Perception of patients with sagittal malocclusion in en-face portraits: a retrospective survey among professionals and laypersons

BACKGROUND: Orthognathic patients are often considered unattractive and seek surgical treatment because they have a poor self-assessment of their face. Since orthognathic malocclusions are predominantly apparent in the sagittal plane, the aim of this study was to investigate whether the presence and type of malocclusion can also be detected by viewing en-face portraits.METHODS: Using a web-based survey, in which we presented enface portraits of orthognathic patients and healthy individuals we investigated whether orthognathic patients are rated less attractive than patients without any type of malocclusion. Statistical analysis are subsequently performed to evaluate the influence of medical education and sex of raters.RESULTS: It could be shown that presence and type of malocclusion can be recognized by isolated examination of en-face image. The existence of Class III malocclusion was detected with high reliability by all raters, whereas patients with Class II malocclusions were occasionally rated as individuals with regular occlusion. Individuals with Class I occlusion were rated most attractive.CONCLUSIONS: Apparently Class II patients benefit from en-face visualization as they are frequently mistaken as individuals without orthognathic malformation and are rated more attractive. As the aesthetic perception of each individual is influenced by numerous factors, it should be noted that the concept of an attractive face depends on biological, cultural and social characteristics and is therefore complex and subject to fluctuations.