Deformidades dentoesqueléticas influenciam no julgamento social das pessoas? / Do dentoskeletal deformities influence people's social judgment?

Os padrões estéticos desempenham um importante papel na aceitação social, por conta disso há uma preocupação acerca dos impactos psicossociais que deformidades dentoesqueléticas podem causar a um indivíduo. Partindo desse pressuposto, esta pesquisa tem por objetivo desenvolver, validar e aplicar um instrumento/questionário que avalie as repercussões estéticas e sociais que a correção ortocirúrgica de classe II causa em indivíduos leigos. Fotografias em vista frontal e lateral de um indivíduo do sexo masculino e outro do sexo feminino, portadores de deformidade dentoesquelética de classe II por retrusão de mandíbula, foram manipuladas (Adobe Photoshop v.23.0.1, Adobe Systems Inc., San Jose, CA) de modo a simular a correção da deformidade dentoesquelética ântero-posterior. Para isso, foi criado, validado e aplicado um questionário contendo 10 perguntas que avaliavam questões estéticas e psicossociais. As respostas às questões foram: certamente sim" = 4 pontos, "talvez sim" = 3 pontos, "neutro" = 2 pontos, "talvez não" = 1 ponto e "certamente não" = 0 pontos. O conjunto de fotografias/questionário foi aplicado a 159 indivíduos leigos, com idades entre 18 e 76 anos. Estatística descritiva (média ± desvio padrão; mediana e intervalo interquartil) e teste de Wilcoxon foram utilizados para comparar os escores de julgamento social. Como resultado, o questionário desenvolvido apresentou aceitabilidade, confirmou a confiabilidade e validade do construto e consistência interna adequada (ICC: 0,5 - 0,7). Independentemente do sexo do indivíduo na imagem, as pontuações de julgamento social, em geral, foram maiores nas fotografias manipuladas que simulam a correção da classe II esquelética por meio de cirurgia ortognática (P < 0,001). Ao comparar as fotografias originais (controle) de acordo com o sexo, o indivíduo do sexo feminino apresentou escores maiores que do sexo masculino (P < 0,001). Portanto, conclui-se que o questionário desenvolvido se mostrou válido para avaliar as repercussões estéticas e sociais que a correção ortocirúrgica classe II causa em indivíduos leigos, além de ter demonstrado que essa maloclusão impacta negativamente na percepção e julgamento social dos leigos. (AU)

Aesthetic standards play an important role in social acceptance. Consequently, there is a concern about the psychosocial impacts that dentoskeletal deformities can cause to an individual. Based on this assumption, this research aims to develop, validate and apply an instrument that assesses the aesthetic and social repercussions class II orthosurgical correction causes in lay people. Front and side photographs of a male and a female subject with dentoskeletal class II deformity due to mandibular retrusion were manipulated (Adobe Photoshop v.23.0.1, Adobe Systems Inc., San Jose, CA) to simulate the correction of anteroposterior dentoskeletal deformity. For this, a questionnaire was created, validated and applied, containing 10 questions that evaluated aesthetic and psychosocial issues. The answers to the questions were: certainly yes" = 4 points, "maybe yes" = 3 points, "neutral" = 2 points, "maybe no" = 1 point and "certainly not" = 0 points. The set of photographs/questionnaire was applied to 159 lay individuals, aged between 18 and 76 years. Descriptive statistics (mean ± standard deviation; median and interquartile range) and Wilcoxon test were used to compare social judgment scores. As a result, the questionnaire developed showed acceptability, confirmed the reliability and validity of the construct and appropriate internal consistency (ICC: 0.5 - 0.7). Independently of the sex of the individual in the image, social judgment scores were generally higher in manipulated photographs that simulate skeletal class II correction of skeletal class II through orthognathic surgery (P < 0.001). When comparing the original photographs (control) according to sex, the female individual had higher scores than the male (P < 0.001). Therefore, it is concluded that the developed questionnaire proved to be valid to evaluate the aesthetic and social repercussions that the class II orthosurgical correction causes in laypersons, in addition to having demonstrated that this malocclusion negatively impacts the laypersons' perception and social judgment. (AU)

Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017.

PURPOSE: The objectives of this study were to evaluate the effect of orthognathic surgery on the long-term quality of life of patients who received this treatment and to delineate the common reasons for dissatisfaction. MATERIALS AND METHODS: In this retrospective cohort study, patients who underwent orthognathic surgery were studied. One hundred thirty-two patients who had undergone orthognathic surgery from 2007 to 2017 in the oral and maxillofacial surgery department participated in this study. They were divided based on their dentofacial deformity into those with Class II malocclusion and those with Class III malocclusion. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 91.7%. No significant difference between male and female patients was found regarding the changes in social, esthetic, and functional aspects before and after orthognathic surgery. Both genders recommended orthognathic surgery for patients with similar problems. One in four patients was dissatisfied with the nasal appearance after the surgical procedure (25.8%). CONCLUSIONS: In this study the patients' satisfaction from the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and then functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance.

Comparison between Classic Twin-block and a Modified Clear Twin-block in Class II, Division 1 Malocclusions: A Randomized Clinical Trial.

AIM: The aim of this study was to compare dentoskeletal effects and patient's satisfaction with a modified twin-block (clear twin-block) and classic twin-block. MATERIALS AND METHODS: A total of 62 patients with skeletal class II malocclusion contributing to mandibular retrognathism with a minimum of 4 mm overjet, the FMA angle between 20 to 25 degree and being in stage 2 to 3 of cervical vertebral maturation participated in this study. Subjects were randomized in 1:1 ratio to classic and clear twin-block. Lateral cephalograms were taken at two stages-Pre- and post-treatment (when the overjet reduced to 1 to 0 mm). All the measurements were done with Dolphin software version 10.5. Four months after the start of the treatment the patients were asked to fill the questioners regarding their compliance from the appliances. RESULTS: Both classic and clear twin-block groups showed mandibular advancement without statistically significant difference between them. However, SNB angle increased slightly more in clear group than the classic one. "Headgear effect" is not statistically noticeable in both groups. However, SNA angle decreased slightly more in classic group. Increased in lower incisors proclination was happening in both groups, but in a clear group, this increase was significantly less. Overbite reduction could be seen in both groups with significantly more reduction in the classic group. CONCLUSION: Increase in lower incisors proclination was less in clear group than the classic one. Overbite reduction was more in the classic group than the classic one. CLINICAL SIGNIFICANCE: Clear twin-block is more beneficial in skeletal class II patients with proclined lower incisors and vertical growth pattern.

A New Approach to Maxillary Protrusion with an Unstable Mandibular Position Accompanied with Unidentified Complaints: Case Report.

This case report describes the importance of combining morphological and functional examination with psychological examination in the establishment ofstable mandibular position in the treatment of maxillary protrusion with unstable mandibular position accompanied by unidentified complaints, which ensures safe orthodontic treatment.

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.

Effect of malocclusion severity on oral health-related quality of life and food intake ability in a Korean population.

INTRODUCTION: The aim of this study was to evaluate the effect of malocclusion severity on oral health-related quality of life and food intake ability in adult patients, controlling for sex, age, and the type of dental clinic visited. METHODS: The sample consisted of 472 Korean patients (156 male, 316 female) with a mean age of 21.1 (SD, 8.6) years in a dental hospital and a private clinic. The correlations between the Korean version of the Oral Health Impact Profile-14 (OHIP-14K), subjective food intake ability (FIA) for 5 key foods, and Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) were investigated. RESULTS: The mean IOTN-DHC and OHIP-14K scores were significantly higher for the dental hospital patients than for the private clinic patients (IOTN-DHC, P <0.001; OHIP-14K, P <0.05). Malocclusion severity was significantly higher in male than in female subjects (P <0.001). Older patients perceived their oral health-related quality of life more negatively than did the teens (P <0.001). As the severity of the malocclusion increased, oral health-related quality of life and masticatory function worsened (OHIP-14K, P <0.001; FIA, P <0.05). CONCLUSIONS: As the severity of the malocclusion and the age of the patients increased, oral health-related quality of life and masticatory function relatively deteriorated. This finding provides evidence that severe malocclusions are associated with lower quality of life and less masticatory efficiency in older patients.

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.

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.

Life-quality of orthognathic surgery patients: the search for an integral diagnosis.

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

[Early orthodontic treatment for growth modification by functional appliances--pros and cons].

The optimal timing for commencement of orthodontic treatment has been controversial. Initial early orthodontic treatment usually begins at the deciduous dentition or early mixed dentition stage and continues for 12-18 months. In most cases, a second treatment phase will be required in the permanent dentition stage to achieve the treatment goals and a stable occlusion. One of the main purposes of the early treatment phase is to affect the growth pattern of the jaw and consequently correct skeletal imbalance and prevent future severe malocclusion by means of growth modification. Some clinicians strongly believe that early intervention with functional appliances improves facial harmony and simplifies as well as shortens the second orthodontic treatment phase. In contrast others advocate that it is unnecessary as the early treatment results will be eliminated by future growth and a recurrent treatment phase is essential in the permanent dentition stage in any case. Thus it is merely a waste of time and resources, and all treatment goals could be reached by a comprehensive single continued treatment phase in the late mixed dentition stage. This article summarizes the scientific literature on the different concepts of early functional orthodontic treatment of Skeletal Class II malocclusion correction vs. a single comprehensive orthodontic treatment process in the late mixed dentition stage. The indications and benefits of each of the approaches are discussed in detail. In conclusion, most of the researchers recommend early orthodontic intervention in children suffering psychological and social problems associated with their malocclusion. Prevention of traumatic injury in cases of maxillary incisor protrusive inclination is also considered an indication for early orthodontic treatment.

Does the British Orthodontic Society orthognathic DVD aid a prospective patient's decision making? A qualitative study.

OBJECTIVES: To explore the views of potential orthognathic patients regarding the influence of the BOS Orthognathic DVD in their decision making process. DESIGN: Qualitative, cross-sectional study. SETTING: A UK dental teaching hospital. PARTICIPANTS: Patients considering orthognathic treatment. METHODS: New patients were recruited from orthognathic clinics following an initial consultation. After an appropriate time to view the DVD, in-depth interviews were conducted with 10 patients (aged 16-48 years) in their homes. Interviews explored the attitudes and perceptions that influenced decisions about surgery, with a focus on the role of the DVD in this process. The interviews were transcribed and a framework analysis was undertaken. RESULTS: The main themes identified were participant perceptions on the patient stories, use of images, the nature of the DVD itself and its usefulness in the decision making process. Participants reported they were heavily influenced by the patient stories. Virtual animations of surgery were seen as useful; whereas the before and after images of surgery were found to be disorientating. The design of the menu resulted in confusion or information being missed. The DVD was seen as a trusted resource, whereas the Internet was seen as biased, general and sensationalistic. CONCLUSIONS: The DVD gives trusted information that patients cannot obtain or process from professional sources or the Internet. If used properly it can have a role in the decision making process, but should be seen within the context of other influences on the patient. This research has highlighted some aspects of the DVD that could be improved upon.

Analysis of anterior dentoalveolar and perioral aesthetic characteristics and their impact on the decision to undergo a Phase II orthodontic treatment.

OBJECTIVES: Researchers have conducted extensive studies regarding dentoalveolar factors that affect anterior dental aesthetics; however, there is no consensus regarding how these factors affect orthodontic treatment decisions. Only a few studies have included multiple factors simultaneously. Therefore, the objective was to investigate if there are identifiable dentofacial and perioral aesthetic factors that bias laypeople towards discontinuing treatment after a phase I treatment with this fixed class II corrector. METHODS: An analysis of photos and dental casts of 60 children (23 males, 37 females) having received phase I orthodontic treatment with the Xbow appliance was conducted. Variables considered were incisor height and width measurements, incisor proportions, incisor angulations, vertical lip thickness, gingival/incisal display, smile width per cent, diastema, midline deviation, smile arc, gender, and use of a 2×4. A principal component analysis and a logistic regression were used to determine which factors related to a patient's likelihood of receiving further orthodontic treatment. RESULTS: Only the angulation of the right maxillary incisors was significantly related to a patient's likelihood (odds ratio 1.886 (1.004-3.466); P = 0.049) to proceed to phase II orthodontic treatment following phase I orthodontic treatment with the Xbow appliance. The odds of proceeding to phase II treatment were 86.6% greater with a one standard deviation increase in the angulation of the right central and lateral incisors. Other factors demonstrated trends but were not statistically significant. LIMITATIONS: Sample in subgroups was small, excluded smiles that did not expose the upper incisor crowns significantly, smiles in real life are observed three-dimensionally, other factors outside the aesthetic measurements were not considered in the analysis. CONCLUSIONS: In this sample, the angulation of the maxillary right incisors was the most significant factor influencing the decision to undergo an orthodontic phase II.

Life-quality of orthognathic surgery patients: The search for an integral diagnosis

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

A decisão de iniciar um tratamento ortodôntico-cirúrgico depende do impacto negativo estético, funcional ou social gerado pela deformidade dentofacial na qualidade de vida de cada paciente. O objetivo deste artigo é demonstrar a importância da avaliação da qualidade de vida desses indivíduos para elevar a taxa de sucesso no tratamento ortodôntico-cirúrgico, por meio da aplicação de questionários específicos antes do início do tratamento. Esses instrumentos avaliam, além do fator estético, as condições funcionais que podem estar afetadas e os problemas psicológicos relacionados à autoestima e à sociabilidade, que devem ser identificados para possibilitar a elaboração de um plano de tratamento individualizado para as expectativas subjetivas do paciente. Assim, torna-se mais previsível obter um alto grau de satisfação ao final do tratamento ortodôntico-cirúrgico, tanto do ponto de vista normativo avaliado pelos profissionais quanto do ponto de vista subjetivo dos pacientes. Apesar da deficiência de dados comparáveis suficientes na literatura disponível para avaliar a extensão da melhora após o tratamento ortodôntico-cirúrgico, há relatos recentes de universidades em diversos países que demonstram uma boa resposta da maioria dos pacientes após a cirurgia, com alto grau de satisfação dos pontos de vista estético, funcional e psicossocial. Conclui-se que o objetivo atual do tratamento ortodôntico associado à cirurgia ortognática consiste em não apenas tratar os componentes estético e funcional da deformidade dentofacial, mas, também, o de considerar o componente psicológico do paciente.

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.

Presurgical motivations, self-esteem, and oral health of orthognathic surgery patients.

PURPOSE: The aim of this study was to evaluate motivations, self-esteem, and oral health for undergoing orthognathic patients by gender in China before orthognathic surgery. PATIENTS AND METHODS: Using a prospective and control study design, 429 subjects in China were collected from December 2010 to May 2011. The patient group consisted of 210 consecutive healthy patients, and 219 young individuals comprised the control group. All the subjects filled out a questionnaire and were assessed by Self-esteem Scale and Oral Health Impact Profile validated for Chinese patients before surgery. To measure the discrepancy, the Student t test was computed. P <0.05 was considered significant. RESULTS: In China, major motivations for orthognathic surgery are to improve facial appearance (83.33%), occlusion (50%), and self-confidence (48.1%). Females expect to improve facial appearance (83.87%), self-confidence (43.55%), and occlusion (41.94%). Males are for the improvement of facial appearance (82.56%), occlusion (63.95%), and self-confidence (54.65%). Self-esteem in the patient group is obviously lower (P < 0.01). There is a significant difference of self-esteem in female groups (P < 0.01), but none in male groups. Statistically significant differences were observed on oral health between both sexes. CONCLUSIONS: (1) Special attention should be paid on patients' ethnic, economic, cultural, and social aspects. In Chinese orthognathic patients, improving facial appearance is the primary motivation. Self-confidence has been more frequently mentioned, while headache far less than other countries. (2) Female patients have less self-esteem than females in the control group. (3) Patients' oral health are worse than those in the control group.

Dentofacial deformities are associated with lower degrees of self-esteem and higher impact on oral health-related quality of life: results from an observational study involving adults.

PURPOSE: Patients with dentofacial deformities tend to show poorer oral health-related quality of life, but few studies thus far have focused on this topic. Therefore, the objectives of this study were to evaluate oral health-related quality of life, self-esteem, and depression in patients with Class II and Class III dentofacial deformities before orthodontic treatment and to compare these patients with controls with harmonic faces. MATERIALS AND METHODS: This observational, cross-sectional study compared 2 groups (experimental vs control) of patients recruited at an outpatient orthodontic clinic. Oral health-related quality of life was assessed using a short form of the Oral Health Impact Profile, self-esteem was evaluated with the Rosenberg Self-Esteem Scale, and depression symptoms were assessed using the General Hospital Depression Scale (outcome variables). The presence of dentofacial deformities (ie, group allocation) was the primary predictor variable. The χ(2) test and Spearman correlation coefficient were used to analyze data. RESULTS: The total sample was composed of 68 individuals (34 in each group). In the experimental group, 55.9% of patients were women, and 88.2% presented a Class III occlusal relation. The mean age in the experimental group was 27.56 years. Significant differences were observed between the 2 groups in oral health-related quality of life (P < .001) and self-esteem (P < .019), but no differences were found for depression (P = .161). CONCLUSIONS: Patients with dentofacial deformities had a more negative oral health-related quality of life and a lower self-esteem compared with controls. No association was observed between dentofacial deformities and depression.