Download Perception of facial profile and orthodontic treatment outcome

International Dental & Medical Journal of Advanced Research (2015), 1, 1–5
ORIGINAL ARTICLE
Perception of facial profile and orthodontic treatment
outcome - importance of patient’s opinion in
treatment plan
Zuber Ahamed Naqvi1, Saleem Shaikh2, Zameer Pasha3
1
Department of Preventive Dentistry-Orthodontics, College of Dentistry Zulfi, Majmaah University, Al Majmaah, Riyadh Province, Kingdom of Saudi Arabia,
Oral Pathology, Department of MDS, College of Dentistry Zulfi, Majmaah University, Al Majmaah, Riyadh Province, Kingdom of Saudi Arabia, 3Oral and
Maxillofacial Surgery, Department of MDS, College of Dentistry Zulfi, Majmaah University, Al Majmaah, Riyadh Province, Kingdom of Saudi Arabia
2
Keywords
Facial profile, perception, protrusive
Correspondence
Zuber Ahamed Naqvi, Department of
Preventive Dentistry-Orthodontics, College
of Dentistry - Zulfi, Majmaah University,
P.O. Box-1042, Al Majmaah 11932, Riyadh
Province, Kingdom of Saudi Arabia.
Email: [email protected]
Received 24 April 2015;
Accepted 27 May 2015
doi: 10.15713/ins.idmjar.22
Abstract
Aim: The aim of this study was to evaluate the accuracy in the perception of the own
facial profile by subjects and to compare the orthodontist’s perception of attractive
profile with those of laypeople and dental students.
Materials and Methods: In this study, 180 subjects (90 dental students and
90 laypeople) from Riyadh province of Saudi Arabia were evaluated by a questionnaire.
The questionnaire was designed to find out the most attractive profile among the
two groups, the perception of own facial profile and expectations of subjects from
orthodontic treatment. The facial profiles of the individuals were evaluated by two
clinicians separately. The differences among groups in the perception of the own profile
were compared by using Chi-square (χ2) test. Kappa coefficient was used to assess the
agreement between the two groups. For all statistical analysis P < 0.05 was set as the
significance level.
Results: The most attractive profile perceived by both the groups was Class I, followed by
straight profile and least attractive was Class III profile with the protrusive mandible. The
difference in the profile perception between the clinicians and subjects was statistically
significant (P < 0.05).
Conclusion: The most attractive profile perceived by both the groups was Class I,
followed by straight profile dental students were more accurate in the perception of the
own profile. The expected profile of patients after orthodontic treatment is not same for
all the subjects.
Facial attractiveness has long been a desirable physical
characteristic in all societies for many centuries.[1] Orthodontic
treatment can influence facial esthetics in a number of ways,
including well-aligned teeth an attractive smile, and a pleasing
facial profile.[2,3] The orthodontist “for each of his efforts, whether
he realizes it or not, makes for beauty or ugliness, for harmony
or disharmony or for perfection or deformity of the face.” Thus,
the contribution of orthodontics and orthognathic surgery to the
esthetic well-being of individuals cannot be ignored.[4]
As Plato said, “beauty lies in the eyes of the beholder.” There
appears to be a great variation in perception of beauty among
individuals, as well as communities and countries.
Perception has been defined as the process by which patterns
of environmental stimuli are organized and interpreted; it can
be influenced by a variety of physical, physiological, and social
factors.[3] Several studies have been conducted on the perception
of facial profile attractiveness.[2,5]
Previous studies that were limited to certain ethnic and racial
groups included very small or biased sample sizes, and the
relationship between the size of the profile changes, and
attractiveness was not fully examined.[6,7]
Finally but most important, treatment planning must be
an interactive process. No longer can the doctor decide, in
a paternalistic way, what is best for a patient. Both ethically
and practically, patients must be involved in the decision-making
process. Ethically patients have the right to control what
International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015
1
Introduction
Perception of facial profile
Naqvi, et al.
happens to them in treatment-treatment is something done
for them, not to them.[8] Hence, in spite of proper treatment
planning by the clinician, the patient may not be satisfied
because the clinician did not take into account the patient’s
perception of their appearance.[9] The clinical success to treat
a orthodontic patient determined by an understanding of the
patient’s soft tissue, treatment limitations, and the extent to
which orthodontist or multidisciplinary treatment can satisfy the
patient’s and orthodontist’s esthetic goals.[10] An orthodontist
perception of an attractive facial profile depends upon the values
or numbers, which were determined by studies conducted on
specific populations. It is not fair to apply the same values for
various populations because there may be differences in opinion
in the perception of esthetic profile among others. Therefore,
many studies have evaluated the perception of attractiveness
and profile standards of Caucasians and African Americans,[6,11]
Japanese,[7] Turkish,[12] and Chinese[13] but not on Riyadh
population of Saudi Arabia.
This study was designed to evaluate the accuracy in the
perception of the own facial profile by subjects and to compare
the orthodontist’s perception of attractive profile with those of
laypeople and dental students.
Materials and Methods
The sample selection was done by a simple random sampling
method. The total sample size of the study was 180, which was
divided into two groups.
Group I: Dental students.
Group II: Laypeople.
The age of the participants was 18-35 years old. The inclusion
criteria include the absence of apparent facial deformities, any
syndrome, facial asymmetry, psychological problems. The subjects
who had undergone or undergoing orthodontic treatment were
not included in the study. The dental student group comprised
of subjects from College of Dentistry, Zulfi, Majmaah University,
Riyadh province, Kingdom of Saudi Arabia. The laypeople group
comprised of subjects randomly selected from the same region.
Individuals were given a questionnaire with silhouettes
[Figure 1] representing Class I, Class II, Class I bimaxillary
a
b
c
protrusion, and Class III and straight facial profile. It was a
questionnaire study. They were asked that whether they notice
any person’s face from lateral side (profile view) and to choose
most attractive facial profile according to them, to choose the
facial profile from the silhouettes that resembles to their facial
profile, whether they felt that facial profile contributes to the facial
beauty and which structures among nose, upper lip, lower lip, and
chin contributes to facial esthetics. It was enquired that whether
they were happy with their facial profile and if they want undergo
orthodontic treatment and if yes then which type of facial profile
they would like to have after orthodontic treatment. Only
completely, filled questionnaires were evaluated for the analysis.
The facial profile of the subjects was evaluated independently
by two specialists to evaluate whether the participants were
accurate in identifying their profile accurately. The agreement
between two observers was evaluated by kappa test. The
differences among the groups in identifying their facial profile
were compared by using chi-square test (χ2), P < 0.05 was
considered as statistically significant.
Result
All the subjects included in this study were in agreement that
facial profile plays an important role in facial esthetics.
The results of this study depicts that the most attractive
facial profile is Class I (73.33%) followed by straight profile
(20.55%), Class I bimaxillary dentoalveolar protrusion (3.88%)
and Class II (2.22%). Class III profile were found to be least
attractive (0%) [Table 1 and Graph 1].
The two groups included in this study were different in their
ability to identify or perceive their profile. The dental student group
was more accurate (82.22%, k = 0.83) in identifying their profile as
compared to laypeople group (30%, k = 0.87). It was found that
the difference in agreement on profile between laypeople and
orthodontist was significant (P < 0.05) [Table 2 and Graph 2].
In this study, it was found that 68.89% of dental students and
36.36% of laypeople were not happy by their facial profile. After
treatment, it was noticed that 48% of dental students and 57.58%
of laypeople want to undergo orthodontic treatment to improve
their facial profile [Table 3 and Graph 3].
d
e
Figure 1: Silhouettes representing, (a) Class I, (b) Class II, (c) Class I bimaxillary protrusion, (d) Class III, (e) straight profile
2
International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015
Naqvi, et al.
Perception of facial profile
This study showed that 85.48% of dental students and
57.58% of laypeople want to undergo orthodontic treatment to
change their facial profile [Table 4 and Graph 4]. After treatment
62.26% of dental students and 42.11% of laypeople subjects like
to have Class I profile after treatment. 33.96% of dental students
and 57.89% of laypeople like to have straight profiled after
treatment [Table 5 and Graph 5].
The subjects in this study from laypeople group felt that
upper and lower lip is more important in esthetic profile whereas
dental students said that along with the lips, nose also plays an
important role in facial esthetics.
In recent times, increased awareness has made facial esthetics
one of the most important factors due to which patients acquired
orthodontic treatment. It is also relative to their popularity
and success especially in the teens and young adults.[14-16]
According to “attractiveness halo” people think that attractive
face is a criterion for positive acceptance and better behavior
in society.[17] One of the main aims of orthodontic treatment
is facial esthetics however, the patient’s perception of esthetic
face depends on the social and cultural rules of the society
whereas the orthodontist prefers to use scientifically derived
Discussion
Medical and dental interventions that are intended to make
the individual either “better than well” or “beyond normal” are
called enhancements. Examples of typical medical and surgical
enhancements are drugs to treat erectile dysfunction, face lifts,
and hair transplants. In this context, orthodontics often can be
considered an enhancement technology.[8]
Table 1: Distribution of most attractive profile according to
subjects in dental and laypeople group
Group
I
A
78.89
Most attractive profile (%)
B
C
D
0.00
4.44
0.00
II
67.78
4.44
3.33
0.00
E
16.67
24.44
Graph 1: Distribution of most attractive profile according to
subjects in dental and laypeople group (results in %)
Table 2: Accuracy in profile judgment by subjects of dental student
and laypeople group (%)
Group
I
II
Similar
82.22
Not similar
17.78
30.00
70.00
Table 3: Subjects were happy of not happy by their facial (%)
Group
I
Happy
31.11
Not happy
68.89
II
63.33
36.67
Graph 2: Accuracy in profile judgment by subjects of dental student
and laypeople group (results in %)
Table 4: Subjects want to undergo orthodontic treatment in dental
student and laypeople group (%)
Group
I
Yes
85.48
No
14.52
II
57.58
42.42
Table 5: Expected facial profile after orthodontic treatment
suggested by dental students and laypeople (%)
Group
I
A
62.26
B
3.77
C
0
D
0
E
33.96
II
42.11
0
0
0
57.89
Graph 3: Subjects were happy of not happy by their facial profile
(results in %)
International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015
3
Perception of facial profile
Graph 4: Subjects want to undergo orthodontic treatment in dental
student and laypeople group (results in %)
Graph 5: Expected facial profile after orthodontic treatment
suggested by dental students and laypeople (results in %)
parameters as guideline.[16,18-20] Hence, professional assessment
is important, but patient’s views about dental appearance should
also be respected and included in the assessment for treatment
planning.[9]
On clinical examination of all the subjects by an orthodontist,
it was found that the most common profile Saudi Arabia
population of Riyadh province is convex profile with a prominent
nose. These results are similar to a study conducted by Sahar F.
Al Barakati on soft tissue facial profile of adult Saudi.[21]
In this study, it was found that 78.89% [Table 1 and Graph 1]
of dental students and 67.78% [Table 1 and Graph 1] of laypeople
suggests Class I profile most attractive. These results are similar
to the previous studies[5,7,9,12,22-24] in which Class I profile was
found to be more attractive and esthetically pleasing but the
results are not in agreement with the study conducted by Soh
Jen concluded that the most attractive facial profile considered
by Chinese male and female was orthognathic.[25]
All the subjects agree that facial profile contributes to the
facial beauty. Among nose, upper lip, lower lips, and chin both
the groups felt that nose plays a major role in facial esthetics
followed by chin and lips. From a clinical point of view, these
findings are most interesting, as the orthodontist’s work is
centered on the mouth. During treatment, he often wants to
influence the appearance of the soft tissue profile.[26]
4
Naqvi, et al.
The superimposition technique acknowledges that the size of
the patient’s nose is a key factor in actual visualized, profile
perceptions (e.g. a patient with a large nose and a moderate
mandibular deficiency may appear to have a severe mandibular
deficiency when viewed in profile because of nasal dominance.[27]
Hence, the prominent nose of these subjects should be considered
during treatment planning because the retraction of teeth
increases the nasolabial angle, which increases the relative nose
prominence, and the treatment results will be unesthetic.
There is a significant difference (P < 0.05) inaccuracy in
the judgment of own facial profile between dental students and
laypeople. Group I was more accurate in identifying their own
profiles (82.22%, k = 0.83) than Group II (30%, k = 0.87) the
group of dental students were more aware of esthetics due the
dental education.[28] Hence, this group was significantly different
in identifying their profile correctly. This result is similar to the
previous studies that showed a significant effect of education and
dental training on the rating of facial attractiveness.[28,29]
When it was enquired that which type of facial profile they
would likely to have after treatment it was noticed that subjects
vary in their opinion. Though most of the subjects in both the
groups like to have Class, I profile after treatment, but 33.96%
of dental students and 57.89% of laypeople like to have straight
profiled after treatment. These results showed that all the patients
do not like same facial profile as orthodontist decide (Class I)
after orthodontic treatment. Hence, the patient must be involved
in decision-making process. During orthodontic treatment his
opinion about final facial profile should be taken and involved
in the final treatment plan if it is in acceptable esthetic limits
and does not affect the stability of treatment results because the
patients have the right to control what happens to them during
the treatment. No longer can the doctor decide, in a paternalistic
way, what is best for a patient.[8]
Conclusions
1. The most attractive profile perceived by both the groups
was Class I, followed by straight profile. Least attractive was
Class III profile with protrusive mandible
2. Dental students were more accurate in perception of own
profile
3. The expected profile of patients after orthodontic treatment
is not always Class I. Hence, they should be involved in
treatment planning.
References
1. Eisenthal Y, Dror G, Ruppin E. Facial attractiveness: Beauty and
the machine. Neural Comput 2006;18:119-42.
2. Orsini MG, Huang GJ, Kiyak HA, Ramsay DS, Bollen AM,
Anderson NK, et al. Methods to evaluate profile preferences
for the anteroposterior position of the mandible. Am J Orthod
Dentofacial Orthop 2006;130:283-91.
3. Giddon DB. Orthodontic applications of psychological
and perceptual studies of facial esthetics. Semin Orthod
International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015
Naqvi, et al.
Perception of facial profile
1995;1:82-93.
4. Angle EH. Classification of malocclusions. Dent Cosm
1899;41:248-64, 350-7.
5. Phillips C, Griffin T, Bennett E. Perception of facial attractiveness
by patients, peers, and professionals. Int J Adult Orthodon
Orthognath Surg 1995;10:127-35.
6. Connor AM, Moshiri F. Orthognathic surgery norms for
American black patients. Am J Orthod 1985;87:119-34.
7. Mantzikos T. Esthetic soft tissue profile preferences among
the Japanese population. Am J Orthod Dentofacial Orthop
1998;114:1-7.
8. William RP, Henry WF, David MS. Contemporary Orthodontics.
4th ed. St. Louis: Mosby, Elsevier; 2007.
9. Mridula T, Zuber AN, Sunil S. Perception of facial profile: How
you feel about yourself. Int J Clin Pediatr Dent 2011;4:109-11.
10. Tarvade SM, Agrawal G. Smile analysis: A review. Part II. Int
J Contemp Dent Med Rev 2015;2015:Article ID: 210115. doi:
10.15713/ins.ijcdmr.68.
11. Polk MS Jr, Farman AG, Yancey JA, Gholston LR, Johnson BE,
Regennitter FJ. Soft tissue profile: A survey of African-American
preference. Am J Orthod Dentofacial Orthop 1995;108:90-101.
12. Türkkahraman H, Gökalp H. Facial profile preferences
among various layers of Turkish population. Angle Orthod
2004;74:640-7.
13. Maganzini AL, Tseng JY, Epstein JZ. Perception of facial
esthetics by native Chinese participants by using manipulated
digital imagery techniques. Angle Orthod 2000;70:393-9.
14. Kerosuo H, Hausen H, Laine T, Shaw WC. The influence of
incisal malocclusion on the social attractiveness of young adults
in Finland. Eur J Orthod 1995;17:505-12.
15. Birkeland K, Bøe OE, Wisth PJ. Relationship between occlusion
and satisfaction with dental appearance in orthodontically
treated and untreated groups. A longitudinal study. Eur J
Orthod 2000;22:509-18.
16. Kiekens RM, Maltha JC, van’t Hof MA, Kuijpers-Jagtman AM.
Objective measures as indicators for facial esthetics in white
adolescents. Angle Orthod 2006;76:551-6.
17. Tarvade SM, Agrawal G. Smile analysis: A review. Part I. Int
J Contemp Dent Med Rev 2015;2015:Article ID: 200115.
doi:10.15713/ins.ijcdmr.64.
18. Spyropoulos MN, Halazonetis DJ. Significance of the soft tissue
profile on facial esthetics. Am J Orthod Dentofacial Orthop
2001;119:464-71.
19. McKoy-White J, Evans CA, Viana G, Anderson NK, Giddon DB.
Facial profile preferences of black women before and after
orthodontic treatment. Am J Orthod Dentofacial Orthop
2006;129:17-23.
20. Miner RM, Anderson NK, Evans CA, Giddon DB. The
perception of children’s computer-imaged facial profiles
by patients, mothers and clinicians. Angle Orthod
2007;77:1034-9.
21. AlBarakati SF. Soft tissue facial profile of adult Saudis. Lateral
cephalometric analysis. Saudi Med J 2011;32:836-42.
22. Little AC, Jones BC, DeBruine LM. Facial attractiveness:
Evolutionary based research. Philos Trans R Soc Lond B Biol Sci
2011;366:1638-59.
23. Knight H, Keith O. Ranking facial attractiveness. Eur J Orthod
2005;27:340-8.
24. Johnston DJ, Hunt O, Johnston CD, Burden DJ, Stevenson M,
Hepper P. The influence of lower face vertical proportion on
facial attractiveness. Eur J Orthod 2005;27:349-54.
25. Soh J, Chew MT, Wong HB. A comparative assessment of the
perception of Chinese facial profile esthetics. Am J Orthod
Dentofacial Orthop 2005;127:692-9.
26. Wisth PJ. Changes of the soft tissue profile during growth. Eur J
Orthod 2007;29:i114-7.
27. Graber TM, Vanarsdall RL, Vig KW. Orthodontics: Current
Principles and Techniques. 4th ed. St. Louis: Mosby, Elsevier;
2005.
28. Phillips C, Tulloch C, Dann C. Rating of facial attractiveness.
Community Dent Oral Epidemiol 1992;20:214-20.
29. Brisman AS. Esthetics: A comparison of dentists’ and patients’
concepts. J Am Dent Assoc 1980;100:345-52.
International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015
5
How to cite this article: Naqvi ZA, Shaikh S, Pasha Z.
Perception of the facial profile and orthodontic treatment
outcome - importance of patient’s opinion in the treatment
plan. Int Dent Med J Adv Res 2015;1:1-5.