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All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale\u00a0(VAS) ratings of changes in facial appearance were assessed.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (<jats:italic>F<\/jats:italic>\u2009=\u20090.91; <jats:italic>P<\/jats:italic>\u2009=\u20090.526; Wilks lambda\u2009=\u20090.93), raters (<jats:italic>F<\/jats:italic>\u2009=\u20091.68; <jats:italic>P<\/jats:italic>\u2009=\u20090.054; Wilks lambda\u2009=\u20090.83), and when testing the combined effect of treatment and rater on the results (<jats:italic>F<\/jats:italic>\u2009=\u20090.72; <jats:italic>P<\/jats:italic>\u2009=\u20090.866; Wilks lambda\u2009=\u20090.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1\/20th of the total VAS length.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Limitations<\/jats:title>\n<jats:p>Retrospective study design.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient\u2019s facial appearance when this treatment option is used.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s40510-019-0294-9","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T01:02:32Z","timestamp":1574643752000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients"],"prefix":"10.1186","volume":"20","author":[{"given":"Mary-Eleni","family":"Zouloumi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kleopatra","family":"Tsiouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Psomiadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga-Elpis","family":"Kolokitha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Topouzelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-6272","authenticated-orcid":false,"given":"Nikolaos","family":"Gkantidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,25]]},"reference":[{"key":"294_CR1","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.1098\/rstb.2010.0404","volume":"366","author":"AC Little","year":"2011","unstructured":"Little AC, Jones BC, DeBruine LM. 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Consent was obtained and signed by all parents or guardians that allowed for the use of the patients\u2019 data for research and publication.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This specific patient (and his parents) provided additional consent for the publication of his facial photos.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}