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Objectives  To assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances.    Subjects and methods  The study sample consisted of 36 pairs of pre- and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed.    Results  The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups ( F  = 0.91;  P  = 0.526; Wilks lambda = 0.93), raters ( F  = 1.68;  P  = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results ( F  = 0.72;  P  = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length.    Limitations  Retrospective study design.    Conclusions  The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient’s facial appearance when this treatment option is used.

Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients