Clinicians’ Perception of the Benefit from Orthognathic Surgery in Patients of Different Racial Background Presenting with a Class III Skeletal Discrepancy

Abstract

Aim: To investigate the impact of patients’ race on influencing whether clinicians perceive benefit from orthognathic surgery in patients with class III skeletal bases. Design: Cross-sectional study. Methods: This study involved sending questionnaires to all consultant orthodontists and maxillofacial surgeons in the United Kingdom using the mailing list from British Orthodontic Society and British Association of Oral and Maxillofacial Surgeons. The questionnaires were sent using a sequential mixed mode approach for the Consultant Orthodontists group and a web-based mode for the Oral and Maxillofacial Surgeons group. The questionnaire used silhouettes of two patients (one Caucasian and one Chinese). These were manipulated to produce a class III skeletal discrepancy. The maxillary position of the selected normal profile silhouettes was manipulated posteriorly from the normal position, in 2 mm increments up to 10 mm. The mandibular position, of the selected normal profile silhouettes, was manipulated anteriorly from the normal position, in 2 mm increments up to 10 mm. A total of 26 silhouettes were constructed. The participants were asked to spend no more than 30 seconds looking at the silhouettes and answer the following questions: “Do you think that a patient, presenting with this profile, would benefit from orthognathic surgery?” and “How do you rate the level of attractiveness of the profile?” Results: There was no statistically significant difference between the perception for the benefit from orthognathic surgery between Consultant Orthodontists’ and Consultant Oral and Maxillofacial Surgeons (p=0.176). The silhouette’s race was featured as highly statistically significant factor predicting the perceived benefit from surgery (p<0.001). The odds of clinicians perceiving a benefit from surgery and therefore recommending an orthognathic surgery approach increased 2.87 times for a Chinese silhouette compared to a Caucasian silhouette with class III skeletal bases. Consultant’s years of experience, gender, specialty, the number of orthognathic patients treated per year, and the consideration of the importance of an attractive appearance were not statistically significant factors predicting perceived benefits from orthognathic surgery. Conclusion: Clinicians perceived benefit from orthognathic surgery in patients with class III skeletal bases was significantly higher for Chinese silhouettes than for Caucasian silhouettes with the same degree of manipulation. The Caucasian ideal profile was considered more attractive than the Chinese ideal profile.