Objective vs. Subjective Esthetics in Orthodontic Patients: An Ongoing RCT

Objectives: Researchers have found that normative (objective) ratings of esthetics are unrelated to subjective esthetic ratings, and are moderated by treatment expectations and self-esteem. This report presents data from an ongoing randomized trial of children undergoing interceptive (IO) or comprehensive orthodontics (CO) with Medicaid funding. Methods: 168 children (9.3 + 1.5 years), primarily ethnic minorities (37% African American, 17% Asian, 14% Latino, 14% mixed, 17% Caucasian) were randomized to IO or CO. Calibrated examiners scored pre-treatment and post-treatment models using the Peer Assessment Rating (PAR) and Index of Complexity, Outcome and Need (ICON). Children rated their teeth, profile, facial and total body image (BI) pre and post-orthodontics. Results: Total BI, Facial and Profile BI were moderately high both pre and post-orthodontics and showed little change. Teeth BI was low at baseline but improved significantly, especially for CO patients. Correlations between BI, PAR and ICON, even the esthetic component of ICON (ICON-AC) were NS at all assessments for IO patients but significant for CO patients at post-orthodontics (PAR: r= -.59; ICON: r=-.61, p<.0001; ICON-AC: r=-.52, p<.001), reflecting greater improvements in this group on BI, PAR and ICON. Although both normative scores and subjective BI scores improved pre to post-orthodontics, correlations between change scores were NS. Conclusion: These interim data support previous research concluding that subjective esthetics is unrelated to objective indicators; orthodontic treatment improves both but large changes in PAR and ICON are uncorrelated with more modest improvement in BI. Supported by NIH Grant U54 DE14254.