The evaluation of the effect levels of facial attractiveness on malocclusion perception by orthodontists, dentists, orthodontic patients and laypeople

Aim: The aim of this study is to evaluate the effect levels of facial attractiveness on malocclusion perception by orthodontists, dentists, orthodontic patients and laypeople with an eye tracking device and questionnaires. Materials and Methods: A preliminary questionnaire was used in the current study to determine photographs of three female patients with low, moderate, and high facial attractiveness. Using the smile photos of three selected patients, 7 modified photographs were created for each patient, including ideal smile (P1), -2 mm low smile line (P2), +4 mm gummy smile (P3), +6 mm gummy smile (P4), maxillary anterior crowding (P5), median diastema (P6) and polydiastema (P7). A total of 24 photographs, including resting photographs (P0), were evaluated by 50 orthodontists, 50 dentists, 50 orthodontic patients and 50 laypeople using eye tracking devices and questionnaires. Results: Total fixation duration and fixation count varied depending on the type of malocclusion, the level of facial attraction, and the participant's occupation. The maxillary anterior crowding photograph has the lowest VAS score at each attractiveness level. VAS scores became similar at each attractiveness level in only P4 photograph and thus the initial difference in facial attractiveness disappeared. Conclusion: While an ideal smile increased facial beauty in individuals with low and moderate facial attractiveness, it did not make a significant contribution to an individual with high facial attractiveness. In general, orthodontists and dentists have a a more critical perception of malocclusion compared to orthodontic patients and laypeople. The least attractive type of malocclusion was maxillary anterior crowding at all facial attractiveness levels. In general, orthodontic patients and laypeople think that anterior crowding and diastema have a more negative impact on facial attractiveness than a low or high gingival smile. A low smile line does not reduce facial attractiveness in a patient with a high attractiveness level. Key words: Eye tracking, facial attractiveness, malocclusion