Esthetic evaluation of profile photographs showing various sagittal and vertical patterns

Introduction

The purpose of this study was to determine the esthetic preferences of people at different levels of society and also to determine whether this preference is affected by sex, age, education level, social status, geographic region, and individual profile factors.

Methods

Facial profile photographs of 1 man and 1 woman, each having a profile designated as ideal (the ideal profile), were digitized. The sagittal and vertical dimensions of these photographs were modified, and 9 variations of each profile picture were obtained using different combinations of alterations. The photographs were scored by 373 participants. For the analysis, Mann-Whitney U and Kruskal Wallis-H tests were used in the comparison of the scores.

Results

The ideal profile was the most preferred in both sexes, whereas the least preferred was a severe Class III malocclusion with a reduced vertical dimension of 8 mm. In general, esthetics decreased as it moved away from the ideal profile in a sagittal or vertical direction.

Conclusions

Some factors from among those sampled (sex, age, education, social status, geographic region, and personal profile) affected esthetic preference, whereas others did not.

Highlights

  • Participants preferred the ideal profiles in both sexes.

  • The participant’s sex had little effect on the evaluation of profile esthetics.

  • Age is significant in evaluating the profile esthetics.

  • Geographic region differences were significant regarding profile preferences.

  • The raters’ profile did not generally affect their esthetic evaluations.

Facial esthetics and physical beauty have been important in every period, from ancient to modern times. Although the concept of esthetics is subjective, people throughout history have tried to explain it with formulas. It was Pythagoras, the Greek philosopher and mathematician, who first tried to explain esthetics mathematically. Later, Euclid, another Greek mathematician, defined Pythagoras’s formulas as the golden ratio in his Elements .

The aim of orthodontic treatment is not only to create the optimum occlusion by ordering the teeth properly but also to achieve an esthetically pleasing face that looks good to the eye. However, defining an esthetic face is not easy because esthetic preferences are influenced by factors such as sex, age, education, culture, and social status. In addition, as stated in many studies, the esthetic perception has changed over time and will likely continue to change.

In the literature, there are many studies on whether esthetic perception is affected by social status, , , whereas the number of studies investigating the effect of factors, such as sex, age, education level, geographic region, and personal profile, is insufficient. There are also many studies in which only the sagittal or the vertical profile esthetics was examined, whereas the number of studies in which both were combined is small.

The purpose of this study was to evaluate the profiles of men and women with different sagittal and vertical patterns from an esthetic point of view by men and women at different levels of society and to determine whether esthetic preferences are affected by individual factors such as sex, age, education level, social status, geographic region, and personal profile. The null hypothesis for this study was that individual factors have no effect on the esthetic preferences of people.

Material and methods

In this study, G∗Power (version 3.0.10, Franz Faul, Universitat, Kiel, Germany) was used to determine the number of samples. According to this, a power of 95% was obtained when the total number of subjects was 324, with a range of 0.25 domains and a significance level of α = 0.05. A total of 373 people (206 female, 167 male) were included in the study. Participants were recruited from the Anatolian population in 2018 according to the following inclusion criteria: (1) aged >18 years, (2) no previous orthodontic treatment (except for the patient group), (3) no history of facial esthetic treatments that could have altered their facial profile (rhinoplasty, orthognathic surgery, botox, etc), and (4) no mental problem that could hinder the evaluation of the questionnaires.

This study was approved by the Regional Ethical Committee on Research of Selçuk University, Faculty of Dentistry (no. 2018/04). All participants signed written informed consent.

For the creation of the profile photographs, a male candidate and a female candidate were selected whose sagittal and vertical skeletal values were within the normal range according to Steiner’s cephalometric analysis. The profile photographs of the 2 selected candidates were taken by the same digital camera (Nikon D7000; Nikon Corporation, Tokyo, Japan) at the same distance and by the same person. As the photographs were taken, the lips were in slight contact with each other and with no tension. One male profile photograph and 1 female profile photograph were obtained in color and transferred to the computer; the photographs were then converted into black and white. Thus, the effect of skin color on esthetic perception was eliminated.

The lateral cephalometric films of the selected women and men were taken. These lateral cephalometric films and the generated black-and-white profile photographs were transferred to the cephalometry drawing program Quick Ceph 2000 (Quick Ceph Systems, San Diego, Calif). The photographs were brought to the same values as the soft tissue norms of Steiner and Ricketts with the help of the program to eliminate slight deviations. To investigate the effect of the vertical movement of the maxilla in the sagittal direction, the maxilla was moved in the vertical direction, the mandible was moved in the sagittal direction, and male and female profile pictures were created in different combinations ( Figs 1 and 2 ). The maxillary and mandibular movements were performed at 4-mm intervals. The 4-mm increments were based on a study by Romani et al.

Fig 1
Female profile photographs created in different combinations.

Fig 2
Male profile photographs created in different combinations.

The maxillary direction changes were made with vertical movements of +8 mm, +4 mm, 0 mm, −4 mm, −8 mm to simulate the total LeFort I osteotomy. Changes in the mandibular direction were performed with sagittal movements of +8 mm, +4 mm, 0 mm, −4 mm, −8 mm to simulate bilateral sagittal split osteotomy. Although the + sign in the maxillary vertical movements indicates the vertical size increase, it shows the prognathia in the mandibular sagittal movements. These movements were combined in the vertical and sagittal directions. Nine female and 9 male profile photographs were created. The combinations are as follows: +4/+4 mm, +8/+8 mm, −4/−4 mm, −8/−8 mm, +4/−4 mm, +8/−8 mm, −4/+4 mm, −8/+8 mm, and 0/0 mm (ideal). The first value depicts the vertical movement direction, and the second shows the sagittal movement direction. With the Quick Ceph 2000 program, the autorotation of the mandible was also added to these movements. Soft tissue movements reflected hard tissue movements, but some artifacts occurred in the jaw and lip morphology. The photograph editing function of the same program was used to eliminate these artifacts.

Nine female and 9 male profile photographs created in black and white were printed on separate A4 (210 × 297 mm) sheets. To test the intrarater reliability, 2 randomly selected +4/−4 mm and −8/+8 mm profile pictures of both sexes were shown twice. As a result, 11 female and 11 male profile pictures were used in this study. The photographs were shown to the participants by using a randomized sequence. The male and female profile pictures were symbolized by the letters M and F , respectively. The photographs were numbered from 1 to 11.

Participants were asked to evaluate the 22 profile photographs from an esthetics point of view and to score them between 1 (very unattractive) and 10 (very attractive). It was stated that the photographs should not be considered for a long time (a maximum of 5 seconds) and that the photographs should not be compared with each other during the scoring.

Statistical analysis

The scores of the 373 participants were analyzed using the SPSS package for statistical analysis (version 21.0; IBM, Armonk, NY). The mean scores and standard deviations of male and female profile photographs were calculated. A Mann-Whitney U test was used to compare 2 groups, and a Kruskal Wallis-H test was used for comparisons of more than 2 groups. In addition, Bonferroni correction was performed separately for each multiple comparison. The Bonferroni adjustments were P ˂0.017, P < 0.0125, P < 0.0083, P < 0.0125, and P < 0.017, in multiple comparisons of age, education, social status, location, and personal profile groups, respectively.

Results

The demographic information of the participants is shown in Figure 3 .

Fig 3
Distribution of the raters according to sex, age, education, social status, location, and personal profile.

The average scores given to the profile photographs are shown in Table I . According to the results, the highest score was given to photograph number 9 in both sexes, and the lowest score was given to photograph number 1.

Table I
Mean scores for female and male profiles
Female profile Mean Standard deviation Male profile Mean Standard deviation
F1 2.28 1.27 M1 1.77 1.00
F2 5.21 2.01 M2 4.44 1.99
F3 4.63 1.84 M3 4.94 1.95
F4 6.13 2.03 M4 5.79 2.00
F5 4.08 1.79 M5 3.60 1.68
F6 3.06 1.81 M6 2.76 1.64
F7 6.60 2.02 M7 5.69 2.09
F8 2.33 1.44 M8 2.29 1.41
F9 7.69 1.91 M9 7.76 1.81

The average values of the scores given by all female and male panel members to all profile photographs are shown in Table II . Male participants rated the F1, M1, M5, and M8 photographs more attractive than did female participants, whereas female participants gave more points to the F9 photograph ( P <0.05) than did the male participants. The F9 and M9 photographs received the highest ratings from both sexes. The F1 photograph received the lowest score from the female participants, and F8 received the lowest score from the male participants. The M1 photograph scored the fewest points from both sexes.

Table II
Comparison of mean scores for female and male profiles by sex
Female profile Females Males P value Male profile Females Males P value
Mean SD Mean SD Mean SD Mean SD
F1 2.13 0.08 2.46 0.10 0.016 M1 1.62 0.05 1.97 0.08 0.002
F2 5.06 0.14 5.38 0.15 0.089 M2 4.52 0.14 4.34 0.14 0.678
F3 4.60 0.13 4.67 0.13 0.766 M3 4.78 0.14 5.14 0.13 0.076
F4 5.97 0.15 6.33 0.14 0.135 M4 5.70 0.14 5.90 0.14 0.442
F5 3.95 0.11 4.25 0.14 0.225 M5 3.39 0.11 3.86 0.13 0.004
F6 2.95 0.12 3.20 0.13 0.079 M6 2.66 0.11 2.89 0.13 0.144
F7 6.63 0.14 6.56 0.15 0.510 M7 5.85 0.15 5.49 0.14 0.131
F8 2.27 0.09 2.39 0.11 0.525 M8 2.12 0.08 2.50 0.11 0.019
F9 7.85 0.13 7.48 0.14 0.026 M9 7.74 0.13 7.77 0.13 0.815

SD , standard deviation.

P < 0.05.

The average values of the scores given by the 18-29 year, 30-39 year, and ≥40 year age groups to all profile photographs are shown in Table III . The F2, F3, F4, F6, F7, F8, and F9 profile pictures and all the male profile pictures showed statistically significant differences between age groups ( P <0.05). The F9 and M9 photographs received the most points from all 3 age groups, and the male profile M1 received the minimum score. The female profile photograph F1 received the lowest score from the 30-39 year and ≥40 year age groups, and the female profile photograph F8 received the lowest score from the 18-29 year age group.

Table III
Comparison of mean scores for female and male profiles by age
Female profile 18-29 y 30-39 y ≥40 y P value Significance between Male profile 18-29 y 30-39 y ≥40 y P value Significance between
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
F1 2.28 0.08 2.07 0.13 2.53 0.17 0.144 M1 1.66 0.05 1.78 0.12 2.27 0.19 0.011 I and III, II and III
F2 5.02 0.12 5.58 0.25 5.57 0.25 0.046 I and II, I and III M2 4.15 0.11 4.45 0.25 5.79 0.25 0.000 I and III, II and III
F3 4.49 0.12 4.81 0.20 5.01 0.22 0.026 I and III, II and III M3 4.65 0.11 4.94 0.23 6.31 0.23 0.000 I and III, II and III
F4 5.89 0.12 6.75 0.24 6.44 0.29 0.002 I and II, I and III M4 5.48 0.12 6.10 0.21 6.85 0.26 0.041 I and III, II and III
F5 4.05 0.11 3.94 0.21 4.44 0.21 0.272 M5 3.43 0.10 3.92 0.19 3.96 0.26 0.018 I and II, I and III
F6 2.93 0.10 3.01 0.19 3.75 0.30 0.047 I and III, II and III M6 2.50 0.08 2.67 0.18 4.11 0.28 0.005 I and III, II and III
F7 6.38 0.12 6.57 0.27 7.66 0.25 0.000 I and III, II and III M7 5.39 0.11 5.24 0.24 7.68 0.27 0.037 I and III, II and III
F8 2.25 0.08 2.08 0.13 3.01 0.28 0.028 I and III, II and III M8 2.14 0.07 2.07 0.12 3.29 0.27 0.026 I and III, II and III
F9 7.48 0.11 7.78 0.26 8.51 0.23 0.000 I and III, II and III M9 7.61 0.11 7.72 0.24 8.50 0.23 0.001 I and III, II and III

SD , standard deviation; I , 18-29 y; II , 30-39 y; III , ≥40 y.

P < 0.05, Bonferroni adjustment was performed in multiple comparisons of age groups. P < 0.017 value was used for statistical significance.

The average values of the scores given by the primary school, high school, university, and doctoral graduates to all profile photographs are shown in Table IV . Only the F5 and M7 photographs showed a statistically significant difference based on the education level ( P <0.05). The most highly rated profile photographs at all educational levels were F9 and M9; the male profile photograph with the lowest score was M1. The female profile photograph that received the lowest points from the primary school and doctoral groups was F1, and the female profile photograph that received the lowest score from high school and university graduates was F8.

Table IV
Comparison of mean scores for female and male profiles by education
Female profile Primary school High school University Doctoral P value Significance between Male profile Primary school High school University Doctoral P value Significance between
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
F1 2.07 0.34 2.47 0.19 2.38 0.09 2.05 0.10 0.145 M1 2.00 0.42 1.83 0.17 1.73 0.06 1.79 0.08 0.809
F2 5.53 0.67 5.18 0.27 5.20 0.15 5.20 0.17 0.986 M2 5.15 0.67 4.40 0.28 4.53 0.15 4.25 0.16 0.549
F3 4.92 0.48 5.16 0.28 4.65 0.13 4.29 0.14 0.053 M3 5.92 0.87 5.00 0.24 5.02 0.15 4.69 0.15 0.390
F4 5.38 0.75 6.62 0.25 6.04 0.14 6.10 0.18 0.167 M4 6.69 0.75 5.57 0.29 5.69 0.15 5.95 0.15 0.206
F5 5.07 0.75 4.16 0.18 4.26 0.13 3.66 0.16 0.015 I and IV M5 5.07 0.79 3.30 0.23 3.60 0.11 3.59 0.13 0.088
F6 3.53 0.85 2.83 0.21 2.96 0.13 3.29 0.15 0.165 M6 4.07 0.92 2.86 0.21 2.78 0.11 2.55 0.13 0.365
F7 6.00 0.74 6.64 0.28 6.53 0.13 6.75 0.18 0.429 M7 6.23 0.87 6.62 0.27 5.66 0.14 5.22 0.17 0.001 II and IV
F8 3.92 0.93 2.10 0.18 2.34 0.09 2.24 0.10 0.209 M8 3.30 0.71 2.57 0.21 2.25 0.09 2.10 0.10 0.394
F9 6.61 0.66 7.64 0.31 7.65 0.12 7.88 0.16 0.185 M9 6.69 0.87 8.11 0.24 7.69 0.12 7.80 0.15 0.201
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Feb 28, 2021 | Posted by in Orthodontics | Comments Off on Esthetic evaluation of profile photographs showing various sagittal and vertical patterns
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