# Three-dimensional evaluation of facial attractiveness of skeletal Class II patient: comparative analysis after orthodontic and surgical simulations

## TL;DR

This study compares how different treatments for skeletal Class II facial structure affect perceived attractiveness using 3D simulations and evaluations from experts and laypeople.

## Contribution

The study introduces a 3D simulation approach to evaluate facial attractiveness outcomes of orthodontic and surgical treatments for skeletal Class II patients.

## Key findings

- Orthodontic preparation combined with combined orthognathic surgery was rated most attractive by all evaluator groups.
- Laypersons and professionals showed agreement on the most and least attractive facial profiles.
- Skeletal Class II without treatment was consistently rated as the least attractive.

## Abstract

The aim of this study was to assess the perception regarding the attractiveness of the face in patients with skeletal Class II and simulations of possible treatments for this condition.

Dental scans, face scans and cone beam computed tomography (CBCT) of a male patient were used. These images were grouped in a software, where the original file was edited in order to achieve a profile that had the most pronounced skeletal and dental Class II (division 1) features, as well as the different proposed treatments: Compensatory orthodontics with extraction of the maxillary first premolars; Compensatory orthodontics associated with surgical advancement of the chin; and Orthodontics associated with combined orthognathic surgery of the maxilla, mandible and counterclockwise rotation of the occlusal plane. These simulations were presented in the form of videos and accompanied by a questionnaire regarding the attractiveness.

The videos were analyzed by 275 evaluators: 109 orthodontists, 91 oral and maxillofacial surgeons and 165 laypersons. The collected data were submitted to analysis of variance (ANOVA) and Student’s t tests, with a significance level of 95%. Individuals with higher levels of education were more rigorous in their aesthetic evaluation, but the most attractive face for all groups was achieved by orthodontic preparation associated with combined orthognathic surgery, while the least attractive was skeletal Class II without treatment.

This study indicate that the face resulting from a skeletal Class II is aesthetically unfavorable and the treatments generate better aesthetic results, especially the orthodontic preparation associated with combined orthognathic surgery.