Perceived Facial Profile Attractiveness in Skeletal Class I, II, and III Malocclusions

Facial profile esthetics play a pivotal role in orthodontic diagnoses, treatment planning, and patient satisfaction; however, the perception of facial attractiveness is inherently subjective and varies according to professional expertise and sociocultural background. This study aimed to compare the perceived attractiveness of standardized sagittal facial profiles across skeletal Class I, II, and III patterns and to investigate the influence of professional training and sociodemographic variables on facial profile evaluations. It was hypothesized that straight facial profiles would be perceived as the most attractive across all observer groups, while deviations from the orthognathic profile would be rated as less attractive, with significant differences based on professional training and sociodemographic variables. This cross-sectional descriptive study included 509 participants, comprising orthodontists, orthodontic Ph.D. students, general dentists, specialist dentists, first- and fifth-year dental students, and laypersons. Seven standardized sagittal facial profile silhouettes (S1–S7) were digitally generated from a standardized lateral facial photograph and evaluated using a seven-point visual analog scale. Participants were also asked to identify the sagittal facial profile range (S8) they ideally preferred to possess. Intergroup comparisons were performed using non-parametric statistical tests (Mann–Whitney U and Kruskal–Wallis). The straight profile (S3) emerged as the most attractive and most frequently preferred across all participant groups, confirming its role as the dominant esthetic reference. Retrusive profiles, particularly bimaxillary retrusion (S2), mandibular retrognathism (S5), and maxillary retrusion (S6), were consistently rated as the least attractive. Significant differences in esthetic perceptions were observed according to the professional expertise, educational level, age, and nationality, whereas gender had no clinically meaningful effect. Orthodontic training was associated with increasingly critical evaluations, especially for protrusive and convex profiles, while laypersons demonstrated greater esthetic tolerance. Both anatomical characteristics and sociocultural experience shape the perception of facial profile esthetics. While the straight profile represents a widely shared aesthetic ideal, increasing orthodontic expertise accentuates discrepancies between professional standards and public preferences. These findings underscore the necessity of integrating patient-centered and culturally sensitive considerations into contemporary orthodontic treatment planning.