Impact of functional orthodontic treatment on facial attractiveness of children with Class II division 1 malocclusion

Background/objectives: Whether orthodontic treatment with functional appliances improves facial aesthetics is still under debate. This study aimed to determine whether functional orthodontic treatment improves the facial attractiveness of patients with Class II division 1 malocclusion. Materials/method: Extraoral lateral photographs of 20 children with Class I (CLI, 11.7 ± 0.8 years), and before (T1) and after treatment (T2) photographs of patients with Class II division 1 (CLII T1 and CLIIT2; mean age ± SD = 11.1 ± 0.6 years) treated with functional appliances, were transformed into black silhouettes. Three panels of examiners including 30 orthodontists (39.0 ± 10.1 years), 30 dentists (40.0 ± 9.7) and 30 laypersons (39.0 ± 9.2) evaluated the attractiveness of patients’ silhouettes using a 100-mm visual analogue scale, and the sagittal position of patients’ upper lip, lower lip, and chin using a 3-point Likert scale.Two-way ANOVA and a chi-square test were used to test differences among groups. Statistically significance was set as P < 0.05. Results: The silhouettes of CLIIT2 individuals were more attractive than those of the other groups (all Ps < 0.001).The upper lip, lower lip, and the chin of these individuals were judged to be normally positioned in 69.5 per cent, 74.9 per cent, and 72.3 per cent of the assessments, respectively (all Ps < 0.05). Limitations: This study did not account for the psychological profile of the examiners, which may have affected the ratings. Conclusions/implications: Orthodontic treatment with functional appliances is associated with a superior facial profile attractiveness. Functional treatment should be considered as a treatment option to improve the facial appearance of children with Class II division 1 malocclusion.