{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:14:24Z","timestamp":1791216864029,"version":"4.1.0"},"reference-count":78,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Search Methods<\/jats:title>\n                  <jats:p>Systematic and unrestricted search of nine databases were performed up to January 2022.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Selection Criteria<\/jats:title>\n                  <jats:p>Studies evaluating facial attractiveness before and after orthodontic treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data Collection and Analysis<\/jats:title>\n                  <jats:p>Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05\/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51\/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: \u22120.89\/ 95% CI: \u22128.72; 6.94) or between different types of Class II correctors (MD: 2.21\/95% CI: \u221216.51; 20.93).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>With the exception of two RCTs, included studies were of unclear or low quality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic\/surgical treatment is compared to orthodontics alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration<\/jats:title>\n                  <jats:p>PROSPERO #: CRD42020169904<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejo\/cjac034","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T13:41:10Z","timestamp":1660916470000},"page":"636-649","source":"Crossref","is-referenced-by-count":24,"title":["The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"44","author":[{"given":"Thaleia","family":"Kouskoura","sequence":"first","affiliation":[{"name":"Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel , 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Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7304-044X","authenticated-orcid":false,"given":"Georgios","family":"Kanavakis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel , Switzerland"},{"name":"Department of Orthodontics and Dentofacial Orthopedics, Tufts University School of Dental Medicine , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"2022120109330443700_CIT0001","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.evolhumbehav.2009.06.005","article-title":"The relative importance of the face and body in judgments of human physical attractiveness.","volume":"30","author":"Currie","year":"2009","journal-title":"Evolution and Human 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