ORIGINAL ARTICLE

Expectations of treatment and satisfaction with

dentofacial appearance in patients applying for
orthodontic treatment
Naomi A. van Wezel,a Annemieke Bos,b and Charlotte Prahlb
Amsterdam, The Netherlands

Introduction: Satisfaction with dentofacial appearance and expectations of orthodontic treatment have been
analyzed in many studies. In 2002, in a study in The Netherlands, signicant correlations were found between dental satisfaction and orthodontic treatment expectations. Satisfaction signicantly decreased with
increasing age. The aim of this study was to compare the satisfaction and expectations of current patients
with the results of a study 10 years ago. Methods: A questionnaire about dentofacial satisfaction and a questionnaire about the expectations of orthodontic treatment were completed by 146 subjects. The mean scores in
the present study were compared with the mean scores 10 years ago. Results: The subjects in the present
study were more satised with their dental appearance. Differences in expectations were found on the subscales of general well-being and self-image. As in the study in 2002, no signicant correlations were found
between sex, satisfaction, and expectations of orthodontic treatment. Dentofacial satisfaction predicts
expectations about orthodontic treatment, especially in the group of subjects aged 17 years and above.
Conclusions: The subjects in this study had greater expectations of orthodontic treatment about general
well-being and were more satised with their dental appearance than were the subjects studied 10 years
ago. (Am J Orthod Dentofacial Orthop 2015;147:698-703)

ou never get a second chance to make a rst

impression. In verbal and nonverbal communication, the face matters. The advantages of beauty
seem to be true, at least at rst meeting. Facial attractiveness is positively associated with high school marks,
good work performance, positive peer relations, social
acceptance, high social status, positive body image,
and good self-concept. It has also been proven that a
malocclusion can have a negative effect on the quality
of life.1-9
Tooth color, missing teeth, and poor tooth alignment are the most common reasons for dissatisfaction
with dentofacial appearance.10-12 It is therefore not

From the Department of Orthodontics, Academic Centre for Dentistry, University

of Amsterdam and Free University, Amsterdam, The Netherlands.
a
Orthodontist.
b
Assistant professor.
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conicts of Interest, and none were reported.
Address correspondence to: Naomi A. van Wezel, Department of Orthodontics,
Academic Centre of Dentistry, Gustav Mahlerlaan 3004, 1081 LA Amsterdam,
The Netherlands; e-mail, n.v.wezel@acta.nl.
Submitted, February 2014; revised and accepted, January 2015.
0889-5406/$36.00
Copyright 2015 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2015.01.024

698

surprising that people seek esthetic dental and

orthodontic care.11-13 Inconsistent results have been
found regarding the association between dentofacial
satisfaction, age, and sex.2,10,14 In some studies, no
sex differences were found regarding dentofacial
satisfaction and treatment expectations,2 but other
studies showed that female subjects were less satised
than were male subjects.10,15
However, it seems that dentofacial satisfaction is
signicantly correlated with expectations of orthodontic
patients about general well-being, improvement of selfimage, and future dental health.2 Also, orthodontic
patients seem to expect improvements in esthetics and
self-esteem, regardless of their sex.2,15-17
Attitudes about dental health change over time.18 In
an epidemiologic dental study in The Netherlands, more
patients were undergoing orthodontic treatment in
2005 than in 1999.19 Also, a change in orthodontic
treatment need was found. The question is whether
these ndings are related to current dentofacial satisfaction and expectations of orthodontic patients at the start
of treatment.
In this study, we replicated the study by Bos et al2 and
compared our results with those results. Because of
controversy about the impact of malocclusion on

van Wezel, Bos, and Prahl

dentofacial satisfaction and treatment expectations in

the orthodontic literature, we examined the effect of
malocclusion on dentofacial satisfaction and treatment
expectations as well.20-22
Based on the results of previous studies, female
patients were expected to be less satised with their dentofacial appearance than male patients.10,14 Based on
the results of Bos et al,2 younger subjects were assumed
to be more satised with their dentofacial appearance
than older subjects. Furthermore, signicant correlations between dentofacial satisfaction and treatment
expectations were expected. We explored whether dentofacial satisfaction and orthodontic treatment expectations have changed over time. Finally, based on the
results of Zhang el,20 we expected that malocclusion
would have no effect on dentofacial satisfaction and
treatment expectations.
MATERIAL AND METHODS

From November 2011 to June 2012, we sent 2 questionnaires to every person applying for orthodontic
treatment at the Academic Centre of Dentistry Amsterdam in The Netherlands. The rst questionnaire
included 16 items about satisfaction with facial appearance before orthodontic treatment to be scored on a
5-point response scale (from I am very unsatised
to I am very satised). It was a modication of the
body-cathexis scale introduced by Secord and Jourard23 in 1953 and was further developed in the
1980s. It gives an assessment of perceived dentofacial
appearance; a high score shows greater satisfaction
with the dentofacial body part being measured.24-28
The second questionnaire included 23 items about
expectations of orthodontic treatment to be scored
on a 7-point response scale (from worse to much
better). It was initially developed for patients undergoing orthognathic surgery and was adjusted for orthodontic patients. It measures long-term expectations
of orthodontic treatment.26,29,30
The same subscales were used as in the study by Bos
et al.2 The questionnaire about satisfaction with facial
appearance was divided into 2 subscales (facial satisfaction and dental satisfaction). The questionnaire about
expectations of orthodontic treatment was divided into
4 subscales (general well-being, self-image, oral function, and future dental health).
The questionnaires were sent to 220 persons
applying for orthodontic treatment at the Academic
Centre of Dentistry in Amsterdam; none had visited
the orthodontic department before. To this type of social science research, the Dutch Medical Research on
Humans Act was not applicable. The questionnaires

699

were returned by 146 subjects (53 male, 93 female),

resulting in a response rate of 67%. There were no
signicant differences in age and sex between responding and nonresponding persons. Subjects with
more than 3 missing responses (n 5 10) were
excluded from the analysis. There were no signicant
differences in age and sex between subjects
who completed the questionnaire and those who did
not.
Subjects older than 60 years (n 5 1) and younger
than 8 years (n 5 1) were excluded from the study.
The mean age of the remaining 134 subjects was 19.6
years (SD, 13.49 years; median, 13 years; age range,
8-60 years). After the initial analysis, the subjects were
divided into 2 age groups, as Bos et al2 did in 2003.
The rst group included subjects from 8 to 16 years
old (n 5 84; 35 boys; mean age, 11.42 years; SD, 1.78
years); the second group included subjects from 17 to
60 years (n 5 50; 15 men; mean age, 33.36 years; SD,
13.43 years). All subjects were invited for a rst consultation. During this consultation, the subjects (n 5 123)
were scored with a Class I (n 5 59), Class II (n 5 57), or
Class III (n 5 7) malocclusion.
Statistical analysis

First, the internal consistencies of the scales and subscales were determined using the Cronbach alpha. To
analyze the effects of sex and age on dental and facial
satisfaction and expectations of orthodontic treatment,
the Mann-Whitney U test was used. Also, the mean
scores of the subscales for the subjects with a Class I
malocclusion were compared with the mean scores for
subjects with a Class II malocclusion using the MannWhitney U test. The Spearman correlation coefcient
was calculated for satisfaction with dental and facial
appearance and expectations of orthodontic treatment.
Next, a multiple regression analysis was performed to
estimate the effect of the initial facial and dental satisfactions on expectations of orthodontic treatment. To
analyze changes in satisfactions and expectations over
time, the mean scores in our study were compared
with the mean scores from the study by Bos et al2 using
1-sample t tests.
RESULTS

The internal consistency in 2012 of the questionnaire

on satisfaction was satisfactory. The Cronbach alpha for
the total scale was 0.93. Internal consistency values for
the 2 subscales were 0.93 and 0.52, respectively, for
satisfaction with facial appearance and dental appearance. The internal consistency of the questionnaire on
expectations was satisfactory as well. The Cronbach

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van Wezel, Bos, and Prahl

700

Table I. Correlations between expectations and satis-

faction

Expectation
Age #16 years
Satisfaction with
facial appearance
Satisfaction with
dental appearance
Age $17 years
Satisfaction with
facial appearance
Satisfaction with
dental appearance

Future
General Self-image/ dental
Oral
well-being appearance health function
0.97

0.36

0.33

0.78

0.64

0.11

0.69

0.13

0.31*

0.29

0.29

0.30*

0.15

0.24

0.14 0.07

*P \0.05.

alpha for the total scale was 0.94, and the internal consistency values for the 4 subscales were 0.94 for general
well-being, 0.91 for self-image, 0.83 for future dental
health, and 0.85 for oral function.
No signicant differences on the subscales and total scales were found between the male and female
subjects for age and sex differences in 2012. However,
age was signicantly related to facial satisfaction
(U 5 1403.500; P 5 0.004), dental satisfaction
(U 5 1461.500; P 5 0.003), and expectations about
self-image (U 5 1536; P 5 0.049). Patients younger
than 17 years of age were more satised with their
facial and dental appearances, and they had lower expectations of orthodontic treatment with regard to
improvements in self-image in comparison with older
subjects.
The group of subjects with a Class III malocclusion
(n 5 7) was relatively small and was therefore excluded
from the analysis. The scores for subjects with a Class I
malocclusion (n 5 59) were compared with the scores
for subjects with a Class II malocclusion (n 5 57). The
Mann-Whitney U test showed no signicant differences
in the subscales and the total scale between subjects
with Class I and Class II malocclusions (facial satisfaction: U 5 1486.50, P 5 0.527; dental satisfaction:
U 5 1433.00, P 5 0.163; general well-being: U 5
1287.50, P 5 0.295; self-image: U 5 1285.00, P 5
0.131; future dental health: U 5 1576.00, P 5 0.908;
and oral function: U 5 1306.00, P 5 0.275).
In Table I, the Spearman correlations between the
different variables were analyzed for the 2 age groups.
Satisfaction with facial appearance was signicantly
correlated with expectations about general well-being
and oral function only for subjects 17 years and older.
No correlation was found between sex and expectations
of orthodontic treatment.

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A multiple regression analysis was used to determine

which variables affected the expectations of orthodontic
treatment for the 2 age groups. Table II shows that facial
satisfaction and dental satisfaction are signicant predictors for expectations about future dental health for
subjects younger than 17 years. Dental and facial satisfaction together explained 12% of the variance of the
subjects' expectations about future dental health. Dental
satisfaction was also a signicant predictor for expectations about oral function for subjects younger than 17
years.
Table III shows that satisfaction with facial appearance was a signicant predictor for all expectations of
orthodontic treatment for subjects 17 years and older.
Dental satisfaction was a signicant predictor only for
expectations about self-image. Dental and facial satisfaction explained 16% of the variance on subjects'
expectations about self-image.
In Table IV, the mean scores and standard deviations
on all subscales of both questionnaires are presented for
both groups in 2002 and 2012. The mean scores from
the present study were compared with the mean scores
from the study of Bos et al.2 Signicant differences
between the subjects in this study and those from the
earlier study were found for dental satisfaction and expectations about general well-being. The subjects in
2012 were signicantly more satised with their teeth
than were those in 2002 and had higher expectations
of orthodontic treatment for their general well-being.
The mean scores for the different age groups from
the present study were compared with the mean scores
for the same age groups from the study in 2002 using
1-sample t tests. For subjects younger than 17 years,
only 1 signicant difference was found for facial satisfaction in both boys (2002, 55.75 [n 5 36]; 2012,
60.79 [n 5 35]; t 5 3.00; P \0.01) and girls (2002,
60.56 [n 5 36]; 2012, 57.32 [n 5 49]; t 5 2.19;
P \0.05). In 2012, boys younger than 17 years were
signicantly more satised with their facial appearance
than were the boys 10 years ago. Girls younger than
17 years in 2012 were signicantly less satised with
their facial appearance than were the girls 10 years ago.
In Tables V and VI, the mean scores and standard
deviations on all subscales of both questionnaires
are presented for the age groups 17 years and older
in 2002 and 2012. As illustrated in Tables V and VI,
both sexes 17 years and older were signicantly
more satised with their teeth in 2012 compared
with 2002. Women 17 years and older, however,
were signicantly more satised with their facial
appearance as well and had signicantly higher expectations about general well-being and self-image than
did the women 10 years ago.

American Journal of Orthodontics and Dentofacial Orthopedics

van Wezel, Bos, and Prahl

701

Table II. Multiple regression for subjects #16 years of age

Expectation
Satisfaction with facial appearance
Satisfaction with dental appearance
R
Adjusted R2

General well-being

Self-image/appearance

Future dental health

b
P
0.176
0.260
0.177
0.258
0.146
0.006

b
0.121
0.246

b
0.436
0.458

Oral function

0.189
0.009

0.351
0.123

b
P
0.251
0.194
0.323
0.036*
0.245
0.034

General well-being

Self-image/appearance

Future dental health

Oral function

P
0.441
0.004y
0.149
0.314
0.413
0.133

0.372
0.385

P
0.435
0.114

P
0.005y
0.003y

*P \0.05; yP \0.01.

Table III. Multiple regression for subjects $17 years of age

Expectation
Satisfaction with facial appearance
Satisfaction with dental appearance
R
Adjusted R2

P
0.011*
0.009y

P
0.025*
0.180

0.345
0.203

0.437
0.156

P
0.343
0.028*
0.098
0.523
0.324
0.064

0.331
0.071

*P \0.05; yP \0.01.

Table IV. Means and standard deviations of all subscales for the total groups in 2002 and 2012
Total groups
20022 (n 5 100)
Subscale
Satisfaction questionnaire
General facial satisfaction
Dental satisfaction
Expectation questionnaire
General well-being
Self-image/appearance
Future dental health
Oral function

2012 (n 5 134)
t

Mean

SD

Mean

SD

56.04
5.99

10.59
1.86

56.76
6.49

10.24
1.87

0.804
3.116

0.420
0.002y

26.54
18.00
19.70
9.56

10.93
7.53
5.97
4.30

28.90
18.73
19.35
9.92

13.21
7.88
5.93
4.77

1.986
1.055
0.680
0.849

0.049*
0.294
0.497
0.397

*P \0.05; yP \0.01.

DISCUSSION

In this study, decreased dentofacial satisfaction with

increasing age was found, as expected. This nding
was consistent with previous studies.2,31 Because the
older subjects were less satised with their dental and
facial appearance than the younger subjects, it is not
surprising that the older subjects expected more
improvement in their self-image. Dental and facial satisfactions were signicant predictors for all expectations of orthodontic treatment in the older age
group. For the younger subjects, facial satisfaction
was found to be a signicant predictor only for expectations of orthodontic treatment about future dental
health. This was in contrast to previous studies. Philips

et al17 found that older patients showed more concern

about functional problems and future dental health
than did younger subjects, and Bos et al2 found that
dental and facial satisfactions were predictors for expectations about general well-being in the younger
age group. Although female subjects were expected
to be less satised with their dentofacial appearance,
no signicant correlations were found between sex,
satisfaction with dental and facial appearances, and expectations of orthodontic treatment. Also, there was no
effect of malocclusion on dentofacial satisfaction. This
result was also found by Taylor et al.21
In comparison with the subjects in 2002, the subjects
in the 2012 study had signicantly higher expectations

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van Wezel, Bos, and Prahl

702

Table V. Means and standard deviations on all subscales for men $17 years in 2002 and 2012
Men
2002 (n 5 11)

2012 (n 5 15)

Subscales
General facial satisfaction
Dental satisfaction
General well-being
Self-image/appearance
Future dental health
Oral function

Mean
53.36
5.00
26.73
19.73
21.82
10.64

SD
10.98
1.73
6.23
8.15
4.26
3.96

Mean
52.53
6.13
27.57
17.20
20.20
11.29

SD
9.90
1.25
13.66
7.59
6.56
5.12

t
0.323
3.523
0.230
1.291
0.956
0.472

P
0.751
0.003*
0.821
0.218
0.355
0.645

*P \0.01.

Table VI. Means and standard deviations of all subscales for women $17 years in 2002 and 2012
Women
2002 (n 5 17)

2012 (n 5 35)

Subscales
General facial satisfaction
Dental satisfaction
General well-being
Self-image/appearance
Future dental health
Oral function

Mean
48.94
5.12
27.00
19.00
19.00
9.47

SD
9.01
1.50
8.31
5.85
5.72
3.86

Mean
54.03
5.77
32.36
22.26
19.62
10.33

SD
9.95
1.78
13.76
8.41
6.11
4.36

t
3.027
2.181
2.239
2.263
0.589
1.137

P
0.005y
0.036*
0.032*
0.030*
0.560
0.264

*P \0.05; yP \0.01.

about orthodontic treatment. This was especially true for

women aged 17 years and older. A reason for the higher
expectations of orthodontic treatment might be that orthodontic treatment has become more common in The
Netherlands during the last decade.19 It can be assumed
that patients see friends and acquaintances who have
been treated successfully and therefore have high expectations for their own orthodontic treatment.
Unexpectedly, the subjects in this study were more
satised with their dental and facial appearances than
were those studied 10 years earlier. A possible explanation for the increased satisfaction over time may be
that decreased anterior crowding in the Dutch population was found between 1999 and 2005.19 Several
studies have shown that anterior crowding is the main
reason for dissatisfaction with dental appearance.10-13
Some limitations of this study must be noted. First, it
describes the responses of subjects applying to the Academic Centre of Dentistry Amsterdam for orthodontic
treatment. Therefore, our results cannot be used for
orthodontic patients in general. Furthermore, the group
in 2002 might not be comparable with the group in
2012. Both groups included different people who
might not be similar for socioeconomic status and

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malocclusion. However, because both groups were large

samples of subjects applying for orthodontic treatment
at the Academic Centre of Dentistry in Amsterdam, a
comparison between them seemed acceptable. Additionally, if the sample of subjects 17 years and older
had been larger and the distribution of the sexes had
been more equal, it is possible that signicant correlations between sex and satisfaction with dental and facial
appearances would have been found. Finally, although
the reliability of the questionnaire on satisfaction with
facial appearance was high, that of the questionnaire
on dental satisfaction was only moderate. To compare
the results of the 2012 study with the results from
2002, the same items were used. To increase the reliability, more items could be added to the subscale of
dental satisfaction in a future study.
In our study, changes in dental and facial satisfaction
and expectations of orthodontic treatment over time
were found. In the future, this study can be replicated
to examine whether there are tendencies toward
increasing dental and facial satisfactions and expectations of orthodontic treatment over time. Additionally,
to analyze the correlations between objective orthodontic treatment need and dental and facial satisfactions

American Journal of Orthodontics and Dentofacial Orthopedics

van Wezel, Bos, and Prahl

and treatment expectations, the index of orthodontic

treatment need could be used.

703

13.

CONCLUSIONS

1.

2.

3.

4.

The subjects in 2012 had higher expectations of

orthodontic treatment about general well-being
than did those studied in 2002, especially the
women 17 years and older.
The subjects in this study were more satised with
their dental and facial appearances than were those
studied 10 years earlier.
No signicant correlations were found between sex,
satisfaction with dental and facial appearances, and
expectations of orthodontic treatment.
Facial satisfaction was a signicant predictor for all
expectations of orthodontic treatment in subjects
17 years and older. For the younger subjects, facial
satisfaction was found to be a signicant predictor
only for expectations about future dental health.

REFERENCES
1. Duggal R, Bansal S. Expectations from orthodontic treatment
patient/parent perspective. J Clin Diagn Res 2010;4:3648-53.
2. Bos A, Hoogstraten J, Prahl-Andersen B. Expectations of treatment and satisfaction with dentofacial appearance in orthodontic
patients. Am J Orthod Dentofacial Orthop 2003;123:127-32.
3. Wedrychowsa-Szulc B, Syrynska M. Patient and parent motivation
for orthodontic treatmenta questionnaire study. Eur J Orthod
2010;32:447-52.
4. Philips C, Bennett ME, Broder HL. Dentofacial disharmony: psychosocial status of patients seeking treatment consultation. Angle
Orthod 1998;68:547-56.
5. Tung AW, Kiyak HA. Psychological inuences on the timing of orthodontic treatment. Am J Orthod Dentofacial Orthop 1998;113:
29-39.
6. Trulsson U, Strandmark M, Mohlin B, Berggren U. A qualitative
study of teenagers' decisions to undergo orthodontic treatment
with xed appliance. J Orthod 2002;29:197-204.
7. Seehra J, Newton JT, DiBiase AT. Bullying in schoolchildrenits
relationship to dental appearance and psychosocial implications:
and update for GDPS. Br Dent J 2011;210:411-5.
8. Helm S, Kreiborg S, Solow B. Psychosocial implications of malocclusion: a 15-year follow-up study in 30-year-old Danes. Am J
Orthod 1985;87:110-8.
9. Agou S, Locker D, Steiner DL, Tompson B. Impact of self-esteem
on the oral-health-related quality of life of children with malocclusion. Am J Orthod Dentofacial Orthop 2008;134:484-9.
10. Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients' satisfaction with dental esthetics. J Am Dent Assoc 2007;138:805-8.
11. Tessarollo FR, Feldens CA, Closs LQ. The impact of malocclusion
on adolescents' dissatisfaction with dental appearance and oral
functions. Angle Orthod 2012;82:403-9.
12. Marques LS, Pordeus IA, Ramos-Jorge ML, Filagonio CA,
Filagonio CB, Pereira LJ, et al. Factors associated with the desire

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.
24.

25.

26.

27.

28.

29.

30.

31.

American Journal of Orthodontics and Dentofacial Orthopedics

for orthodontic treatment among Brazilian adolescents and their

parents. BMC Oral Health 2009;9:34.
Xiao-ting L, Tang Y, Huang XL, Wang H, Cheng YX. Factors inuencing subjective orthodontic treatment need and culture-related
differences among Chinese natives and foreign inhabitants. Int J
Oral Sci 2010;2:149-57.
Tin-Oo MM, Saddki N, Hassan N. Factors inuencing patient satisfaction with dental appearance and treatments they desire to
improve aesthetics. BMC Oral Health 2011;11:6.
Prabakaran R, Seymour S, Moles DR, Cunningham SJ. Motivation
for orthodontic treatment invested with Q-methodology: patients'
and parents' perspectives. Am J Orthod Dentofacial Orthop 2012;
142:213-20.
Pabari S, Moles DR, Cunningham SJ. Assessment of motivation
and psychological characteristics of adult orthodontic patients.
Am J Orthod Dentofacial Orthop 2011;140:263-72.
Philips C, Broder HL, Bennett ME. Dentofacial disharmony: motivations for seeking treatment. Int J Adult Orthodon Orthognath
Surg 1997;12:7-15.
Bos A, Hoogstraten J, Prahl-Andersen B. A comparison of dental
health care attitudes in the Netherlands in 1985, 1995, and
2001. Community Dent Oral Epidemiol 2003;31:207-12.
Poorterman JHG. Tandheelkundige verzorging Jeugdige Ziekenfonds verzekerden. Eindmeting 2005. Amsterdam: Academisch
Centrum Tandheelkunde Amsterdam, 2005.
Zhang M, McGrath C, Hagg U. The impact of malocclusion and its
treatment on quality of life: a literature review. Int J Paediatr Dent
2006;16:381-7.
Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ.
Effect of malocclusion and its treatment on the quality of life of
adolescents. Am J Orthod Dentofacial Orthop 2009;136:382-92.
Masood Y, Masood M, Zainul NN, Araby NB, Hussain SF,
Newton T. Impact of malocclusion on oral health related
quality of life in young people. Health Qual Life Outcomes
2013;11:25.
Secord PF, Jourard SM. The appraisal of body-cathexis: bodycathexis and the self. J Consult Psychol 1953;17:343-7.
Kiyak HA, West RA, Hohl T, McNeill RW. The psychological impact
of orthognathic surgery: a 9-month follow-up. Am J Orthod 1982;
81:404-12.
Kiyak HA, McNeill RW, West RA, Hohl T, Heaton PJ. Personality
characteristics as predictors and sequelae of surgical and conventional orthodontics. Am J Orthod 1986;89:383-92.
Kiyak HA, Zeitler DL. Self-assessment of prole and body image
among orthognathic surgery patients before and two years after
surgery. J Oral Maxillofac Surg 1988;46:365-71.
Maxwell R, Kiyak HA. Dentofacial appearance: a comparison of patient self-esteem techniques. Int J Adult Orthodon Orthognath
Surg 1991;6:123-31.
Philips C, Bennett ME. Psychosocial ramications of orthognathic surgery. In: Oral and Maxillofacial Surgery. Philadelphia:
W. B. Saunders; 2000, p. 506-34.
Ostler S, Kiyak HA. Treatment expectations versus outcomes
among orthognathic surgery patients. Int J Adult Orthodon
Orthognath Surg 1991;6:123-31.
Philips C, Hill B, Cannac C. The inuence of video imaging on
patients' perceptions and expectations. Angle Orthod 1995;65:
263-70.
Gosney MB. An investigation into some of the factors inuencing
the desire for orthodontic treatment. Br J Orthod 1986;13:86-94.

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