A comparative assessment of the perception of Chinese facial profile esthetics

Tanzanian Population's Perspective on Facial Profile Esthetic Preferences

Background: The perception of facial profile attractiveness varies among individuals and may influence clinical decision-making in orthodontic dentofacial treatment goals. Objective: The aim of the study was to evaluate the facial profile preferences of Tanzanian individuals. Materials and Methods: This cross-sectional study was conducted at Muhimbili University Dental Clinic in Dar es Salaam, Tanzania. A total of 387 participants, including 146 females and 241 males, were selected based on their lack of technical awareness of the facial profiles. The mean age of the male and female participants was 27.94 ± 7.67 and 28.98 ± 7.76 years, respectively. The participants were asked to evaluate male and female facial profiles and score them on a scale of 1-4, with no score being assigned to more than one profile. The relative frequency of the profile scores was calculated, and a t-test and analysis of variance (ANOVA) were used to compare the preferences across different groups. A statistical significance was set at a 95% confidence interval (CI), with a p-value of p < 0.05 considered significant. Results: Among the male profiles, 48.3% (187) of the participants ranked profile M1, "normal maxilla, retruded mandible", as the most attractive, while 48.1% (186) ranked profile M2, "retruded maxilla, protruded mandible", as the least preferred. Statistically significant differences were observed between age groups and income groups (p < 0.05) in the ratings of each male profile. For the female profiles, 56.6% (219) of the raters preferred profile F4, "straight", while profile F3, "protruded maxilla, normal mandible", was ranked as the least preferred by 51.7% (200) of the participants. Significant differences were observed in the ratings of profile F4, "straight", between groups (p < 0.05), except when comparing ratings between genders, where no significant difference was found. No statistically significant differences on age or income were observed for profile F3, "protruded maxilla, normal mandible". Conclusions: The most preferred profiles among the Tanzanian population were the male profile with a mandibular retrusion (M1) and the female straight profile (F4).

Ideal mentolabial sulcus depth in long-face, short-face, and normal-face in female individuals

PURPOSE

The harmony between the lips and the chin is an essential parameter in facial esthetics, and the mentolabial sulcus (MLS) represents the level of this harmony. This study aimed to assess the effect of MLS depth on facial profile attractiveness in long-face, short-face, and normal-face Iranian female individuals.

METHODS

An observational study with a questionnaire was conducted, and a profile photograph of an Iranian female with class I occlusion was altered to create long-face, normal-face and short-face profiles with MLS depth ranging from 1 to 12 mm. Sixty-five lay people and 24 orthodontists rated the attractiveness of images using a 7-point Likert scale. Data were analyzed by independent t-test and Spearman's correlation coefficient using IBM SPSS Ver. 22.

RESULTS

The ideal depth of MLS ranged from 5 to 7 mm for normal-face and short-faced and 6-8 mm for long-face Iranian females. The acceptable MLS depth was found to be up to 8 mm in normal-face and up to 10 mm in long-face and short-face females. normal-face images acquired the maximum score of attractiveness, followed by short-face images, while long-face images were the least attractive according to both observer groups. There was general agreement amongst orthodontists and lay people scoring process; however, orthodontists gave significantly higher scores for normal face images than lay people.

CONCLUSION

The optimal MLS depth in different facial types should be considered in treatment planning for orthognathic surgery and genioplasty.

Facial features of cartoon characters and their perceived attributes

The aim of this study is to investigate the relationship between skeletal antero-posterior profile of popular family cartoon characters and their perceived personal characteristics. The Internet Movie DataBase (IMDB) was used to identify popular animated family movies released since 2000. Cartoon characters were identified, and classified based on their gender (male/female), skeletal profile (Class I, II or III) and character assessment (protagonist/antagonist). Descriptive statistical analysis was carried out. Chi Square analysis was used to assess the differences (p-value) between gender and character assessment against the skeletal profile. Fifty popular animated family movies were identified. Within these 88 humanoid cartoon characters were identified made up of 32 male protagonists, 27 female protagonists, 22 male antagonists and 7 female antagonists. 40, 30, 21 were assessed as having a Class I, II and III skeletal profiles respectively. Statistically significant differences were observed in both FPFA and MPFP values for Class III characters (P = 0.009 and P = 0.006, respectively). However, no significant variations were noted when comparing the remaining groups. Female antagonists and male protagonists were most likely to be portrayed with a Class III skeletal pattern when compared to female protagonists and male antagonists respectively.

Influence of the Rater's Gender on Assessing Facial Beauty in Adult Patients With Vertical and Horizontal Growth Patterns

Background The evaluation of attractiveness varies from one civilization, culture, and environment to another and between individuals. Gender can also play a role in determining the standards of attractiveness. The purpose of this study was to evaluate the effect of the rater's gender on the assessment of adult facial attractiveness with a vertical and horizontal growth pattern in patients with skeletal Class I malocclusion. Methodology The study sample comprised extraoral photos taken before the treatment of 120 patients (30 males and 30 females in each group) with skeletal Class I malocclusion and vertical and horizontal growth patterns according to the Bjork sum aged between 18 and 25 years. A panel of 30 laypersons (aged 19-25 years with an average age of 23 ± 0.53 years), including raters from both genders, were selected equally using a disproportionate stratified sampling method through a computer-generated list. The raters used the visual analog scale (VAS) to provide a score for each photograph's aesthetic quality. The most attractive group, which received the greatest aesthetic score, and the least attractive group, which received the lowest aesthetic score, were the two groups formed based on each photograph's mean aesthetic scores. Overall, 13 patients were chosen for each group. Subsequently, the average assessment score for every patient photo set was determined. Independent-sample t-tests were employed to ascertain if the raters' gender made a statistically significant difference in assessing patients with vertical and horizontal growth patterns. Results There were statistically significant differences between the gender of raters in evaluating female patients with vertical growth patterns (p < 0.001), where the average rating of the female raters was significantly greater than that of the male raters in evaluating female patients. In addition, there were statistically significant differences between the gender of raters in evaluating female patients with horizontal growth patterns (p = 0.009), where the average rating of the male raters was significantly greater than that of the female raters in evaluating female patients. Conclusions There is a limited effect of the rater's gender in evaluating facial aesthetics. However, the facial features of female patients with long faces are preferred by females more than males, and males are more critical in evaluating these patients. On the other hand, males favor the facial features of female patients with short faces more than females, and females are more critical in evaluating these patients. These results suggest considering patients' personal characteristics with vertical and horizontal growth patterns during diagnosis and treatment planning.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Influence of facial width on the perception of lip protrusion and its differences between profile and 3-dimensional video clip

INTRODUCTION

This study evaluated the influence of facial width on the perception of lip protrusion and investigated the concordance between 2-dimensional (2D) profile images and 3-dimensional (3D) video clips in assessing lip protrusion.

METHODS

An Asian female standard head model was created using 3D modeling software. Eight head models were constructed by modifying the standard head model in terms of facial width (broad, neutral, and slim) and lip protrusion (retrusive, straight, and protrusive). Overall, 97 Asian raters rated the lip protrusion from the 2D profiles and 3D rotation video clips of the 9 models.

RESULTS

No significant differences were found in the perception of lip protrusion in terms of sex, age, or occupation. Compared with the 2D profiles, the 3D video clips were rated as more protrusive in 8 of the 9 head models, with the retrusive broad, retrusive neutral, straight broad, and straight slim faces showing statistical significance (P <0.01). The rating is significantly higher in slim faces than in broad faces across the 3 groups of 2D profiles (P <0.01). For 3D video clips, the rating was higher in slim faces than in broad faces in all 3 groups, whereas differences were significant in the straight and protrusive groups only (P <0.01).

CONCLUSIONS

In this study, 3D video clips were more sensitive to the perception of lip protrusion than were 2D profiles to some extent. The lips were rated relatively more protrusive in a slim face than in a broad face. Therefore, the relationship between facial width and lip protrusion should be considered in orthodontic treatment goals and treatment plans.

Modified maxillomandibular advancement surgery for the treatment of obstructive sleep apnoea: a scoping review

Modified maxillomandibular advancement (MMMA) has been proposed as an alternative to the classic maxillomandibular advancement (MMA) in East and Southeast Asian populations in which bimaxillary protrusion is a prevalent trait. The key difference between MMMA and MMA is the inclusion of anterior segmental osteotomies to reduce the protrusion of the perioral region. The aim of this scoping review was to identify the variations in MMMA and treatment outcomes. A search was conducted in the PubMed, Embase, and Cochrane electronic databases for articles published up to January 2023. Ten articles were included in this review. Three variations of MMMA have been reported in the literature. Treatment outcomes have mostly been favourable for all of these variations. Mandibular advancement of >10 mm and a greater than 50% reduction in the apnoea-hypopnoea index (AHI) have been well reported. Improvements in other outcome measures, such as enlargement of the airway dimension on computed tomography and the Epworth Sleepiness Scale score, have also been shown. Despite additional surgical procedures, complications have been uncommon and mostly minor in nature. It is necessary to be cognizant of MMMA and its variations when providing sleep surgery for East and Southeast Asian patients, tailoring this to the patient's profile and needs.

Multinational study on profile preference of laypersons

BACKGROUND

This study aimed to assess the facial profile preferences of lay people in seven locations from different countries and whether their place of residence, sex, age, race, education, or income influenced the decision.

METHODS

After altering the lip and nose in 1 mm increments in the sagittal and sagittal/vertical directions, 50 profile silhouettes with white-like facial features were rated by evaluators. The soft tissue values were integrated into the profiles, and profile preferences were identified for each location. An ANOVA with post hoc Tukey test was used to compare the differences in mean preference in each location. A multivariable regression model was used to assess the effect of the demographics of the evaluator on preference.

RESULTS

Thirteen profiles were ultimately analyzed. The mean for profile preference was significantly different across locations (P < 0.0001). For evaluators in the United States and Lebanon, the most preferred profile had the original lip and original nose. In Switzerland and South Africa, retrusive lips, and a small and less upturned nose was most preferred. In Japan and Saudi Arabia, the most preferred profile had the original lip and a protrusive nose that was less upturned. A protrusive lip with a small, upturned nose was preferred in Turkey. Profile change (P < 0.0001), location (P < 0.0001), sex (P < 0.0001), and race (P = 0.02) were significant confounders; in contrast, age, education, and income were not significant.

CONCLUSIONS

Profile preference is different among the seven locations. For the most part, lay people prefer profiles within one SD from white norms. Also, an upturned nose is the least favored in most of the locations. Sex and race are also significant confounders.

CLINICAL RELEVANCE

An orthodontic treatment plan decision is affected by an individual's preference for their facial appearance. This study helps clinicians understand how racial and regional differences may affect patients' preferences and, therefore, their expectations for orthodontic treatment results.

Condylar positional changes and remodeling following bimaxillary anterior segment osteotomy with and without Le Fort I osteotomy: a three-dimensional comparative analysis

OBJECTIVE

To evaluate 3D condylar displacement and long-term remodeling following the correction of bimaxillary protrusion by anterior segment osteotomy (ASO) with and without Le Fort I surgery.

MATERIALS AND METHOD

This retrospective study included 32 adults with bimaxillary protrusion who underwent ASO alone (group 1) or with concomitant Le Fort I osteotomy (group 2). Subject's computed tomography scans at basic (T0), immediate postoperatively (T1), and at 1 year or more follow-up (T2) were collected. The condyle displacement was measured at superior-inferior, lateromedially, and anteroposterior surfaces, while condyle remodeling was measured at the superior, lateral, anterior, medial, and posterior surfaces. All 3D analyses were performed using 3D Slicer software (4.11.2).

RESULTS

At T1, 52.7%, 86.7%, and 94.4% of condyles in group 1 were displaced inferiorly, laterally, and posteriorly, respectively, as well as 75%, 89.2%, and 53.5% of condyles in group 2, which had not fully returned to the original preoperative positions at T2. Condylar remodeling was observed in both groups at T2, and no significant difference was found in the overall condylar volume between T1 and T2 in both groups. Patients in group 2 exhibited significant bone resorption at both lateral and anterior surfaces compared to group 1 (P = 0.000 and 0.01, respectively).

CONCLUSION

This study's results demonstrated that ASO is associated with a degree of condylar changes even if the posterior mandible is not osteomized. The positional changes vary between bimaxillary ASO alone and those with simultaneous Le Fort I osteotomy. However, both groups' condyle volume remained stable at the long-term follow-up.

The reliability of analytical reference lines for determining esthetically pleasing lip position: An assessment of consistency, sensitivity, and specificity

INTRODUCTION

This study aimed to identify a simple yet reliable soft-tissue parameter for the clinical determination of esthetic lip position by investigating the most consistent reference lines and assessing their sensitivity and specificity.

METHODS

A total of 5745 records from Chinese patients aged >18 years were screened. In part I of the study, lateral view photographs of 96 subjects (33 males, 63 females) with esthetic facial profiles were selected. The profile esthetics of each photograph was first scored by 52 dental students, followed by 97 laypeople on a 5-point attractiveness scale. For the top 25% of photographs with the highest score for each sex (8 males, 16 females), the consistency of 6 commonly used reference lines were assessed to determine the esthetic lip position. In part II of the study, lip positions relative to Steiner's (S) and Ricketts' (E) lines in the profile photographs of 86 patients (43 males, 43 females) deemed to have an esthetically unpleasing profile were compared with those in 86 Chinese movie star idols (43 males, 43 females).

RESULTS

In part I of the study, the S, E, and Burstone's (B) lines exhibited the lowest standard deviations for the upper and lower lips. B line was excluded from further analysis because of its higher mean absolute values, and S and E lines were used for the subjective assessment in part II of the study. In part II, the S line showed a sensitivity of 86.0% and 86.0% and a specificity of 81.4% and 83.7% for males and females, respectively. In contrast, the E line presented a sensitivity of 88.4% and 93.0% and a specificity of 79.1% and 74.4% for males and females, respectively.

CONCLUSIONS

S, E, and B lines were the most consistent soft-tissue parameters among both sexes; however, because of the smaller absolute values, the S line would be more convenient among the 3 for a quick clinical assessment of lip position. Moreover, the performance of both S and E lines was similar among both sexes, which supports using these lines in assessing the esthetic lip position.

Influence of social media on the esthetic perception of the lip profile of orthodontic patients

Objective

To identify the use of social media as an influencing factor of the orthodontic patient's preferences regarding the lip profile protrusion.

Methods

A two-part cross-sectional questionnaire was distributed to orthodontic patients in Spain and The Netherlands. The first part collected general data and frequency of use of different social media. The second part consisted of a series of modified female and male silhouettes presenting different lip profile positions. Each participant was required to choose both the (male and female) most attractive silhouette and the least attractive one.Student t-test, one-way ANOVA and Chi-square test were performed. Effect sizes were calculated to express the magnitude of differences between samples.

Results

The Spanish sample resulted in a moderate higher tendency (R² = 0.060) to choose protrusive lips as the most attractive lip profile for females, on subjects with more frequent use of social media. A medium tendency (R²⁼0,26) was observed as result of low users of social media choosing and ideal lip profile for men.The Dutch sample showed that high users of social media tended to choose as attractive a more protrusive female lip profile versus low users (p < .01). This was also observed (p < .05) on male attractive lip profiles.

Conclusions

Results suggest that frequent users of social media platforms tend to prefer more protruded lips than their less frequent counterparts. This information is valuable to be considered when formulating a treatment plan to satisfy the patient's expectations.

The role of anterior segmental osteotomies in orthognathic surgery for protrusive faces in a Southeast Asian population: 10-year retrospective data of 51 patients treated in a single centre

Bimaxillary protrusion is a dentofacial deformity common in the East Asian population. It is often difficult to decide between orthodontic and surgical retraction to treat patients with bimaxillary protrusion, especially if surgery to correct skeletal base discrepancies is also required. The objective of this study was to investigate the treatment outcomes of surgical versus orthodontic retraction in patients with bimaxillary protrusion undergoing orthognathic surgery. A retrospective cohort study was conducted, where the medical records and radiographs of 51 patients with bimaxillary protrusion who had an anterior segmental osteotomy concomitant with orthognathic surgery were examined. Patients who had bimaxillary anterior segmental osteotomies were more likely to achieve an inter-incisal angle of 135 ± 5° at the end of treatment, when compared to patients who had orthodontic retraction (P < 0.01). The total treatment duration of patients who had bimaxillary anterior segmental osteotomies was significantly shorter as compared to that of the patients who only had these osteotomies in the maxilla (P < 0.001) or mandible (P = 0.012). Complications and permanent long-term sequelae following anterior segmental osteotomies were uncommon. It is concluded that bimaxillary anterior segmental osteotomies are a viable alternative for patients with concomitant bimaxillary protrusion and skeletal base discrepancies. This allows for a significantly shorter treatment time and greater correction of inter-incisal angles, without a significant increase in complications.

Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

BACKGROUND

Orthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concern, orthodontists have been striving to seek new methods for shortening orthodontic treatment time. Piezocision, as a popular alternative treatment, has been widely used in different types of tooth movement. However, its effect on en-masse retraction of maxillary anterior teeth remains unclear. This randomized controlled trial intends to figure out the role piezocision plays in accelerating en-masse retraction.

METHODS

This protocol is designed for a prospective, single-center, assessor-blinded and parallel-group randomized controlled trial. Twenty adult patients aged from 18 to 40 whose orthodontic treatment required bilateral maxillary first premolars extraction will be randomly assigned to the piezocision group and the control group at a ratio of 1:1. The piezocision group will undergo en-masse retraction immediately after the piezo surgery, while the control group will start en-masse retraction directly. Both groups will be followed up every 2 weeks to maintain the retraction force until the end of space closure. The space closing time is set as the primary endpoint. Meanwhile, the secondary endpoints include the change of root length, labial and palatal alveolar bone thickness, vertical bone height, probing depth of maxillary anterior teeth, cephalometric measurements, visual analogue scale, and postoperative satisfaction questionnaire.

DISCUSSION

This study will attempt to provide more convincing evidence to verify whether piezocision will shorten the time of en-masse retraction or not. Distinguished with previous studies, our study has made some innovations in orthodontic procedure and primary outcome measurement, aiming to clarify the efficacy and safety of piezocision-assisted en-masse retraction in Chinese population.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR 1900024297 . Registered on 5 July 2019.

Customized maxillary incisor position relative to dentoskeletal and soft tissue patterns in Chinese women: A retrospective study

Objective

To provide reliable prediction models based on dentoskeletal and soft tissue variables for customizing maxillary incisor positions and to optimize digitalized orthodontic treatment planning.

Methods

This study included 244 Chinese women (age, 18–40 years old) with esthetic profiles after orthodontic treatment with fixed appliances (133 in group I 1° ≤ The angle between the nasion [N]-A point [A] plane and the N-B point [B] plane [ANB] ≤ 4°; 111 in group II 4° < ANB ≤ 7°). Dental, skeletal, and soft tissue measurements were performed on lateral cephalograms of the participants. Correlation and multiple linear regression analyses were used to determine the influence of dentoskeletal and soft tissue variables on maxillary incisor position.

Results

The ideal anteroposterior position of the maxillary incisor varied between sagittal skeletal patterns. The position of the maxillary incisor correlated with the sagittal discrepancy between the maxilla and the mandible (ANB), protrusion of the midface, nasal tip projection, development of the chin, and inclination of both the maxillary and mandibular incisors. Distance from the maxillary central incisor to nasion-pogonion plane predicted using multiple linear regression analysis was accurate and could be a practical measurement in orthodontic treatment planning.

Conclusions

Instead of using an average value or norm, orthodontists should customize a patient’s ideal maxillary incisor position using dentoskeletal and soft tissue evaluations.

An establishment of various cephalometric parameters in an Urban setup in Odisha and linking it with the discernment of pleasant profiles by lay persons

Aim:

To evaluate cephalometric parameters of orthodontic population in an urban setup in Odisha using Steiner's, Tweed's and Rakosi's analysis and compare it with the established Caucasian norms.

Methodology:

Pre-treatment patient records from a dental hospital were collected. Lateral cephalograms of the normal and supernormal sample were traced. Cephalometric features relating to various facial hard tissue that determine balance and harmony were measured using Steiner's, Tweed's and Rakosi's analysis. The values obtained were compared with the established Caucasian norms. Comparison of mean values were done via independent sample t test and ANOVA. Subsequently post hoc Tukey's was used to establish the significance of the mean difference of all the variables used.

Results:

Significant differences were obtained for lower incisor to NB, mandibular plane angle, FMA, FMIA, articular angle, basal plane angle, inclination angle, Rakosi Jarabak ratio and interincisal angle.

Conclusion:

Fundamental variations were seen in various parameters. Perception of lay persons can be of aid to the clinician in assembling commendations for alternative treatment plans.

Effect of Observer's Sex and Chin Prominences on the Perception of the Lower Lip-Chin Prominence Angle

ABSTRACT

This study aimed to identify the preferred range of lower lip-chin prominence angles in the Korean population and evaluate the effect of the individual lower lip-chin prominence angle on perceptions of esthetic chin profile.Chin prominence silhouettes were used to assess the lower lip-chin prominence preference. The observers randomly categorized each image as (1) normal, (2) slightly abnormal but not requiring surgical correction, and (3) abnormal and requiring surgery. Individual lower-chin prominence angles of all observers were analyzed using standardized clinical photographs.The normal range of lower lip-chin prominence angle is 0° to 25°; socially acceptable range is 0° to -10°, 25° to 40°; range needing surgery is -10° to -30° and 40° to 45°. Women are more tolerant to chin protrusion. A protrusive chin is more acceptable in observers with retrusive chin profile.Skeletal Class II profile is more acceptable than skeletal Class III in the Korean population. The individual lower-chin prominence angle could affect perception of desired surgery. These findings indicate that patient-specific treatment planning is important in achieving satisfaction in chin surgery.

Facial profile study using 3-dimensional photographs to assess esthetic preferences of Hong Kong Chinese orthognathic patients and laypersons

INTRODUCTION

This study was conducted to investigate and compare esthetic perceptions of different facial profiles among Hong Kong Chinese laypersons and patients scheduled for orthognathic treatment.

METHODS

Two sets of 3-dimensional facial photographs (1 male and 1 female) each comprised 7 images that showed different dentoskeletal relations (ie, Class I, bimaxillary protrusion, bimaxillary retrusion, maxillary protrusion, maxillary retrusion, mandibular protrusion, and mandibular retrusion). The sets of photographs were shown to 101 laypersons (age, 28.87 ± 6.22 years) and 60 patients seeking orthognathic treatment (age, 27.12 ± 6.07 years). They rated their esthetic perceptions of the photographs on the basis of a 100 mm visual analog scale (VAS) from 0 (very unattractive) to 100 (very attractive).

RESULTS

The dentoskeletal Class I facial profile was ranked as the most attractive profile. Female orthognathic judges selected the retrusive maxilla while male orthognathic judges and male and female laypersons ranked the mandibular protrusion profile as the least attractive profile for both females and males. A bimaxillary protrusive female profile was viewed as more attractive by the orthognathic male (P = 0.006) and female (P = 0.006) judges, compared with female layperson judges. After adjustment for age, no statistically significant interaction between sex and judges (P >0.10) for all VAS scores were detected. For the female bimaxillary protrusive profile, orthognathic patient judges assigned a mean VAS score of 9.174 points higher than layperson judges (95% confidence interval, 3.11-15.24; P = 0.003).

CONCLUSION

Dentoskeletal Class I facial profile was generally considered the most attractive profile in both sexes; male and female orthognathic patients preferred a bimaxillary protrusive female profile. A concave facial profile was perceived as least attractive in both sexes.

Patterns of Facial Profile Preference in a Large Sample of Dental Students: A Cross-Sectional Study

The objective of this study was to explore dental students’ facial profile preferences in a large sample of students. Nine hundred and nineteen dental students of four dental schools were involved. As part of a larger study on dentofacial esthetics, six photo series consisting of one unaltered and four altered variants of the same female profile were distributed among the students. The altered features were ones that are esthetically significant according to the literature. The students had to indicate the photo in each series that they preferred. The data were analyzed in a regression model in which preference in the given photo series was the dependent variable and gender, grade of studies, and dental school were the factors. Eight hundred and sixty-one students (93.7%) responded. Gender and dental school were not associated with the observed preferences, but the grade of studies was associated for three of the modified parameters: chin prominence, the sagittal position of the maxillary dental arch, and the simultaneous modification of the prominence of the chin and the nose. This study has confirmed several earlier observations, and new observations have also been made. We have demonstrated that the anteroposterior position of the maxillary incisors may be an important determinant of profile esthetics, even if this position does not influence the situation of the soft tissues and if the forehead cannot be used as a reference. We have also shown that the harmony between the nose and the chin overrides the importance of their individual dimensions.

The Surgery-first Approach to Orthognathic Surgery

ABSTRACT

The purpose of this study was to compare the outcomes between the conventional surgical approach (CSA) and the surgery-first approach (SFA) for both traditional orthognathic osteotomies (LeFort/BSSO) and anterior segmental osteotomies (ASO). This was a retrospective cohort study of patients treated at the Hanoi Plastic Surgery Center from January 2000 to December 2012. The study predictors were the type (LeFort/BSSO or ASO) and timing (CSA or SFA) of surgery. The study outcomes were total treatment time and the rates of complication and relapse. 146 patients were included in the study, of whom 99 (67.8%) were treated with traditional osteotomies and 47 (32.2%) were treated with ASO. In the traditional osteotomy group, there were no significant differences in complication (P = 0.84) or relapse (P = 0.77) rates between CSA and SFA. There were no complications or relapses in the ASO group. Total treatment time was significantly decreased when using the SFA for both orthognathic osteotomies (-3.9 months, P < 0.01) and ASO (-3.3 months, P < 0.01). Our results showed that the SFA was able to achieve similar clinical outcomes to CSA but in a shorter treatment time. The SFA was effective for not only traditional orthognathic osteotomies but also ASO.

Evaluation of Lip Position in Esthetically Pleasing Profiles Using Different Reference Lines: A Photographic Study

The aim of this article is to assess the lip position using five different reference lines in individuals with a pleasing profile.

A cross-sectional study was conducted with a sample size of 200 subjects chosen from the local North Indian population. Non-growing subjects, between the age group of 18 years and 25 years with a pleasing facial profile were screened for the study via a questionnaire-based method to confirm their North Indian ancestry (history of past two generations from North India). All subjects included in the study gave their due consent to be a part of the study.

The following conclusions were derived: Norms for the horizontal lip position were derived for the North Indian population. Upper lip position in relation to S1 (Steiner’s) line and Ricketts’ E line showed females having protrusive lips, while S2 (Sushner’s) line showed protrusive upper lip in males. S1 (Steiner’s) line, showing protrusive lower lip in females. The norms derived in this study showed statistically significant difference with retrusive upper and lower lips when compared to normative values of Ricketts’ E plane and retrusive lower lip when compared to normative values of Sushner’s line. Sushner’s S2 line showed the maximum stability and consistency; hence, it is the line of choice to judge the sagittal lip positions in profile analysis.

Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients

Supplemental Digital Content is available in the text.

Background:

Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study.

Methods:

We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions.

Results:

Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics.

Conclusions:

Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.

The study of tooth angulation and inclination for bracket design of Deutromalay race: A comparison study to white race

BACKGROUND

The Indonesian population consist of Deutromalay and Protomalay races, with the Deutromalay race being most of the population. In 1972, Lawrence F. Andrews introduced the "six keys of normal occlusion," which was based on a white sample. This study aimed to identify standard tooth angulation and inclination in the Deutromalay race, which might help in future development of bracket prescription specific to the population.

METHODS

This cross-sectional study was conducted on a representative sample of 190 subjects (112 male and 78 female subjects) aged 14 to 22 years from the Deutromalay population. Data collection was performed by two investigators following the methodology prescribed by Andrews for measuring tooth crown angulations and inclinations. Inter-rater reliability was measured with kappa statistics. Data were analyzed using SPSS software, version 25. Independent-samples t-tests were used for significance testing. The alpha level for statistical significance was set at 0.05, two-tailed.

RESULTS

The kappa statistic came out to be 0.80, which showed substantial agreement. The results of the t-test for tooth angulation and inclination found significant differences between male and female subjects for some teeth within the Deutromalay sample. In addition, significant differences were found for most teeth between the Deutromalay and white samples.

CONCLUSIONS

Significant differences in crown angulation and inclination values exist for most teeth in the Deutromalay sample studied compared with the white norms reported by Andrews. This points to the possible need to develop a new preadjusted bracket prescription specific for the Indonesian (Deutromalay) population.

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether ''being beautiful'' would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25-35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid's bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Perceived treatment need in patients with different facial profiles

BACKGROUND

Understanding each patient's perception about his/her malocclsuion is important for developing an optimum treatment plan. The objective of this study was to determine the perceived treatment need (PTN); among patients with convex, straight, or concave profiles.

MATERIALS AND METHODS

A total of 153 orthodontic patients were categorized into three groups (n = 51) based on their facial contour angle (FCA): convex, FCA >13°; straight, FCA 5°-13°; or concave, FCA <5°. The patients were given questionnaires composed of altered FCAs of one male and one female photograph and asked to rate the PTN using a 100-point visual analog scale labeled from 0 as no need to 100 as absolute need for orthodontic treatment.

RESULTS

There was no significant difference in the PTN score for each image between the male and female participants. For the male and female images, an extremely concave profile received the highest score, whereas a normal or slightly convex profile obtained the lowest score. There was no significant difference between groups for the male images, whereas the extremely concave profile female images received a significantly higher score in the concave group compared with the straight group.

CONCLUSIONS

The PTN in patients with different facial types was similar. They tend be dissatisfied with their appearance. Male and female patients shared the same PTN.

Evaluation of the relationship between malar projection and lower facial convexity in terms of perceived attractiveness in 3-dimensional reconstructed images

Background

This study aimed to investigate dental student’s perception of facial attractiveness with regard to different combinations of anteroposterior malar-jaw positions using 3-dimensional (3-D) reconstructed images of subjects.

Methods

Two Chinese young adults (1 male and 1 female) with straight profiles and average malar projections were selected for the study. 3-D facial images and cone-beam computed tomography images of these two subjects were superimposed using 3-D imaging software. Lateral and oblique views of nine different images were created by moving the maxillomandibular complex and/or zygomatic bone by 4 mm either forward or backward along the sagittal plane. One hundred three undergraduate dental students (n = 24, 33, and 46 students from the Year 3, 4, and 5, respectively) then scored lateral and 45° oblique view images of the newly reconstructed faces.

Results

In the present study, images with a neutral malar and retruded jaws were found to be the most attractive in both male and female subjects. In addition, the Protruded malar (PM) group (p < 0.001), and the Retruded Jaws (RJ) group were rated more attractive (p < 0.001). Furthermore, the Relatively Prominent malar (RP) group was rated more attractive (p < 0.001) when malar-jaw relative positions were compared.

Conclusion

This study shows that a neutral or a protruded malar favours facial attractiveness in both Chinese male and female subjects. Therefore, an appropriate relationship between malar projection and lower facial convexity should be taken into consideration while designing the orthodontic/orthognathic treatment plans for enhanced aesthetic outcomes.

Chinese facial physiognomy and modern day aesthetic practice

BACKGROUND

Physiognomy is still practiced in China and is a factor influencing the cosmetic procedures offered by aesthetic practitioners, and treatments requested by patients.

OBJECTIVE

The aim of this study was to assess the prevalence of belief in physiognomy in China and its effect on cosmetic treatments requested and offered by aesthetic practitioners.

METHODS AND MATERIALS

This study consisted of a survey given to the general public (online) and Chinese aesthetic practitioners (face to face).

RESULTS

A total of 1816 responses (1070 general public, 746 aesthetic practitioners) were collected. About 63% of the general population and 86.3% of the aesthetic practitioners stated they believed in facial physiognomy. A majority of the general population surveyed believed that facial appearance can determine various aspects of their life. However, the majority believed changing their facial features would not affect factors believed to be determined by physiognomy. A total of 73.9% of the aesthetic practitioners thought their belief in physiognomy affected the treatments they suggest and most believed belief in physiognomy influences treatments requested.

CONCLUSION

The belief in facial physiognomy has a direct impact and needs to be taken into consideration during patient consultation.

Investigate the oral health impact and quality of life on patients with malocclusion of different treatment needs

Background

This study compared oral health impacts and QoL among patients with different malocclusion types and a normal population by using self-report questionnaires.

Methods

In this cross-sectional study, 214 healthy adults were divided into 3 groups: (1) Normal, control group; (2) ORTHO, patients who received orthodontic treatment; and (3) OGS group, patients who received orthognathic surgery (OGS). The timing of measurement were at the initial stage of the orthodontic therapy and before surgery. Two questionnaires and one additional item were used: the 36-item Short Form Health Survey (SF-36) for QoL, the 14-item Oral Health Impact Profile (OHIP-14) for oral health-related QoL (OHRQOL) and one additional item for aesthetic evaluation. Descriptive and inferential statistical analyses were used to compare the 3 groups. The effects of 3 malocclusion types, gender, age, and facial asymmetry in the OGS group were also evaluated.

Results

The ORTHO and OGS groups had higher negative impacts than did the Normal group in the OHIP-14, but not much difference in the SF-36. The item of aesthetics related to oral health impact was the lowest in the OGS group. The patients in the ORTHO group with a Class II malocclusion were most dissatisfied in the SF-36 and OHIP-14. In the OGS group, the women dissatisfied in the OHIP-14 and the aesthetic. The older patients had higher negative impacts in the OHIP-14 than the younger patients. The patients with facial asymmetry did not suffer higher negative impacts than did the patients with a symmetrical face in the SF-36 and OHIP-14.

Conclusions

The majority of the patients who required orthodontics or OGS reported a higher negative impact in the OHIP-14 compared with the normal controls, but not in the SF-36. Class II malocclusion suffered from highest psychological stress and aesthetic sensitivity than the other two subgroups in the ORTHO group.

Three-dimensional cephalometric analysis of the maxilla: Analysis of new landmarks

INTRODUCTION

Clinical evaluation of the midface including the paranasal and upper lip regions is highly subjective and complex. Traditional and 3-dimensional cephalometrics were not developed with the clinical appearance of these midfacial areas in mind and are therefore inappropriate surrogates for the clinical appearance of the midface, making them unsuitable as aids in diagnosing dentofacial deformities. The aim of this study was to evaluate traditional as well as newly defined landmarks and measurements and their correlation with clinical appearance of the midface.

METHODS

Fifty-two subjects who underwent full-field cone-beam computed tomography were recruited for this study. A single examiner assessed each subject's midfacial region (paranasal and upper lip), and a second examiner obtained traditional and newly defined cephalometric measurements for each subject. Both examiners were blinded to each other's data throughout the study. Statistical analysis was performed to assess the correlations of the traditional and novel cephalometric measurements with clinical midfacial findings. The impact of the soft tissue thickness in the paranasal region was also analyzed. The performance of any classification derived from statistically significant variables was analyzed with the use of micro-F scores and area under the receiver operating characteristic curve (AUC).

RESULTS

Both traditional (SNA) and newly defined measurements (SN_ANS, SN_PR, SN_NP, SN_h) had no statistically significant correlation with clinical paranasal diagnosis. However, in the absence of upper lip procumbency or protrusion, SN_NP and SN_h had statistically significant correlations with clinical paranasal diagnosis (P = 0.047 and P = 0.003, respectively). For upper lip analysis, both traditional (SNA) and newly defined measurements (SN_CEJ) had strong correlations with clinical upper lip diagnosis (P < 0.001). All statistically significant cephalometric variables had good intra- and interobserver reliability (correlation coefficients ≥0.972 and ≥ 0.968, respectively) except SNA, which had a low interobserver reliability (correlation coefficient 0.739). Fitted models for paranasal and upper lip analyses showed low micro-F scores, indicating low precision and recall. However, AUC values of 0.7019 and 0.6362 for the paranasal and upper lip analysis, respectively, suggest improved performance of the model when properly trained with a larger sample size.

CONCLUSIONS

Newly defined measurements SN_h and SN_NP correlated with clinical paranasal diagnosis only in the absence of upper lip procumbency and protrusion. SNA and SN_CEJ were strongly correlated with clinical upper lip diagnosis. However, fitted models based on this study sample yielded low micro-F scores, making the fitted models currently unsuitable for anything besides correlation with clinical findings. A larger sample size will be necessary to further clarify the potential roles of these measurements, especially given the reasonable AUC values. The findings of this study demonstrate the highly subjective and relative nature of midfacial diagnosis and the importance of clinical judgment despite the potential utility of some traditional and new measurements.

Hakeem M, Yamaki M. Perception of dental professionals and lay people to altered facial esthetics

Introduction

The aim of this study was to examine whether dental professionals and lay people group do agree in their perception of digitally altered facial components or not.

Materials and Methods

A frontal photograph of a Saudi young man was taken, imported, and digitally altered to a series of images of 16 photographs. Eyes, nose, mouth, and chin were altered gradually from the original photograph and were rotated 1°, 3°, and 5°. 225 raters (60 lay people, 41 orthodontists, 77 dentists, and 47 dental students) were invited and asked to evaluate the original and altered images using a visual analog scale.

Results

Lay people were less critical and gave higher ratings than dentists when evaluating rotated eyes of 5°. Orthodontists gave higher ratings than lay people and dental students at distinguishing of 1° of rotated nose. Orthodontists were less critical in rating larger alterations of the nose at 3° than lay people. Orthodontists were also less discriminating of minor alterations of the lips. They could not detect mouth rotation of 1° compared to lay people and dental students.

Conclusions

The results of this study underline the importance of developing an objective index to enumerate the magnitude of facial asymmetries.

The Ideals of Facial Beauty Among Chinese Aesthetic Practitioners: Results from a Large National Survey

Abstract

As the demand for cosmetic procedures increases, the importance of patient-centred care in this field becomes more prominent. The aesthetic practitioners’ ideals of beauty, in addition to their knowledge and perception of patients’ ideals of beauty and expectations, are important during doctor–patient communication. These are important in strengthening practices of patient-centred communication and treatment. This study was conducted to investigate ideals of facial beauty among Chinese aesthetic practitioners. A questionnaire with simple sketches of facial features was given to aesthetic practitioners in Chinese cosmetology hospitals and clinics to assess aesthetic practitioners’ ideals of beauty and their preferences for facial shapes, facial profile, nose and lip shape, jaw angle, and chin shape. A total of 596 surveys were completed. This survey revealed that Chinese aesthetic practitioners preferred a heart/inverted triangular facial shape with a reduced lower face height, a straight and small nose, as well as lips that are full medially and taper off laterally with well-defined borders and Cupid’s bow. An obtuse jaw angle for women and a square well-defined jaw angle for men, and a round and pointy chin for both women and men were the most preferred. A majority (66.7%) of the respondents said they would have plastic surgery. However, if given the choice 82.9% indicated they would opt for non-surgical procedures. Finally, a clear majority (90.5%) believed that being beautiful would improve their daily life. The results were then compared to a similar previous study in which the same ideals of beauty were investigated among Chinese laypersons. This information will help the aesthetic professionals to understand their patient’s requests and expectations better and therefore aid in offering and providing treatments that are in line.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey

Abstract

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether “being beautiful” would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid’s bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Changes in Soft Tissue Profile After Orthodontic Treatment With and Without Extraction: A Systematic Review and Meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis was to evaluate the soft tissue changes in adult orthodontic patients who received extraction treatment in comparison to their counterparts who received nonextraction orthodontic treatment.

METHODS

Electronic databases (CENTRAL-Cochrane Register of Controlled Trials, PubMed, Embase, EBESCOhost, LILACS, and Google Scholar) were searched up to March 2015. Handsearching was performed too. The selection process included controlled trials (prospective or retrospective and randomized or nonrandomized) on adult patients receiving orthodontic extraction treatment compared within the same study to a group treated without extraction. The outcomes of interest were the changes in linear and angular cephalometric measurements specific for soft tissue profile. Studies which fulfilled the selection criteria were retrieved. They were assessed for methodological quality based on a validated checklist. Studies of moderate to high quality were included.

RESULTS

Of the nine full texts which fulfilled the selection criteria, 5 were eligible for the quantitative analysis; they scored a moderate quality. Meta-analysis showed a significant increase regarding the nasolabial angle, upper lip thickness, labrale superioris to E-Line, and labrale inferioris to E-line in the extraction group, suggesting the flattening of the profile following extraction treatment.

CONCLUSION

A significant retraction of the lips and an increase in the nasolabial angle are associated with extraction protocols, but the degree to which these changes are considered detrimental/beneficial to the profile could be affected by different factors. Since these finding are based on studies of moderate quality, future research with well-conducted methodologies are highly recommended.

Clinician, dental student, and orthognathic patient perception of black-and-white silhouette lateral profile dimensions of ideal chin position in a Chinese population

OBJECTIVES

This study aimed to investigate differences in the influence of chin prominence and length on perception of facial aesthetics by Chinese dental clinicians, orthognathic patients, and dental students.

STUDY DESIGN

Male and female silhouette lateral profiles were modified to obtain 28 facial profiles by altering chin prominence and length by 3 mm in the sagittal and vertical planes. Images were rated by 70 clinicians, 30 orthognathic patients, and 100 dental students on a 7-point Likert scale.

RESULTS

Perceived attractiveness was highest when the male chin prominence (MCP) was -3 mm to 3 mm and the female chin prominence (FCP) was 3 mm. In contrast, male chin length (MCL) of 0 to 3 mm and female chin length (FCL) of 0 mm were considered the most attractive. In the sagittal and vertical profiles, MCP (-9 mm), FCP (-9 mm), FCL (-9 mm), and MCL (-9 mm) were ranked least attractive.

CONCLUSIONS

The overall aesthetic opinions of orthognathic patients, clinicians, and dental students are similar. The greater the retrusion or protrusion of the chin and the shorter or longer the chin length, the lower were the rates of facial aesthetics and the greater were the desire for surgery.

Effect of frontal facial type and sex on preferred chin projection

Objective

To investigate the effects of frontal facial type (FFT) and sex on preferred chin projection (CP) in three-dimensional (3D) facial images.

Methods

Six 3D facial images were acquired using a 3D facial scanner (euryprosopic [Eury-FFT], mesoprosopic [Meso-FFT], and leptoprosopic [Lepto-FFT] for each sex). After normal CP in each 3D facial image was set to 10° of the facial profile angle (glabella–subnasale-pogonion), CPs were morphed by gradations of 2° from normal (moderately protrusive [6°], slightly protrusive [8°], slightly retrusive [12°], and moderately retrusive [14°]). Seventy-five dental students (48 men and 27 women) were asked to rate the CPs (6°, 8°, 10°, 12°, and 14°) from the most to least preferred in each 3D image. Statistical analyses included the Kolmogorov-Smirnov test, Kruskal-Wallis test, and Bonferroni correction.

Results

No significant difference was observed in the distribution of preferred CP in the same FFT between male and female evaluators. In Meso-FFT, the normal CP was the most preferred without any sex difference. However, in Eury-FFT, the slightly protrusive CP was favored in male 3D images, but the normal CP was preferred in female 3D images. In Lepto-FFT, the normal CP was favored in male 3D images, whereas the slightly retrusive CP was favored in female 3D images. The mean preferred CP angle differed significantly according to FFT (Eury-FFT: male, 8.7°, female, 9.9°; Meso-FFT: male, 9.8°, female, 10.7°; Lepto-FFT: male, 10.8°, female, 11.4°; p < 0.001).

Conclusions

Our findings might serve as guidelines for setting the preferred CP according to FFT and sex.

Perception of Esthetic Impact of Smile Line in Complete Denture Wearers by Different Age Groups

PURPOSE

To evaluate esthetic perceptions based on tooth exposure when smiling of patients wearing complete dentures by evaluators in different age groups.

MATERIALS AND METHODS

Alterations were made to a front view photograph of a smiling patient wearing complete maxillary and mandibular dentures. Alterations in the smile line were simulated to increase or decrease tooth exposure (increments of 0.5 mm). For this purpose, image manipulation software was used. After manipulation, images were printed on photo paper, attached to a questionnaire, and distributed to individuals in three age groups (n = 150). To evaluate the esthetic perception for each image, a visual analog scale was used, with 0 representing least attractive, 5 representing attractive, and 10 representing very attractive. Differences between examiners were analyzed using the Mann-Whitney test. All statistical analyses were performed with a degree of confidence of 95%.

RESULTS

Two evaluators did not observe any differences between images. The images given the best and worst scores were E and O (alterations of 2 and 7 mm), respectively, in the 15- to 19-year-old group, B and O (alterations of 0.5 and 7 mm), respectively, in the 35- to 44-year-old group, and A and M (no alteration and 6 mm alteration), respectively, in the 65- to 74-year-old group. When the images were presented together (images 1 and 2), the unaltered image was selected by individuals of different age groups as the best, and the image with a change of 7 mm was selected as the worst.

CONCLUSION

In this study, complete dental prostheses with smile lines that coincided with the cervical margins of the anterior teeth were the most acceptable. Less exposure of the maxillary teeth when smiling corresponded with decreased attractiveness.

[Facial profile preferences: a cross-sectional survey]

INTRODUCTION

The aim of this study is to identify facial profile preferences among Lebanese orthodontists, general dentists and laypersons.

MATERIALS AND METHODS

A lateral photograph of a young man and young woman with a class I skeletal relationship was used. Each photograph was manipulated, using Dolphin Imaging System^®, to produce six other photographs in which anteroposterior variations in the position of the maxilla and/or the mandible were made. A total of 120 participants were asked to rank the photographs of each gender from most to least attractive.

RESULTS

The straight profile was the most favored in men and women; however more lip protrusion for women and maxillary retrusion for men are tolerated.

DISCUSSION

Our results represent the mean evaluation of a Caucasian society, this does not mean that every straight profile will be perceived as an attractive one. Hence the importance of an individualized treatment planning for a successful orthodontic treatment.

Comparison of esthetics perception and satisfaction of facial profile among male adolescents and adults with different profiles

Objective:

To evaluate esthetics perception and satisfaction of the facial profile among Iranian male adolescents and adults.

Materials and Methods:

In this cross-sectional study, male subjects referred to Orthodontic Department of Mashhad Dental School were enrolled (n = 84) and were divided into two groups: Adolescents (n = 39), and adults (n = 45). They were also assigned to straight, convex, or concave profile groups based on the facial profile angle (G-Sn-Pog’). An ideal silhouette of the lower facial profile was designed in Adobe® Photoshop® CS2 software (Kansas, USA). Then, eight other silhouettes representing different relations of the maxilla and mandible were constructed. Patients were asked to use numbers 1–10 to rank the facial profiles in the order of the attractiveness, and choose a silhouette that best closely resembled their own profile. Moreover, using a questionnaire patients were asked to rank their satisfaction with their profile, and asked to assign a number (1–5) to each question as follows; one represented the least satisfaction, while five reflected the highest satisfaction.

Results:

Adult and adolescent subjects with straight (adults: 12.0 ± 1.9, adolescents: 12.8 ± 1.05) and concave (adults: 10.0 ± 2.14, adolescents: 10.0 ± 2.08) profile showed the highest and the least satisfaction with their own profile, respectively. Both adult and adolescent group selected “retrognathic maxilla, prognathic mandible” as the least attractive profile. Overall, “straight” and “bimaxillary dentoalveolar retrusion” were chosen as the most attractive silhouettes in adolescent and adults, respectively. In comparison to a professional opinion (clinician ranking), 42.9% of adolescents and 22% of adults were able to correctly diagnose their own profiles type.

Conclusion:

Most of the male adolescents and especially adults diagnosis of their own profile differed with a professional assessment.

Multiracial Facial Golden Ratio and Evaluation of Facial Appearance

This study aimed to investigate the association of facial proportion and its relation to the golden ratio with the evaluation of facial appearance among Malaysian population. This was a cross-sectional study with 286 randomly selected from Universiti Sains Malaysia (USM) Health Campus students (150 females and 136 males; 100 Malaysian Chinese, 100 Malaysian Malay and 86 Malaysian Indian), with the mean age of 21.54 ± 1.56 (Age range, 18–25). Facial indices obtained from direct facial measurements were used for the classification of facial shape into short, ideal and long. A validated structured questionnaire was used to assess subjects’ evaluation of their own facial appearance. The mean facial indices of Malaysian Indian (MI), Malaysian Chinese (MC) and Malaysian Malay (MM) were 1.59 ± 0.19, 1.57 ± 0.25 and 1.54 ± 0.23 respectively. Only MC showed significant sexual dimorphism in facial index (P = 0.047; P<0.05) but no significant difference was found between races. Out of the 286 subjects, 49 (17.1%) were of ideal facial shape, 156 (54.5%) short and 81 (28.3%) long. The facial evaluation questionnaire showed that MC had the lowest satisfaction with mean score of 2.18 ± 0.97 for overall impression and 2.15 ± 1.04 for facial parts, compared to MM and MI, with mean score of 1.80 ± 0.97 and 1.64 ± 0.74 respectively for overall impression; 1.75 ± 0.95 and 1.70 ± 0.83 respectively for facial parts. In conclusion: 1) Only 17.1% of Malaysian facial proportion conformed to the golden ratio, with majority of the population having short face (54.5%); 2) Facial index did not depend significantly on races; 3) Significant sexual dimorphism was shown among Malaysian Chinese; 4) All three races are generally satisfied with their own facial appearance; 5) No significant association was found between golden ratio and facial evaluation score among Malaysian population.

A study to evaluate cephalometric hard tissue profile of Tamil population for orthognathic surgery

The primary aim of this study is to compare, the cephalometric hard tissue profile values and analysis between Tamil and Caucasian population. The study also aims to create a better understanding in the facial proportions of Tamil Nadu population and to have better diagnosis and treatment planning for orthognathic surgery for Tamil population in Tamil Nadu.

Facial profile esthetic preferences: perception in two Brazilian states

OBJECTIVE:

The aim of this study was to assess the regional influence on the perception of facial profile esthetics in Rio de Janeiro state (RJ) and Rio Grande do Sul state (RS), Brazil.

METHODS:

Two Caucasian models, a man and a woman, with balanced facial profiles, had their photographs digitally manipulated so as to produce seven different profiles. First year dental students (laypeople) assessed the images and classified them according to their esthetic preference.

RESULTS:

The result of the t test for independent samples showed differences among states for certain facial profiles. The female photograph identified with the letter 'G' (mandibular retrusion) received higher scores in RS state (p = 0.006). No differences were found for male photographs (p > 0.007). The evaluators' sex seemed not to influence their esthetic perception (p > 0.007). Considering all evaluators together, ANOVA/Tukey's test showed differences among the profiles (p ≤ 0.05) for both male and female photographs. The female photograph that received the highest score was the one identified with the letter 'F' (dentoalveolar bimaxillary retrusion/ straight profile). For the male profiles, photograph identified with the letter 'E' (dentoalveolar bimaxillary protrusion/ straight profile) received the best score.

CONCLUSION:

Regional differences were observed regarding preferences of facial profile esthetics. In Rio de Janeiro state, more prominent lips were preferred while in Rio Grande do Sul state, profiles with straight lips were favored. Class III profiles were considered less attractive.

Comparing esthetic smile perceptions among laypersons with and without orthodontic treatment experience and dentists

Objective

The purpose of this study was to examine whether orthodontic treatment experience affects the individual's perception of smile esthetics and to evaluate differences among orthodontically treated laypersons, non-treated laypersons, and dentists by using computerized image alterations.

Methods

A photograph of a woman's smile was digitally altered using a software image editing program. The alterations involved gingival margin height, crown width and length, incisal plane canting, and dental midline of the maxillary anterior teeth. Three groups of raters (orthodontically treated laypersons, non-treated laypersons, and dentists) evaluated the original and altered images using a visual analog scale.

Results

The threshold for detecting changes in maxillary central incisor gingival margin height among laypersons was 1.5 mm; the threshold of dentists, who were more perceptive, was 1.0 mm. For maxillary lateral incisor crown width and height, the threshold of all three groups was 3.0 mm. Canting of the incisal plane was perceived when the canting was 3.0 mm among non-treated laypersons, 2.0 mm among treated laypersons, and 1.0 mm among dentists. Non-treated laypersons could not perceive dental midline shifts; however, treated laypersons and dentists perceived them when the shift was ≥ 3.0 mm.

Conclusions

Laypersons with and without orthodontic treatment experience and dentists have different perceptions of smile esthetics. Orthodontically treated laypersons were more critical than non-treated laypersons regarding incisal plane canting and dental midline shifts. Based on these findings, it is suggested that orthodontic treatment experience improved the esthetic perceptions of laypersons.

Comparison of White and Chinese perception of esthetic Chinese lip position

OBJECTIVE

To compare the esthetic preference of White and Chinese judges with regard to Chinese lip position.

MATERIALS AND METHODS

The profile images of a dental and skeletal Class I Chinese adult male and female were digitally adjusted to Chinese mean values. The lip profile was adjusted with the upper and lower lip at the mean distance from the Ricketts' E-line. These images were used as baseline images and were further digitally manipulated to generate six additional images with the upper and lower lip such that they lay 0.5, 1.0, and 2.0 standard deviations (SDs) in front of or behind the E-line. An additional image was modified based on a White mean value. The images were viewed and ranked by 251 White and Chinese judges (dentists and laypersons) in Australia and China.

RESULTS

Significantly more Chinese judges ranked the retrusive profiles higher than the White judges. The White judges also ranked the profile image adjusted to -0.5 SD as the most esthetic for both the female and male, while the Chinese judges ranked the -1.0 SD profile as the most esthetic.

CONCLUSIONS

The ethnicity of the judges is a significant factor influencing the perception of esthetic lip position. The Chinese judges prefer a more retrusive profile and are more likely to rate a protrusive profile as unacceptable, compared with the White judges.

Is Beauty in the Eye of the Beholder but Ugliness Culturally Universal? Facial Preferences of Polish and Yali (Papua) People

Previous studies suggest that human facial attractiveness is culturally universal. As they were conducted among Western populations and populations strongly influenced by the Western culture, it is not obvious if the preferences would also be the same in populations isolated from this culture. It is also not certain if the agreement would be the same in the case of attractive and unattractive faces. In the presented study participated 103 people from the Yali tribe (Papua, Indonesia) and 99 Poles. Their task was to choose the most attractive and unattractive face of the opposite sex from a set of 4 pictures (one attractive, one unattractive and two average faces of Polish people chosen in a pre-test). We showed significant cross-cultural differences in attractiveness preferences and similarities in choices of unattractive faces. We speculate that across cultures unattractiveness could be assessed on the basis of the same cues to health and biological quality. Attractiveness criteria seem to be more complex, specific to each population, and dependent on the population's ecological conditions and morphological characteristics.