orthodontists, respectively. The agreement was considered substantial and almost perfect for the patients, and substantial for lay people and orthodontists. The intraexaminer systematic error of the facial

Discussion

Understanding the patients' expectations about the treatment and their self-perception of facial esthetics and smile is an important aid during orthodontic planning. The concern about the patient's facial perception evidences a paradigm shift, in which the treatment planning—initially performed only by the orthodontists—currently considers the participation of patients. In this sense, because of the lack of studies in the literature evaluating the perception of patients by a complete evaluation

Conclusions

  • 1.

    Deviation from a balanced profile did not influence facial pleasantness according to patients, lay people, or orthodontists. The only exception was noted in the assessment of the profile photographs by orthodontists, which attributed to lower scores for patients with convex profiles.

  • 2.

    The assessment of facial esthetics by orthodontists was different from patients and lay people. Orthodontists attributed lower pleasantness scores in almost all evaluations.

  • 3.

    Although a tendency to attribute lower

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    • All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

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