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

A Comparison of Esthetic Preferences on Female Skeletal Class II Alterations among Laypeople of Different Facial Profiles

OBJECTIVES

 This study aimed to investigate the influences of assessors' different personal profiles on the esthetic perception of Class II facial profile corrections and the agreement between profile and silhouette images.

MATERIALS AND METHODS

 A profile photo of a female with skeletal Class II was digitally altered into three profile and three silhouette images (most pronounced Class II division 1 characteristic, more retruded upper lip position, and more protruded mandibular position). Ninety-six laypeople from three facial profile groups (straight, convex, and concave profiles) chose these images for facial attractiveness. Data were analyzed using an SPSS program. Cohen's kappa coefficient and intraclass correlation coefficients were applied to determine intraparticipant and intra-examiner reliabilities. Chi-square tests were used to test between-group preferences and the relationship of profile preference with other factors. Cohen's kappa coefficient was used to test the agreement in selecting profile and silhouette images (p = 0.05).

RESULTS

 All groups favored profiles with a protruded mandibular position (11-degree facial contour angle [FCA] and 91-degree nasolabial angle [NLA]). Despite facial profile differences, preference remained consistent (p = 0.649). The convex group showed a stronger inclination toward an untreated-simulating profile (17-degree FCA and 91-degree NLA). Preferences were consistent regardless of sex (p = 0.198) and education (p = 0.105). The percentage of agreement between profile and silhouette images in the total sample was 67.71% (kappa = 0.386). All groups of participants chose the more retruded upper lip position (17-degree FCA and 107-degree NLA) profile in silhouette more than in photograph.

CONCLUSION

 All groups preferred a mandibular advancement-simulating profile. Using the photographs or silhouettes to assess the esthetic preference resulted in a similar trend. However, the flatter profile was more preferred in silhouette than in photograph.

Does Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) reflect the impact of malocclusion on facial aesthetics?

INTRODUCTION

Malocclusion is presumed to have adverse effects on dental and facial attractiveness, leading to deleterious psychosocial impact and Quality of life(QoL) of the individual. The Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) has proved to be effective for assessment of psychosocial impact of malocclusion on dental aesthetics, but it's effectiveness for assessing facial aesthetics is unknown.

OBJECTIVE

The aim of the present study was to assess the effectiveness of PIDAQ on its ability to reflect the psychosocial impact of malocclusion on facial attractiveness, using the Facial Aesthetic index (FAI) after its translation and validation in the regional language.

METHODS

The 23-item PIDAQ, after translation process, cross-cultural adaptation and pilot testing, was administered to 330 subjects (62.5 % females and 37.5 % males; age range 18-30 years) with varying degrees of severity of malocclusion, assessed by the two components of the Index of Orthodontic Treatment Need (Dental Health Component, IOTN-DHC, for normative need; and self-administered Aesthetic Component, IOTN-AC, for subjective need) and FAI.

RESULTS

The internal consistency and test-retest reliability were good (Cronbach's alpha = 0.859 - 0.958; Intraclass correlation coefficient =0.984). FAI, IOTN-DHC and IOTN-AC scores showed highly significant correlation with PIDAQ scores, depicting strong convergent validity (p< 0.001). One-way analysis of variance (ANOVA) and Bonferroni post-hoc test showed highly significant correlations (p-value < 0.001) for all comparisons. There were no significant differences between responses of males and females. The regional version of PIDAQ had excellent reliability.

CONCLUSIONS

PIDAQ showed good psychometric properties and was able to effectively reflect the psychosocial impact of malocclusion on altered facial aesthetics.

Effect of smile esthetics on the quality of life in a Han Chinese population

OBJECTIVE

This study aimed to explore the influence of smile esthetics on the quality of life in a Han Chinese population.

METHODS

A total of 110 Han Chinese volunteers (52 males and 58 females, mean age 26.7 years) were recruited, and frontal images of their smiles were collected. A photoediting program was used to evaluate the following components of smile esthetics: the buccal corridor ratios, the angle between the interpupillary and commissural lines, the number of visible teeth, and width-to-length ratios of the maxillary central incisors. Oral health-related quality of life (OHRQoL) in these volunteers was evaluated using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed by using Pearson's correlations and multiple linear regression (α = 0.05).

RESULTS

Compared to males, females scored higher on psychological impact (p = 0.017). Moreover, the number of visible teeth had a significant effect on social impact, psychological impact and esthetic concern (all p < 0.05). However, the buccal corridor ratios, the angle between the interpupillary and commissural lines, and the width-to-length ratios of the maxillary central incisor did not correlate with the OHRQoL (all p > 0.05).

CONCLUSIONS

The number of visible teeth significantly influenced the quality of life in a Han Chinese population. Smile esthetics had a significantly greater psychological impact on females than males.

CLINICAL SIGNIFICANCE

This study highlights the effects of smile esthetics on the quality of life in a Han Chinese population. Female patients may raise more esthetic concerns in clinical practice.

Esthetic preferences of orthodontists, dentists, and plastic surgeons for balanced facial profiles

PURPOSE

The aim of this investigation was to determine whether the facial esthetics of subjects rated as "attractive" can be related to specific cephalometric soft tissue parameters.

METHODS

The profile silhouettes of 100 subjects (45 males and 55 females) were rated by 60 esthetics specialists (20 orthodontists, 20 dentists, and 20 plastic surgeons) using a Likert scale, and 30 of the subjects were selected as being "attractive". The cephalometric measurements of the attractive group were then compared with norms for the general Caucasian population.

RESULTS

The effects of specific measured parameters on profile beauty grades were assessed using the median test, and the following variables were found to show significant correlations between the Caucasian norms and the attractive profile group: the ratio of the upper to lower face height (P = 0.011), the ratio of the subnasale - labrale inferius (Sn-Li) and labrale inferius - menton (Li-Me`) lines (P = 0.011), the distance between the chin and the subnasale perpendicular (P = 0.002), upper lip thickness (P = 0.021), soft tissue chin thickness (P = 0.021), vertical height ratio (P = 0.021), and nasolabial angle (P = 0.021).

CONCLUSION

A straight profile with a fuller and more protruded upper lip, a higher nasal tip, and a smaller lower facial third are considered to be the most attractive facial features, and may be useful for improvement of facial esthetics.

Perceptual difference of smile aesthetics between 2-dimensional photographs and 3-dimensional dentofacial images: a cross-sectional study

BACKGROUND

The aim of this study was to compare the perceptual difference of smile aesthetics between 2D photographs and 3D dentofacial images as perceived by orthodontists and graduate students.

METHODS

Forty-eight subjects finished orthodontic treatment were recruited with 2D photographs of frontal, oblique and lateral views as well as 3D dentofacial images. Twelve senior orthodontists and 13 postgraduate students were asked to rate the 2D and 3D smile simulations based on visual analog scale (VAS) and to vote for smile features that affect the attractiveness of smile. At the end, they completed a questionnaire about their views on different smile simulations. Wilcoxon signed-rank, Bland-Altman analysis, and multiple linear regression were used to compare the ratings and votes of smile perception between raters and between records.

RESULTS

Orthodontists and postgraduate students rated smile consistently with 2D photographs, while orthodontists tended to give a higher rate for unattractive smiles and a lower rate for attractive smiles with 3D dentofacial images. The 3D dentofacial images were rated significantly lower than 2D photographs and the voting of most of the smile features showed significant negative main effect on VAS scores, while the effect of demographic characteristics of raters, voting on visible width of upper dentition and buccal corridor was not significant. In addition, a significant negative main effect of commissure and facial profile was found on the rating discrepancy between 2D and 3D images.

CONCLUSIONS

Senior orthodontists tend to perceived 3D images more conservatively in smile evaluation. 3D dentofacial images were rated lower than 2D photographs and most of the smile features affect the aesthetic perception of smile. The perceptual difference of commissure and facial profile contributed to the lower ratings in 3D dentofacial images.

Is Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) Valid for the Indian Population?-A Psychometric Study

Objectives:

A culturally adapted and validated Oral Health-Related Quality of Life (OHRQoL) inventory helps to reliably compare patient perceptions among different populations. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) evaluates the impact of dental aesthetics on OHRQoL. This study aimed to develop a regional version of PIDAQ (PIDAQ_Mal) for the Indian population and to assess differences in perceptions due to malocclusion in different population groups.

Materials and Methods:

PIDAQ_Mal was derived through the translation process and pilot-tested to assess test–retest reliability. Psychometric properties were tested on 285 subjects (31.2% males, 68.8% females; age range 18–25 years). Normative treatment need was assessed using Index of Orthodontic Treatment Need (IOTN)-Dental Health Component and subjective assessment using IOTN-Aesthetic Component (AC) and Perception of Occlusion Scale (POS). PIDAQ_Mal mean domain scores were compared with those of the previously validated versions to assess difference in perceptions.

Results:

Internal consistency and test–retest reliability were good (Cronbach’s α = 0.83–0.88; Intraclass Correlation Coefficient = 0.74–0.91). IOTN-AC and POS scores showed significant correlation with PIDAQ_Mal scores ensuring convergent validity (P < 0.001). Discriminant validity was confirmed by statistically significant differences (P < 0.001) in PIDAQ_Mal scores between subjects with no treatment need and moderate/definite need. Factor analysis derived four domains with one item showing cross-loading. Difference in mean domain scores among the previously validated versions of PIDAQ confirmed socio-cultural differences in perceptions due to malocclusion.

Conclusion:

PIDAQ_Mal was found to be reliable and valid for the Indian subjects and can be used as a condition-specific OHRQoL measure. Socio-cultural differences in perceptions were brought to light using the translated scale.