ORTHODONTICS

Orthodontists and lay people rate masculine soft tissue

profiles similarly but feminine soft tissue profiles differently
Shmuel Einy, DMD, MSc/Tzemach Miri, DMD, MSc/Eyal Katzhendler, DMD, MSc/Dror Aizenbud, DMD, MSc/
Krausz Emanuela, DMD, MSc/Paul Zaslansky, PhD, DMD

Objective: An esthetic facial soft tissue profile is an important higher than general dental practitioners (P < .0001) or laypeople
objective of contemporary orthodontics. The extent to which (P < .020). Similar to the general population, orthodontists gave
clinicians and the public agree on profiles that are esthetically higher ratings to concave profiles for masculine profiles, but sig-
acceptable versus profiles recommended for treatment is un- nificantly lower ratings for feminine profiles. The severely convex
clear. Thus, this work examined the profile considered esthetic male profile was the least attractive to clinicians and laypeople.
by laypeople and general dental practitioners compared to or- There was a significant difference in the attractiveness of the fe-
thodontists. Method and materials: An Israeli balanced male– male profile between practitioners (P < .001 and P < .02 for gen-
female group comprising 284 participants (orthodontists [n = 86], eral dental practitioners and orthodontists, respectively) and
general dental practitioners [n = 64], laypeople [n = 134]) rated laypeople. Conclusions: The findings suggest that orthodontic
the attractiveness of five standardized masculine and feminine training and clinical adherence to strict beauty norms results in
profiles presented in standardized silhouettes ranging from more critical judgment of female attractiveness, which may af-
f
concave to convex. Results: Laypeople see no esthetic differ- fect orthodontic treatment. They indicate trends that reflect
ence between masculine and feminine profiles, and prefer changes in recent decades in the public perception of facial
moderately concave over moderately convex and severely con- beauty, which may affect patient expectations of treatment out-
cave over severely convex profiles. While all raters preferred comes. (Quintessence Int 2021;52:72–79; doi: 10.3290/[Link].a45269)
the straight silhouettes, orthodontists rated them significantly

Key words: esthetics, facial profile, gender differences, perception, soft tissue

The soft tissue profile is evaluated during routine orthodontic practitioners, and laypeople.5-7 Importantly, deviations from
treatment planning1 by means of cephalometric analysis and the ideal profile that are considered unacceptable to ortho-
facial appraisal. An important soft tissue characteristic is facial dontists and other dental practitioners, are sometimes surpris-
convexity, which describes the extent to which the profile is ingly pleasing to laypeople.8 Laypeople tend to rate facial at-
straight. The orthodontist relies on the cephalometric evalu- tractiveness higher compared to clinicians, who are more
ation, even though it is no longer considered sufficient to critical in judging esthetics and may be looking for different
achieve an esthetic orthodontic outcome.2 Subjective feelings facial attributes than laypeople.9,10 Among dental practition-
about esthetics, dominated by social norms, influence the per- ers, orthodontists are more critical than other practitioners
ception of beauty,3,4 which does not necessarily reflect ortho- when assessing facial asymmetry.11 Interestingly, however,
dontic standards. Previous studies identified some differences judgment of “facial attractiveness” by orthodontists from very
in esthetic preferences among orthodontists, general dental different cultural backgrounds is more similar than expected,

72 QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021

 Einy et al

eg Chinese vs North American orthodontists.12 Although facial Method and materials

esthetics is influenced by age,13 ethnic origin,14 and may even
be influenced by gender,13 the perception of profile esthetics Ethical approval
by patients and parents, who are usually laypeople, is often
not considered. The experiment was approved by the Helsinki committee of
Facial convexity is determined by an angle formed by three Rambam Health Care Campus (0176-14-RMB) and all the meth-
soft tissue points (the soft tissue glabella, subnasale, and soft ods were performed in accordance with the relevant guidelines
tissue pogonion), and does not change much with age.15 In the and regulations. Written informed consent was obtained from
idealized facial profile, the subnasale is located 5.5 mm away all the participants. All the participants were at least 18 years old.
from a vertical line from the soft tissue glabella, where the lat-
ter is known as the A point. This profile corresponds to the
Attractiveness ratings
Bolton standards that have been in use for more than a century,
based on the average norms for young adults (18 years and Three different groups of raters (orthodontists, general dental
older).16 The convexity of the soft tissue profile is influenced by practitioners, and laypeople) were recruited in 2015 and each
the protrusive inclination of the maxillary incisors, and may be was asked to rank their perception of attractiveness of several
corrected during orthodontic treatment by means of incisor standardized facial silhouettes (see next section). The group of
retraction or protraction.2 There are, however, differences in the orthodontists in this study (n = 86) were all dental practitioners
masculine and feminine profile convexities.13,17 A straighter pro- with formal orthodontic postgraduate training, recruited either
file with a more prominent chin is considered more masculine, from postgraduate orthodontic departments or were invited to
whereas increased upper lip protrusion is considered more participate during professional orthodontic conferences. The
feminine. It has been shown18 that for female patients, a con- group of general dental practitioners (n = 64) were all licensed
vex, Class II malocclusion is preferred with the mandible slightly dentists with no formal orthodontic training, actively involved
retrusive with respect to the maxilla. In male patients, a con- in patient care across the entire country. The laypeople
cave, Class III malocclusion and a straighter profile with a prom- (n = 134) included in this study were a heterogenous group of
inent chin are favored. These differing preferences suggest that parents, patients, and dental auxiliary staff attending clinics
there may be differences in how clinicians and the general pop- across the country. This group lacked any formal dental educa-
ulation judge facial esthetics, and consequently, which soft tis- tion, and only had some basic understanding of what ortho-
sue profile should be corrected by orthodontic means. dontic treatment goals entail. Each evaluator examined and
Esthetics is determined by multiple parameters and can be rated the same silhouettes assigned once to a masculine and
judged based on very different modalities. Although both 2D once to a feminine patient. The sex (M/F) of each evaluator was
and 3D images of patients are routinely used to assess facial noted, as well as age and any relevant dental formal education
esthetics, silhouettes are more objective and reliable. They including years of experience (applicable only for the general
allow easy comparisons between different observers and dental practitioner and orthodontist groups). Attractiveness
experimental cohorts.4 Indeed the use of silhouettes was found was ranked on a five-point numerical (Likert) scale, where 5
to be the least subjective profile-evaluation approach,17,19 since represented “the most attractive profile” and 1 represented “the
silhouettes incorporate a surprisingly large amount of informa- least attractive profile.”
tion regarding attractiveness.20 It was shown that side profiles
“elicited highly reliable attractiveness ratings across partici-
Standardized facial silhouette profiles
pants” and that silhouettes are gender-sensitive powerful tools
for facial esthetic quantification.21 A designer sketched an ideal, natural, harmonious soft tissue
The objective of this study was to evaluate the differences profile. Additional, less-attractive convex and concave profiles
and similarities in rating the attractiveness of facial profiles by were also constructed, where the 5.5-mm horizontal distance
orthodontists, general dental practitioners, and laypeople. The of the subnasale was changed by either increasing or decreas-
assumption was that no differences exist in the assessment of ing protrusion by small increments of 1.5 mm. In this manner,
soft tissue facial attractiveness by orthodontists, general dental two additional increasingly concave and two increasingly con-
practitioners, and laypeople, which served as the null hypoth- vex profiles were produced, resulting in a series of five profiles
esis in this study. ranging from severely concave to severely convex (Fig 1).

QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021 73

 ORTHODONTICS

A B C D E

Fig 1 Standardized silhouettes: A, severely concave; B, moderately concave; C, straight; D, moderately convex; E, severely convex.

These profiles span the full range of observed maxilla to Results

mandible saggital relationships and were marked A to E (sil-
houette A = concave, silhouette E = convex). The idealized pro- A total of 86 orthodontists, 64 general dental practitioners and
file, corresponding to the straight profile, was silhouette C. The 134 laypeople evaluated each of the five profiles presented in
moderately and the severely concave profiles B and A were this study. The average age of raters for the three groups was
4.0 mm and 2.5 mm from the vertical soft tissue glabella-sub- 42 ± 13 years. For the orthodontist group, 48 raters were male
nasale line, respectively. Similarly, the moderately and severely and 38 were female. In the general dental practitioner group,
convex profiles D and E were 7.0 mm and 8.5 mm from the ver- 41 raters were male and 23 were female. The laypeople group
tical soft tissue glabella-subnasale line, respectively. The pro- was gender balanced, comprising 67 male and 67 female raters.
files were printed, once as a masculine and once as a feminine Orthodontists and general dental practitioners reported 8 to
silhouette, on a white background (Fig 1) to standardize the 9 years of clinical experience. Figures 2 to 4 compare the mas-
evaluation, and were presented to each evaluator (from each of culine and feminine attractiveness rankings, showing the aver-
the orthodontist, general dental practitioner, and laypeople age and standard error of the rank given by the orthodontist,
groups) for rating. general dental practitioner, and laypeople groups, respectively.
For each profile, error bars depict the standard error. No statis-
tical differences were found between the three groups with
Statistical analyses
reference to gender (M/F), age, and years of professional expe-
Data were analyzed by SPSS (version 21, IBM). Descriptive sta- rience. All three groups rated the straight profile (silhouette C)
tistics of the rankings depict mean and standard deviation of as the most attractive profile. For the feminine straight profile,
the mean. Repeated measures ANOVA was used to evaluate the orthodontists gave higher rankings than both general den-
differences between the three groups of evaluators, taking into tal practitioners and laypeople. Table 1 provides the complete
account the participant’s age, gender, and, for the dental prac- set of evaluations for the feminine results. Laypeople rated the
titioners, occupational experience. ANOVA was performed to moderately concave profile (silhouette B) more attractive than
determine whether there was a statistical difference between orthodontists and general dental practitioners (P = .026 and
the three groups of evaluator results for the five silhouettes. P = .001, respectively). The severely concave profile (silhouette
P < .05 was considered significant. The Fisher exact test and A) was rated the least attractive by both orthodontists and gen-
Mann-Whitney U test were used to assess the differences in eral dental practitioners, while laypeople rated the severely
ranking based on years of practitioner experience; the Krus- convex profile (silhouette E) as the least attractive. All groups
kal-Wallis test was used to test for differences between the exhibited a preference for the concave profiles.
three groups of raters for each of the silhouettes.

74 QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021

 Einy et al

Score

2a Silhouette 2b
b Silhouette

Figs 2a and 2b Orthodontist attractiveness scores for (a) masculine and (b) feminine soft tissue profiles. The transition from concave to
convex profile is depicted by the letters A to E. Average scores and standard deviations are plotted for male and female raters. Error bars depict
standard error of the mean.

Discussion compared with the expectations of the general population.

This suggests that there may be a different appreciation of
The study findings reject the null hypothesis. The differences in facial beauty by orthodontic clinicians and by the general pub-
the perceptions of soft tissue facial attractiveness between lay- lic, at least with respect to the preference of concave soft tissue
people and dental practitioners (general dental practitioners profiles in the feminine silhouette. This discrepancy may even,
and orthodontists) were quantified. Unlike general dental prac- in certain cases, lead orthodontists to recommend treatment
titioners and laypeople, the group of orthodontists considered that patients do not necessarily prefer. Conversely, it may relax
the concave feminine soft tissue profile as extremely unat- clinician concerns of worsening the facial profile attractiveness
tractive. For the masculine profile, orthodontists agreed with in females, eg, by recommending extraction versus nonex-
ratings by both general dental practitioners and laypeople. traction treatment in borderline cases, which is considered to
Presumably, orthodontists base their esthetic evaluation on the have minimal effects on the facial profile.22
standards advocated in the formal literature, professional Facial esthetics and the improvement of the facial profile
guidelines, and cephalometric standards. Laypeople, on the are an important objective of orthodontic treatment,23,24 al-
other hand, base their perceptions of facial esthetics on the though they are, to some extent, subjective. The facial profile
current social trends and beauty culture.3 Indeed, professional serves as a reliable characteristic that is well reproduced in rat-
dental education, based on norms defined in the first half of ings of different participant surveys,21 even when assessed in
the last century, may impose different standards of esthetics very simple black and white silhouettes. Esthetic perception

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 ORTHODONTICS

Score

Silhouette Silhouette
3
3a 3b

Figs 3a and 3b General dental practitioner attractiveness scores for (a) masculine and (b) feminine soft tissue profiles. The transition from
concave to convex profile is depicted by the letters A to E. Average scores and standard deviations are plotted for male and female raters.
Error bars depict standard error of the mean.

depends on several variables including sex, ethnicity,25 and so- tive feminine facial profile (silhouette E), may be related to the
cial norms.3,4 However, from the time that the prevailing stan- widely accepted premise that the severely concave profile
dards were established (around WWII), there have been sub- (skeletal Class III) is less attractive than the severely convex pro-
stantial changes in the perception of esthetics.26,27 Importantly, file (skeletal Class II).32 The laypeople showed clear preference
esthetic ‘norms’ are identified for orthodontic and orthognathic to concave over convex profiles. This corresponds with previ-
treatment, which require adaptation to the changing times, ous reports33 that laypeople are less critical of Class III profiles
due to alterations in the trends and norms of populations seek- than orthodontists.
ing treatment.28 Overall, faces considered to be more attractive match the
Similar to previous reports,28 it was found that a straight cephalometric and facial norms.18 Nonetheless, the present
profile is the most attractive facial profile for both the mascu- findings suggest that social norms do not always coincide with
line and feminine silhouettes. Overall, the preference towards the ideal orthodontic standards.29,34 Undoubtedly, dental pro-
straight profiles shows that Israeli male and female raters hold fessionals are more skillful at identifying facial and dental
facial beauty expectations that are similar to those of raters in esthetic anomalies.7 They routinely assess the degree of skele-
other societies,29 sharing a common esthetic standard with tal malocclusion more correctly than laypeople,12,35 but in the
American30 and Asian populations.31 The significant differences present study they seem to do this differently for masculine
that were revealed in how orthodontists rate the least attrac- versus feminine severely concave and severely convex profiles.

76 QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021

 Einy et al

Score

Silhouette Silhouette
4a 4b

Figs 4a and 4b Laypeople attractiveness scores for (a) masculine and (b) feminine soft tissue profiles. The transition from concave to convex
profile is depicted by the letters A to E. Average scores and standard deviations are plotted for male and female raters. Error bars depict standard
error of the mean.

On the other hand, laypeople tend to rate people as more profile, is ranked higher among orthodontists because they are
attractive than orthodontists do.13 Increasing the patient’s more sensitive to deviations from norms. A comparison be-
self-awareness can minimize misconceptions,3 since individual tween orthodontists and oral surgeons shows similarities in
preferences should ideally be incorporated into what the esthetic estimation, perhaps due to frequent exposure of these
orthodontist has to offer during treatment. disciplines to the soft tissue profile esthetics as well as to or-
Ranking of profiles by evaluating silhouettes provides a thognathic surgery.32,36
simple and inexpensive means to reliably standardize and The present findings suggest that despite similar orthodon-
quantify an otherwise very subjective measure of facial tic education, female and male orthodontists rate the severely
beauty.21 Such standardization has not yet been shown for the convex profile somewhat differently, with the male evaluators
more recent 3D imaging software. Although all evaluators being more critical. It has been shown that male and female
found the straight profile to be the most attractive, orthodon- raters are able to identify gender in silhouettes,21 which could
tists rated it with higher scores. It has been shown32 that al- affect personal esthetic preference. This may imply a gender-re-
though orthodontists and general dental practitioners often lated difference between male and female orthodontic evalua-
agree, sometimes the former overemphasize minor dental es- tors. Note, however, that this finding did not reach statistical
thetic deviations that general dental practitioners ignore. Thus, significance in light of the limited number of participants in the
a straight profile, which was considered the most acceptable present study.

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 ORTHODONTICS

Table 1 Feminine silhouette attractiveness (mean ± standard deviation) by orthodontist (Orth), dental practitioner (DP), and lay people (LP)

Group A B C D E
Orth (n = 86) 1.5930 ± 0.80261 3.4884 ± 0.74745 4.3605 ± 0.93195 3.7907 ± 0.97155 1.7558 ± 0.90666
DP (n = 64) 2.0545 ± 1.33913 3.2545 ± 1.00403 3.9636 ± 1.15412 3.6182 ± 1.22461 2.1273 ± 1.18719
LP (n = 134) 2.4776 ± 1.25486 3.8433 ± 1.08201 3.9403 ± .94798 3.1493 ± 1.20467 1.5746 ± 1.02874
Kruskal Wallis test Orth vs LP, P < .0001; DP Orth vs LP, P = .019; DP Orth vs LP, P = .001; Orth Orth vs DP, P = .029; Orth vs. LP, P = .015; DP
vs LP, P = .015 vs LP, P = .001 vs DP, P = .025 Orth vs LP, P < .0001 vs LP, P < .0001

This work is not without limitations. In light of the relatively soft tissue profiles. Furthermore, they expressed a clear pref-
small sample in the study, generalizability of the results to erence toward the moderately and severely concave profiles.
other populations and cultures remains to be validated. Further This is different from the perceptions of skilled dental practi-
research on larger international cohorts is therefore advocated, tioners. It is likely that orthodontists should give their patients
also in order to draw more conclusive findings about the effects a stronger voice in determining the choice of treatment in
of the orthodontist gender. Although this work has the prag- light of their preferences. This may prevent disappointments
matic advantage of simplicity due to the use of black and white of patients who might expect a different esthetic outcome.
silhouettes, there are more technologically advanced methods, Female orthodontists appear to rate the convex profile as
such as video and 3D visualization, that may provide further being more pleasing than male raters, raising the possibility
insights into what the different groups of raters perceive. Addi- that gender plays a role in the esthetic classification adopted
tional knowledge from other disciplines such as plastic surgery by orthodontists. Further studies are warranted to reveal any
may further expand knowledge on this subject. significant gender-related differences that may exist in pre-
ferences.

Conclusions
Declaration
The results of this study reveal that laypeople see no differ-
ence between the esthetics of the masculine and feminine The authors declare no competing interests.

References
1. McNamara Jr JA, Keim RG. JCO inter- 5. Pace M, Cioffi I, D’antò V, Valletta A, 9. Papamanou DA, Gkantidis N, Topouzelis
views: Dr. Jim McNamara on early orthodon- Valletta R, Amato M. Facial attractiveness of N, Christou P. Appreciation of cleft lip and pal-
tic and orthopedic treatment, Part 1. J Clin skeletal class I and class II malocclusion as ate treatment outcome by professionals and
Orthod 2014;48:535–548. perceived by laypeople, patients and clin- laypeople. Eur J Orthod 2012;34:553–560.
icians. Minerva Stomatol 2018;67:77–85. 10. Chung EH, Borzabadi-Farahani A, Yen
2. Sarver D, Proffit W. Diagnosis and treat-
6. Zarif Najafi H, Sabouri SAA, Ebrahimi E, SLK. Clinicians and laypeople assessment of
ment planning in orthodontics. In: Graber
Torkan S. Esthetic evaluation of lip position facial attractiveness in patients with cleft lip
TM, Vanarsdall RL, Vig WL (eds). Orthodon- and palate treated with LeFort I surgery or
in silhouette with respect to profile diver-
tics: Current Principles and Techniques. 4th late maxillary protraction. Int J Pediatr Oto-
gence. Am J Orthod Dentofac Orthop 2016;
edn. St Louis: Mosby 2005:24–25. rhinolaryngol 2013;77:1446–1450.
149:863–870.
3. Yin L, Jiang M, Chen W, Smales RJ, Wang 11. Kokich VO, Kokich VG, Kiyak HA.
7. Pithon MM, Santos AM, Couto FS, et al.
Q, Tang L. Differences in facial profile and Perceptions of dental professionals and
Perception of the esthetic impact of mandib-
dental esthetic perceptions between young laypersons to altered dental esthetics:
ular incisor extraction treatment on layper-
adults and orthodontists. Am J Orthod Den- Asymmetric and symmetric situations. Am
sons, dental professionals, and dental J Orthod Dentofac Orthop 2006;130:141–151.
tofac Orthop 2014;145:750–756. students. Angle Orthod 2012;82:732–738. 12. Xu T-M, Korn EL, Liu Y, et al. Facial at-
4. Trulsson U, Strandmark M, Mohlin B, Berg- 8. Kokich VO, Kiyak HA, Shapiro PA. Com- tractiveness: Ranking of end-of-treatment
gren U. A qualitative study of teenagers’ deci- paring the perception of dentists and lay facial photographs by pairs of Chinese and
sions to undergo orthodontic treatment with people to altered dental esthetics. J Esthet US orthodontists. Am J Orthod Dentofac
fixed appliance. J Orthod 2002;29:197–204. Dent 1999;11:311–324. Orthop 2008;134:74–84.

78 QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021

 Einy et al

13. Kiekens R, van’t Hof M, Straatman H, 22. Kirschneck C, Proff P, Reicheneder C, 30. Polk MS, Farman AG, Yancey JA,
Kuijpers-Jagtman AM, Maltha J. Influence of Lippold C. Short-term effects of systematic Gholston LR, Johnson BE, Regennitter FJ. Soft
panel composition on aesthetic evaluation premolar extraction on lip profile, vertical tissue profile: a survey of African-American
of adolescent faces. Eur J Orthod dimension and cephalometric parameters in preference. Am J Orthod Dentofacial Orthop
2007;29:95–99. borderline patients for extraction therapy: a 1995;108:90–101.
14. Singh S, Deshmukh S, Merani V, Rejintal retrospective cohort study. Clin Oral Investig 31. Bronfman CN, Janson G, Pinzan A,
N. Mean values of Arnett’s soft tissue analysis 2016;20:865–874. Rocha TL. Cephalometric norms and esthetic
in Maratha ethnic (Indian) population: a 23. William Arnett G, Bergman RT, Speidel profile preference for the Japanese: a sys-
cephalometric study. J Int Soc Prev Commu- T, Waite D. Facial keys to orthodontic diagno- tematic review. Dent Press J Orthod 2015;
nity Dent 2016;6:327–337. sis and treatment planning—Part II. Am 20:43–51.
15. Bergman RT, Waschak J, Borzabadi- J Orthod Dentofac Orthop 1993;103:395–411. 32. Soh J, Chew MT, Wong HB. Professional
Farahani A, Murphy NC. Longitudinal study 24. Maganzini AL, Schroetter SB, Freeman assessment of facial profile attractiveness.
of cephalometric soft tissue profile traits K. Improvement in smile esthetics following Am J Orthod Dentofac Orthop
between the ages of 6 and 18 years. Angle orthodontic treatment: A retrospective study 2005;128:201–205.
Orthod 2014;84:48–55. utilizing standardized smile analysis. Angle 33. Fabré M, Mossaz C, Christou P, Kiliaridis
16. Broadbent BH, Broadbent BH, Golden Orthod 2014;84:492–499. S. Orthodontists’ and laypersons’ aesthetic
WH. Bolton Standards of Dentofacial Devel-
25. Hwang H-S, Kim W-S, McNamara JA. assessment of Class III subjects referred for
opmental Growth. St Louis: Mosby, 1975.
Ethnic differences in the soft tissue profile of orthognathic surgery. Eur J Orthod
17. Czarnecki ST, Nanda RS, Currier GF. Korean and European-American adults with 2009;31:443–448.
Perceptions of a balanced facial profile. Am normal occlusions and well-balanced faces. 34. Bonetti GA, Alberti A, Sartini C, Parenti
J Orthod Dentofac Orthop 1993;104:180–187. Angle Orthod 2002;72:72–80. SI. Patients’ self-perception of dentofacial
18. Macias Gago AB, Romero Maroto M, 26. Nguyen DD, Turley PK. Changes in the attractiveness before and after exposure to
Crego A. The perception of facial aesthetics Caucasian male facial profile as depicted in facial photographs. Angle Orthod
in a young Spanish population. Eur J Orthod fashion magazines during the twentieth 2011;81:517–524.
2012;34:335–339. century. Am J Orthod Dentofacial Orthop 35. Hönn M, Dietz K, Godt A, Göz G. Per-
19. Foster EJ. Profile preferences among 1998;114:208–217. ceived relative attractiveness of facial pro-
diversified groups. Angle Orthod 27. Berneburg M, Dietz K, Niederle C, Goz files with varying degrees of skeletal anoma-
1973;43:34–40. G. Changes in esthetic standards since 1940. lies. J Orofac Orthop Fortsch Kieferorthop
20. Legan HL, Burstone CJ. Soft tissue Am J Orthod Dentofacial Orthop 2005;66:187–196.
cephalometric analysis for orthognathic sur- 2010;137:450.e1–e9. 36. Maple JR, Vig KWL, Beck FM, Larsen PE,
gery. J Oral Surg 1980;38:744–751. 28. Einy S, Horwitz J, Aizenbud D. Wilcko- Shanker S. A comparison of providers’ and
21. Davidenko N. Silhouetted face profiles: dontics: an alternative adult orthodontic consumers’ perceptions of facial-profile at-
A new methodology for face perception re- treatment method: rational and application. tractiveness. Am J Orthod Dentofac Orthop
search. J Vis 2007;7:6–16. Alpha Omegan 2011;104:102–111. 2005;128:690–696.
29. Naini FB, Donaldson ANA, McDonald F,
Cobourne MT. Influence of chin height on
perceived attractiveness in the orthognathic
patient, layperson, and clinician. Angle Orthod
2012;82:88–95.

Shmuel Einy Tzemach Miri Instructor, Orthodontic and Craniofacial Depart-

ment, Graduate School of Dentistry, Rambam Health Care Campus,
Haifa, Israel
Eyal Katzhendler Instructor, Department of Orthodontics, Fac-
ulty of Dental Medicine, Hebrew University – Hadassah School of
Dental Medicine Jerusalem, Israel
Dror Aizenbud Assistant Professor, Bruce and Ruth Rappaport
Faculty of Medicine, Technion - Israel Institute of Technology, Haifa,
Israel; Orthodontic and Craniofacial Department, Graduate School
of Dentistry, Rambam Health Care Campus, Haifa, Israel
Krausz Emanuela Instructor, Orthodontic and Craniofacial De-
partment, Graduate School of Dentistry, Rambam Health Care
Shmuel Einy Adjunctive Senior Lecturer, Bruce and Ruth Campus, Haifa, Israel
Rappaport Faculty of Medicine, Technion - Israel Institute of Tech-
nology, Haifa, Israel; Orthodontic and Craniofacial Department, Paul Zaslansky Group Leader, Department for Restorative and
Graduate School of Dentistry, Rambam Health Care Campus, Haifa, Preventive Dentistry, Center for Craniofacial Sciences, Charité –
Israel Universitätsmedizin Berlin, Germany

Correspondence: Shmuel Einy, Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, PO Box 9602, 31096,
Israel. Email: dreinysh@[Link]

QUINTESSENCE INTERNATIONAL | volume 52 • number 1 • January 2021 79