Facial esthetic perception between skeletal Class III patients treated with conventional and surgery-first orthognathic approaches.

Objectives: To compare the profile attractiveness of skeletal Class III patients treated with either a surgery-first approach (SFA) or a conventional surgery approach (CSA), as perceived by surgeons, orthodontists, and laypersons. Materials and Methods: Thirty-four patients were assigned to either the SFA or CSA group retrospectively based on the surgical protocol performed and were evaluated by three distinct groups: oral and maxillofacial surgeons, orthodontists, and laypersons (n = 23 per group). Profile images before (T1) and after orthodontic-surgical treatment (T2) were analyzed using a 5-point Likert scale. Then participants answered the following question: "Which surgical technique was used, CSA or SFA?" Statistical analyses including the Spearman correlation coefficient, the Friedman test, the κ test, independent t-tests, and one-way analysis of variance were conducted to assess correlations and comparisons among evaluator groups (P < .05). Results: A high and positive correlation (r = 0.86, P < .001) was demonstrated for scores between surgeons and orthodontists, and a low correlation was demonstrated between laypeople and specialists (r = 0.55, P = .01 and r = 0.48, P = .03). No statistically significant relationships were found between esthetic perceptions and the surgical approach regardless of the level of expertise of the evaluators, and it was also not possible to differentiate between the surgical approaches used. Conclusions: In this study, we indicate that the choice of orthognathic surgical protocol, whether surgery-first or conventional, did not significantly influence the perceived facial profile attractiveness of skeletal Class III patients. These findings support the clinical viability of the SFA protocol, particularly in cases where treatment time or patient preference are factors in decision-making.