Facial changes after orthognathic surgery in class III patients, as perceived by professionals, patients and lay people. A blind study based on 3D models

Aim. Normalization of facial appearance represents for the orthognathic patients the primary goal of treatment. An objective method for evaluating how the facial defects and their correction are perceived by non professional observers is lacking. Optical scanned 3D models and blind external evaluation may represent a reliable method of investigation. Methods. Facial 3D models were reconstructed from laser scanned data obtained before and one year after treatment on 12 class III patients, and on 12 control subjects. Thirty-one examiners with different backgrounds (10 orthodontists, 10 operated patients and 11 lay people) were presented the models in a blind random order, and answered a questionnaire investigating the perceived need of treatment and the observer’s judgement. Results. The class III patients present unpleasant facial features, which induce the attribution of negative intellectual and personality traits, which are similarly detected by different observers. Orthodonticsurgical treatment is able to improve general appreciation and to normalize perception. The appreciation of facial shapes seems to be observer-dependent and influenced by previous experiences and cultural background. Conclusion. Outcome studies involving facial esthetic correction should rely on objective measuring methods. The use of optical 3D models and external examiners may be proposed as the standard in evaluation of facial deformities and of their treatment.