Practitioner and Patient Perceptions of Orthodontic Treatment: Is the Patient Always Right?

Study on decision-making for orthodontic treatment plans based on analytic hierarchy process

BACKGROUND

Orthodontics is a common treatment for malocclusion and is essential for improving the oral health and aesthetics of patients. Currently, patients often rely on the clinical expertise and professional knowledge of doctors to select orthodontic programs. However, they lack their own objective and systematic evaluation methods to quantitatively compare different programs. Therefore, there is a need for a more comprehensive and quantitative approach to selecting orthodontic treatment plans, aiming to enhance their scientific validity and effectiveness.

METHODS

In this study, a combination of the analytic hierarchy process (AHP) and semantic analysis was used to evaluate and compare different orthodontic treatment options. An AHP model and evaluation matrix were established through thorough research and semantic analysis of patient requirements. This model considered various treatment factors. Expert panels were invited to rate these factors using a 1-9 scale. The optimal solution was determined by ranking and comparing different orthodontic treatment plans using the geometric mean method to calculate the weights of each criterion.

RESULTS

The research indicates a higher preference for invisible correction compared to other orthodontic solutions, with a weight score that is 0.3923 higher. Factors such as comfort and difficulty of cleaning have been given significant attention.

CONCLUSION

The Analytic Hierarchy Process (AHP) method can be utilized to effectively develop orthodontic treatment plans, making the treatment process more objective, scientific, and personalized. The design of this study offers strong decision support for orthodontic treatment, potentially improving orthodontic treatment outcomes in clinical practice and ultimately enhancing oral health and patients' quality of life.

Perception and analysis of lip-line canting by different populations

INTRODUCTION

This study aimed to provide a valuable reference for the precise diagnosis and treatment of lip-line canting (LLC) in an orthodontic clinic, determine the average observed LLC that would need treatment, and compare the differences in different populations.

METHODS

We took frontal photographs of an adult female with rough facial symmetry and processed them into fully symmetrical frontal images using Photoshop (Adobe Systems, San Jose, Calif). After that, the lip line was rotated clockwise with a gradient of 1° to obtain 8 different pictures. Next, without informing the observers of the aim of the study, we randomly selected 60 dentists, 60 orthodontic patients, and 60 non-oral-related practitioners to observe the LLC in the photographs. We numbered all the images randomly, and the evaluators categorized them as a little LLC not requiring treatment and marked LLC requiring treatment. We then analyzed the results statistically.

RESULTS

Among the 240 observers, the average perception of LLC was 2.65°, and it was 4.1° for those requiring treatment. Orthodontists were more sensitive to the LLC than dentists and non-oral-related practitioners, and orthodontic patients were more sensitive than non-oral related practitioners (P <0.05). Overall, the tolerance value of the orthodontic patients was the least (P <0.05).

CONCLUSIONS

Among all the observers, orthodontic patients had the highest requirement for LLC. This finding could help therapists consider patient expectations when determining treatment plans.

Likert scale vs visual analog scale for assessing facial pleasantness

INTRODUCTION

This study aimed to compare the 2 most commonly used methods for assessing facial pleasantness, the Likert scale and the visual analog scale (VAS).

METHODS

For assessing facial pleasantness, an album was assembled containing the front and profile view facial photographs of 10 patients (5 females, 5 males) who sought orthodontic treatment representing each of the different sagittal and vertical facial discrepancies (straight profile, convex profile, concave profile, long faces, and short faces). The facial pleasantness of the patients was judged by 3 groups of 90 evaluators (47 females and 43 males): 30 orthodontists (mean age, 32.41 years), 30 oral maxillofacial surgeons (mean age, 36.83 years), and 30 laypeople (mean age, 36.83 years). The evaluators judged the facial pleasantness using VAS and a 5-point Likert scale. At the end of the evaluation, the evaluators completed a questionnaire about their preferred scale. Analysis of variance and Tukey and Kruskal-Wallis tests were used to compare the data from VAS and Likert scale, respectively. The Spearman correlation coefficient was used to estimate the correlation between the 2 scales. Fisher transformation and z-statistic were used to estimate the correlation among the evaluator groups. In all tests, a 5% statistical significance level was adopted.

RESULTS

Both scales presented similar answers; only VAS values for the scores of pleasant and very pleasant according to the Likert scale could not be distinct. Most evaluators preferred the Likert scale as they found it easier to convey their opinion than VAS.

CONCLUSIONS

Although both scales can be used to assess facial pleasantness, the Likert scale seems more appropriate as the evaluators preferred it because of its simplicity.

Self-perception of facial esthetics by patients with different profiles compared with assessments of orthodontists and lay people

INTRODUCTION

This study evaluated the perception of facial esthetics of patients with different profiles as assessed by orthodontists, lay people, and patients.

METHODS

The sample comprised 120 patients (81 females, 39 males; mean age, 26.3 years) selected from private practices at the onset of orthodontic treatment. The patients were divided into 3 groups of 40 according to the type of facial profile. The groups were composed of straight, concave, and convex profiles, on the basis of the facial convexity angle (G.Sn.Pog') measured on the initial cephalometric tracings. Patients analyzed only their frontal (smiling and at rest) and profile facial photographs and evaluated the pleasantness of these images on a 5-point Likert scale. A group of 30 orthodontists and 30 lay people also evaluated the patients' facial pleasantness, using the same scale. Factorial analysis of variance (convexity and sex) was used to evaluate the differences between the convexities, and analysis of variance mixed model (type of evaluator and sex) to compare the 3 categories of evaluators, using the aligned rank transform technique. The correlation between the convexity angle and facial pleasantness was assessed by the Spearman correlation coefficient.

RESULTS

Patients and lay people assigned higher pleasantness scores than orthodontists, with statistically significant differences for all evaluations, except for the frontal analysis of the convex group. The correlation coefficients regarding profile convexity and facial pleasantness were negative, indicating a tendency that more convex or concave facial profiles received lower pleasantness scores; however, this correlation was only significant in the evaluation of profile photographs by orthodontists.

CONCLUSIONS

Patients with different profiles were scored with acceptable faces by lay people and patients themselves. Orthodontists' perceptions were different; they attributed lower pleasantness scores. Discrepant profiles affect facial esthetics in the profile view when judged by orthodontists.

Aesthetic facial perception and need for treatment in simulated laterognathism in male faces of different ethnicities

PURPOSE

This study aimed to compare the aesthetic perception and treatment need in individuals of different ethnicities with various degrees of laterognathism assessed by orthodontists, oral and maxillofacial surgeons, and laypersons.

METHODS

Three male descendants of different ethnicities were assessed, in which the mandibular deviation was manipulated digitally in different angulations (from 0 to 8°). The assessment was performed by three groups (orthodontists, maxillofacial surgeons, and laypersons (n = 20)), and it consisted of scoring the degree of pleasantness of the images presented in a numerical scale and indicating or not a corrective treatment for the respective image.

RESULTS

The higher the degree of deviation, the lower the scores assigned to the image (p < 0.05). Laypersons assigned the highest scores, with a significant difference between laypersons and oral and maxillofacial surgeons (p < 0.05). In terms of treatment need according to the group of evaluators, there were no statistically significant differences among them (p > 0.05). Moreover, the increase in degree of deviation increased the perception of treatment need (p < 0.05). The African faces received the highest scores, with significant differences from the Caucasian faces (p < 0.05). The overall tendency was higher treatment indication for the Caucasian faces, with statistically significant differences from the African faces (p < 0.05).

CONCLUSION

The greater the mandibular deviation, the lower the aesthetic pleasantness. Laypersons are less critical regarding the assessment of mandibular deviation. There was no difference for treatment indication by the different groups of evaluators. In addition, ethnicity may influence the perception and treatment indication.

The influence of sagittal position of the mandible in facial attractiveness and social perception

OBJECTIVE:

This study aims at comparing the perception of orthodontists, maxillofacial surgeons, visual artists and laypersons when evaluating the influence of sagittal position of the mandible - in lateral view - in facial attractiveness; at a job hiring; and in the perception of socioeconomic profile.

METHODS:

A black male, a white male, a black female and a white female with harmonic faces served as models to obtain a facial profile photograph. Each photograph was digitally manipulated to obtain seven facial profiles: an ideal, three simulating mandibular advancement and three simulating mandibular retrusion, producing 28 photographs. These photographs were evaluated through a questionnaire by orthodontists, maxillofacial surgeons, visual artists and laypersons.

RESULTS:

The anteroposterior positioning of the mandible exerted strong influence on the level of facial attractiveness, but few significant differences between the different groups of evaluators were observed (p < 0.05).

CONCLUSIONS:

The profiles pointed as the most attractive were also pointed as more favorable to be hired to a job position and pointed also as having the best socioeconomic condition.

Orthodontic Metallic Lingual Brackets: The Dark Side of the Moon of Bond Failures?

Lingual orthodontics, among both young and adult patients, increased in popularity during last years. The purposes of the present investigation were to evaluate the shear bond strength (SBS) values and Adhesive Remnant Index (ARI) scores of different lingual brackets compared with a vestibular control bracket. One hundred bovine teeth were extracted and embedded in resin blocks. Four different lingual brackets (Idea, Leone; STB, Ormco; TTR, RMO; 2D, Forestadent) and a vestibular control bracket (Victory, 3M) were bonded to the bovine enamel surfaces and subsequently shear tested to failure utilizing a Universal Testing Machine. SBS values were measured. A microscopic evaluation was performed to obtain ARI scores. Statistical analysis was performed at a statistically significant level of p < 0.05 to determine significant differences in SBS values and ARI Scores. No statistically significant variations in SBS were reported among the different groups. Conversely, significant differences were shown in ARI scores among the various groups. Clinical relevance of the present study is that orthodontists can expect similar resistance to debonding forces from lingual appliances as with vestibular brackets.