The changes of self-esteem, sensitivity to criticism, and social appearance anxiety in orthognathic surgery patients: A controlled study.

OBJECTIVES: To evaluate the changes of psychologic parameters, such as self-esteem, sensitivity to criticism, and social appearance anxiety, in skeletal Class III patients undergoing orthognathic surgery and to compare the psychologic status of skeletal Class III patients with control subjects. METHODS: The first group consisted of 60 patients with a mean age of 22.07 ± 1.30 years who did not need orthognathic surgery. The second group comprised 45 patients with skeletal Class III malocclusion (mean age 21.40 ± 2.02 years) who were evaluated in terms of psychologic changes from before to after surgery. A third group consisted of 50 Class III patients (mean age 20.09 ± 2.59 years) who were evaluated before surgery and a different 50 Class III patients (mean age 22.15 ± 2.03 years) who were investigated after surgery. The Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale were used to evaluate psychologic parameters both before and after surgery. Analysis was carried out with the use of independent- and dependent-sample t tests, 1-way analysis of variance, and post hoc Tukey test. RESULTS: Self-esteem of the patients with skeletal Class III malocclusion increased, and sensitivity to criticism and social appearance anxiety decreased significantly after the surgery (P <0.001). In the patients with Class III malocclusion, self-esteem was significantly lower and social appearance anxiety significantly higher before orthognathic surgery than in the control group, and at the postoperative evaluation Class III patients had significantly higher self-esteem than the control group (P <0.001). CONCLUSIONS: Through the improvement in facial appearance after surgery, patients' self-esteem increases and their sensitivity to criticism and social appearance anxiety decrease.

Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017.

PURPOSE: The objectives of this study were to evaluate the effect of orthognathic surgery on the long-term quality of life of patients who received this treatment and to delineate the common reasons for dissatisfaction. MATERIALS AND METHODS: In this retrospective cohort study, patients who underwent orthognathic surgery were studied. One hundred thirty-two patients who had undergone orthognathic surgery from 2007 to 2017 in the oral and maxillofacial surgery department participated in this study. They were divided based on their dentofacial deformity into those with Class II malocclusion and those with Class III malocclusion. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 91.7%. No significant difference between male and female patients was found regarding the changes in social, esthetic, and functional aspects before and after orthognathic surgery. Both genders recommended orthognathic surgery for patients with similar problems. One in four patients was dissatisfied with the nasal appearance after the surgical procedure (25.8%). CONCLUSIONS: In this study the patients' satisfaction from the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and then functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance.

When Do Skeletal Class III Patients Wear Their Reverse Pull Headgears?

Objective. The aim of this study is to evaluate the factors that affect wearing time and patient behavior during reverse pull headgear therapy with a newly designed reverse pull headgear. Methods. In clinical practice, new reverse pull headgears were applied to fifteen patients. The patients were monitored during reverse pull headgear therapy and the data were evaluated. Statistical analysis was made. Results. During the study, patients were monitored successfully and the evaluations showed that patients wear the new reverse pull headgears mostly at night. There are differences between days of week and hours of day. Weekends are more popular than weekdays for wearing reverse pull headgear. Conclusions. This new type of reverse pull headgears can be used successfully in clinical practice and can help the clinician. Study showed that the most important factor that affects the cooperation of reverse pull headgear patient is aesthetic appearance.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample.

OBJECTIVE: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. MATERIAL AND METHODS: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. RESULTS: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. CONCLUSION: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

[Unfavorable outcomes in orthognathic surgery]. / Chirurgie orthognathique : les cas défavorables∗.

Successful completion of an orthodontic-surgical protocol requires faultless involvement of all the parties concerned, both the practitioners and the patient. When the result achieved does not match esthetic and/or functional expectations, the outcome may be seen as a failure by the patient, the practitioners or even both. Two situations comprising a potential for failure will be analyzed here: unfavorable outcomes and the psychological difficulties involved in accepting a new face.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample

ABSTRACT Objective: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. Material and Methods: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. Results: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. Conclusion: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

RESUMO Objetivo: comparar os escores relacionados à autoestima de adolescentes com 12 a 16 anos de idade, portadores de diferentes tipos de má oclusão de Angle, em uma amostra de peruanos. Métodos: um estudo transversal foi conduzido com uma amostra de 276 adolescentes (159, 52 e 65, respectivamente, com má oclusão de Classe I, II e III de Angle) da cidade de Trujillo, Peru. Os participantes foram instruídos a completar a Escala de Autoestima de Rosenberg (Rosenberg self-esteem scale, ou RSES), e também foram submetidos a exames clínicos para determinar qual sua má oclusão, segundo a classificação de Angle. A análise de covariância (ANCOVA) foi utilizada para comparar os escores da RSES dos adolescentes com más oclusões de Classes I, II e III, controlando-se os fatores demográficos dos participantes. Resultados: as médias dos escores da RSES dos adolescentes com Classes I, II e III foram, respectivamente: 20,47 ± 3,96, 21,96 ± 3,27 e 21,26 ± 4,81. O teste ANCOVA revelou que o escore da RSES dos adolescentes com Classe II foi significativamente maior do que o escore dos adolescentes com Classe I, mas não houve diferenças entre os outros grupos de más oclusões. Uma análise adicional sugeriu que podem ser somente os adolescentes Classe II, subdivisão 2, que apresentam autoestima mais elevada, quando comparados aos adolescentes Classe I. Conclusão: esse estudo mostrou que, no geral, a autoestima dos adolescentes incluídos na amostra estudada não variou em função da má oclusão apresentada. Inesperadamente, apenas os adolescentes com Classe II - especialmente os com Classe II, subdivisão 2 - relataram apresentar uma autoestima mais elevada do que os adolescentes com Classe I. Uma análise mais detalhada deve ser conduzida, avaliando qual característica oclusal da região anterior tem mais impacto.

Effect of malocclusion severity on oral health-related quality of life and food intake ability in a Korean population.

INTRODUCTION: The aim of this study was to evaluate the effect of malocclusion severity on oral health-related quality of life and food intake ability in adult patients, controlling for sex, age, and the type of dental clinic visited. METHODS: The sample consisted of 472 Korean patients (156 male, 316 female) with a mean age of 21.1 (SD, 8.6) years in a dental hospital and a private clinic. The correlations between the Korean version of the Oral Health Impact Profile-14 (OHIP-14K), subjective food intake ability (FIA) for 5 key foods, and Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) were investigated. RESULTS: The mean IOTN-DHC and OHIP-14K scores were significantly higher for the dental hospital patients than for the private clinic patients (IOTN-DHC, P <0.001; OHIP-14K, P <0.05). Malocclusion severity was significantly higher in male than in female subjects (P <0.001). Older patients perceived their oral health-related quality of life more negatively than did the teens (P <0.001). As the severity of the malocclusion increased, oral health-related quality of life and masticatory function worsened (OHIP-14K, P <0.001; FIA, P <0.05). CONCLUSIONS: As the severity of the malocclusion and the age of the patients increased, oral health-related quality of life and masticatory function relatively deteriorated. This finding provides evidence that severe malocclusions are associated with lower quality of life and less masticatory efficiency in older patients.

Impact of orthosurgical treatment phases on oral health-related quality of life.

INTRODUCTION: In this cross-sectional study, we investigated the impact of the orthosurgical treatment phases on the oral health-related and condition-specific quality of life (QoL) of patients with dentofacial deformities. METHODS: Two hundred fifty-four orthognathic patients were allocated into 4 groups according to treatment phase: initial (not yet treated), presurgical orthodontics, postsurgical orthodontics, and retention. Data were collected using the Oral Health Impact Profile to evaluate the oral health-related QoL, the Orthognathic QoL Questionnaire to analyze the condition-specific QoL, and the Index of Orthodontic Treatment Need to assess malocclusion severity and esthetic impairment. Specific malocclusion characteristics were also documented. RESULTS: A negative binomial regression analysis showed that the initial group had a more negative oral health-related QoL than did the postsurgical, presurgical, and retention groups (relative risks, 1, 0.79, 0.74 and 0.25, respectively). The initial group had a more negative condition-specific QoL than did the presurgical, postsurgical, and retention groups (relative risks, 1, 0.77, 0.38 and 0.15, respectively) regardless of age, income, or education; women reported greater negative impacts than men. Certain occlusal traits were related to higher Orthognathic QoL Questionnaire scores (P <0.01). CONCLUSIONS: Patients who completed their orthosurgical treatment had a significantly better oral health-related QoL and a more positive esthetic self-perception than did those undergoing treatment and those who were untreated. Crowding, crossbite, open bite, concave profile, edge-to-edge overjet, or Class III malocclusion negatively affected oral health-related QoL.

Oral Impacts on Quality of Life in Adult Patients with Class I, II and III Malocclusion.

PURPOSE: To compare the social impact of malocclusion on quality of life between adult patients with Angle Class I, II and III malocclusion. MATERIALS AND METHODS: A total of 222 adult patients (139, 42 and 41 with Angle Class I, II and III malocclusion, respectively) were recruited voluntarily from those attending the Orthodontic Clinic of Khyber College of Dentistry in Pesh awar, Pakistan. Participants were asked to complete the Urdu version of the short form of the Oral Health Impact Profile (OHIP-14), which was previously validated for this study. Multivariate analysis of variance (MANOVA) was used to compare the seven OHIP-14 domains scores and the total score between patients with malocclusion Class I, II and III. RESULTS: Adults with Class III malocclusion had a significantly higher OHIP-14 total score than those with Class I malocclusion (a mean difference of 5 units between groups), but there were no differences between other Angle malocclusion groups. In addition, adults with Class III malocclusion reported greater impacts on the three OHIP-14 disability domains (physical, psychological and social) than those with Class I malocclusion. No significant interactions with sex and age were found. CONCLUSION: These findings suggest that adult patients with Class III malocclusion had a poorer quality of life than those with Class I malocclusion. Differences were mainly found in the physical, psychological and social disability domains of the OHIP-14 instrument.

Early orthognathic surgery in response to bullying due to malocclusion.

Urifavourable dental and facial features can have a psychological impact on patients. Orthodontic treatment can have a positive impact on the psychosocial well-being of patients who are bullied about dentofacial features. The use of orthognathic surgery in growing patients to correct dentofacial deformity is a controversial topic. This case report describes the treatment performed for a 13-year-old girl who presented complaining of a "different bite and prominent chin", which was attracting insults at school. Insults regarding her teeth and jaw caused symptoms such as anxiety and stomach pains prior to school in the morning. As a result of the negative psychological effects of the serious bullying, it was decided to proceed with early orthognathic surgery for psychological reasons. As orthognathic surgery is usually timed in the late teens, or early twenties when growth is near completion, the risks of further growth and relapse were discussed at length with the patient and her parents, especially when informed consent was being obtained. Treatment included orthodontic alignment of the arches, early orthognathic bimaxillary surgery and post-surgical orthodontics to detail the occlusion. There was a dramatic improvement in the patient's self-esteem, with return to school and extra school activities only weeks after the surgery. This case demonstrates that early intervention may be appropriate for some orthognathic patients in exceptional circumstances. The patient and her parents were very happy with the outcome but post-treatment growth was unfavourable as expected.

Assessing changes in quality of life using the Oral Health Impact Profile (OHIP) in patients with different classifications of malocclusion during comprehensive orthodontic treatment.

BACKGROUND: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment. METHODS: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance. RESULTS: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1. CONCLUSIONS: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.

Patient's Satisfaction in Skeletal Class III Cases Treated With Two-Jaw Surgery Using Orthognathic Quality of Life Questionnaire: Conventional Three-Stage Method Versus Surgery-First Approach.

OBJECTIVE: To compare the quality of life (QoL) of Class III patients between conventional three-stage method (CTM) and surgery-first approach (SFA) using Orthognathic QoL Questionnaire (OQLQ). MATERIALS AND METHODS: The subjects consisted of 26 Class III patients treated with nonextraction and two-jaw surgery. They were divided into CTM group (N = 15) and SFA group (N = 11). They retrospectively rated the OQLQ scores of 4 domains (social relationship, facial esthetics, function, and awareness of dentofacial deformity) using 0 to 4 scale at initial (T0), just before surgery (T1), 3 month after surgery (T2), and at debonding (T3). Mann-Whitney test and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS: After total OQLQ score of CTM group was deteriorated at T1 stage compared with T0 stage, it was improved at T2 and T3 stages (T0 = 53.9, T1 = 58.1, T2 = 23.5, and T3 = 11.6). Total OQLQ score of SFA group, however, was improved at T2 and T3 stages compared with T0 stage (T0 = 51.6, T2 =  3.1, and T3 = 11.4; T1 was omitted.). Orthognathic QoL Questionnaire scores and their amounts of change did not show any significant difference in each domain and at each stage between 2 groups (T0, T2, T3, ΔT2 - T0, ΔT3 - T2, ΔT3 - T0; all P > 0.05). Both groups showed large change in effect size (ES) of all domains with descending order during T3 - T0: facial esthetics, oral function, social relationship, and awareness of dentofacial deformity (CTM group: -3.97, -3.40, -2.23, -1.25; SFA group: -2.83, -2.33, -1.76, -1.73) CONCLUSIONS: SFA might have an advantage over CTM group in terms of no deterioration stage of OQLQ score.

How Do Patients and Parents Decide for Orthodontic Treatment-Effects of Malocclusion, Personal Expectations, Education and Media.

OBJECTIVES: To examine patients' and parents' perceptions and expectations from orthodontic treatment. STUDY DESIGN: 491 patients (274 female, 217 male) aged 14-22 years, and 399 parents (245 female, 154 male) completed a questionnaire about preferences, needs and expectations about orthodontic treatment, and scored the present problem. Continuous variables were compared by Mann-Whitney U and Kruskal-Wallis tests, whereas Chi-square test was used for categorical variables. RESULTS: Patients'(77.1%) and parents'(84.6%), decision about orthodontic treatments were influenced by suggestion of dentists. Patients who decided to attend to clinic by themselves were higher than parents (p=0.006). Dental aesthetics was the determinant factor for treatment demand for patients(61.0%) and parents(57.3%). Improvement in oral functions was more important for Class III patients than Class I patients (p=0.040). Adult patients/parents with higher education gave more importance to oral functions as well as dental aesthetics (p=0.031). There was no difference among Angle classifications regarding orthodontic problem scores. Parents found media sources valuable (p=0.018) but majority expected dentists for information about orthodontic treatments. Education degree of adult patients/parents effected this decision(p=0.002). CONCLUSIONS: Desire to have better dental aesthetics was the primary motivating factor for all participants. Clinicians should consider concerns of Class III patients about oral functions during treatment planning.

An Assessment of the Quality of Life of Patients With Class III Deformities Treated With Orthognathic Surgery.

PURPOSE: To evaluate quality of life (QoL) from a broad perspective by a comparison of Turkish patients undergoing orthognathic surgery to correct Angle Class III skeletal deformity with a control group composed of participants without dentofacial deformity using general health, generic oral health, and condition-specific QoL approaches. MATERIALS AND METHODS: Thirty patients who underwent orthognathic surgery to correct Class III relations (monomaxillary and bimaxillary groups) and 30 participants with Class I skeletal structure and good dentofacial harmony (control group) were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), generic oral health-related QoL through a 14-item Short-Form Oral Health Impact Profile (OHIP-14), and generic health-related QoL through a 36-item Short-Form Health Survey (SF-36) were assessed. RESULTS: When the groups were compared, OQLQ scores showed a significant difference in the oral function domain only in the bimaxillary group (P < .05), and OHIP-14 scores showed significant differences in half the OHIP-14 subscale scores in the monomaxillary and bimaxillary groups (P < .05). The SF-36 scores showed significant differences only for the vitality domain in the monomaxillary group and the vitality and mental health domains in the bimaxillary group (P < .05). CONCLUSIONS: For condition-specific and health-related QoL, the QoL of orthognathic surgical patients appeared to be similar to that of participants without dentofacial deformities. Oral health-related QoL of orthognathic surgical patients seemed moderately similar to that of participants without dentofacial deformities. The combined use of these methods is helpful for evaluating QoL from a larger perspective.

The impact of dental appearance and anxiety on self-esteem in adult orthodontic patients.

OBJECTIVES: To analyse the relationship between different dimensions of dental appearance impact and self-esteem in adult patients undergoing orthodontic treatment, with special attention to the possible mediating role of anxiety. SETTING AND SAMPLE POPULATION: A quasi-experimental design was used with a matched control group (without orthodontic treatment). In each group (experimental and control), there were 85 patients. MATERIAL AND METHODS: The impact of dental appearance was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). State anxiety was assessed with the State Anxiety Inventory (STAI-S) and self-esteem with Rosenberg's self-esteem scale. RESULTS: In both groups (experimental and control), self-esteem correlates negatively, ranging between 0.26 and 0.43, with all dimensions of dental appearance impact (except for the positive dental self-confidence dimension, where all correlations were positive). Anxiety correlates positively, ranges between 0.35 and 0.44, with social impact, psychological impact and aesthetic concern, although it maintains no significant correlations with dental self-confidence. Nevertheless, in patients undergoing orthodontic treatment, anxiety plays a mediating role between dental impact dimensions and self-esteem, whilst for the control group anxiety only plays a mediator role between psychological impact and self-esteem. CONCLUSION: Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults.

TMD in class III patients referred for orthognathic surgery: psychological and dentition-related aspects.

OBJECTIVE: To investigate temporomandibular disorders (TMD), psychosocial, and occlusal variables in class III orthognathic surgery patients with respect to the control subjects, and to compare psychosocial and occlusal features in class III patients with different Research Diagnostic Criteria for TMD (RDC/TMD) diagnoses. MATERIALS AND METHODS: The study enrolled 44 class III patients referred for orthognathic surgery and 44 individuals without a malocclusion. TMD, depression and somatization were assessed by RDC/TMD. Occlusal analysis included Helkimo's Occlusal Index items, overjet and overbite. RESULTS: In the controls, patients with class III deformities had higher prevalence of myogenic TMD, increased grade of chronic pain, and more occlusal deviations. Within the study group, TMD patients reported higher depression score (P < 0.01), myofascial pain was related to higher depression and somatization grades (P < 0.01, P < 0.05 respectively), and disc displacement showed relation with RCP-ICP slide interferences (P < 0.05). CONCLUSION: With respect to subjects without a malocclusion, TMD in class III dentofacial deformities is similar in prevalence, but differs in clinical appearance. Occlusal, but not psychosocial features deviate from those in the controls. While psychosocial variables accompanied TMD and myofascial pain, increased RCP-ICP slide was related to disc displacement in class III patients.

Perceived changes by peer group of social impact associated with combined orthodontic-surgical correction of class III malocclusion.

OBJECTIVES: Whereas the psychosocial benefits of orthognathic treatment for the individual patient are established, there is little data relating to social perceptions in relation to changes in facial appearance as a result of combined orthodontic and orthognathic treatment. This study aimed to investigate the social impact of combined orthodontic-orthognathic surgical correction for class III malocclusion in Caucasian subjects. METHODS: This cross-sectional study compared perceptions of facial appearance prior to and after orthognathic correction of class III malocclusion. Eighty undergraduate students were shown photographs of four Caucasian subjects (2 male and 2 female) pre- and post-orthognathic class III correction. Observers were asked to rate these subjects in relation to four different outcomes: (i) social competence (SC); (ii) intellectual ability (IA); (iii) psychological adjustment (PA); (iv) attractiveness. A mixed-model analysis of variance (ANOVA) was calculated to determine the effect of each variable. RESULTS: Statistically significant differences were found in ratings of the same face before and after treatment. After treatment, faces were rated as more psychologically adjusted, more sociable, more likely to be successful and more attractive; with the mean psychological adjustment rating being associated with the most change (before treatment=8.06 [SD 2.30]; after treatment=6.64 [SD 2.03], t=2.04, p<0.001). CONCLUSIONS: After combined orthodontic-orthognathic correction of class III malocclusion in Caucasians, individuals are rated by young adults as being better adjusted both psychologically and socially, more likely to be successful and more attractive.

Life-quality of orthognathic surgery patients: the search for an integral diagnosis.

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

Does the British Orthodontic Society orthognathic DVD aid a prospective patient's decision making? A qualitative study.

OBJECTIVES: To explore the views of potential orthognathic patients regarding the influence of the BOS Orthognathic DVD in their decision making process. DESIGN: Qualitative, cross-sectional study. SETTING: A UK dental teaching hospital. PARTICIPANTS: Patients considering orthognathic treatment. METHODS: New patients were recruited from orthognathic clinics following an initial consultation. After an appropriate time to view the DVD, in-depth interviews were conducted with 10 patients (aged 16-48 years) in their homes. Interviews explored the attitudes and perceptions that influenced decisions about surgery, with a focus on the role of the DVD in this process. The interviews were transcribed and a framework analysis was undertaken. RESULTS: The main themes identified were participant perceptions on the patient stories, use of images, the nature of the DVD itself and its usefulness in the decision making process. Participants reported they were heavily influenced by the patient stories. Virtual animations of surgery were seen as useful; whereas the before and after images of surgery were found to be disorientating. The design of the menu resulted in confusion or information being missed. The DVD was seen as a trusted resource, whereas the Internet was seen as biased, general and sensationalistic. CONCLUSIONS: The DVD gives trusted information that patients cannot obtain or process from professional sources or the Internet. If used properly it can have a role in the decision making process, but should be seen within the context of other influences on the patient. This research has highlighted some aspects of the DVD that could be improved upon.

Life-quality of orthognathic surgery patients: The search for an integral diagnosis

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

A decisão de iniciar um tratamento ortodôntico-cirúrgico depende do impacto negativo estético, funcional ou social gerado pela deformidade dentofacial na qualidade de vida de cada paciente. O objetivo deste artigo é demonstrar a importância da avaliação da qualidade de vida desses indivíduos para elevar a taxa de sucesso no tratamento ortodôntico-cirúrgico, por meio da aplicação de questionários específicos antes do início do tratamento. Esses instrumentos avaliam, além do fator estético, as condições funcionais que podem estar afetadas e os problemas psicológicos relacionados à autoestima e à sociabilidade, que devem ser identificados para possibilitar a elaboração de um plano de tratamento individualizado para as expectativas subjetivas do paciente. Assim, torna-se mais previsível obter um alto grau de satisfação ao final do tratamento ortodôntico-cirúrgico, tanto do ponto de vista normativo avaliado pelos profissionais quanto do ponto de vista subjetivo dos pacientes. Apesar da deficiência de dados comparáveis suficientes na literatura disponível para avaliar a extensão da melhora após o tratamento ortodôntico-cirúrgico, há relatos recentes de universidades em diversos países que demonstram uma boa resposta da maioria dos pacientes após a cirurgia, com alto grau de satisfação dos pontos de vista estético, funcional e psicossocial. Conclui-se que o objetivo atual do tratamento ortodôntico associado à cirurgia ortognática consiste em não apenas tratar os componentes estético e funcional da deformidade dentofacial, mas, também, o de considerar o componente psicológico do paciente.