Virtual surgical planning in orthognathic surgery: a dental hospital's 10-year experience

PURPOSE

The primary objective of this study was to evaluate how the utilization of virtual surgical planning (VSP) and the epidemiological profile of patients undergoing orthognathic surgery (OGS) have changed in the past decade.

METHODS

The records of patients who had undergone orthognathic surgery at a national dental hospital were reviewed. Trends in VSP, epidemiological data, presentation of dentofacial deformity, and management details were recorded.

RESULTS

A total of 1184 patients were included in this study. The majority of the patients seeking treatment in this dental hospital were young Chinese adults with dentofacial deformities requiring bimaxillary surgeries. Most patients presented with a skeletal Class III pattern (79.0%), and asymmetry was diagnosed in 80.8% of all cases.

CONCLUSION

There was an initial slow pick-up rate for VSP, but this rapidly increased to a high adoption rate of 98.7-100% between 2019 and 2021. Together with an increasing body of evidence suggesting greater accuracy in VSP, utilization in this technology can be enhanced with greater familiarity with the technology and improvements in the VSP services.

Factors influencing the perception of profile beauty in Class III dental compensation: A comparative cross-sectional study according to three categories of assessors

INTRODUCTION

The main objective of this study was to evaluate the different factors influencing the perception of female profile facial beauty in Class III patients with protruded mandible that can be treated with orthodontic dental compensation: (1)severity of the protrusion, (2) the upper incisors inclination and (3) the presence of jawlines. The secondary objective was to determine if the rater's gender and profession played a role in the assessment of the preferred profile.

METHODS

A normal and smiling photographs of a female subject with normal facial and skeletal profile criteria were digitally manipulated to obtain 3 different mandibular sagittal positions: 0mm, +4mm and +8mm. Each position of the chin was evaluated with the presence or not of jawlines. In the smiling profiles, the same chin modifications were scored, and the maxillary incisor inclination was changed from 0 to +10 degrees with 5 degrees increments. A total of 320 raters (107 dentists, 103 orthodontists and 110 laypeople) scored the attractiveness of the different images using a Visual Analogue Scale. The limit of statistical significance was P<0.05. Generalized estimating equation (GEE) models were conducted to assess the predictors of variations in ratings within each set of photos, as well as the interactions of predictors where adjusted odds ratios (aOR) and their 95% confidence intervals were calculated and reported.

RESULTS

In the profiles without a smile, image +4mm chin (Class III treated by compensation) and image +8-mm mandible (Class III not treated) were selected as the most and least attractive images, respectively, by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). No significant difference was found between genders in this study.

CONCLUSIONS

Class III treated by compensation (+4mm) are more attractive than non-treated Class III (+8mm) by almost all groups with no difference. The presence of jawlines has a positive role in facial attractiveness. In the smiling profiles, all the examiners showed a preference for image +4-mm chin and a slight protrusion of maxillary incisors (+5 degrees). Orthodontists older than 50 years old are aware of the difficulty to treat a skeletal Class III and tend to accept it due to their long career experience. No significant difference was found between genders in this study.

Effect of Class II functional treatment on facial attractiveness, as perceived by professionals and laypeople

The literature offers different perspectives for and against two-phase treatment of skeletal Class II malocclusion. Facial attractiveness is an important aspect to take into account, given that children with skeletal Class II are often bullied by their peers and have low self-esteem and a lower social perception. The aim of the present study was to evaluate the aesthetic perception of facial profiles by a large number of observers, before and after treatment with a functional appliance, compared to untreated controls. The pre- and post-treatment cephalograms of 20 Class II subjects treated with Sander’s bite-jumping appliance and 20 untreated historical controls were collected and transformed into black and white silhouettes depicting only the lower third of the face. An online questionnaire comprising the silhouettes of the two groups, three “calibration” profiles and an “ideal” profile was submitted to dentists, orthodontists, undergraduates and laypeople, asking them to rate the profile’s attractiveness using a Visual Analogue Scale (VAS). The effect of treatment, and observers’ age, expertise and gender were analysed. The calibration images and the ideal profiles were used to evaluate the coherence of each observer’s judgement. The protocol was approved by the local Ethics Committee. Nine-hundred and ten questionnaires were collected. Treated subjects showed a larger improvement of facial attractiveness compared to controls. A significant effect of gender on the observer’s ratings was observed. Some observers showed incoherent judgement, which had a significant effect on the regression model. In conclusion, early treatment with functional appliances seems to improve patients’ facial aesthetics. This improvement is perceived equally by dental professionals and laypeople.

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.

Changes in the facial soft tissue profile after maxillary orthognathic surgery

Objectives

To compare the changes of the soft tissue profile in relation to the displacement of the underlying hard structures in maxillary orthognathic surgery and to contribute to the esthetic prediction of the facial profile after surgical procedures.

Materials and methods

We analyzed the sagittal changes in the facial soft tissue profile related to surgical changes in skeletal structures after maxillary osteotomy in a retrospective study. The study sample comprised 115 adult patients between the ages of 18–50 years who had undergone maxillary orthognathic surgery and interdisciplinary orthodontic treatment at the Department of Orthodontics, Ludwig-Maximilians University of Munich, Germany. LeFort I osteotomy cases in both maxillary monognathic and bignathic osteotomy procedures were included. All subjects had received rigid fixation. A cephalometric analysis of presurgical and postsurgical cephalograms was performed and the correlations between hard tissue and soft tissue change ratios were evaluated using a bivariate linear regression analysis. A vertical line through the landmark sella (S) perpendicular to the nasion-sella line (NSL) served as the reference plane.

Results

The subnasale (Sn) followed the A point (A) by 57%, the soft tissue A point (A′) followed the A point (A) by 73% and the upper lip, represented by the landmark labrale superius (Ls) followed the upper incisor (Is) by 73%; all three in a linear correlation with a mean prediction error of nearly 2 mm.

Conclusion

The scatterplots show a linear correlation with a wide spread for all three pairs of reference points. The wide spread and the high prediction error of almost 2 mm indicate low predictability of the expected lip position and Sn.

Does age influence self-perception of the soft-tissue profile in children?

INTRODUCTION

Appreciation of the soft-tissue profile is important in orthodontic diagnosis and treatment. However, are the patients themselves aware of their profile appearance? We aimed to evaluate if age influences self-perception of the soft-tissue profile in children.

METHODS

The study population for this prospective cross-sectional investigation consisted of 3 groups of 60 patients, classified according to age (<12 years; 12-15 years; >15 years). Each subject's right-sided facial profile was photographed to obtain a silhouette. Facial profile silhouette templates were created to represent the local population. Each subject's photograph was inserted into the corresponding template, and the subjects were asked to identify themselves. Facial profile self-recognition was recorded as a binary variable (yes or no). Other recorded variables included age, sex, and sexual maturity rating (using Tanner staging). Chi-square tests were used to analyze facial profile self-recognition between different subgroups, and stepwise multiple regression was used to predict the probabilities of facial profile self-recognition, with age, sexual maturity rating, and other recorded variables as independent variables.

RESULTS

Eighty percent of subjects aged >15 years recognized their own profile, compared with only 55% and 50% of subjects aged 12-15 years and <12 years, respectively. Subjects aged >15 years were significantly more likely to recognize their profile than younger subjects (P = 0.001). Similarly, subjects with the most advanced sexual maturity rating (stage V) were significantly more likely to recognize their profile (85% self-recognition) than those in groups I-IV (P <0.001). Girls were more likely to recognize their profiles than boys (P = 0.028). When using multiple regression analysis, sexual maturity rating appears to be the only significant predictor for facial profile self-recognition (R² = 0.25; P <0.001).

CONCLUSIONS

Facial profile self-recognition seems to improve with age and sexual maturity (sexual maturity rating stage V). Because orthodontic treatment planning takes possible soft-tissue changes into account, it is important to evaluate the degree of self-perception of the patients to adapt our goals and treatment discussions.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery

Objective

The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople.

Results

The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small.

Conclusion

The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Public Perception of Helical Rim Deformities and Their Correction With Ear Molding

BACKGROUND

Among congenital ear deformities, helical rim deformities are most common. Non-surgical ear molding has emerged as an effective option to treat helical rim deformities and could reduce the need for surgery later in a child's life. Despite this, there has never been a study examining how the general public rates corrections after ear molding.

METHODS

A retrospective chart review was conducted of all consecutive patients with helical rim deformities treated with InfantEar TM Molding System. Amazon Mechanical Turk (MTurk) was used to survey blinded respondents using photographs of patients' ears to determine the degree of normalcy on a scale of 1 (not normal) to 10 (completely normal) before and after molding. Ratings of ears were compared using a paired t test and percent improvement from baseline.

RESULTS

A total of 59 ears met criteria for evaluation by 497 MTurk respondents. Average age of patients at the time of treatment was 34.2 ± 16.8 days and mean therapy duration was 31.3 ± 13.1 days. A paired t test analysis found that MTurk respondents identified significant improvement in 91.5% of ears (n = 54) (P < 0.05). The percent improvement in observed helical rim change was on average 82.7 ± 61.1%.

CONCLUSION

Ear molding is an effective and safe way to address helical rim deformities early in the neonatal period. The general public is able to recognize ears with rim deformities as abnormal, and appreciate the difference in architecture after molding. Crowdsourcing technology offers an opportunity to measure laypeople's perceptions regarding outcomes after ear molding.

The influence of sagittal position of the mandible in facial attractiveness and social perception

OBJECTIVE:

This study aims at comparing the perception of orthodontists, maxillofacial surgeons, visual artists and laypersons when evaluating the influence of sagittal position of the mandible - in lateral view - in facial attractiveness; at a job hiring; and in the perception of socioeconomic profile.

METHODS:

A black male, a white male, a black female and a white female with harmonic faces served as models to obtain a facial profile photograph. Each photograph was digitally manipulated to obtain seven facial profiles: an ideal, three simulating mandibular advancement and three simulating mandibular retrusion, producing 28 photographs. These photographs were evaluated through a questionnaire by orthodontists, maxillofacial surgeons, visual artists and laypersons.

RESULTS:

The anteroposterior positioning of the mandible exerted strong influence on the level of facial attractiveness, but few significant differences between the different groups of evaluators were observed (p < 0.05).

CONCLUSIONS:

The profiles pointed as the most attractive were also pointed as more favorable to be hired to a job position and pointed also as having the best socioeconomic condition.

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.

Orthognathic Surgery Has a Significant Effect on Perceived Personality Traits and Emotional Expressions

BACKGROUND

The effects of orthognathic surgery go beyond objective cephalometric correction of facial and dental disproportion and malocclusion, respectively. The authors hypothesized that there is tangible improvement following surgery that alters publicly perceived personality traits and emotions.

METHODS

The authors used Amazon.com's Mechanical Turk (MTurk), a crowdsourcing tool, to determine how preoperative and postoperative images of orthognathic surgery patients were perceived on six personality traits and six emotional expressions based on posteroanterior and lateral photographs. Blinded respondents provided demographic information and were randomly assigned to one of two sets of 20 photographs (10 subjects before and after surgery).

RESULTS

Data on 20 orthognathic surgery patients were collected from 476 individuals. The majority of participants were female (52.6 percent), 18 to 39 years old (67.9 percent), Caucasian (76.6 percent), had some college or technical training or graduated college (72.7 percent), and had an annual income between $20,000 and $99,999 (74.6 percent). A paired t test analysis found that subjects were perceived significantly more favorably after orthognathic surgery in 12 countenance categories: more dominant, trustworthy, friendly, intelligent, attractive, and happy; and also less threatening, angry, surprised, sad, afraid, and disgusted (p < 0.05). Raters with the highest annual income perceived a greater magnitude of dominance after surgery than those earning less (p < 0.001).

CONCLUSIONS

There is significant improvement in the countenance of patients after orthognathic surgery, with both perceived personality traits and emotions deemed more favorable. Additional work is needed to better understand the physiologic underpinnings of such findings. Crowdsourcing technology offers a unique opportunity for surgeons to gather data regarding laypeople's perceptions of surgical outcomes in areas such as orthognathic surgery.

Perceptions of Pre- to Postsurgical Profile Changes in Orthognathic Surgery Patients and Their Correlation with Photogrammetric Changes: A Panel Study

PURPOSE

The objective was to compare the pre- and postsurgical profile changes after surgical correction of prognathism and maxillary hypoplasia, as perceived by panels of orthodontists, maxillofacial surgeons, laypersons and patients and to identify photogrammetric changes that might be related to preferred ratings.

MATERIALS AND METHODS

Each panel consisted of six males and six females who rated sets of pre- and postsurgical lateral photographs of 20 female and 20 male patients using a five-point scale. Patients rated their own set of photographs. Pre- to postsurgical differences of photogrammetrically assessed landmarks were recorded as a surgical change.

RESULTS

No significant differences in ratings between panels and patients could be detected. Significant correlation coefficients (r) were obtained between the ratings of all panel groups and between the ratings and changes in facial convexity (r = 0.351-0.542). Correlations with changes of the mentolabial angle were found to be significant for old orthodontists, male laypersons, and male patients (r = 0.332-0.609). Ratings of female and young laypersons were correlated with the horizontal changes in the lower face (r = 0.324-0.379).

CONCLUSION

Information gathered from this study will support the cooperation of the medical staff and might assist in treatment planning.

Dental esthetics and quality of life in adults with severe malocclusion before and after treatment

OBJECTIVE

To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups.

MATERIALS AND METHODS

Fifty-two patients (36 women, 16 men; age 18-61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need.

RESULTS

Oral health-related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health-related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups.

CONCLUSION

Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health-related quality of life, particularly by decreasing psychological discomfort and psychological disability.

Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals

OBJECTIVES

The aim of the study was to identify differences in the aesthetic evaluation of profile and frontal photographs of (1) patients treated for complete left-sided cleft lip and palate and (2) control patients by laypeople and professionals.

MATERIALS, SUBJECTS, AND METHODS

Left-side profile and frontal photographs of 20 adult patients treated for complete left-sided cleft lip and palate (10 men, 10 women, mean age: 20.5 years) and of 10 control patients with a class I occlusion (five men, five women, mean age: 22.1 years) were included in the study. The post-treatment photographs were evaluated by 15 adult laypeople, 14 orthodontists, and 10 maxillofacial surgeons. Each photograph was judged on a modified visual analogue scale (VA S, 0-10; 0 'very unattractive' to 10 'very attractive'). A four-level mixed model was fitted in which the VA S score was the dependent variable; cases, profession, view, and rater were independent variables.

RESULTS

Compared with laypersons, orthodontists gave higher VA S scores (+0.69, 95% confidence interval (CI) [0.53, 0.84]; P < 0.001), followed by surgeons (+0.21, 95% CI [0.03, 0.38], P = 0.02). Controls were given significantly higher scores than patients with clefts for profile and frontal photographs (+1.97, 95% CI [1.60; 2.35], P < 0.001). No significant difference was found between the scores for the frontal and lateral views (P = 0.46).

CONCLUSIONS

All the different rater panels were less satisfied with the facial aesthetics of patients with clefts compared with that of control patients. Further research should evaluate whether these findings correlate with patients' self-perception and to what extent it affects the patients' psychosocial well-being.

Preoperative incisor inclination in patients with Class III dentofacial deformities treated with orthognathic surgery

Our aim was to evaluate cephalometrically the preoperative inclination of the incisors in a group of 50 patients with Class III dentofacial deformities whose immediate preoperative lateral cephalometric radiographs were analysed after they had been treated by maxillary advancement. The radiographs were hand-traced by the same operator who made the cephalometric analysis. Mean values for each measurement were compared with the normal values using Student's t-test (p<0.05). Results showed significantly increased inclination of the upper incisors, with a mean U1-NA angle of 27.58° and a mean U1-PP angle of 116°. The lower incisors were also inclined lingually, with a mean L1-NB angle of 22.53° and a mean IMPA of 83.13°. Thirty-five of the patients had labial inclination of the upper, and 28 lingual inclination of the lower, incisors. Mean inclinations of upper and lower incisors differed from the normal values, and the inclination of the lower incisors was more likely to be decompensated than that of the upper incisors.

Perceptions of dental aesthetics of Class III and anterior open bite malocclusions: a comparison between 10- to 11-year-old schoolchildren and orthodontists

OBJECTIVE

To compare perceptions of dental aesthetics of Class III and anterior open bite (AOB) malocclusions between 10- to 11-year-old Birmingham schoolchildren and orthodontists.

MATERIALS AND METHODS

Thirty-one orthodontists practicing in Birmingham (UK) and 383 school children aged 10-11 years from a random and representative sample of seven primary schools in South Birmingham participated in the study. Participants were asked to assess five anterior photographs of the dentition representing varying degrees of aesthetic impairment of Class III and AOB malocclusions. Perceptions of dental aesthetics were determined using the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN).

RESULTS

Perceptions of dental aesthetics were similar among males and females (P > .05). Both groups allocated the highest median AC score to the photo representing severe Class III malocclusion and the lowest to the photo representing mild Class III and AOB malocclusion. Differences in perceived dental aesthetics were significant for photos representing severe Class III and moderate AOB malocclusions, with orthodontists perceiving greater aesthetic impairment for severe Class III and schoolchildren for moderate AOB, respectively (P < .05).

CONCLUSIONS

Schoolchildren and orthodontists perceived Class III malocclusions to have greater aesthetic impairment compared to AOB malocclusions. Surprisingly, none of the median AC scores allocated to the five photos were in the "Definite need" for treatment category. The IOTN may not be sensitive to these types of malocclusions. This finding merits further investigation.

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.

Professionals' and laypersons' appreciation of various options for Class III surgical correction

SUMMARY

The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative the overjet, the larger the nasofacial angle, the smaller the nasomental angle, the greater the preference for the Le Fort I option). Wits appraisal seemed to be important in decision making between the mandibular setback and bimaxillary options (the more negative the Wits appraisal, the greater the preference for the latter option).