Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample.

OBJECTIVE: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. MATERIAL AND METHODS: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. RESULTS: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. CONCLUSION: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample

ABSTRACT Objective: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. Material and Methods: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. Results: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. Conclusion: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

RESUMO Objetivo: comparar os escores relacionados à autoestima de adolescentes com 12 a 16 anos de idade, portadores de diferentes tipos de má oclusão de Angle, em uma amostra de peruanos. Métodos: um estudo transversal foi conduzido com uma amostra de 276 adolescentes (159, 52 e 65, respectivamente, com má oclusão de Classe I, II e III de Angle) da cidade de Trujillo, Peru. Os participantes foram instruídos a completar a Escala de Autoestima de Rosenberg (Rosenberg self-esteem scale, ou RSES), e também foram submetidos a exames clínicos para determinar qual sua má oclusão, segundo a classificação de Angle. A análise de covariância (ANCOVA) foi utilizada para comparar os escores da RSES dos adolescentes com más oclusões de Classes I, II e III, controlando-se os fatores demográficos dos participantes. Resultados: as médias dos escores da RSES dos adolescentes com Classes I, II e III foram, respectivamente: 20,47 ± 3,96, 21,96 ± 3,27 e 21,26 ± 4,81. O teste ANCOVA revelou que o escore da RSES dos adolescentes com Classe II foi significativamente maior do que o escore dos adolescentes com Classe I, mas não houve diferenças entre os outros grupos de más oclusões. Uma análise adicional sugeriu que podem ser somente os adolescentes Classe II, subdivisão 2, que apresentam autoestima mais elevada, quando comparados aos adolescentes Classe I. Conclusão: esse estudo mostrou que, no geral, a autoestima dos adolescentes incluídos na amostra estudada não variou em função da má oclusão apresentada. Inesperadamente, apenas os adolescentes com Classe II - especialmente os com Classe II, subdivisão 2 - relataram apresentar uma autoestima mais elevada do que os adolescentes com Classe I. Uma análise mais detalhada deve ser conduzida, avaliando qual característica oclusal da região anterior tem mais impacto.

Oral Impacts on Quality of Life in Adult Patients with Class I, II and III Malocclusion.

PURPOSE: To compare the social impact of malocclusion on quality of life between adult patients with Angle Class I, II and III malocclusion. MATERIALS AND METHODS: A total of 222 adult patients (139, 42 and 41 with Angle Class I, II and III malocclusion, respectively) were recruited voluntarily from those attending the Orthodontic Clinic of Khyber College of Dentistry in Pesh awar, Pakistan. Participants were asked to complete the Urdu version of the short form of the Oral Health Impact Profile (OHIP-14), which was previously validated for this study. Multivariate analysis of variance (MANOVA) was used to compare the seven OHIP-14 domains scores and the total score between patients with malocclusion Class I, II and III. RESULTS: Adults with Class III malocclusion had a significantly higher OHIP-14 total score than those with Class I malocclusion (a mean difference of 5 units between groups), but there were no differences between other Angle malocclusion groups. In addition, adults with Class III malocclusion reported greater impacts on the three OHIP-14 disability domains (physical, psychological and social) than those with Class I malocclusion. No significant interactions with sex and age were found. CONCLUSION: These findings suggest that adult patients with Class III malocclusion had a poorer quality of life than those with Class I malocclusion. Differences were mainly found in the physical, psychological and social disability domains of the OHIP-14 instrument.

Assessing changes in quality of life using the Oral Health Impact Profile (OHIP) in patients with different classifications of malocclusion during comprehensive orthodontic treatment.

BACKGROUND: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment. METHODS: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance. RESULTS: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1. CONCLUSIONS: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.

How Do Patients and Parents Decide for Orthodontic Treatment-Effects of Malocclusion, Personal Expectations, Education and Media.

OBJECTIVES: To examine patients' and parents' perceptions and expectations from orthodontic treatment. STUDY DESIGN: 491 patients (274 female, 217 male) aged 14-22 years, and 399 parents (245 female, 154 male) completed a questionnaire about preferences, needs and expectations about orthodontic treatment, and scored the present problem. Continuous variables were compared by Mann-Whitney U and Kruskal-Wallis tests, whereas Chi-square test was used for categorical variables. RESULTS: Patients'(77.1%) and parents'(84.6%), decision about orthodontic treatments were influenced by suggestion of dentists. Patients who decided to attend to clinic by themselves were higher than parents (p=0.006). Dental aesthetics was the determinant factor for treatment demand for patients(61.0%) and parents(57.3%). Improvement in oral functions was more important for Class III patients than Class I patients (p=0.040). Adult patients/parents with higher education gave more importance to oral functions as well as dental aesthetics (p=0.031). There was no difference among Angle classifications regarding orthodontic problem scores. Parents found media sources valuable (p=0.018) but majority expected dentists for information about orthodontic treatments. Education degree of adult patients/parents effected this decision(p=0.002). CONCLUSIONS: Desire to have better dental aesthetics was the primary motivating factor for all participants. Clinicians should consider concerns of Class III patients about oral functions during treatment planning.

The impact of dental appearance and anxiety on self-esteem in adult orthodontic patients.

OBJECTIVES: To analyse the relationship between different dimensions of dental appearance impact and self-esteem in adult patients undergoing orthodontic treatment, with special attention to the possible mediating role of anxiety. SETTING AND SAMPLE POPULATION: A quasi-experimental design was used with a matched control group (without orthodontic treatment). In each group (experimental and control), there were 85 patients. MATERIAL AND METHODS: The impact of dental appearance was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). State anxiety was assessed with the State Anxiety Inventory (STAI-S) and self-esteem with Rosenberg's self-esteem scale. RESULTS: In both groups (experimental and control), self-esteem correlates negatively, ranging between 0.26 and 0.43, with all dimensions of dental appearance impact (except for the positive dental self-confidence dimension, where all correlations were positive). Anxiety correlates positively, ranges between 0.35 and 0.44, with social impact, psychological impact and aesthetic concern, although it maintains no significant correlations with dental self-confidence. Nevertheless, in patients undergoing orthodontic treatment, anxiety plays a mediating role between dental impact dimensions and self-esteem, whilst for the control group anxiety only plays a mediator role between psychological impact and self-esteem. CONCLUSION: Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults.

Evaluation of facial attractiveness for patients with malocclusion: a machine-learning technique employing Procrustes.

OBJECTIVE: To establish an objective method for evaluating facial attractiveness from a set of orthodontic photographs. MATERIALS AND METHODS: One hundred eight malocclusion patients randomly selected from six universities in China were randomly divided into nine groups, with each group containing an equal number of patients with Class I, II, and III malocclusions. Sixty-nine expert Chinese orthodontists ranked photographs of the patients (frontal, lateral, and frontal smiling photos) before and after orthodontic treatment from "most attractive" to "least attractive" in each group. A weighted mean ranking was then calculated for each patient, based on which a three-point scale was created. Procrustes superimposition was conducted on 101 landmarks identified on the photographs. A support vector regression (SVR) function was set up according to the coordinate values of identified landmarks of each photographic set and its corresponding grading. Its predictive ability was tested for each group in turn. RESULTS: The average coincidence rate obtained for comparisons of the subjective ratings with the SVR evaluation was 71.8% according to 18 verification tests. CONCLUSIONS: Geometric morphometrics combined with SVR may be a prospective method for objective comprehensive evaluation of facial attractiveness in the near future.

Effect of incisor position on the self-perceived psychosocial impacts of malocclusion among Chinese young adults.

OBJECTIVE: To evaluate the impact of the incisor position on the self-perceived psychosocial impacts of malocclusion among Chinese young adults. MATERIALS AND METHODS: This cross-sectional study included a convenience sample of 17.1- to 22.3-year-old young adults (n = 1005). The five groups represented were normal occlusion as well as incisor Class I, Class II/1, Class II/2, and Class III malocclusion. For clinical assessment, the incisor relationship was evaluated according to the British Standards Institute Incisor Classification, and the self-perception of dental esthetics was assessed using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Statistical analysis involved the analysis of variance and Tukey multiple-comparison post hoc tests. RESULTS: Psychosocial impacts were different among the five groups for the four PIDAQ domains (P < .001 for all four domains). Statistically significant differences were found between the four malocclusion groups and the normal occlusion group in all four domains (P < .001 for all four domains). Furthermore, statistically significant differences were found between four malocclusion groups. CONCLUSIONS: All four malocclusion groups had more severe psychosocial impacts than the normal occlusion group in the four PIDAQ domains. Statistically significant differences were also found between the four malocclusion groups; these malocclusion groups ranked by score, highest to lowest, were Class III, Class II/1, Class II/2, and Class I.

Assessing the influence of lower facial profile convexity on perceived attractiveness in the orthognathic patient, clinician, and layperson.

OBJECTIVE: The aim was a quantitative evaluation of how the severity of lower facial profile convexity influences perceived attractiveness. STUDY DESIGN: The lower facial profile of an idealized image was altered incrementally between 14° to -16°. Images were rated on a Likert scale by orthognathic patients, laypeople, and clinicians. RESULTS: Attractiveness ratings were greater for straight profiles in relation to convex/concave, with no significant difference between convex and concave profiles. Ratings decreased by 0.23 of a level for every degree increase in the convexity angle. Class II/III patients gave significantly reduced ratings of attractiveness and had greater desire for surgery than class I. CONCLUSIONS: A straight profile is perceived as most attractive and greater degrees of convexity or concavity deemed progressively less attractive, but a range of 10° to -12° may be deemed acceptable; beyond these values surgical correction is desired. Patients are most critical, and clinicians are more critical than laypeople.

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.

Factors associated with long-term patient satisfaction.

OBJECTIVE: To identify factors associated with patient satisfaction at least 5 years after orthodontic treatment. MATERIALS AND METHODS: A total of 209 orthodontic patients were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances. Dental casts (n = 627) were examined using the Peer Assessment Rating (PAR) Index pretreatment (T1), at the end of treatment (T2) and at a long-term follow-up (mean, 8.5 years; T3). At T3, a Dental Impact on Daily Living questionnaire was used to assess the long-term effects of orthodontic treatment on daily living and satisfaction with the dentition. Multiple regression analyses were used to quantify associations between patient satisfaction and changes produced by the orthodontic treatment (PAR T2-T1), posttreatment stability (PAR T3), age at the start of treatment (T1), treatment duration (T2-T1), gender, and extraction. RESULTS: Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at least 5 years after treatment. Regression analysis showed that satisfaction was significantly associated only with the long-term posttreatment PAR index (r(2) = 0.125, P < .0001). No significant association was observed with the severity of malocclusion at the beginning (PAR-T1) or end of the orthodontic treatment (PAR-T2), age at T1, the amount of time taken during orthodontic treatment, gender, or extraction. CONCLUSIONS: Over the long term, patient satisfaction is slightly associated with the stability of the orthodontic treatment regardless of the initial occlusal condition or the final result of the orthodontic treatment.

Condition-specific impacts on quality of life attributed to malocclusion by adolescents with normal occlusion and Class I, II and III malocclusion.

OBJECTIVE: To compare the prevalence, intensity, and extent of condition-specific oral impacts on quality of life attributed to malocclusion by Brazilian adolescents with normal occlusion and those with Angle Class I, II, and III malocclusion. MATERIALS AND METHODS: Four groups of 55 adolescents were configured such that each group represented normal occlusion, as well as Angle Class I, II, and III malocclusion. No radiographs were taken. Adolescents aged 15 to 16 years were selected from those attending all secondary schools in Bauru (Sao Paulo, Brazil). The Oral Impacts on Daily Performances index was used to collect data on condition-specific impacts (CSIs) attributed to malocclusion. The prevalence, as well as the intensity and extent, of CSIs was compared among the four groups with the use of Chi-square and Kruskal-Wallis tests, respectively. RESULTS: Groups were comparable according to sex, age, and socioeconomic status. The prevalence of CSI was significantly different between groups (P = .039). Class II and III malocclusion groups reported a higher prevalence of CSI than those with normal occlusion and Class I malocclusion. However, the intensity and extent of CSI were not significantly different between groups. CONCLUSIONS: The prevalence, but not the intensity and extent, of CSIs attributed to malocclusion differed among groups with different malocclusions. The present findings support the concept that malocclusion has physical, psychological, and social effects on quality of life.

Attractiveness of facial profiles as rated by individuals with different levels of education.

OBJECTIVE: The reasons people consult the orthodontist are functional, prophylactic and esthetic in nature, which is why it is important to know (in justifying an intervention for esthetic reasons) what patients themselves find attractive, and whether German university graduates and non-graduates would evaluate the attractiveness of profile views of Class-I, -II and -III patients differently. We also were interested in identifying per group the degree of deviation (from a "normal" skeletal profile) from which the appraisers would judge that profile to be unattractive. MATERIALS AND METHODS: A total of five skeletal Class-I patients with straight-average faces (ideal biometric face as defined by A. M. Schwarz 1958) were transformed to reflect three Class-II profile variants and three Class-III profile variants with Onyx Ceph software. Out of the 35 profiles thus obtained we formed two groups of 20 each. Group 1 comprised the five straight-average (biometric) faces and six retrognathic and nine prognathic profile variants. Group 2 comprised the same five straight-average faces and the remaining retrognathic and prognathic profile variants. Both face groups were evaluated by 117 university graduates (65 men and 52 women) and 103 non-graduates (49 men and 54 women) between 23 and 41 years old. The participants were randomly assigned to the two groups. These volunteers were asked to rate the profiles along a scale of 0 (least attractive) to 10 (most attractive). The paper copies with the profiles were assessed in comparison to a single profile that had been classified with an average of 7.6 by ten orthodontists. RESULTS: Both groups of observers perceived the five straight-average faces similarly in the first and second scoring rounds. The straight-average face was perceived as the most attractive by both the university graduates (mean: 5.37; 95% CI: 5.15-5.59) and non-graduates (mean: 5.71; 95% CI: 5.48-5.95), followed immediately by mildly and moderately retrognathic, as well as mildly prognathic profile lines. Both groups perceived extremely prognathic and retrognathic profile lines as the least attractive (mean value for graduates: 4.27; 95% CI: 4.05-4.49; for nongraduates: 4.83; 95% CI: 4.59-5.06), with the university graduates' ratings being significantly lower than those of the nongraduates. Grouping the subjects by gender yielded only minor differences in perception. CONCLUSION: The straight-average face was perceived as being the most attractive by representative populations in Germany. On the whole, the university graduates were more critical in their ratings than non-graduates.

Smile esthetics: perception and comparison of treated and untreated smiles.

INTRODUCTION: Although orthodontic treatment is based primarily on occlusal relationships, greater attention is now paid to enhancing dentofacial characteristics to produce optimal facial esthetics. The purposes of this study were to compare smile esthetics among extraction and nonextraction patients and a control group, assess certain dentofacial characteristics in those groups, and discuss how these features relate to smile esthetics. METHODS: Panels of orthodontists, plastic surgeons, artists, general dentists, dental professionals, and parents used a 5-point scale to rate smiling photographs of 25 extraction, 25 nonextraction, and 25 untreated control subjects. Dentofacial characteristics of the 3 groups were obtained from lateral cephalometric analyses, direct biometric measurements, and frontal photographs. Smile esthetics and differences among the 3 groups were subjected to 1-way analysis of variance (ANOVA), and Pearson correlation coefficients were calculated to determine the relationship of the variables to the esthetic score. RESULTS: The mean esthetic scores for the extraction, nonextraction, and control groups were 3.15, 3.12, and 3.26, respectively. Visible dentition width relative to the smile width ratio and intercanine distance relative to smile width ratio were significantly different among the groups, with extraction patients showing a slightly wider dental arch relative to the soft tissue (P < .05). There was also a significant difference in the U1-SN angle among the groups (P < .05), and this variable showed a strong correlation with the esthetic score as did maxillary gingival display (P < .05). However, our study groups could not be differentiated in smile esthetics.

Perceived relative attractiveness of facial profiles with varying degrees of skeletal anomalies.

OBJECTIVE: The objective of this study was to answer the following questions: Are profiles of Class I patients perceived as more attractive than profiles of Class II or Class III patients in Germany today? How pronounced must a skeletal malocclusion be to be perceived as less attractive? Are there differences in perception between dentists and laypersons? MATERIAL AND METHOD: For the present study we examined seven patients with skeletal Class I, orthognathic maxillae and mandibles, and straight average faces (ideal biometric face as defined by A. M. Schwarz). Using the Onyx Ceph software, their profile lines were modified to reflect three different Class II profile variants and three different Class III profile variants. The 49 profiles thus obtained were assigned to two groups. Group 1 comprised the seven straight average faces and the first part of the retrognathic and prognathic profile variants. Group 2 comprised the same seven straight average faces and the remaining retrognathic and prognathic profile variants. Both groups of faces were scored by 130 laypersons and 126 dentists. RESULTS: Both groups of observers perceived the seven straight average faces similarly both in the first and second (subsequent) scoring rounds. The straight average face was perceived as most attractive by laypersons (mean, 5.48; 95% confidence interval (CI:) 5.33-5.60) and dentists (mean, 5.44; 95% CI, 5.28-5.50) alike, followed by the mildest variant of the retrognathic face (laypersons, mean, 4.85; 95% CI, 4.68-5.01; dentists, mean, 4.98; 95% CI, 4.81-5.10). Dentists differentiated more clearly by degree of skeletal malocclusion than did laypersons. Both groups alike perceived the extreme variant of the prognathic and retrognathic profile lines as the least attractive. Grouping the subjects by gender yielded only minor differences in perception. CONCLUSION: The straight average face is perceived as most attractive by representative German populations today. Dentists make clearer gradual distinctions in their perceptions than do laypersons.