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)

[Perceived attractiveness and other characteristics of different male facial types before and after orthognathic surgery].

Orthognathic intervention has not only profound implications on the individual's function and esthetics, but also on the perception of his surrounding environment. In this study, frontal and profile photographs of 3 groups of men (a control group with normal profile and prognathic and retrognathic profiles, before and after orthognathic surgery) were shown in random order to a group of 83 women, who were asked to rate the pictures according to attractiveness and several personality traits on an analog scale. Results show that men with normal profiles got the most positive scores on all categories. Men with prognathic profiles were perceived as more aggressive and assertive, while men with retrognathic profiles were perceived as less intelligent and reliable. After orthognathic intervention both retrognathic and prognathic groups had a significant improvement in their scores, which were closer to the normal profile group.

Assessing the influence of chin prominence on perceived attractiveness in the orthognathic patient, clinician and layperson.

The purpose of this investigation was to undertake an objective and quantitative evaluation of how the degree of chin prominence influences perceived attractiveness. The chin prominence of an idealized profile image was altered in 2 mm increments from -24 to 12 mm, in order to represent retrusion and protrusion of the chin, respectively. These images were rated on a 7-point Likert scale by a pre-selected group of pre-treatment orthognathic patients, clinicians and laypeople. In treatment planning to alter the sagittal prominence of the chin in an individual with an otherwise normal soft tissue facial profile, an 'ideal' sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. Chin retrusion or protrusion up to 4mm is essentially unnoticeable. Surgery is desired for chin protrusions greater than 6mm and retrusions greater than 10mm. The overall direction of aesthetic opinion appears to be the same for all the observer groups; the greater the retrusion or prominence of the chin, the less the rating of the perceived attractiveness and the greater the desire for surgical correction.

Facial profile preferences: differences in the perception of children with and without orthodontic history.

INTRODUCTION: Improved facial esthetics can be fully achievable only if facial preferences of the treated group are known. We hypothesized that facial profile perception and preferences could be influenced by orthodontic treatment. METHODS: Differences in facial profile preferences between children with and without an orthodontic history were investigated in a sample of 1626 children aged 12 to 19 years (mean age, 14.8 ± 2.2 years) from 24 public schools in Zagreb, Croatia, randomly selected by using a cluster sampling procedure. Eight profile distortions for each sex, morphed by a digital imaging technique, were used for estimation. Analysis of variance (ANOVA), Bonferroni, and 2 independent sample t tests were used to compare the preferences of the groups. RESULTS: A straight profile was the most favored in both sexes, regardless of previous orthodontic history. A bimaxillary alveolar protrusive profile with thicker lips was preferred among the female profiles, and a bimaxillary retrusive profile with flat lips and a prominent chin was preferred among the male profiles. Orthodontic history and personal facial profile had little effect, and sex had a slightly greater influence on personal facial profile preferences. CONCLUSIONS: It seems that orthodontic therapy has no clinically relevant influence on facial profile preferences. Depending on the patient's sex, orthodontists should have different criteria for treating borderline patients with bimaxillary dentoalveolar protrusion and mandibular prognathism.

Influence of anteroposterior mandibular positions on facial attractiveness in Japanese adults.

INTRODUCTION: Our aims in this study were to determine the anteroposterior facial relationship that is regarded as most attractive by Japanese laypersons in a questionnaire survey and to evaluate which analysis of the soft-tissue profile is most suitable for Japanese people. METHODS: We showed 262 Japanese laypersons (121 male, 141 female) 9 morphed profile images with Point B and menton anteriorly or distally moved by software and asked them to number them sequentially according to their attractiveness. To examine which analysis best reflects facial attractiveness as judged by laypersons, we made 5 types of analyses of the facial profile with 11 variables in the 9 images. RESULTS: The normal face was judged favorably; however, an attractive profile might be different for each subject. The 3 highest ranking profiles (normal face and moderate mandibular retrusions) were often favorites, and 2 profiles (severe mandibular protrusions) were liked the least for most subjects. However, the other images showed a wide range of distribution. Mandibular retrusion was generally more favored than mandibular protrusion and bimaxillary protrusion (severe chin retrusion) had a high attractiveness ranking and was well accepted in the Japanese population. CONCLUSIONS: To evaluate the profiles of Japanese subjects, it is important to evaluate not only the esthetic line defined by the nose and chin, but also the balance of the upper and lower lips defined by the posterior reference line--ie, Burstone's Sn-Pog' line.

Anteroposterior position of mandible and perceived need for orthognathic surgery.

PURPOSE: This study investigated the association between the anteroposterior position of the mandible and the perceived need for orthognathic surgery. MATERIALS AND METHODS: Profiles of 2 men, 1 black and 1 white, and 2 women, 1 black and 1 white, were photographed and altered to produce photos with a straight profile and 6 simulations of mandibular discrepancies, 3 by retrusion and 3 by protusion from each original face. The 28 faces were evaluated by orthodontists, maxillofacial surgeons, artists, and laypersons. RESULTS: The greatest numbers of indications for surgery were made for male convex profiles and for female concave profiles. Laypersons were more tolerant to profile changes, whereas maxillofacial surgeons indicated surgery and stated that they would seek facial surgery if profiles were their own in a greater number of cases. CONCLUSION: The angle of facial convexity has a strong effect on the perceived need for orthognathic surgery.

Influence of chin prominence on esthetic lip profile preferences.

INTRODUCTION: The purpose of this study was to determine the influence of chin prominence on preferred lip position in profile. METHODS: Five "male" and 5 "female" silhouette profiles differing only in the degree of mandibular retrognathism or prognathism (-25 degrees, -18 degrees, -11 degrees, -4 degrees , and +3 degrees facial contour angles) were created. Using a computer animation program, the evaluators moved the upper and lower lips independently into the positions they deemed to be the most esthetic for each profile. The evaluators included white male and female adolescent orthodontic patients, parents of patients, and orthodontists. RESULTS: In general, no differences in preferred lip position were found between the -11 degrees and -4 degrees profiles or between the -18 degrees and +3 degrees profiles, but preferences for each of the 3 profile groupings (-11 degrees and -4 degrees, -18 degrees and +3 degrees, and -25 degrees) were different. Fuller lip positions were preferred for the more extreme retrognathic and prognathic profiles, whereas more retrusive lip positions were preferred for the more average profiles. No differences were found among the 3 evaluator groups or between male and female evaluators. Scattered differences were found among lip preferences for male and female profiles.

An Asian community's perspective on facial profile attractiveness.

AIM: To assess the facial profile preferences of laypersons in an Asian community and the influence of age, ethnic and gender on profile selection. METHODS: A sample of 149 laypersons (65.1% Chinese, 21.5% Malays and 13.4% Indians), comprising of 112 females (75.2%) participated in the study. The mean age was 24.6 years (SD 4.4). A facial profile photograph and a lateral cephalometric radiograph of a Chinese male and female adult with a normal profile and a class I incisor and skeletal relationship were digitized to create a baseline template. Computerized digital photographic image modification was carried out on the template to obtain seven facial profiles [bimaxillary protrusion, protrusive mandible, retrusive mandible, normal profile (incisor and skeletal class I pattern), retrusive maxilla, protrusive maxilla and bimaxillary retrusion] for each gender. The laypersons were asked to rank the profiles of each gender on a scale of 1 (very attractive) to 7 (least attractive). RESULTS: Orthognathic Chinese male and female profiles were perceived to be the most attractive. A male orthognathic profile with normative Chinese cephalometric values was perceived to be more attractive than a 'flatter' bimaxillary retrusive profile. Bimaxillary retrusion and normal Chinese female profiles were perceived to be the most attractive. A male or female profile with a protrusive mandible was judged to be the least attractive. Age, gender and ethnicity were nonsignificant predictors for the most attractive female profile. CONCLUSIONS: Orthognathic Chinese male and female profiles were judged to be the most attractive by Asian adult laypersons. Male and female profiles with mandibular protrusion were judged to be the least attractive.

Methods to evaluate profile preferences for the anteroposterior position of the mandible.

INTRODUCTION: Facial profile disharmonies in the anteroposterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. Various methods are available for assessing profile preferences, and differences between them could affect treatment decisions. The purposes of this study were to compare and contrast 3 methods of evaluating profile preferences for the AP position of the mandible. METHODS: Facial profile preferences of white orthodontists (n = 28) and white (n = 56) and Japanese-American (n = 55) laypeople were evaluated. The esthetic significance of variations in the AP position of the mandible was investigated by using 3 methods: a traditional semantic differential scale, the Perceptometrics method (Health Programs Intl, Wellesley, Mass), and the implicit association test (IAT). RESULTS: Findings from the semantic differential scale show that, overall, there is a general preference among orthodontists and laypeople for an orthognathic profile (P <.001). Findings from the Perceptometrics method indicate that orthodontists consider the most pleasing profile to be more forward than do lay subjects (P <.001). The IAT results show a positive bias among all 3 groups toward orthognathic profiles and a negative bias toward profiles with mandibular retrognathism or prognathism. The IAT suggested that laypeople were more tolerant of mandibular prognathism in men than in women (P <.01), and more tolerant of mandibular retrognathia in white women than in men (P = .03). CONCLUSIONS: These results support the benefits of using both implicit and explicit methods to assess facial profile preferences.

A comparative assessment of the perception of Chinese facial profile esthetics.

INTRODUCTION: The aim of this study was to compare the perception of male and female Chinese facial profile esthetics between dental professionals, dental students, and laypersons. MATERIAL: The sample comprised 31 dental professionals (20 orthodontists, 11 oral surgeons), 92 dental students, and 152 laypersons in an Asian community. The facial profile photographs and lateral cephalometric radiographs of a Chinese man and a woman, each with a normal profile, a Class I incisor relationship, and a Class I skeletal pattern, were digitized. The digital images were modified to obtain 7 facial profiles for each sex. The images were constructed by altering cephalometric skeletal and dental hard tissue Chinese normative values by 2 standard deviations in the anteroposterior plane only. The 7 profiles were (1) bimaxillary protrusion, (2) protrusive mandible, (3) retrusive mandible, (4) normal profile (Class I incisor with Class I skeletal pattern), (5) retrusive maxilla, (6) protrusive maxilla, and (7) bimaxillary retrusion. RESULTS: Normal and bimaxillary retrusion Chinese male and female profiles were perceived to be highly attractive by all 3 groups. Profiles with a protrusive mandible were perceived to be the least attractive. Dental professionals, dental students, and laypersons were highly correlated for the perception of male (r > 0.67) and female (r > 0.93) profile esthetics. All correlation coefficients were found to be significant for the perception of female profiles, but, for male profiles, only the correlation coefficient between dental students and laypersons was significant. CONCLUSIONS: Chinese male and female profiles that were normal or had bimaxillary retrusion were perceived to be highly attractive by dental professionals, dental students, and laypersons, and profiles with a protrusive mandible were perceived to be the least attractive. Dental students and laypersons were more tolerant of a male profile with a retrusive mandible than were dental professionals, and all groups were more tolerant of bimaxillary protrusion in women than in men. Dental professionals, dental students, and laypersons had a similar trend in male and female esthetic preferences. The perception of female profiles by all 3 groups was highly and significantly correlated. Only the perception of male esthetics by dental students and laypersons was not significantly correlated with dental professionals.

Facial profile preferences among various layers of Turkish population.

There are many criteria and methods used to constitute and determine a standardized esthetic concept in orthodontics. However, the subjectivity of the esthetic concept is the common opinion of the authors. Ethnic and racial differences play a major role in diversifying esthetic preferences. The aims of this study were to determine the general esthetic preference of a Turkish population and to find out whether this preference was affected by sex, age, education, social status, geographic location, or personal profile. Toward these aims, eight profile estimates for each sex were morphed by a video imaging technique and then scored by 400 participants. Analysis of variance (ANOVA) and independent sample t-tests were used to compare the preferences of the groups. The orthognathic profile in both sexes was selected as the most preferred profile whereas the convex profile with a prognathic maxilla and a retrognathic mandible were the least preferred. The public also admired fuller and protrusive lips in females and retrusive lips with a prominent nose and chin in males. Sex, age, education, social status, geographic location, and personal profile were also shown to affect the public's profile preferences.

Esthetic soft tissue profile preferences among the Japanese population.

The purpose of this study was to determine the facial profile preferences in a sample of 2651 randomly selected panelists (mean age, 29.3 +/- 10.1 years) from Japanese cultural and educational backgrounds. Five facial profile types were computer-generated by an orthodontist to represent distinct facial types. Subjects were asked to rank the profiles in descending order of attractiveness. The ranking was as follows: orthognathic profile, bimaxillary retrusive profile, bimaxillary protrusive profile, mandibular retrognathic profile, and mandibular prognathic profile. The differences in rank scores between all the profile types were statistically significant (p < 0.05).

Ranking of facial profiles among Asians.

The purpose of this study was to determine the facial profile preferences in a sample of 1,189 Asian teenagers (aged 15.3 +/- 3.2 years). Five facial profile types were computer-generated by trained personnel (orthodontists and oral maxillofacial surgeons) to represent distinct facial types. Subjects were asked to rank the profiles in descending order of attractiveness. The ranking was as follows: orthognathic profile, bimaxillary retrusive profile, bimaxillary protrusive profile, mandibular retrognathic profile, and mandibular prognathic profile. The differences in rank scores between all the profile types were statistically significant (p < 0.05). Assessment of profile types among lay personnel could provide clinicians an indication into the relative attractiveness among profile types and health care workers in treatment prioritization among dysmorphic facial types.

Impact of orthognathic surgery on normal and abnormal personality dimensions: a 2-year follow-up study of 61 patients.

The psychological adjustments and self-concepts of 61 orthognathic surgery patients were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. The impact of orthognathic surgery on self-concept and personality adjustment was assessed. Significant improvements in group scores were found with the use of a repeated measures ANOVA in the following subscales of personality disturbances: general maladjustment, psychosis, neurosis, personality disorder, and personality integration. A significantly positive effect was also observed in the following subscales of self-concept: self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict. The improved changes in psychological profile two years after orthognathic surgery are encouraging.

Self-assessment of profile and body image among orthognathic surgery patients before and two years after surgery.

Ninety patients undergoing surgery at two major university hospitals completed self-ratings of their profile, perceived deviations from the ideal profile, and a measure of body image. Identical measures were obtained presurgically and two years following surgery. Patients diagnosed with mandibular hypoplasia perceived themselves significantly more prognathic on the maxillary dimension and most retrognathic on the mandibular dimension; their self-drawings reflected a shorter vertical dimension. These perceptions approached the normal range at the postsurgical assessment. Patients treated for maxillary hypoplasia, however, rated themselves in the mandibular prognathic range both before and after surgery. These patients were also more likely to perceive other deviations from the ideal in their facial features 2 years after surgical correction. Body image did not differentiate among diagnostic categories, but showed overall improvements for all patients from presurgery to postsurgery. Profile drawings appear to be the most statistically and clinically useful method of determining patients' self-assessments of deviations from normal, and their perceptions of treatment needs.

[Facial profile--psychological profile]. / Profil facial--profil psychologique.

The morphological organisation of the face reflects the individual's social context and heredity and also reveal certain personality traits. Emotional facial expression is a very special form of communication. This functional and behavioural dynamic leads to the formation of a certain anatomical structure as a result of repetitive functions. The psychological examination of nineteen retrognathic patients and seven prognathic patients revealed the timid, inhibited of even anxious personality of the first group of patients in contrast with the extraverted and frequently aggressive personality of prognathic patients.

[Dentofacial orthopedics and morphopsychology]. / Orthopédie dento-faciale et morpho-psychologie.

Acquired maxillo-facial deformities and in particular those related to problems of facial expression are nevertheless influenced by certain hereditary factors, amongst which the constitutional type or the temperament of the individual play a major role. Morpho-psychology (L. Corman), or the art of relating physical details (especially the shape and characteristics of the face) with psychological state demonstrates correlations between the type of deformity and that of the temperament and explains them. After a brief review of the essential principles of morpho-psychology, the authors study a number of special morpho-psychological types presenting with a significant frequency maxillo-facial deformities, themselves special, and which for this reason they call "morpho-psychological types with a high orthodontic risk". They conclude that it would appear that insufficient importance is attributed at present to psychological factors in the aetiopathogenesis of dysmorphoses and feel that an overall approach to the deformed child is indispensable to progress in the specialty.