The influence of lower face vertical proportion on facial attractiveness

A Literature Review of Vertical Dimension in Prosthodontics Theory and Practice - Part 1: Theoretical Foundations

Vertical dimension (VD) is a critical factor in prosthodontics, playing a pivotal role in the functional and aesthetic outcomes of dental treatments. This literature review explores theoretical foundations and the various aspects of VD, including its definition, measurement, and clinical significance in prosthodontics. The relationship between VD and temporomandibular disorders (TMDs) is examined. Additionally, the impact of VD on facial proportions and aesthetics is significant, as it affects the lower third of the face and influences the patient's overall appearance and self-esteem. In conclusion, understanding the intricate relationship between VD, TMDs, facial aesthetics, and psychological well-being is essential for effective prosthodontic treatment. This comprehensive review provides valuable insights into the multifaceted role of VD in enhancing both functional and aesthetic outcomes, ultimately improving patient satisfaction and quality of life.

Vertical Dentofacial Skeletal Divergency Is Not Linked with Oral Health-Related Quality of Life

The aim of this study is to assess how vertical skeletal malocclusion affects oral health-related quality of life (OHRQoL) among a sample of individuals comprising adolescents, young adults, and adults seeking orthodontic treatment. From January 2019 to March 2020, participants were consecutively enrolled. The assessment of OHRQoL involved measurement using the oral health impact profile (OHIP-14). Lateral cephalograms were performed to measure the vertical skeletal divergency with four cephalometric measurements. Descriptive and inferential statistical analyses were performed. The Mann-Whitney test was applied to compare OHRQoL scores according to the vertical dimension category. The mean age of the participants ranged between 30.3 ± 14.9 and 29.9 ± 14.4 and there was a majority of female participants, between 64.1% and 65.9%. There were no statistically significant differences observed between hyperdivergent and normodivergent groups in either the total score or any domain of the OHIP-14 questionnaire. Individuals with hyperdivergent facial morphology did not show a reduced OHRQoL compared with a normodivergent facial type.

Does different vertical position of maxillary central incisors in women with different facial vertical height affect smile esthetics perception?

BACKGROUND

The aim of this study was to assess the esthetic perceptions of orthodontists, prosthodontists and laypersons with regard to different vertical positions of the maxillary central incisors related to lateral incisors for different facial vertical height cases.

SUBJECT AND METHODS

Frontal full-face photographs showing social smiles of three adult women aged between 18 and 25 years were used. Vertical position of the maxillary central incisor was changed (intruded or extruded) with 0.5 mm increments according to the reference gingival line resulting five images for each woman in a full-face view yielding a total of 15 images. A visual analog scale was placed below each smile to allow the raters to evaluate the attractiveness of each smile independently. One-way analysis of variance was used to determine whether there was a difference between more than two independent groups in terms of quantitative variables. Comparisons of more than two dependent groups were examined with repeated measures one-way ANOVA. The significance level was taken as 0.05 for all analyses.

RESULTS

For increased facial vertical height, the highest scores for orthodontists were given to the 0.5 mm extruded (64.18 ± 26.36), for prosthodontists to the control (57.28 ± 19.80), and for layperson to the 1 mm extruded (61.27 ± 25.98) central incisor position. For decreased facial vertical height, the highest scores were obtained at the 0.5 mm intrusion with an increasing pattern from orthodontists to laypersons (63.95 ± 22.08 for orthodontists, 79.87 ± 21.43 for prosthodontists, and 79.88 ± 19.17 for laypersons). All three rater groups gave the highest scores to the 0 mm (control) smile design for normal facial vertical height. When these scores were compared among the groups, laypersons gave significantly higher scores compared to orthodontists (p < 0.001) and prosthodontists (p = 0.005).

CONCLUSIONS

The facial vertical height significantly affected the perception of smile esthetics. Keeping the distance between the central and lateral incisors longer than 1 mm in individuals with increased facial height may be important in terms of increasing patient satisfaction in terms of clinical aesthetics. On the contrary, keeping the distance between the central and lateral incisors shorter than 1 mm may create a more esthetically acceptable result in individuals with short facial height.

Facial Soft Tissue Characteristics Among Sagittal and Vertical Skeletal Patterns: A Cone-Beam Computed Tomography Study

Background Facial esthetics depend on the skeletal and dental structures underlying variable facial soft tissue thickness. In this social context, determining the relationship between external soft tissue and underlying skeletal and dental hard tissue is essential for detailed orthodontic diagnosis and treatment planning. Objective This study aims to measure facial soft tissue thickness in different sagittal and vertical skeletal patterns. Methodology This is an observational study utilizing pre-existing cone-beam computed tomography (CBCT) images of 170 subjects (110 females and 60 males) with a mean age group of 37.45 ± 13.83 years. CBCT images were then classified sagittally based on the point A-Nasion-point B (ANB) angle from Steiner's analysis into skeletal Class I, Class II, and Class III. Furthermore, vertical patterns were grouped based on the Frankfort-mandibular plane angle (FMA) from Tweed's analysis into hyperdivergent, hypodivergent, and normodivergent facial types. One-way ANOVA was used to compare the means of facial soft tissue thickness between the skeletal groups, followed by Tukey's post-hoc test for individual comparison. Multinomial logistic regression analysis was used to test the association between gender, age, and skeletal groups. The significance level was 0.05. Results One-way ANOVA revealed statistically significant differences in both sagittal and vertical groups (p≤0.05). Tukey's post hoc analysis showed that the skeletal Class III group has increased soft tissue thickness in the subnasale, upper lip, and mention compared to Class I and Class II subjects. Moreover, the hypodivergent group demonstrated increased soft tissue thickness in gnathion and mentioned landmarks in relation to the other groups. Multinomial logistic regression analysis showed significant differences between groups according to both gender and sagittal skeleton patterns (p≤0.05), with males less likely to be in Class II. Conclusions Skeletal Class III and hypodivergent groups have thicker soft tissue in specific facial landmarks. Sexual dimorphism was marked in soft tissue measurements.

Can smile influence the lower anterior vertical facial height on frontal view in an adult Asian female subject? A cross-sectional study

Objectives:

Smile is a universal phenomenon, the effect of which is not discovered on the lower anterior facial height (LAFH). The objective of this study was to determine the influence of smile on different LAFH in frontal view as assessed by different panels of raters using visual analog scale (VAS) in a female subject.

Material and Methods:

The frontal photographs (at rest and on smile) were taken at natural head position of a female subject aged 28 years old after taking informed consent. LAFH of the photographs was modified using a Photoshop software (Adobe Systems, San Jose, Calif.). Sixty raters equally divided into orthodontic residents, general dentists, and laypersons were given a VAS to make subjective assessments of facial attractiveness of the modified photographs. Comparison of raters’ scores was done using Kruskal–Wallis and Mann–Whitney U-tests. Wilcoxon Signed-Rank test was used to compare the esthetic scores of the subject at rest and with smile.

Results:

The mean age of the all raters was comparable (early adulthood). All raters preferred normal or slightly shorter LAFH in both postures, that is, at smile and rest. Similarly, all raters disliked long face modifications. On comparing smile and rest photographs at various LAFH, we found less VAS scores for smile. Gender of raters played no role in difference of VAS scores.

Conclusion:

All the panels of rater found normal LAFH to be the most attractive; however, the panels disliked long face modifications on both smile and at rest. Smile had no positive influence on the VAS scores as assumed so the effect of “Smiloflage” must be investigated further to understand it properly.

Influence of Lip Projection and Chin Position on Facial Profile Preferences Among Various Layers of Polish Population. Part 1

Purpose

This study aims to evaluate how the extent of altering lip projection in women and chin position in men influences the 22-year-old Caucasian's facial profile attractiveness, in relation to respondents' sex, age and place of residence.

Materials and Methods

One female and one male orthognathic (SNA angle = 79-85°, Z angle = 75-78°) face profiles, with lips correctly positioned in relation to the E-line were photographed and digitally modified. This processing resulted in 30 photographs varying as for 1. the SNA angle determining orthognathic, prognathic (SNA angle >85°), or retrognathic (SNA angle <79°) profile and 2. lip projection/chin position: normal or protruded/retruded by 1 or 2 mm. The photographs were always shown in the same order to 418 respondents (306 women and 112 men) aged between 15 and 73 years, who provided their place of residence. The 11-point visual analogue scale (VAS) was used for the assessment of the facial profile attractiveness.

Results

All respondents found the prognathic profile with correct lip position in woman and correct chin position in man most attractive. Each major deviation from the norm resulted in a decrease in the scores awarded. Men ranked rethrognathic profiles significantly (p < 0.05) higher than women. The respondents under and over 25 years also differred (p < 0.05) in their evaluation: the older viewers were more critical regarding all female profiles with an exception of the retrognathic profile with 2 mm lips protrusion. The respondents' place of residence did not affect the rating.

Conclusion

1 mm modification of lip projection and chin position significantly alter ranking the face profile attractiveness, thus any aesthetic medicine applied in this area requires extreme caution. Moreover, visualizing the results should be mandatory, especially in women older than 25 years of age, who are the most critical evaluators.

It is All Relative: Associations of Facial Proportionality, Attractiveness, and Character Traits

BACKGROUND

Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness.

OBJECTIVE

The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings between "anomalous" and "typical" faces using a large dataset.

METHODS

Ratings of 597 unique individuals from the Chicago Face Database were used. A formula was developed as a proxy of relative horizontal proportionality, where a proportionality score of "0" indicated perfect proportionality and more negative scores indicated less proportionality. Faces were categorized as "anomalous" or "typical" by 2 independent reviewers based on physical features.

RESULTS

Across the ratings for all faces, Spearman correlations revealed greater proportionality was associated with attractiveness (ρ = 0.292, P < 0.001) and trustworthiness (ρ = 0.193, P < 0.001), while lesser proportionality was associated with impressions of anger (ρ = 0.132, P = 0.001), dominance (ρ = 0.259, P < 0.001), and threateningness (ρ = 0.234, P < 0.001). Mann-Whitney U tests revealed the typical cohort had significantly higher levels of proportionality (-13.98 versus -15.14, P = 0.030) and ratings of attractiveness (3.39 versus 2.99, P < 0.001) and trustworthiness (3.48 versus 3.35, P < 0.001).

CONCLUSIONS

This study demonstrated that facial proportionality is not only significantly associated with higher ratings of attractiveness, but also associated with judgements of trustworthiness. Proportionality plays a role in evoking negative attributions of personality characteristics to people with facial anomalies.

Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male

INTRODUCTION

Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness.

METHODS

This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups.

RESULTS

Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P = 0.028) and -15° MII (P = 0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P = 0.022), and 4% LAFH ratio (P = 0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest.

CONCLUSIONS

All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

Effects of the new COVID-19 normal on customer satisfaction: Can facemasks level off the playing field between average-looking and attractive-looking employees?

The attractiveness of service employees can have a significant impact on customer attitudes and behaviors. While frontline employees can reduce the risk of the COVID-19 transmission and infection by wearing facemasks, doing so can also influence customers' perceptions of employees' attractiveness and thus affect customer satisfaction. Based on the Gestalt theory, this study explores the impact of hotel employees' facemask-wearing on customer satisfaction through two experimental studies. The results indicate that average-looking frontline employees who wear facemasks induce high levels of customer satisfaction. However, while the impact of wearing facemasks on customer satisfaction is not significant for attractive-looking male frontline employees, attractive-looking female frontline employees who wear facemasks induce lower customer satisfaction. Customers' perception of employees' physical attractiveness fully mediates the effects of wearing facemasks on customer satisfaction in the case of average-looking employees. Customers' self-perceived physical attractiveness moderates the mediated effects. Implications that can help hotel managers improve customers' service evaluations during the COVID-19 pandemic are provided.

A comparative study between the effect of reverse curve of Spee archwires and anterior bite turbos in the treatment of deep overbite cases: A randomized clinical trial

OBJECTIVES

To compare deep overbite treatment using 0.016 × 0.022 nickel-titanium lower reverse curve of Spee archwire (LRCA) or metal anterior bite turbos (ABTs).

MATERIALS AND METHODS

48 patients with deep overbite malocclusion were randomly allocated into two groups. Group I (age = 18.4 ± 2.8 years, overbite = 5.8 ± 0.6 mm) was treated with LRCA, while Group II (age = 18.2 ± 3.1 years, overbite = 5.2 ± 0.4 mm) was treated with ABTs bonded to the palatal surface of the upper central incisors. Two cephalograms were taken for each patient, at post-alignment stage (T1) and post-leveling stage (T2). The primary outcomes were the anteroposterior and vertical changes of the lower teeth. The secondary outcomes were the effect on upper incisor inclination and the vertical linear changes of upper teeth, to assess the sagittal and vertical skeletal changes, and to compare the duration of overbite correction.

RESULTS

42 of the 48 patients recruited completed the study (21 in each group). At T2, the lower incisors proclined more in Group I (P ≤ .001). Both lower second molars (P ≤ .001) and lower first molars (P = .001) tipped more distally, while the lower first premolar tipped more mesially, in Group I (P < .05). All cusps of both lower molars showed more extrusion in Group II (P < .05) except for the mesial cusp of lower second molars (P = .095). The duration of overbite correction was shorter using the ABTs by 1.7 months (4.85 ± 1.56 and 3.15 ± 0.93 months for Group I and Group II, respectively).

CONCLUSIONS

LRCA causes lower incisor proclination with distal tipping of lower molars, while ABTs result in lower posterior tooth extrusion.

The influence of incisor inclination and anterior vertical facial height on facial attractiveness in an Asian woman

INTRODUCTION

Orthodontic treatment can help improve facial attractiveness through the modification of factors affecting the soft tissue profile. The objectives of this study were to determine the impact of different maxillary incisal inclinations and lower anterior facial heights (at rest and with a smile) on the facial attractiveness of an Asian woman, as perceived by different panels of raters using visual analog scale (VAS) scores.

METHODS

A cross-sectional study was performed with 66 raters equally divided into 3 panels that consisted of general dentists, orthodontic residents, and laypersons. Raters assessed modified photographs of a subject with various incisor inclinations and lower anterior facial height/total anterior facial height (LAFH/TAFH) on lateral profile view. Modifications were made using Photoshop software (Adobe, San Jose, Calif). Subjective evaluations of facial attractiveness were performed by raters using VAS. Kruskal-Wallis test was used to compare VAS scores among raters. Mann-Whitney U test was applied to compare VAS scores between groups.

RESULTS

Significant differences in VAS scores were found among raters for -10° (P = 0.004) and -15° (P = 0.021) incisal inclinations. Significant differences were found in VAS scores for -8% LAFH/TAFH (P = 0.044) and 4% LAFH/TAFH with smile (P = 0.002).

CONCLUSIONS

Professionals preferred normal incisal inclinations to be the most attractive. General dentists found reduced facial height to be unattractive. Orthodontic residents and laypersons considered increased LAFH/TAFH to be most unattractive. Smile had a negative impact on VAS scores at extreme anterior facial height modifications.

Influence of facial components in class III malocclusion esthetic perception of orthodontists, patients, and laypersons

PURPOSE

The aim of the present study was to investigate the influence of different facial components (face length, lip volume, nose size, and cheekbone contour) on the perception of facial attractiveness of patients with Angle class III malocclusion in different categories of responders (orthodontists, laypersons, patients) with two-dimensional (2D) and three-dimensional (3D) simulations.

METHODS

An ideal standard 3D face was manipulated to create a class III facial malocclusion. Four facial components were modified (face length, lip volume, nose size and cheekbone contour) and the resulting simulations were used to obtain 2D figures and 3D videos, which were evaluated in a survey by orthodontists, patients, and laypersons.

RESULTS

No significant differences were detected between the 2D figures and 3D video simulations. Good correspondence was shown between the three categories of responders for the most and the least attractive faces. Smaller lips and bigger nose, regardless to the vertical dimension (short or long face), were found to be the least attractive features with agreement of all respondents.

CONCLUSION

Regarding class III facial attractiveness perception, the sum of all facial features and not the alteration of a single component alone seems to play a key role in the perception of facial attractiveness. The 2D or 3D perspective did not play a significant role in perception and the analyzed categories of responders did not show significant differences when perceiving facial attractiveness of the utilized simulations.

Evaluation of the Perspectives of Orthodontists and Laypersons About the Effect of Orthodontic Treatment on Facial Aesthetics of Young Turkish Patients

Aim:

To compare the perspective of orthodontists and laypersons on the effects of orthodontic treatment on facial aesthetics in young Classes I, II, and III Turkish patients.

Materials and Methods:

In this cross-sectional study, a total of 60 patients (30 males and 30 females, 9 to 17 years of age) was included using randomization in strata and then divided equally ( n = 15) into four groups according to the Angle classification. Photographs during frontal and lateral resting and also smiling were obtained from each patient before and after orthodontic treatment. A panel consisting 50 laypersons and 50 orthodontists was invited for the evaluation of the initial and final photos by using the visual analogue scale and a five-point scale to determine similarities and differences of their perspectives in the effects of orthodontic treatment on facial aesthetics. The data were analyzed by independent t-test, one-way analysis of variance, and Pearson’s correlation test.

Results:

The evaluation of facial aesthetics and treatment changes were not affected by the age and gender of the panel members ( P <.05). Angle Class III patients were given lower scores by both orthodontists ( P < .001) and laypersons ( P < .05), but no significant differences were found between any of other classes ( P >.05). Orthodontists reported greater improvement for Class III than in Class II Division 1 ( P < .05) however laypersons did not notice the changes after orthodontic treatment for any of Angle classes ( P >.05).

Conclusion:

Class III patients received lower scores for aesthetics from both panels. Laypersons may not be concerned about the effects of orthodontic treatment on facial aesthetics in patients with any Angle class. Orthodontists have seen more facial aesthetic changes after orthodontic treatment in Class III patients.

Esthetic evaluation of profile photographs showing various sagittal and vertical patterns

INTRODUCTION

The purpose of this study was to determine the esthetic preferences of people at different levels of society and also to determine whether this preference is affected by sex, age, education level, social status, geographic region, and individual profile factors.

METHODS

Facial profile photographs of 1 man and 1 woman, each having a profile designated as ideal (the ideal profile), were digitized. The sagittal and vertical dimensions of these photographs were modified, and 9 variations of each profile picture were obtained using different combinations of alterations. The photographs were scored by 373 participants. For the analysis, Mann-Whitney U and Kruskal Wallis-H tests were used in the comparison of the scores.

RESULTS

The ideal profile was the most preferred in both sexes, whereas the least preferred was a severe Class III malocclusion with a reduced vertical dimension of 8 mm. In general, esthetics decreased as it moved away from the ideal profile in a sagittal or vertical direction.

CONCLUSIONS

Some factors from among those sampled (sex, age, education, social status, geographic region, and personal profile) affected esthetic preference, whereas others did not.

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

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.

Thresholds of Abnormality Perception in Facial Esthetics among Laypersons and Dental Professionals: Frontal Esthetics

Aim

To find thresholds at which laypersons and dental professionals perceive abnormalities in two facial frontal esthetics variables: facial symmetry and vertical harmony.

Materials and Methods

A baseline frontal image of a young male face with optimum facial proportions was generated from a real image using a photo editing software. Different facial asymmetry images were then generated from this image by manipulating the chin point position at 2 mm increment to the left side. Vertical harmony was perceived through manipulating lower anterior facial height (LAFH) at a ratio of 2% of increased and decreased heights. A total of 120 raters divided equally into four groups of laypersons, general dental practitioners (GDPs), orthodontists, and oral and maxillofacial surgeons (OMFSs) rated these images using an analog scale of 100 mm long. Using ANOVA and Tukey post hoc tests at P < 0.05, the image that showed the first statistical difference compared to the baseline was considered as a threshold of abnormality.

Results

The image of 4 mm asymmetry was defined by the laypersons and GDPs as the threshold of abnormality, while the orthodontists and OMFSs realized that at 2 mm. Laypersons and GDPs defined a threshold of 46% as an abnormal decrease in the LAFH and the other 2 groups at 48%. All dental professionals groups rated the image of 54% as an abnormal increase in the LAFH while laypersons perceived that at 56%.

Conclusion

These thresholds regarding frontal esthetics may contribute to the process of establishing proper orthodontic treatment planning that suits the highest facial esthetic standards.

Effect of increasing occlusal vertical dimension on lower facial form and perceived facial esthetics: A digital evaluation

STATEMENT OF PROBLEM

Increasing occlusal vertical dimension (OVD) is often indicated in complex prosthodontic rehabilitations to gain restorative space and improve the occlusal relationship and esthetics. The effect of increasing occlusal vertical dimension on lower facial height (distance from subnasale to soft-tissue menton) and perceived facial esthetics is not well understood.

PURPOSE

The purpose of this clinical study was to investigate the effect of incremental increases in the occlusal vertical dimension on lower facial height and perceived facial esthetics by using a digital approach.

MATERIAL AND METHODS

Twenty-five participants with Class I jaw relationship and no loss of OVD participated in the study. Custom mandibular devices were digitally designed and 3-dimensionally printed to increase the OVD by 3, 6, and 9 mm in each participant. Three-dimensional facial scans and frontal photographs were made with the participants wearing a specific device to achieve the desired OVD increase. The lower facial height, total facial height (distance between nasion to soft-tissue menton), nasolabial angle, lip width, and lip height were digitally measured on facial scans. All measurements were recorded in a computer-aided design (CAD) software program and were repeated 3 times. Subsequently, frontal photographs of 10 participants were randomly selected for survey. Three groups each of 10 prosthodontists, general dentists, or laypersons participated in the survey and were asked to detect OVD difference in 2 photographs of the same participant and to rank facial esthetics at varying OVDs. One-way repeated measures ANOVA (α=.05) for the facial measurements and descriptive statistics for the survey results were used.

RESULTS

Lower facial height, the ratio of lower facial height to total facial height, lip height, and nasolabial angle increased with an OVD increase, whereas lip width decreased (P<.001). Bonferroni corrected paired t tests revealed all groups of OVD increase to be significantly different from each other (P<.001) except for an OVD increase to 6 mm versus 9 mm in lip height (P=.540) and lip width (P=.019), respectively. Prosthodontists, general dentists, and laypersons could detect a +3 mm OVD increase 63.9%, 62.5%, and 56.5% of the time, respectively. The participants' original OVD was considered the most esthetic (60.0%, 45.0%, and 68.0%) by prosthodontists, general dentists, and laypersons, respectively.

CONCLUSIONS

Increased OVD increases lower facial height, the ratio of lower facial height to total facial height, lip height, and nasolabial angle but decreases lip width. Prosthodontists are more sensitive to a smaller increase in OVD, closely followed by general dentists and then laypersons. In case of no loss of OVD, a vertical increase as small as 3 mm can be detected by both dentists and the general public and perceived as less esthetic. The larger the increase in OVD, the more detectable the difference and the less the faces are perceived as esthetic.

Frontal sinus: is it a predictor for vertical malocclusions?

The aim of the present study was to evaluate 3D frontal sinus morphology in consideration with different vertical facial developments. The study was conducted with the pre-treatment CBCT images of 87 patients, who were divided into 3 groups according to the sum of the posterior angle. The frontal sinus measurements were performed on the axial, sagittal, and coronal sections of the CBCT images. Craniofacial measurements were performed on the lateral cephalograms, obtained from the CBCT scans. Normal distribution of the data was confirmed by the Kolmogorov-Smirnov test. ANOVA, followed by post hoc Duncan tests, was used to compare the differences among the three groups. The relationships between sinus dimensions and craniofacial parameters were assessed by the Pearson's correlation coefficient (P < 0.05). The maximum anterior-posterior dimension of the frontal sinuses (0.017), the width of the right (0.020) and left (0.041) frontal sinuses, and the anterior-posterior dimension of the left (0.038) frontal sinus were significantly smaller in the hyperdivergent group compared to hypodivergent group. There was no significant difference between groups in terms of the height of the frontal sinuses. Significant correlation was noted between the maximum anterior-posterior dimension of the frontal sinus and SN-PP, N-Me, N-ANS, SN-GoGn, Post. sum, and Jarabak's ratio. No significant correlation between the height of the frontal sinuses and the craniofacial measurements was found. Individuals with vertical growth pattern presented decreased anterior-posterior dimension of the frontal sinuses, revealing significant correlations with vertical craniofacial parameters.

Perception of Dental Students and Laypersons to Altered Dentofacial Aesthetics

Aims and Objectives:

The aims of the study were to comprehensively assess the perception of altered dentofacial aesthetics between dental students and laypersons and to identify the threshold where different variables such gender and clinical training impair dentofacial attractiveness.

Materials and Methods:

Ten photographs were digitally manipulated involving three facial, two smile, four dental, and one gingival components. Fifty images were randomized and rated according to attractiveness by two groups dental students which subdivided into preclinical students and clinical students, and laypersons. The participants evaluated the original and manipulated images using a visual analog scale. The responses were then analyzed using Mann–Whitney U test.

Results:

The results showed threshold levels of noticeable differences between varying levels of discrepancy. The overall perception of aesthetics was high among dental clinical students with the highest perception toward facial profile and the lowest toward gingival margin height. Of the respondents, no differences were found in the perception between male and female participants. Dental students perceived aesthetic components more accurately than laypersons.

Conclusion:

Dental students group had a better perception of dentofacial aesthetics than included laypersons. Unlike gender, clinical training has a substantial positive effect on the assessment of beauty. Dental students sub divided into dental preclinical students and dental clinical students (clinical training is a variable of all subgroups).

Impact of functional orthodontic treatment on facial attractiveness of children with Class II division 1 malocclusion

Background/objectives

Whether orthodontic treatment with functional appliances improves facial aesthetics is still under debate. This study aimed to determine whether functional orthodontic treatment improves the facial attractiveness of patients with Class II division 1 malocclusion.

Materials/method

Extraoral lateral photographs of 20 children with Class I (CLI, 11.7 ± 0.8 years), and before (T1) and after treatment (T2) photographs of patients with Class II division 1 (CLII T1 and CLII T2; mean age ± SD = 11.1 ± 0.6 years) treated with functional appliances, were transformed into black silhouettes. Three panels of examiners including 30 orthodontists (39.0 ± 10.1 years), 30 dentists (40.0 ± 9.7) and 30 laypersons (39.0 ± 9.2) evaluated the attractiveness of patients’ silhouettes using a 100-mm visual analogue scale, and the sagittal position of patients’ upper lip, lower lip, and chin using a 3-point Likert scale. Two-way ANOVA and a chi-square test were used to test differences among groups. Statistically significance was set as P  &lt;  0.05.

Results

The silhouettes of CLII T2 individuals were more attractive than those of the other groups (all Ps &lt; 0.001). The upper lip, lower lip, and the chin of these individuals were judged to be normally positioned in 69.5 per cent, 74.9 per cent, and 72.3 per cent of the assessments, respectively (all Ps &lt; 0.05).

Limitations

This study did not account for the psychological profile of the examiners, which may have affected the ratings.

Conclusions/implications

Orthodontic treatment with functional appliances is associated with a superior facial profile attractiveness. Functional treatment should be considered as a treatment option to improve the facial appearance of children with Class II division 1 malocclusion.

A cross-cultural study of sex-typicality and averageness: Correlation between frontal and lateral measures of human faces

OBJECTIVES

Facial averageness and sexual dimorphism are extensively studied attractiveness markers, which are viewed as possible indicators of biological quality. Both are complex morphological traits, and both can be easily assessed from frontal and lateral projection of a human face. Interestingly, examination of mutual relations between the frontal and lateral dimensions of these markers has so far received little attention in published research.

METHODS

In our cross-cultural study, we used geometric morphometric data from male and female faces from Brazil, Cameroon, Colombia, and the Czech Republic, and analyzed correlations between frontal and lateral measurements of averageness and degree of maleness/femaleness, that is, the individual variation in features that characterize sexual dimorphism. We also analyzed whether the association between frontal and lateral measurements differed in men and women.

RESULTS

In general, our results showed a moderate correlation in sexually dimorphic features between lateral and frontal facial configuration in both sexes, while frontal and lateral facial averageness was moderately correlated only in women. This pattern was less consistent when individual populations were analyzed separately.

CONCLUSIONS

We suggest that, in general, the weak association between lateral and frontal facial configurations may be the result of selection pressures in favor of individual identity signals. Moreover, especially in women, the frontal and lateral dimension of a given facial attractiveness marker may provide similar information about the qualities of the individual. The absence of a significant correlation in male facial averageness suggests that frontal and lateral averageness convey different information about an individual.

Association of facial sagittal and vertical characteristics with facial aesthetics in the Northern Finland Birth Cohort 1966

OBJECTIVE

To explore the association of facial sagittal and vertical dimensions with aesthetic assessment by three panel groups.

MATERIALS AND METHODS

The study population comprised adult individuals from the Northern Finland Birth Cohort 1966 (NFBC1966). A clinical oral examination including digital facial photographs was performed. The study population was divided into subjects with the lowest and highest values in soft tissue measurements in lower anterior facial height percentage (LAFH%) (60 subjects) and antero-posterior jaw relationship [soft tissue A-point, nasion, and B-point (ANB) angle; 60 subjects] and a control group (30 subjects). Frontal and profile facial photographs were presented to three panel groups: five orthodontists, five dentists, and five laypersons, who evaluated the photographs using the visual analogue scale (VAS).

RESULTS

This study showed significant differences in VAS mean scores between the panel groups. Curve estimation revealed a significant quadratic association between aesthetic VAS evaluation and ANB angle for all panel groups. The association between ANB angle and perceived facial attractiveness was highest among orthodontists (R2 = 0.276, P = 0.001 for males; R2 = 0.285, P = 0.001 for females). However, no statistically significant association was found between facial attractiveness and LAFH%.

CONCLUSION

Facial sagittal dimensions appeared to influence facial aesthetics more than vertical dimensions in middle-aged adults. In their perception of facial aesthetics, orthodontists were more influenced by antero-posterior jaw relationships than dentists and laypersons. The overall perception of facial attractiveness related to facial dimensions appeared to differ between the panel groups in female and male faces.

Hakeem M, Yamaki M. Perception of dental professionals and lay people to altered facial esthetics

Introduction

The aim of this study was to examine whether dental professionals and lay people group do agree in their perception of digitally altered facial components or not.

Materials and Methods

A frontal photograph of a Saudi young man was taken, imported, and digitally altered to a series of images of 16 photographs. Eyes, nose, mouth, and chin were altered gradually from the original photograph and were rotated 1°, 3°, and 5°. 225 raters (60 lay people, 41 orthodontists, 77 dentists, and 47 dental students) were invited and asked to evaluate the original and altered images using a visual analog scale.

Results

Lay people were less critical and gave higher ratings than dentists when evaluating rotated eyes of 5°. Orthodontists gave higher ratings than lay people and dental students at distinguishing of 1° of rotated nose. Orthodontists were less critical in rating larger alterations of the nose at 3° than lay people. Orthodontists were also less discriminating of minor alterations of the lips. They could not detect mouth rotation of 1° compared to lay people and dental students.

Conclusions

The results of this study underline the importance of developing an objective index to enumerate the magnitude of facial asymmetries.

360 Degrees of Facial Perception: Congruence in Perception of Frontal Portrait, Profile, and Rotation Photographs

Studies in social perception traditionally use as stimuli frontal portrait photographs. It turns out, however, that 2D frontal depiction may not fully capture the entire morphological diversity of facial features. Recently, 3D images started to become increasingly popular, but whether their perception differs from the perception of 2D has not been systematically studied as yet. Here we investigated congruence in the perception of portrait, left profile, and 360° rotation photographs. The photographs were obtained from 45 male athletes under standardized conditions. In two separate studies, each set of images was rated for formidability (portraits by 62, profiles by 60, and 360° rotations by 94 raters) and attractiveness (portraits by 195, profiles by 176, and 360° rotations by 150 raters) on a 7-point scale. The ratings of the stimuli types were highly intercorrelated (for formidability all rs > 0.8, for attractiveness all rs > 0.7). Moreover, we found no differences in the mean ratings between the three types of stimuli, neither in formidability, nor in attractiveness. Overall, our results clearly suggest that different facial views convey highly overlapping information about structural facial elements of an individual. They lead to congruent assessments of formidability and attractiveness, and a single angle view seems sufficient for face perception research.

Perception of facial, dental, and smile esthetics by dental students

OBJECTIVE

To comprehensively assess dental students' perception of facial, dental and smile esthetics and to assess whether such a perception varies by gender, clinical training, and Grade Point Average (GPA).

MATERIALS AND METHODS

Series of photographs were digitally manipulated involving three facial, two smile, four dental, and one gingival components. Students in preclinical and clinical levels evaluated the original and manipulated images using a visual analogue scale scored from 1 to 5 where 5 is the standard image and 1 is the least pleasant one. The responses were then analyzed using Mann-Whitney test. A P value of < .05 was considered significant.

RESULTS

Four hundred and eight dental students participated in this study. With regard to the overall esthetics, males and clinical students scored higher than females and preclinical students, respectively, did. With regard to the individual esthetic components, males had significantly higher scores in buccal corridors, midline shift, clinical crown width, and gingival marginal height, while females had significantly higher score in median diastema (P < .05). Clinical students had a better perception of facial asymmetry, gingival display, buccal corridors, and clinical crown width compared to the preclinical students. Effect of GPA was minimal and even contradictory; students with lower GPA had a better perception of midline deviation and occlusal canting than those with higher GPA scores.

CONCLUSIONS

Male dental students, and unexpectedly unlike females, have a better perception of facial and dental esthetics. Unlike GPA, whose effect was minimal, clinical training has a substantial positive effect on the assessment of beauty.

CLINICAL SIGNIFICANCE

Appropriate perception of facial, dental and smile esthetics by dental students is of paramount importance for providing adequate dental services and for improving and polishing their professionalism.© 2018 Wiley Periodicals, Inc.

Clinician, dental student, and orthognathic patient perception of black-and-white silhouette lateral profile dimensions of ideal chin position in a Chinese population

OBJECTIVES

This study aimed to investigate differences in the influence of chin prominence and length on perception of facial aesthetics by Chinese dental clinicians, orthognathic patients, and dental students.

STUDY DESIGN

Male and female silhouette lateral profiles were modified to obtain 28 facial profiles by altering chin prominence and length by 3 mm in the sagittal and vertical planes. Images were rated by 70 clinicians, 30 orthognathic patients, and 100 dental students on a 7-point Likert scale.

RESULTS

Perceived attractiveness was highest when the male chin prominence (MCP) was -3 mm to 3 mm and the female chin prominence (FCP) was 3 mm. In contrast, male chin length (MCL) of 0 to 3 mm and female chin length (FCL) of 0 mm were considered the most attractive. In the sagittal and vertical profiles, MCP (-9 mm), FCP (-9 mm), FCL (-9 mm), and MCL (-9 mm) were ranked least attractive.

CONCLUSIONS

The overall aesthetic opinions of orthognathic patients, clinicians, and dental students are similar. The greater the retrusion or protrusion of the chin and the shorter or longer the chin length, the lower were the rates of facial aesthetics and the greater were the desire for surgery.

Impact of skeletal divergence on oral health-related quality of life and self-reported jaw function

OBJECTIVE

To investigate the differences in oral health-related quality of life (OHRQoL) and self-reported jaw function between patients with hyperdivergent and normodivergent facial types.

METHODS

Eighty patients with a distinctively hyperdivergent facial type (mandibular plane angle greater than 2 standard deviations, or 42°) and 80 controls were individually matched according to age, sex, ethnicity, and treatment stage. Data were collected using self-report questionnaires such as the Oral Health Impact Profile (OHIP-14) and Jaw Functional Limitation Scale (JFLS-8).

RESULTS

The mean age of the patients was 17.2 ± 4.6 years (range, 12-9 years), with most (65.0%) being female and of New Zealand European origin (91.3%). Individuals with hyperdivergent facial types had higher overall and social domain scores on the OHIP-14 (p < 0.05) than did the ones with normodivergent facial types. However, the intergroup differences in JFLS-8 scores were not significant (p > 0.05).

CONCLUSIONS

Jaw function appears to be similar in individuals with hyperdivergent and normodivergent facial morphologies. However, those with hyperdivergent facial types are more likely to self-report poorer OHRQoL than are those with normal faces, especially in relation to social aspects.

Cephalometric analysis for functional occlusion

Background

Various elements contributing to good functional occlusion have not been clearly assessed with cephalometrics for the diagnosis of functional problems and their application in clinical practice. The aim of this study, therefore, was to analyze different components of functional occlusion to formulate concise functional cephalometric analysis.

Materials and Methods

Eighty-two cases (38 males and 44 females), with class I occlusion and balanced facial profile, were examined based on the selection criteria, and cephalograms were taken in natural head position. All the radiographs were then analyzed using various functional parameters.

Results

The mean values of condylar path angle and incisal path angle were 55.83° and 65.67°, respectively, with large deviations. However, both showed positive correlation. The value of the angle of long axis of mandibular incisor with respect to the line joining center of condyle and lower incisor tip was 88.04°. Moreover, the angle between the occlusal plane and horizontal plane was 12.88°. In vertical plane, lower face height (LFH) was found to be slightly less than the upper face height. Maxilla contributed around 45% of the LFH while mandible formed about 60%. Furthermore, upper alveolar component (maxillary alveolar height) formed more than half of the maxilla (53.79%) whereas lower alveolar component (mandibular alveolar height) was 74.8% of the mandible.

Conclusion

This study has analyzed various components of functional occlusion and formulated a concise functional cephalometric analysis for diagnosis, treatment planning, and assessment of treatment results.

Photogrammetric Analysis of Attractiveness in Indian Faces

Background

The objective of this study was to assess the attractive facial features of the Indian population. We tried to evaluate subjective ratings of facial attractiveness and identify which facial aesthetic subunits were important for facial attractiveness.

Methods

A cross-sectional study was conducted of 150 samples (referred to as candidates). Frontal photographs were analyzed. An orthodontist, a prosthodontist, an oral surgeon, a dentist, an artist, a photographer and two laymen (estimators) subjectively evaluated candidates' faces using visual analog scale (VAS) scores. As an objective method for facial analysis, we used balanced angular proportional analysis (BAPA). Using SAS 10.1 (SAS Institute Inc.), the Turkey's studentized range test and Pearson correlation analysis were performed to detect between-group differences in VAS scores (Experiment 1), to identify correlations between VAS scores and BAPA scores (Experiment 2), and to analyze the characteristic features of facial attractiveness and gender differences (Experiment 3); the significance level was set at P=0.05.

Results

Experiment 1 revealed some differences in VAS scores according to professional characteristics. In Experiment 2, BAPA scores were found to behave similarly to subjective ratings of facial beauty, but showed a relatively weak correlation coefficient with the VAS scores. Experiment 3 found that the decisive factors for facial attractiveness were different for men and women. Composite images of attractive Indian male and female faces were constructed.

Conclusions

Our photogrammetric study, statistical analysis, and average composite faces of an Indian population provide valuable information about subjective perceptions of facial beauty and attractive facial structures in the Indian population.

Changes in cephalometric variables after orthognathic surgery and their relationship to patients' quality of life and satisfaction

OBJECTIVES

This study was designed to assess the relationship between postsurgical cephalometric changes and quality of life and satisfaction after orthognathic surgery.

MATERIAL AND METHODS

Sample size consisted of 30 patients with class III and 25 patients with class II malocclusion treated with bilateral sagittal split osteotomy and Le Fort I osteotomy. Profile convexity, lower facial height proportion, lip position and length, nose, and chin position were measured on pre and post-treatment cephalograms. To assess the patients' satisfaction and quality of life (QoL) after surgery, the questionnaire of the Rustemeyer's study and Oral Health Impact Profile (OHIP) questionnaire were used, respectively. The paired-sample t-test, Spearman correlation analysis and Pearson correlation analysis was used in SPSS statistical software.

RESULTS

In class III malocclusion patients, decrease in facial angle, convexity angle, mentolabial angle, and increase in upper lip protrusion had the most positive impact on QoL. Decrease in facial angle and increase in upper lip protrusion were correlated positively with satisfaction questionnaires. In class II malocclusion patients, increase in convexity angle, facial angle and mentolabial angle had the most positive impact on satisfaction and QoL.

CONCLUSIONS

Consideration both subjective and objective parameters affecting on the patients' satisfaction and their quality of life is essential.

The impact of education on the perception of facial profile aesthetics and treatment need

BACKGROUND

The purpose of this study was to evaluate the influence of education on the perception of various male and female Caucasian profiles with respect to attractiveness and treatment need.

METHODS

Four hundred questionnaires were distributed among six groups of raters (nonacademic laymen, academic laymen, preclinical students, clinical students, orthodontists, and maxillofacial surgeons). Male and female profile images were altered digitally in the sagittal and vertical dimensions resulting in nine different male and female profiles. The raters had to assess the images according to attractiveness and treatment needs.

RESULTS

Three hundred four questionnaires were completed in this study. Age and gender of the rater had no significant influence on the perception of profile attractiveness. The different groups of raters perceived the Class I normodivergent profiles as most attractive. Significant differences in the perception of attractiveness were seen between laymen, orthodontists, and maxillofacial surgeons. The orthodontists and maxillofacial surgeons reported treatment needs the most. The orthodontists were most sensitive in discerning profiles.

CONCLUSION

Attractive male and female profiles are recognizable by any rater. Education seemed to have a significant influence on facial profile perception and recommendation for treatment need of unattractive profiles. Professionals should be aware of their judgment discrepancy to laymen.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

How does variation in lower anterior face height influence perceived attractiveness? A quantitative investigation

OBJECTIVE

The purpose of this investigation was to undertake an objective and quantitative evaluation of how severity of lower anterior face height (LAFH) variations influences perceived attractiveness.

DESIGN

Cross-sectional study

SETTING

St George's Hospital, London, UK PARTICIPANTS AND METHODS: The LAFH of an idealized male and female frontal facial image were altered in 2·5 mm increments from -20 to 20 mm (male images) and from -10 to 20 mm (female images), in order to represent reduction and increase in height of this region. These images were rated by a pre-selected group of pre-treatment orthognathic patients (n = 75), clinicians (n = 35) and laypersons (n = 75).

OUTCOME MEASURES

Ratings on a seven-point Likert scale.

RESULTS

With an increase in LAFH, desire for surgery became significant at 15-16 mm for male faces and 13-14 mm for female faces. With a reduction in LAFH, desire for surgery became significant at -14 to -17 mm for male faces; a smaller reduction of -6 to -8 mm led to a significant desire for surgery for female faces.

CONCLUSIONS

The classical vertical facial trisection canon of upper face height as one-third (33·3%), midface height as one-third (33·3%) and LAFH as one-third (33·3%) of total anterior face height may be used as an 'ideal' proportional ratio. Mild LAFH variations were largely acceptable. In terms of the percentage LAFH to total anterior face height (TAFH) and anterior face height (AFH), observers did not desire surgery for LAFH variations of 25-42% of TAFH (40-66% of AFH) for male faces, and 28-42% of TAFH (45-66% of AFH) for female faces.

Preferences of AP position of the straight Caucasian facial profile

INTRODUCTION

Several investigators have compared the perception of profile attractiveness between professional and non-professional people, different groups of clinicians, and different ethnic groups. Our aim was to study preferences for facial protrusion in the lateral view for a straight Class I profile and to study the influence of gender, age, sex preference, and profession.

MATERIAL AND METHODS

Portrait images of one male and one female model with a Class I occlusal relationship were warped into nine different antero-posterior positions. An internet site was established to reach as many people as possible, and a request was sent by email to participate in a scientific experiment. Finally, 1707 Caucasion assessors could be grouped.

RESULTS

The preferred male profile is the straight full ante profile. For a feminine facial profile, the straight average and the straight 2/3 ante profiles were perceived as the most attractive. Surgeons tended to give significantly higher scores to attractive (ante) profiles, which correlated strongly with scores of the orthodontists.

CONCLUSION

Whenever possible with combined orthodontic/surgery treatment, straight ante profiles should be aimed for.

Long-term occlusal and soft-tissue profile outcomes after treatment of Class II Division 1 malocclusion with fixed appliances

INTRODUCTION

Our objective was to determine which factors were predictive of good long-term outcomes after fixed appliance treatment of Class II Division 1 malocclusion.

METHODS

Two hundred seven patients with Class II Division 1 malocclusion were examined in early adulthood at a mean of 4.6 years after treatment with fixed appliances. The peer assessment rating index was used to evaluate dental alignment and occlusal relationships. The soft-tissue profile was assessed with the Holdaway angle.

RESULTS

Logistic regression identified 3 pretreatment variables that were predictive of a good facial profile (Holdaway angle) at recall: the lower lip to E-plane distance (P <0.001; smaller distance behind the E-plane means a better outcome), ANB angle (P = 0.001; smaller ANB means a better outcome), and extraction pattern (P = 0.026). Linear regression analysis showed that 2 pretreatment variables were predictive of a favorable PAR score at recall: SNB angle (P = 0.001; larger SNB means a better outcome) and extraction pattern (P = 0.034).

CONCLUSIONS

Three pretreatment cephalometric measures (lower lip to E-plane distance, ANB angle, and SNB angle) were predictive of the outcome in the treatment of Class II Division 1 malocclusion. The extraction pattern was also found to be a predictor of outcome.

The perception of facial aesthetics in a young Spanish population

Improved facial aesthetics is one aim of orthodontic treatment. This study was designed to determine if the faces considered more beautiful in a young population exhibit the same parameters used by orthodontists to assess successful results. A panel of 34 laypeople (30 females and 4 males) evaluated a set containing one frontal, one frontal during smiling, and one profile photograph of 89 students (77 females and 12 males) on a 5-point attractiveness scale, in relation to a set of reference photographs. For each photographic set, the mean and final scores were calculated. Once the sample was established, 11 subjects (9 females and 2 males) with the highest final facial aesthetic score were selected and cephalometric analysis was performed. All cephalometric measurements were within the norm for the total sample. When the sample was divided by gender, Wilcoxon's W non-parametric test showed significant differences between the male and female photographs; while females tended to a Class II malocclusion, with the mandible slightly retrusive to the maxilla, males tended to a Class III and showed a straighter profile with a prominent chin; the face height ratio was higher in males. There were no significant differences between genders for lower lip to E plane. The findings show that the faces considered more attractive fulfilled the cephalometric and facial norms.

Influence of lower facial height changes on frontal facial attractiveness and perception of treatment need by lay people

OBJECTIVE

To test the hypothesis that lower facial height has no influence on frontal facial attractiveness and treatment need perception of lay people.

MATERIALS AND METHODS

Frontal facial silhouettes of a man and a woman with normal lower facial height values (male: 81.5 mm; female: 70.5 mm) were modified by increasing and decreasing their lower facial heights in steps of 1 mm to obtain frontal images with different lower facial height alterations ranging from +6 mm to -6 mm for each sex. A panel of 100 lay people scored each silhouette's attractiveness on a 100-mm visual analogue scale (VAS) and also indicated whether they would seek treatment if the image represented their own. The Wilcoxon signed rank test was used to compare the VAS scores.

RESULTS

Unaltered +/-1-mm and +/-2-mm silhouettes got the highest VAS scores. Scores were significantly lower (P < or = .001) as the divergence from the normal value exceeded 2 mm. Beyond +3 mm and -4 mm in females and +4 mm and -3 mm in males the difference between the scores became statistically insignificant. At +/-4 mm, more than 75% of the raters elected to have treatment.

CONCLUSION

The hypothesis was rejected.

Perception of facial profile attractiveness of different antero-posterior and vertical proportions

This study investigated the influence of changing the antero-posterior (AP) and vertical proportions of the lower face on the rankings of facial attractiveness. Four hundred and fifty-four (219 males and 235 females) native Jordanians of various ages and professions rated the attractiveness of a sequence of antero-posteriorly and vertically altered male and female profile images. Attractiveness ranking scores were obtained from the visual assessment of these digitally altered male and female profile images that represented a range of AP and vertical lower facial proportions. The mean and standard deviation (SD) for the rank scores were calculated. Statistical analyses were employed for comparison between the different age groups, genders, and professions. A Class I male profile with a normal lower face height and Class I female profile with a reduced lower face height were ranked as the most attractive. Class II male and female profiles with increased lower face heights were ranked as least attractive. As the vertical and AP dimensions diverged from normal, attractiveness decreased. Images with Class II profile features and increased lower face heights were considered less attractive than corresponding images with Class III profile features and reduced lower face heights. Gender had a limited influence on the perception of attractiveness. A significant difference was found between dentists and lay people in the perception of profile attractiveness.

3D soft tissue analysis--part 2: vertical parameters

INTRODUCTION

The increasing relevance of 3D methods in orthodontic diagnostics and treatment planning calls for the development of new analysis methods and the definition of three-dimensional mean values.

OBJECTIVE

The aim of this study was to develop a reliable three-dimensional (3D) analysis of facial soft tissues. Our objectives were to determine vertical 3D mean values and define the relationship between vertical skeletal parameters and digitally-recorded 3D soft tissue parameters.

PATIENTS AND METHODS

A total of 100 adult patients (female symbol = 53, male symbol = 47) of Caucasian ethnic origin were included in the study. Patients with syndromes, cleft lip and palate, noticeable asymmetry or anomalies in the number of teeth were excluded. Arithmetic means for three vertical 3D soft tissue parameters were calculated. The parameters were analyzed biometrically in terms of their reliability and gender-specific differences. Furthermore, the 3D soft tissue values were analyzed with regard to any correlations with vertical cephalometric values. In addition, we employed stepwise discriminant analysis, a multivariate statistical method, to examine the extent to which correct assessment of craniofacial morphology is possible by referring to those 3D parameters.

RESULTS

We successfully defined reproducible 3D mean values for the 3D soft tissue parameters, demonstrating highly significant correlations between the vertical 3D soft tissue measurements and cephalometric measurements. 89.8% of the patients could be correctly assigned to a vertical or horizontal craniofacial morphology according to the 3D soft tissue values.

CONCLUSION

3D soft tissue analysis provides information about vertical skeletal parameters, allowing assessment of vertical craniofacial morphology. Further investigation will be required so that 3D soft tissue diagnosis can be integrated into treatment planning and assessment as a supportive diagnostic tool in the future.

Assessed facial normality after Twin Block therapy

SUMMARY

The first aim of this study was to identify any difference in the perception of facial normality between orthodontists and lay people of patients with the initial presentation of a Class II division 1 malocclusion, the second is to investigate whether there was an identifiable facial change following Twin Block (TB) therapy, and lastly, the relationship between identifiable facial change and clinical measurements was explored. Animated laser scans of 16 randomly selected adolescent patients, nine males aged 12-14 years and seven females aged 11-13 years with Class II division 1 malocclusions before and after TB therapy, were assessed on a visual analogue scale (VAS) by 34 orthodontists and 35 lay people. The 'Mark and Measure' and 'Orientated' techniques were used to determine soft tissue dimensions. Overjet was also recorded. Non-parametric statistical analyses were employed, including Mann-Whitney, Wilcoxon signed value, and Spearman's rank-order correlation tests. There was no statistically significant difference in facial normality scores of adolescents before TB therapy when assessed by orthodontists (46.2 mm) and lay people (50.9 mm; P = 0.120). However, TB therapy significantly improved the assessment score of the orthodontists (54.8 mm) and lay people (57.8 mm; P = 0.000). Using a 5 per cent threshold in categorization of change in VAS scores, the majority of assessors perceived an overall 'improvement' (87.0 per cent). An increase in soft tissue lower face height (ST LFH) and overjet reduction was strongly correlated with the higher assessments of lay people (r = 0.515) and orthodontists (r = -0.505), respectively. Although orthodontists and lay people assess facial normality of patients with Class II division 1 malocclusions similarly, following TB therapy an increase in ST LFH with lay people and overjet reduction with orthodontists were most closely related to improved facial normality.

Correlations between cephalometric and photographic measurements of facial attractiveness in Chinese and US patients after orthodontic treatment

INTRODUCTION

Orthodontists rely on esthetic judgments from facial photographs. Concordance between estimates of facial attractiveness made from lateral cephalograms and those made from clinical photographs has not been determined. We conducted a preliminary examination to correlate clinicians' rankings of facial attractiveness from standardized end-of-treatment facial photographs (Photo Attractiveness Rank) with cephalometric measurements of facial attractiveness made for the same subjects at the same time.

METHODS

Forty-five Chinese and US orthodontic clinicians ranked end-of-treatment photographs of separate samples of 45 US and 48 Chinese adolescent patients for facial attractiveness. Separately for each sample, the photographic rankings were correlated with the values of 21 conventional hard- and soft-tissue measures from lateral cephalograms taken at the same visits as the photographs.

RESULTS

Among US patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for profile angle, chin prominence, lower lip prominence, and Z-angle, and also with lower values for angle of convexity, H-angle, and ANB. Among Chinese patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for Z-angle and chin prominence, and also with lower values for angle of convexity, H-angle, B-line to upper lip, and mandibular plane angle. Chinese patients whose %lower face height values approximated the ethnic "ideal" (54%) tended to rank higher for facial attractiveness than patients with either higher or lower values for %lower face height. The absolute values of the correlations for the 7 US measures noted above ranged from 0.41 to 0.59; those of the 7 Chinese measures ranged from 0.39 to 0.49.The P value of the least statistically significant of these 14 correlations was 0.006, unadjusted for multiple comparisons. On the other hand, many cephalometric measures believed by clinicians to be indicators of facial attractiveness failed to correlate with facial attractiveness rank for either ethnicity at even the P <0.05 level, including SN-pogonion angle, lower incisor to mandibular plane angle, and Wits appraisal.

CONCLUSIONS

In general, there was less association than expected or desired between objective measurements on the lateral cephalograms and clinicians' rankings of facial attractiveness on sets of clinical photographs.