Introduction: This study evaluated differences between laypersons and orthodontists in rating facial attractiveness in borderline class III surgical/orthodontic cases. The purpose was to determine whether orthognathic surgery or camouflage is a better alternative for observable esthetic improvement in borderline Class III surgical/orthodontic patients. This study will aid the orthodontist in recommending treatment options to enhance profile attractiveness of borderline Class III surgical/orthodontic patients. Materials and Methods: Thirty profile images of treated borderline class III surgical/orthodontic cases were selected. Fifteen of the profile images were of cases that had been treated by orthodontics alone, and fifteen images were of cases that had been treated by a combination of orthodontics and surgery. Profile images were modified in Photoshop to mask the face and eyes. Patients selected for this study: 1) were 16-25 years of age, 2) had a half-step or more Class III molar relationship, 3) had a pretreatment ANB greater than -4° and less than 1°, and 4) had a Wits appraisal less than -1.5mm and greater than -4mm. Patients with craniofacial anomalies and skin conditions were excluded from this study. Two groups of thirty raters evaluated the profile images for facial attractiveness by marking a 10 cm visual analog scale. One group of raters was composed of thirty orthodontists and the other group was composed of thirty laypersons. In order to evaluate intra-individual reproducibility of the measuring system, ten duplicate sets of profile images were added to the series. Results: The repeated measures ANOVA F-test results found a statistically significant difference between facial attractiveness scores (p = 0.000), with higher ratings by orthodontists. There was no statistically significant difference between treatment type (p = 0.278). Intraclass correlation results indicate excellent reliability. The ICC was 0.774 (95% CI; 0.733, 0.808). The level of significance was set at α = .05. Conclusions: In evaluating facial attractiveness of borderline Class III surgical/orthodontic cases, laypersons are more critical than orthodontists. Furthermore, surgery or camouflage treatment provides similar esthetic improvement in profile attractiveness in borderline class III surgical/orthodontic patients.

LLU Discipline

Orthodontics and Dentofacial Orthopedics


Orthodontics and Dentofacial Orthopedics


School of Dentistry

First Advisor

Stacey, Graham

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded

January 2011

Date (Title Page)




Library of Congress/MESH Subject Headings

Facial attractiveness; Orthognathic surgery;

Subject - Local

Class III surgical/orthodontic cases



Page Count

85 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives