American Journal of Orthodontics and Dentofacial Orthopedics
Original articlePatient- and clinician-perceived need for orthognathic surgery
Section snippets
Subjects and methods
This was a questionnaire-based study undertaken at John Radcliffe Hospital, Oxford, United Kingdom. Ethical approval was obtained, and all patients consented in writing. Forty consecutive new patients (16 men, 24 women) referred by general dental practitioners, fulfilling the following criteria, were recruited from orthognathic clinics: over 16 years of age, about to undergo orthognathic treatment, no history of orthodontic treatment or facial surgery, and no congenital deformities (eg, clefts)
Results
In general, there was good repeatability among patients. The ICC results were all within the acceptable range, with all values above 0.70. However, the Bland-Altman method highlighted a slight bias in the scoring of dental appearance and overall need for treatment.
In general, clinicians exhibited good repeatability when rating perceived need for treatment based on facial appearance, dental appearance, and function. Repeatability for overall need for treatment was below 0.70 but was still
Discussion
Although the ICC scores for patient repeatability were all high (>.70), the Bland-Altman method highlighted a slight bias for dental appearance and overall need for treatment. This might be a reflection of the small sample size for the repeatability study. In addition, there could be a tendency for patients to modify their scores after considering the initial rating. However, the mean differences in the repeatability study were small compared with those in the main study, and this, considered
Conclusions
The results of this study suggest that:
- 1
Orthodontists and maxillofacial surgeons rated a greater need for orthognathic treatment based on facial appearance than patients.
- 2
Maxillofacial surgeons rated a greater need for orthognathic treatment based on overall treatment need than patients.
- 3
Large variation existed within both the orthodontist and maxillofacial surgeon groups, but neither group appeared to exhibit more variability than the other.
- 4
Maxillofacial surgeons rated treatment need based on
References (16)
- et al.
The psychological and social aspects of orthognathic treatment
Am J Orthod
(1982) - et al.
Patient motivation and response to surgical correction of prognathism
J Oral Surg
(1976) - et al.
Perceptions of facial profile and their influence on the decision to undergo orthognathic surgery
Am J Orthod
(1985) - et al.
Profilemetrics and facial esthetics
Am J Orthod
(1978) - et al.
Perceptions of dentofacial morphology by laypersons, general dentists and orthodontists
J Am Dent Assoc
(1979) - et al.
Nicknames, teasing, harassment and the salience of dental features among school children
Br J Orthod
(1980) Social and psychological implications of dentofacial disfigurement
Angle Orthod
(1970)- et al.
Facial deformity in childhoodseverity and psychological adjustment
Child Care Health Dev
(1991)
Cited by (36)
Is there a difference in judgement of facial appearance depending on ethnic background? Photographic evaluation of facial appearance in orthognathic surgery
2020, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :It is, however, not clear to what extent ethnic differences affect the decisions about planning treatment in orthognathic surgery. Previously, evaluation of facial appearance and need for treatment has been based on both professional and lay judgements of photographs,17,18 with ambiguous results. In this study we have compared evaluations of facial aesthetics by evaluators from different ethnic backgrounds.
Redo orthognathic surgery: a report of 10 cases
2019, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyOutcome of photographic evaluation of facial appearance in orthognathic surgery: how does it correlate with planning of treatment and patient-reported outcome?
2019, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :However, this type of evaluation could be affected by the patient’s subjective impression of a poor baseline standard of facial aesthetics, which might indicate a degree of satisfaction that did not correspond to the environmental opinion. Facial appearance and the need for treatment have also been evaluated through both lay and professional judgement of photographs.15,16 However, the results are ambiguous and show both conformity and differences between the assessments of professionals and patients.
Skeletal stability of surgery-first bimaxillary orthognathic surgery for skeletal class III malocclusion, using standardized criteria
2016, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Through preoperative orthodontic treatment, conventional orthognathic surgery facilitates skeletal stability, which in turn, enhances and enables postoperative stability in the occlusion. Nevertheless, conventional orthognathic surgery is accompanied by drawbacks such as a prolonged duration of treatment, unaesthetic appearance during the treatment period, and dysmasesis.1,2 In this study of class III malocclusion, postoperative skeletal changes were evaluated according to the inclusion or exclusion of preoperative orthodontic treatment.
Perception of oral and maxillofacial surgeons, orthodontists and laypersons in relation to the harmony of the smile
2014, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :The present study aimed to find the opinion of observers in respect to this association, without specifically determining a value for it. In the literature, surgeons typically have a greater tendency to indicate orthognathic surgery for patients with dentofacial deformities than orthodontists (Juggins et al., 2005; Bell et al., 1985), which was not the case when comparing the groups in the present study. This result may suggest an improvement in the interaction between specialties, with regard to the patient's interests, and knowledge exchange among the specialties to achieve facial harmony satisfaction for all involved (professional and patient).
Psychosocial Considerations in the Evaluation and Treatment of Dentofacial Deformities
2013, Orthognathic Surgery: Principles and Practice