Three-dimensional aesthetic assessment of class II patients before and after orthognathic surgery and its association with quantitative surgical changes

Abstract

The aim of this study was to compare evaluations of the aesthetic outcome of class II orthognathic patients, as performed by observers with varying expertise using three-dimensional (3D) facial images, and to examine the relationship of aesthetic ratings in relation to quantitative surgical changes. Pre- and postoperative 3D facial images of 20 surgically treated class II patients (13 female, 7 male) were assessed for aesthetics by orthodontists, maxillofacial surgeons, and laypeople. Attractiveness ratings for the lips, chin, and overall facial aesthetics were evaluated on a 5-point Likert scale. Correlation between the aesthetic scores was obtained and quantitative surgical changes were examined. For all groups of observers, significant improvements in attractiveness scores were found, especially for the chin assessment. Orthodontists perceived the greatest improvement and laypeople the smallest. Overall, laypeople scored higher with less variability, but with lower intra- and inter-observer agreement. No significant correlation was found between the aesthetic improvement and soft tissue surgical changes. To avoid patient dissatisfaction, it is important to bear in mind that the demands and perception of aesthetic improvement after orthognathic surgery are higher for clinicians than for the general public.

Accuracy and reliability of 2-dimensional photography versus 3-dimensional soft tissue imaging

“…3 Even though quantitative studies exist in the literature, these devices have barely been compared in a qualitative manner. 24,27,28 Stebel et al qualitatively compared 2D and 3D stereophotogrammetry images to evaluate nasolabial aesthetics and found that SPG was more reliable and informative than 2D imaging, which corresponds with our findings. 28 However, in our study, the observers were more confident with LS than with 2D images, in contrast with the findings of Zogheib et al 24 The main limitations of this study are related to laser scanning, such as motion artefacts in the orbital region related to the blinking reflex, the application of chin support, and a long capture process, which might have influenced the results.…”

“…28 However, in our study, the observers were more confident with LS than with 2D images, in contrast with the findings of Zogheib et al 24 The main limitations of this study are related to laser scanning, such as motion artefacts in the orbital region related to the blinking reflex, the application of chin support, and a long capture process, which might have influenced the results. 1,27,29 To overcome these limitations, we recommend utilizing marker-free fixed 3D stereophotogrammetric systems such as the 3D Vectra ® H1, 3dMDface TM (3dMD LLC, Atlanta, USA) and Di3D TM (Dimensional Imaging, Glasgow, UK) imaging systems. 30 The reliability of the subjective observations might have been affected by the experience and relatively small number of the observers.…”

Applying artificial intelligence to assess the impact of orthognathic treatment on facial attractiveness and estimated age

“…Thus untreated, the patients would have suffered a steady decrease simply owing to ageing, and this effect is insufficiently accounted for when comparing to pre-treatment score. Second, it is a noted phenomenon seen in numerous investigations that the use of a discrete scale to score intra-individual changes of facial aesthetics in orthognathic patients ordinarily results in small quantitative increments 9,16,27 .…”

“…Much research has been devoted to accurately evaluate the aesthetic outcome of orthognathic treatment. Improvements in facial appearance have been studied based on self-reported scores of patients [6][7][8] or orthodontists and maxillofacial surgeons appraising the changes in soft tissue proportions and facial aesthetics 9 . However, all historical approaches fall short to adequately address the assessment of social attractiveness 10 .…”

Quantification of Facial Traits

“…Facial symmetry perception may vary from observer to observer (Scheib et al, 1999). Also different parts of the face contribute differently to the perception of symmetry (Hwang et al, 2012; Storms et al, 2017).…”