{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:54:51Z","timestamp":1791287691951,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":278,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Dentistry"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the agreement, reliability and convergent validity of the five\u2010point ordinal Likert scale and a 100\u2009mm visual analog scale (VAS) for three\u2010dimensional (3D) esthetic assessment of primary unilateral cleft lip repair using a counterbalanced crossover design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Fifty lay observers (25 males, 25 females) evaluated 3D stereophotogrammetric facial models of 10 children with nonsyndromic unilateral cleft lip and palate at three time points: preoperative (T0), 1\u2010month postoperative (T1), and 6\u2010months postoperative (T2). Nine morphological items were assessed using both the five\u2010point Likert scale and a 100\u2009mm VAS. A counterbalanced crossover design with a 2\u2010week washout period and inversion of scale order was implemented to minimize recall and order effects. Pairwise agreement analyses between the categorized VAS and the five\u2010point Likert scale (interscale, test\u2013retest, presentation\u2010mode, and longitudinal agreement) were assessed using Cohen\u2019s kappa (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      ). Overall inter\u2010rater reliability was evaluated using the intraclass correlation coefficient (ICC), while convergent validity between the categorized VAS and the five\u2010point Likert scale was assessed using Spearman\u2019s rank correlation coefficient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pairwise agreement between the categorized VAS and the five\u2010point Likert scale ranged from\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.54 to\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.80, indicating moderate\u2010to\u2010substantial agreement. Overall inter\u2010rater reliability was excellent for both instruments (ICC\u2009=\u20090.849\u20130.982). Test\u2013retest agreement was slight to fair (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u2009\u22120.05 to 0.49), while agreement between full\u2010face and cropped image presentation was generally limited (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u2009\u22120.01 to 0.43). Longitudinal agreement across surgical stages was uniformly slight (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u2009\u22120.05 to 0.18), reflecting expected changes in postoperative morphology rather than measurement instability. Convergent validity between the categorized VAS and the five\u2010point Likert scale was excellent (Spearman\u2019s\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.948\u20130.974; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009 &lt; 0.001). Subgroup analyses by evaluator sex and cleft index revealed no consistent patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both the five\u2010point Likert scale and the VAS demonstrated excellent overall inter\u2010rater reliability and excellent convergent validity. However, because agreement analyses required categorization of the continuous VAS, the present findings do not establish whether preservation of its continuous measurement properties would provide additional discriminatory capability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>For 3D esthetic assessment of primary unilateral cleft lip repair, both the five\u2010point Likert scale and the VAS provide reliable group\u2010level evaluations. Standardized image presentation protocols and the use of multiple evaluators are recommended to improve the consistency of esthetic auditing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijod\/3592943","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:26:34Z","timestamp":1791285994000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison Between the Likert Scale and the Visual Analog Scale for the 3D Esthetic Assessment of Primary Cleft Lip Repair: A Prospective Study"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1339-9172","authenticated-orcid":false,"given":"Edoardo","family":"Staderini","sequence":"first","affiliation":[{"name":"Department of Head and Neck and Sense Organs A. Gemelli University Policlinic IRCCS Catholic University of Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Orthodontics Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Pediatric Dentistry Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-0479","authenticated-orcid":false,"given":"Federica","family":"Guglielmi","sequence":"additional","affiliation":[{"name":"Department of Head and Neck and Sense Organs A. Gemelli University Policlinic IRCCS Catholic University of Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Orthodontics Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Pediatric Dentistry Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2907-6680","authenticated-orcid":false,"given":"Carmen Chiara","family":"Nacca","sequence":"additional","affiliation":[{"name":"School of Dentistry Catholic University of the Sacred Heart  Largo Agostino Gemelli 8 Rome 00168 Italy  unicatt.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3418-2846","authenticated-orcid":false,"given":"Licia","family":"Leccese","sequence":"additional","affiliation":[{"name":"School of Dentistry Catholic University of the Sacred Heart  Largo Agostino Gemelli 8 Rome 00168 Italy  unicatt.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7287-7563","authenticated-orcid":false,"given":"Antonino","family":"Fiorino","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Reproductive Sciences and Dentistry Federico II University of Naples  Naples Italy  unina.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0797-5172","authenticated-orcid":false,"given":"Massimo","family":"Cordaro","sequence":"additional","affiliation":[{"name":"Department of Head and Neck and Sense Organs A. Gemelli University Policlinic IRCCS Catholic University of Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Orthodontics Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"},{"name":"Postgraduate School of Pediatric Dentistry Catholic University of the Sacred Heart  Rome 00168 Italy  unicatt.it"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zama","sequence":"additional","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Children\u2019s Hospital Bambino Ges\u00f9 IRCCS  Rome Italy  ospedalebambinogesu.it"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2012.04.001"},{"key":"e_1_2_14_2_2","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1597\/11-207","article-title":"Scoring Systems of Cleft-Related Facial Deformities: A Review of literature","volume":"50","author":"Mosmuller D. 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