Perceptions of dental esthetics of Asian orthodontists and laypersons

Facial features of cartoon characters and their perceived attributes

The aim of this study is to investigate the relationship between skeletal antero-posterior profile of popular family cartoon characters and their perceived personal characteristics. The Internet Movie DataBase (IMDB) was used to identify popular animated family movies released since 2000. Cartoon characters were identified, and classified based on their gender (male/female), skeletal profile (Class I, II or III) and character assessment (protagonist/antagonist). Descriptive statistical analysis was carried out. Chi Square analysis was used to assess the differences (p-value) between gender and character assessment against the skeletal profile. Fifty popular animated family movies were identified. Within these 88 humanoid cartoon characters were identified made up of 32 male protagonists, 27 female protagonists, 22 male antagonists and 7 female antagonists. 40, 30, 21 were assessed as having a Class I, II and III skeletal profiles respectively. Statistically significant differences were observed in both FPFA and MPFP values for Class III characters (P = 0.009 and P = 0.006, respectively). However, no significant variations were noted when comparing the remaining groups. Female antagonists and male protagonists were most likely to be portrayed with a Class III skeletal pattern when compared to female protagonists and male antagonists respectively.

The relationship between different levels of facial attractiveness and malocclusion perception: an eye tracking and survey study

INTRODUCTION

The aim of this study was to investigate the relationship between levels of facial attractiveness and the perception of different types of malocclusion.

METHODS

A preliminary questionnaire was used to assign photographs of three female patients to low, moderate, and high facial attractiveness designations. Seven modified photographs for each smile photograph of each of these three patients were created. The evaluated photographs were as follows: P0: at rest position, P1: ideal smile, P2: - 2-mm (low) smile line, P3: + 4-mm gummy smile, P4: + 6-mm gummy smile, P5: maxillary anterior crowding, P6: median diastema, P7: polydiastema. An eye tracking device and a questionnaire were used to collect data from orthodontists, dentists, orthodontic patients, and laypeople.

RESULTS

Total fixation duration varied depending on the type of malocclusion, the level of facial attraction, and the participants' occupations. In general, orthodontists and dentists had higher total fixation duration scores than orthodontic patients and laypersons. The maxillary anterior crowding photograph had the lowest visual analysis scale score at each attractiveness level (low, medium, and high). Visual analysis scale scores became similar at each attractiveness level only in the P4 photographs, and thus the difference in facial attractiveness disappeared.

CONCLUSION

While a worsening of the ideal smile had a smaller impact on aesthetic perceptions in an individual with low facial attractiveness, it had a significant negative impact on a person with high facial attractiveness. Anterior crowding and diastema had a more negative impact on facial attractiveness than low or high smile lines.

Pathways between verbal bullying and oral conditions among school children

PURPOSE

To investigate the direct and indirect pathways between verbal bullying and adverse oral conditions among school-aged children.

METHODS

A cross-sectional survey was conducted with 8- to 10-year-old children, enrolled in public schools in Southern Brazil. Verbal bullying was collected by self-reports. Independent variables included sociodemographic characteristics (sex, age, household income, and caregivers' educational level) and oral conditions (anterior open bite, anterior teeth crowding, upper anterior diastema, large overjet, untreated dental caries, and PUFA index). The pathways between verbal bullying and the independent variables were analysed through structural equation modelling.

RESULTS

1369 children were included. The prevalence of verbal bullying was 26.2% (95% confidence interval [CI] 23.9-28.6%). Verbal bullying was directly influenced by large overjet (standard coefficient [SC] 0.13, P < 0.01), untreated dental caries (SC 0.63, P = 0.01) and PUFA index (SC 0.75, P = 0.02). Sex (SC - 0.005, P = .04) and age (SC - 0.006, P < 0.01) indirectly influenced verbal bullying via untreated dental caries.

CONCLUSIONS

Verbal bullying was directly influenced by large overjet, untreated dental caries and PUFA index. Sex and age indirectly impacted verbal bullying through untreated dental caries.

Premature loss of primary molars: impact on the oral health-related quality of life of schoolchildren

PURPOSE

Evaluate the impact of the premature loss of primary molars due to caries on oral health-related quality of life (OHRQoL) in schoolchildren.

METHODS

A cross-sectional study was conducted with children eight to ten years of age at public schools in the city of Florianópolis selected through cluster sampling. The collection of the clinical data occurred in the school setting by four trained and calibrated examiners (Kappa > 0.7) DMFT/dmft index, PUFA/pufa index, accentuated overjet, and anterior open bite. Sex and age of the child and guardian's schooling (classified as ≤ 8 or > 8 years) were collected through a questionnaire answered by the guardians. OHRQoL was assessed using the Child Perceptions Questionnaire 8-10. The data were submitted to bivariate, multivariate, and hierarchical Poisson analyses.

RESULTS

A total of 1456 children participated in the study. The prevalence of premature tooth loss due to caries was 5.8% (n = 85). The prevalence of negative impact on OHRQoL was 47.4% (n = 691). Negative impact on OHRQoL was significantly associated with the premature loss of primary molars (p < 0.001) as well as the sex (girls), guardian's schooling (> 8 years) and the presence of untreated caries (p < 0.001).

CONCLUSION

The premature loss of primary molars due to caries was associated a negative impact on the OHRQoL of children eight to ten years of age. Negative impact is also associated with untreated caries, sex, and the level of schooling of guardians.

Perceptions of NZ orthodontists and periodontists on the management of gingival recession in orthodontic patients

BACKGROUND

This study aimed to investigate the perceptions and opinions of orthodontists and periodontists on the management of gingival recession in orthodontic patients.

METHODS

An online survey was sent to 29 periodontists and 80 orthodontists registered and currently practising in New Zealand. All participants answered questions about the timing and clinical indications of mucogingival surgeries in orthodontic patients diagnosed with mucogingival deformities.

RESULTS

Most periodontists and orthodontists believed that gingival grafts should ideally be performed after orthodontic treatment. In clinical practice, 40% of periodontists indicated that they would receive referrals after completion of orthodontic treatment. However, 29.6% of orthodontists indicated that they would refer to a periodontist before orthodontic treatment in clinical practice. The most crucial factor that affected periodontists' decision-making was 'evidence-based guidelines' (35.0%), followed by 'clinical experience' (30.0%) and 'patient concerns' (15.0%). All four factors of 'gingival phenotype', 'presence of gingival recession', 'amount of keratinised tissue' and 'planning specific tooth movements' were equally considered by orthodontists regarding their decision-making.

CONCLUSIONS

The majority of the surveyed New Zealand periodontists and orthodontists expressed a belief that the ideal timing for the management of gingival recessions would be after the completion of orthodontic treatment.

Impact of variations in maxillary lateral incisor dimensions on smile esthetics

INTRODUCTION

Dentofacial esthetics has become an increasingly important topic in recent years among orthodontic patients, so it is suggested that the esthetic perspectives of clinicians and patients be considered when planning orthodontic treatment. The maxillary lateral incisors play a key role in smile esthetics. The purpose of this study was to investigate the effect of dimensional changes of the maxillary lateral incisors on smile esthetics as perceived by orthodontists, general dentists, and laypersons.

METHODS

This was a descriptive cross-sectional study. A photograph showing an attractive smile was selected. The dimensions of the maxillary lateral incisors were edited with photograph editing software to represent variations in width, crown length, gingival height, and mesial angulation. Groups of orthodontists, general dentists, and laypersons (n = 16 per group) evaluated the smile attractiveness of the images using the Likert scale according to smile esthetics criteria. Statistical analysis was performed using SPSS software (version 25) and Kruskal-Wallis statistical test. The significance level was set at 0.05.

RESULTS

There was no significant difference between mean scores of lateral incisor golden proportion changes, vertical crown length changes, gingival height changes, and mesial angulation changes (P >0.05). All groups found 1 mm more incisally positioned gingival height of lateral incisor than the central incisor and 1 mm more apically positioned incisal edge of lateral incisor than the central incisor to be the most attractive. In the group of orthodontic specialists, the 20° mesial angulation and in the other 2 groups the 10° and 15° mesial angulation had the highest score.

CONCLUSIONS

Partial deviations from the ideal esthetic proportions were not detected by laypersons, general dentists, or orthodontists and are acceptable and even attractive from the point of view of patients. Some adherence to these ratios will be acceptable in dental treatments.

Smile Attractiveness Evaluation of Patients Selected for a U.S.-Based Board Certification Examination

Objectives The aims of this study were to assess smile attractiveness of a collection of 68 smiling photographs of successfully treated cases submitted to the American Board of Orthodontics (ABO) clinical examination and identify variables that influence the assessment.

Materials and Methods A panel of 81 non-Caucasian assessors from various clinical disciplines were instructed to score the smile attractiveness on a visual analog scale from 1 (least attractive) to 10 (most attractive) and to select which components contributed to a lesser attractive smile. The mean, standard deviations (SDs), and quartiles of the smile attractiveness were obtained with descriptive statistics. Multilinear regression analysis was performed to investigate the scores of the perceived quality of smile attractiveness when the clinical disciplines and gender of the assessors were the factors taken into consideration. Receiver operating characteristic (ROC) curve was generated to establish the relationship between smile attractiveness and the achievement of a perfect smile.

Results The mean (SD) rating of each clinical photograph of the anterior occlusion on smiling ranged from 3.11 (1.47) as the least attractive smile to 7.59 (1.45) as the most attractive smile. The overall mean (SD) score for smile attractiveness was 5.30 (1.10). Problems associated with teeth, gingiva, and lips corresponded with a reduction of the smile attractiveness score by 1.56, 1.82, and 1.47, respectively. Gender was not associated with smile attractiveness ratings. Orthodontists, periodontists, and prosthodontists demonstrated no difference in the ratings, while plastic surgeons were more critical than orthodontists regarding smile attractiveness.

Conclusions This study suggested that only 2 out of 68 AOB validated treatment finishes had a perfect and attractive smile.

Evaluations of the facial attractiveness of young women with severe maxillary anterior crowding by orthodontists and laypeople with and without orthodontic treatment experience in Japan

INTRODUCTION

Maxillary anterior crowding (MxAC) has been considered to be an esthetically favorable characteristic of young women in Japan. It has been hypothesized that laypeople and orthodontists have different esthetic preferences; however, to date, this has not been investigated in detail. Therefore, the present study compared the facial attractiveness of women with MxAC and the interpretation of MxAC among orthodontists and laypeople with and without orthodontic treatment experience in Japan.

METHODS

Thirty-eight orthodontists, 42 laypeople with orthodontics (patients), and 43 laypeople without orthodontics (laypeople) evaluated the attractiveness of resting and smiling frontal images of 12 women with MxAC (MxAC models; mean age, 21.7 ± 2.6 years) and 12 women with normal occlusion (normal models; mean age, 20.1 ± 0.7 years) using a visual analog scale. In addition, they responded to a questionnaire that asked them to select the terms most closely associated with MxAC. All evaluators and models were Japanese.

RESULTS

For all evaluator groups, the facial attractiveness of the MxAC models was significantly lower than that of the normal models for both the resting and smiling images. For MxAC models, orthodontists evaluated resting images more attractive than smiling images, whereas laypeople evaluated smiling images more attractive than resting images. Significantly more patients and laypeople than orthodontists selected "cute" as the term most closely associated with MxAC (P <0.05).

CONCLUSIONS

The orthodontists, patients, and laypeople showed a different tendency in their facial attractiveness preferences. Regardless of their orthodontic experience, the laypeople showed more positive interpretations of MxAC than orthodontists. This finding seems to be influenced by Japanese culture, which values irregularity in nature as one form of beauty.

A Communication Guide for Orthodontic-Restorative Collaborations: An Orthodontic Perspective on the Importance of Working in a Team

As both restorative dentists and specialists have their respective realms of expertise, it is important to develop a team of qualified providers to improve treatment outcomes for patients. In many cases, this involves collaboration between a restorative dentist and orthodontist. Effective communication is critical, with the dentist's understanding of basic orthodontic terminology and case planning considerations. Recognizing the context in which to apply normative occlusal and cephalometric values often necessitates comprehensive specialty-level experience. All providers should recognize when to involve the indicated team members when complex multidisciplinary treatment needs are present. The team approach offers an opportunity to optimize excellent patient care.

Relationship between the psychosocial impact of dental aesthetics and perfectionism and self-esteem

Background

Awareness of the influence of personality traits such as self-esteem and perfectionism on the aesthetic self-image can help clinicians to improve their patients’ satisfaction and quality of life. The main objective of this study was to examine the relationship between self-esteem, perfectionism and the psychosocial impact of dental aesthetics, and their association with gender.

Material and Methods

A descriptive-analytical cross-sectional study was conducted in a sample of 301 students of the Faculty of Medicine and Dentistry of the University of Valencia, aged between 18 and 30 years. Each participant was asked to complete a survey comprising three questionnaires: PIDAQ (Psychosocial Impact of Dental Aesthetics Questionnaire), MPS (Multidimensional Perfectionism Scale) and RSS (Rosenberg Self-esteem Scale). The response rate was 79%.

Results

The mean age was 20.8 years; 226 were women (75 %) and 75 were men (25 %). A negative correlation (Pearson = -0.387) was found between the total PIDAQ score and self-esteem. The correlation with perfectionism was found to be positive (Pearson = 0.281). On comparing the questionnaire and subscale scores by gender, the only statistically significant differences were in perfectionism (men 97.4, women 89.1) and self-confidence (men 22.1, women 23.5).

Conclusions

The students most affected by poor dental aesthetics had lower self-esteem and higher levels of perfectionism. The men presented higher levels of perfectionism than the women, while the latter displayed greater self-confidence in their dental aesthetics. Clinicians should pay greater attention to these traits and to their implications for treating these patients.

Key words:Psychosocial impact of dental aesthetics questionnaire, multidimensional perfectionism scale, rosenberg self-esteem scale, students.

Smile esthetics: Impact of variations in the vertical and horizontal dimensions of the maxillary lateral incisors

OBJECTIVE

The purpose of this study was to determine the perception of trained dental professionals and laypersons toward the esthetic impact of variations in the vertical position, width, and gingival height of the maxillary lateral incisor.

MATERIALS AND METHODS

The present study analyzed the perspective of smile photographs by dental professionals such as "fifty orthodontics and fifty general dental practitioners (GDPs)" as well as fifty laypersons, consisting of an equal number of male and female participants. Photographs edited to depict alteration of golden proportion, incisal length, and gingival height of lateral incisor. SPSS software was used to analyze the data and determine the significant difference within all the participants, at 0.05% level (95% confidence interval).

RESULTS

There was no significant difference in ranking between the genders. Golden proportion of 62%-67% were ranked the highest by orthodontists, whereas GDPs and laypersons preferred 67%. Regarding gingival display, corrected height of -0.5 and -1 mm received highest ranking from all the three groups. In case of lateral incisal length, -0.5 mm was ranked highest by laypersons, in contrast to -1 mm by orthodontists and GDPs.

CONCLUSION

Specific differences were observed in the ranking of smile esthetics by health-care professionals and laypersons. Golden proportion of 62% and 67% were ranked the highest by orthodontists, whereas GDPs and laypersons preferred 67%. Corrected gingival height of -0.5 and -1 mm received highest ranking from all the three groups. In case of lateral incisal length, -0.5 mm was ranked highest by laypersons, in contrast to -1 mm by orthodontists and GDPs.

Perception of altered smile esthetics among Moroccan professionals and lay people

Objective

To evaluate and compare the impact of altered smile characteristics on the perception of smile esthetics between Moroccan dentists and lay people.

Materials and methods

Thirty-four digital smile photographs displaying alterations in crown length and width, lateral incisor gingival margin position, gingival exposition, midline diastema, and upper midline deviation were presented to a sample of 30 dentists and 30 lay people. The ratings were assessed with a visual analog scale.

Results

Compared to that of lay people, Moroccan dentists’ evaluation of the gingival smile was more critical when the decrease in central incisor crown length was 2.5 mm (p < 0.001) or greater and when the increase in gingival exposition was 4 mm or greater (p < 0.01). Moroccan dentists were also critical in their evaluation of maxillary lateral incisor crown width alterations (p < 0.05) and incisal midline deviations (p < 0.05). However, the professionals and lay people similarly evaluated irregularities in the incisor gingival margin position. Increases in the midline diastema were judged critically by both Moroccan dentists and lay people.

Conclusions

In this sample, Moroccan dentists evaluate smile esthetic alterations more critically than Moroccan lay people. This difference in perception of smile discrepancies must be taken into account during the finishing phases of orthodontic treatment and restoration of the anterior teeth in Moroccan patients.

The impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions

OBJECTIVE

To investigate the impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions and to identify components of malocclusion that may contribute to these outcomes.

MATERIALS AND METHODS

The sample comprised 704 secondary school adolescents aged 12 to 13 years from Balneário Camboriú, Brazil. A trained and calibrated orthodontist examined the severity of malocclusion using the Dental Aesthetic Index (DAI). A pretested questionnaire was used to assess reported dental appearance, self-perception of speech, and self-perception of masticatory function using a 5-point scale of oral health status. The outcomes of the present study were dissatisfaction with dental appearance and dissatisfaction with oral functions. Simple and multivariate logistic regression analysis was performed to explore the association between DAI and outcomes and to quantify the effect of DAI components on dissatisfaction with dental appearance.

RESULTS

Each DAI unit increase led to a significant increase of 5% in the likelihood of dissatisfaction with dental appearance (OR: 1.05; 95% CI 1.01-1.08). DAI components that exerted influence on dissatisfaction with dental appearance were: missing teeth (P  =  .010), largest maxillary anterior irregularity ≥3 mm (P  =  .013), and largest mandibular anterior irregularity ≥2 mm (P  =  .008). There was no association between severity of malocclusion and dissatisfaction with oral functions.

CONCLUSIONS

Severity of malocclusion interfered with satisfaction of dental appearance in this population. Missing teeth and anterior irregularity were identified as factors influencing this outcome.

Patients' self-perception of dentofacial attractiveness before and after exposure to facial photographs

OBJECTIVE

To determine whether exposure to pretreatment photographs of themselves influenced patients' self-perception of dentofacial attractiveness and willingness to undergo treatment.

MATERIALS AND METHODS

A total of 100 subjects of white ancestry aged 18 years or older (Study Group) and 100 sex- and age-matched controls (Control Group) were selected. Photographs of the frontal view of the face and the profile view of the face, both at rest and while smiling, were taken of each participant. Only Study Group subjects were given a printed copy of their own images to be examined at home between the initial observation (T0) and a set date an average of 30 days later (T1). Each of the 200 subjects in the study completed a questionnaire at T0 and T1 exploring happiness regarding their smiles and their facial profiles, as well as willingness to undergo treatment.

RESULTS

At T1 in the Study Group, 50% of subjects responded with a lower opinion of their facial profiles than at T0; 11% and 45% were willing to undergo more comprehensive procedures to change the appearance of their smiles and profiles, respectively. No statistically significant change was seen in questionnaire answers between T0 and T1 for the Control Group.

CONCLUSION

Laypeople generally are not aware of their facial profiles. Pretreatment photograph exposure can increase profile self-awareness, an important factor in reducing the discrepancy between orthodontists' and patients' visual emphasis on dentofacial esthetics.

Percepção das alterações no plano gengival na estética do sorriso

OBJETIVO: esse estudo analisou a percepção de 80 profissionais de Odontologia e 80 indivíduos leigos, pacientes de consultórios particulares e da Faculdade de Odontologia da Universidade Federal do Espírito Santo, quanto à presença de alterações no plano gengival. MÉTODOS: a fotografia de uma mulher jovem sorrindo foi digitalmente modificada, produzindo alterações simétricas na altura gengival dos incisivos centrais e incisivos laterais, tornando o plano gengival progressivamente ascendente. Foi solicitado que os indivíduos escolhessem a foto mais agradável e, depois disso, o entrevistador questionava o indivíduo para verificar se o mesmo sabia o que estava sendo alterado na sequência de fotos, ou seja, se identificava as alterações feitas no plano gengival. RESULTADOS: os resultados mostraram que houve uma prevalência significativa na seleção do plano gengival harmonioso no grupo de dentistas e de pacientes (p<0,001; p<0,05, respectivamente) e que não houve diferenças significativas entre as especialidades integrantes do grupo de dentistas (p=0,538), o que aconteceu no grupo de leigos (p=0,05), demonstrando maior percepção do grupo de pacientes de consultório. A identificação da alteração no plano gengival foi significativa no grupo de dentistas (p<0,001) sem diferenças significativas dentre as especialidades do grupo, e não foi significativa no grupo de leigos (p=0,100). Foi evidenciada também uma identificação do problema significativamente superior no grupo de dentistas em relação ao grupo de leigos (p<0,001). CONCLUSÃO: concluiu-se, portanto, que alterações simétricas acima de 2mm podem ser percebidas por dentistas e leigos, que não existem diferenças nessa percepção entre as especialidades odontológicas estudadas e que o grupo de pacientes de consultório foi significativamente mais perceptivo que os pacientes da UFES.

Orthodontic Space Closure versus Prosthetic Replacement of Missing Upper Lateral Incisors in Patients with Bilateral Cleft Lip and Palate

Objective

To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate. The predominant mode of prosthetic replacement was resin-bonded bridges.

Patients and Methods

The retrospective study group consisted of 17 patients treated with orthodontic space closure (13 men, four women; median age, 27.1 years; interquartile range, 20.6 to 33.3 years) and 10 patients treated with prosthetic replacement (five men, five women; median age, 27.7 years; interquartile range, 20.9 to 39.7 years). Dental aesthetics were evaluated by the patients and by a professional panel. Mandibular function was evaluated by means of the mandibular function impairment questionnaire. The level of mandibular impairment was calculated using the Function Impairment Rating Scale.

Results

With respect to dental aesthetics, no significant differences between patients treated with orthodontic space closure and prosthetic replacement were found. With respect to function, the level of mandibular impairment was significantly higher in patients treated with prosthetic replacement compared with patients treated with orthodontic space closure, as indicated by high scores on specific masticatory functions.

Conclusion

Orthodontic space closure and prosthetic replacement in bilateral cleft lip and palate patients produce similar results in terms of aesthetics. In terms of function, prosthetic replacement results in significantly more impairment of specific masticatory functions.

Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population

INTRODUCTION

The purpose of this study was to evaluate the effects of malocclusion and orthodontic treatment on adolescent self-esteem.

METHODS

A total of 4509 middle school students were clinically evaluated for dental crowding. Lip protrusion was also measured with a specially designed ruler. Rosenberg's self-esteem scale was used to determine each subject's level of self-esteem.

RESULTS

The results showed that sex played a role in the relationship between self-esteem and malocclusion. For the girls, crowding of the anterior teeth had significant effects on their self-esteem; however, there was no significant difference in the boys' self-esteem. After fixed orthodontic treatment, the girls had higher self-esteem than the untreated malocclusion group. Girls with an ideal profile and good tooth alignment also showed higher self-esteem than students with crowding or protrusion.

CONCLUSIONS

This clinical study proved that malocclusion and fixed orthodontic treatment can affect self-esteem in adolescent girls.

Comparison of Chinese and US orthodontists' averaged evaluations of "facial attractiveness" from end-of-treatment facial photographs

INTRODUCTION

This study continues our assessment of agreement and disagreement among 25 Chinese and 20 US orthodontists in the ranking for facial attractiveness of end-of-treatment photographs of randomly sampled growing Chinese and white orthodontic patients. The main aims of this article were to (1) measure the overall pattern of agreement between the mean rankings of US and Chinese orthodontists, and (2) measure the strength of agreement between the rankings of the US and Chinese orthodontists for each patient.

METHODS

Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 US patients and 48 Chinese patients. For each patient, a separate mean rank was computed from the responses of each group of judges. Pearson correlations between the mean ranks of the 2 groups of judges were used to measure their overall agreement. Paired and unpaired t tests were used to measure the agreement between the judges of the 2 groups for each patient.

RESULTS

The overall agreement between the mean rankings of the US and Chinese judges was very high. For the US patients, the correlation between the Chinese and US judges means was r = 0.92, P <0.0001. For the Chinese patients, the analogous value was r = 0.86, P <0.0001. Agreement between the 2 groups of judges concerning each patient was also generally strong. For two thirds of the patients, the mean ranks of the US and Chinese judges differed by less than 1 unit in a scale of 12. However, for 6 patients considered individually (5 Chinese and 1 US), the assessment of the 2 groups of judges was statistically significantly different at P values ranging from 0.02 to less than 0.0001, even after the Bonferroni correction.

CONCLUSIONS

These findings demonstrate that orthodontic clinicians can reliably identify and rank subtle differences between patients, and that differences between judges and between patients can be distinguished at a high level of statistical significance, given appropriate study designs. However, the reasons clinicians give for the differences in their judgments are more difficult to investigate and will require further study.