Estudo comparativo do índice de agradabilidade na análise facial para fins de diagnóstico e tratamento ortodôntico

Abstract

Orthodontists have the ability to change the facial characteristics of their patients and, consequently, affect their lives. Therefore, it is necessary for them to understand the aesthetic standards for an attractive face. The Subjective Facial Analysis allows the study of aesthetic evaluation performed routinely by society. Through this analysis we classify individuals, according to aesthetic pleasantness, in aesthetically pleasing, aesthetically acceptable and aesthetically unpleasant, according to their personal opinion. One of the objectives of this analysis is to facilitate communication between the patient and the professionals involved in the treatment. In this context, the objective of this study was to verify whether the visualization of two- dimensional (2D) or three-dimensional (3D) images had any effect on the classification of facial attractiveness, seeking to establish a harmonious dentition that is healthy and aesthetically pleasing. The sample of the present study consisted of 50 adult individuals, female and male, with a minimum age of 18 years. In order to determine the subjective aesthetic facial analysis, a group of two orthodontist evaluators, with more than 5 years of experience in the specialty and calibrated in the method, were asked to rate the individuals' facial profile, classifying them as aesthetically unpleasant (1, 2 or 3), aesthetically acceptable (notes 4, 5 or 6) and aesthetically pleasing (notes 7, 8 or 9) in two moments interspersed within 15 days. The evaluations were performed following two forms of image acquisition: the first using standardized photographic images of the face in 2D and the second using standardized images of the face in 3D with the scanner33 SenseTM (3D Systems, Canada). The order of presentation started with 2D images, followed by 3D images, which were presented using the Power PointTM Office 365 software. In order to assess the intra-examiner and inter-examiner agreement in the subjective aesthetic and morphological assessment, the 50 individuals in the sample were evaluated and submitted to the same classification with a 15-day interval between the two assessments. For the analysis of the error, the Kappa coefficient was used, which analyzes the agreement between two non-parametric variables. The Kappa coefficient for intra-examiner agreement between the first and the second evaluation of 2D photographic images was 0.65, whereas for 3D scanned images, the Kappa coefficient was 0.82, demonstrating a high confidence index for this assessment. The evaluation of 3D images also demonstrated a superior result in the confidence level of the same examiner (Kappa 0.67) in relation to 2D photographs. Analyzing all the data of the study together, we verified a greater intra and inter examiner agreement, in the analysis of the 3D stepped images, for the Facial Pleasure index.