Aesthetic Evaluation of Skeletal Class III Patients Treated With Orthognathic Surgery or Facemask Therapy

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BACKGROUND: This study aimed to evaluate how changes in facial aesthetics of skeletal class III patients, treated with different modalities-bimaxillary surgery, maxillary surgery, or facemask therapy-were perceived by panelists with diverse professional and demographic backgrounds. METHODS: Pretreatment and posttreatment profile photographs and silhouettes of 29 skeletal class III patients (bimaxillary=9, maxillary=9, facemask=10) were evaluated by 180 panelists (90 females, 90 males) from 9 groups: dental students, orthodontists, plastic surgeons, oral and maxillofacial surgeons, general dentists, otorhinolaryngologists, fine arts students, and parents of orthodontic patients. A visual analog scale (VAS) was used for scoring, and intergroup differences were analyzed using mixed-effects linear models. RESULTS: Posttreatment aesthetic scores increased significantly in all treatment modalities (P<0.05), with the greatest improvement in the bimaxillary surgery group and the least in the facemask group. Profile photographs consistently received higher ratings than silhouettes (P<0.05). No gender differences were observed in profile evaluations, although male panelists rated silhouettes higher (P<0.05). Parents of orthodontic patients gave the highest scores, while professionals were more critical. CONCLUSIONS: The most pronounced aesthetic improvement in skeletal class III patients was achieved through surgical interventions. Aesthetic perception was influenced not only by the treatment modality but also by the professional and demographic characteristics of the evaluators. These findings emphasize the importance of considering patient expectations and societal perceptions of facial aesthetics in clinical decision-making.