Perceptions of mandibular asymmetry among orthodontists, oral and maxillofacial surgeons, and laypersons

Facial asymmetry is one reason orthodontic patients seek treatment. This study assessed the effect of mandibular asymmetry on facial esthetics and treatment needs perceived by laypersons, orthodontists, and maxillofacial surgeons.

In this descriptive cross‑sectional study, the frontal image of a model was captured and symmetrized from the facial midline using Adobe Photoshop software. The mandible was rotated 0°–8° with 1° intervals. Images were presented to 41 laypersons, 39 orthodontists, and 29 surgeons using an online questionnaire. The observers rated each image’s esthetics with a 0–100 Visual Analog Scale and determined their treatment need by choosing one of the following three choices: No need for treatment, needs treatment, acceptable, but better to be treated. Analysis of variance for repeated measurements model. The regression method, Kruskal–Wallis analysis, was used for statistical analysis and the level of significance was set as P < 0.05.

The images with 0° and 1° rotation received the highest esthetic rates among all three groups, while the images with 8° rotation were the least attractive ones. Furthermore, the image esthetic ratings significantly affected their treatment need. Mandibular asymmetry diagnosis threshold was 1° for orthodontists, and 3° for both laypersons and surgeons. The treatment need threshold was 5°, 6°, and 7° for surgeons, orthodontists, and laypersons, respectively.

The esthetics of images decreased when mandibular asymmetry increased. Treatment need was also related to increased asymmetry. Orthodontists were the most sensitive group in diagnosis, while surgeons were the most sensitive ones when it came to treatment.