Facial aesthetics and the divine proportion: a comparison of surgical and non-surgical class II treatment.

OBJECTIVE: This study was designed to compare selected divine or golden proportions in Class II division 1 patients treated either during the growth phase with an activator and fixed appliances or after the completion of growth with fixed appliances and orthognathic surgery; and to determine the associations between divine facial proportions and perceived facial attractiveness. METHODS: The material consisted of subjects with Class II division 1 malocclusions treated either with upper and lower fixed appliances and orthognathic surgery or with activators followed by fixed appliances. There were 23 females and 9 males in the surgical group (Mean age: 23.5 years; SD: 9.6 years) and 17 females and 11 males in the non-surgical group (Mean age: 10.8 years; SD: 1.1 years). The divine relationships of the subjects were assessed on pre- and post-treatment lateral cephalometric radiographs, and on lateral and frontal facial photographs. In addition, the attractiveness of the subjects was scored by a panel of judges using a visual analogue scale. Facial aesthetic scores were then correlated with the presence of particular divine facial proportions. RESULTS: On average, few ratios fitted the divine proportion, either before or after treatment in either treatment group. There was, however, significant individual variation in the presence or otherwise of these divine proportions, as there were with changes in the proportions with treatment. Regardless of the treatment method, ratios in some patients moved toward the divine proportion, while those in others moved away from it. A comparison of the two treatment groups both before and after treatment showed that the mean group values for some of the proportions differed. These differences could largely be explained by differences in growth status and treatment method. CONCLUSION: Neither treatment method was more likely to result in a greater number of divine proportions, and the achievement of divine proportions seemed to have little, if any, influence on overall aesthetic outcomes.

Perception of facial esthetics: a comparison of similar class II cases treated with attempted growth modification or later orthognathic surgery.

In recent years, there has been considerable interest in the esthetic outcomes of various types of Class II treatment. In this study, it was the authors' intent to determine the esthetic outcomes for 60 Class II division 1 patients: 28 patients treated during the active growth phase with an activator and fixed appliances and 32 patients treated at the completion of growth with fixed appliances and by orthognathic surgery. Using a visual analogue scale, a mixed panel of 14 judges scored the pre- and posttreatment attractiveness of these patients from frontal and lateral facial photographs. Statistical analysis by two-sample t-tests indicated that, on average, esthetic scores improved with treatment, regardless of the treatment modality. There was, however, considerable individual variation in the degree of improvement, even to the point that there was a decline in esthetics for some patients. Despite somewhat different modes of treatment, it was found that neither the average pre- and posttreatment esthetic scores nor the change in esthetic score with treatment was significantly different for the two groups. Although clinical planning decisions should still be made on an individual basis, the findings of this study suggest that the perceived esthetic outcome in many Class II division 1 patients may well be just as favorable, regardless of whether they are managed early during the growth phase or later, at the completion of growth by orthognathic surgery.