The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis

Abstract

Background Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated. Objective The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness. Search Methods Systematic and unrestricted search of nine databases were performed up to January 2022. Selection Criteria Studies evaluating facial attractiveness before and after orthodontic treatment. Data Collection and Analysis Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed. Results Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: −0.89/ 95% CI: −8.72; 6.94) or between different types of Class II correctors (MD: 2.21/95% CI: −16.51; 20.93). Limitations With the exception of two RCTs, included studies were of unclear or low quality. Conclusions Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic/surgical treatment is compared to orthodontics alone. Registration PROSPERO #: CRD42020169904

The effect of orthodontic treatment on smile attractiveness: a systematic review

“…If proper mechanics are applied during treatment, the position of the anterior dentition is not compromised after the extraction of premolars and thus, optimal smile esthetics can be achieved. This result is confirmed in a previous systematic review investigating the effect of orthodontic treatment on facial attractiveness, which indicated that current evidence shows no significant difference between extraction and non-extraction cases [23].…”

“…In cases, for example‚ where the patient declines any type of surgical intervention, choosing a camouflage treatment, that respects the biological boundaries of tooth movement, may be adequate to provide a pleasing smile appearance that meets the patient's wishes. Similar studies that have compared surgical to non-surgical orthodontic treatments regarding their effect on facial attractiveness have shown that surgical treatments improve facial attractiveness by approximately 5% more than non-surgical ones [23]. These small differences reported by studies comparing surgical to non-surgical treatments should, however, be interpreted within the context of the examined samples.…”

“…This is based on a single investigation comparing extraction treatment to no treatment that reported a difference between groups of 22% [32]. This percentage is significantly higher when compared to the improvement that orthodontic treatment brings to overall facial attractiveness, which has been found to be approximately 9% [23]. This difference is expected since orthodontic treatment affects primarily the lower third of the face and most importantly the oral and perioral structures.…”

“…For example, a more esthetically pleasing smile may be less attractive than a less esthetic, but more natural smile. Current evidence regarding the effect of orthodontic treatment on facial attractiveness demonstrates that individuals who have received treatment are perceived as 9% more attractive compared to untreated individuals; nevertheless, the quality of the available evidence is considered weak [23]. Furthermore, orthodontics is more likely to have a more significant effect on the smile than the entire face.…”

Deferoxamine mesylate enhances mandibular advancement‐induced condylar osteogenesis by promoting H‐type angiogenesis

“…Class II malocclusion manifested by mandibular deficiency destroys the facial attractiveness 1 . Promoting mandibular growth through functional orthopaedic treatments, such as mandibular advancement (MA)‐induced condylar remodelling, has been shown to be effective in improving facial aesthetics 2 .…”