Esthetic perception of orthodontic appliances by Brazilian children and adolescents

ABSTRACT Objective: The objective of this present study was to understand how children and adolescents perceive esthetic attractiveness of a variety of orthodontic appliances. It also analyzed preferences according to patients' age, sex and socioeconomic status. Methods: A photograph album consisting of eight photographs of different orthodontic appliances and clear tray aligners placed in a consenting adult with pleasing smile was used. A sample of children or adolescents aged between 8 and 17 years old (n = 276) was asked to rate each image for its attractiveness on a visual analog scale. Comparisons between the appliances attractiveness were performed by means of nonparametric statistics with Friedman's test followed by Dunn's multiple comparison post-hoc test. Correlation between appliances and individuals' socioeconomic status, age, sex, and esthetic perception was assessed by means of Spearman's correlation analysis. Results: Attractiveness ratings of orthodontic appliances varied nonsignificantly for children in the following hierarchy: traditional metallic brackets with green elastomeric ligatures > traditional metallic brackets with gray elastomeric ligatures > sapphire esthetic brackets; and for adolescents, as follows: sapphire esthetic brackets > clear aligner without attachments > traditional metallic brackets with green elastomeric ligatures. The correlation between individuals' socioeconomic status and esthetic perception of a given appliance was negative and statistically significant for appliances such as the golden orthodontic brackets and traditional metallic brackets with green elastomeric ligatures. Conclusion: Metal appliances were considered very attractive, whereas aligners were classified as less attractive by children and adolescents. The correlation between esthetic perception and socioeconomic status revealed that individuals with a higher socioeconomic level judged esthetics as the most attractive attribute. For those with higher economic status, golden orthodontic brackets and traditional metallic brackets with green elastomeric ligatures were assessed as the worst esthetic option.

摘要
目的：本研究旨在探究儿童与青少年对各类正畸矫治器的审美感知，并依据患者的年龄、性别及社会经济地位分析其审美偏好。
方法：本研究采用一套包含8张照片的相册，照片展示了佩戴于一名签署知情同意书且笑容美观的成年受试者面部的不同正畸矫治器及透明托盘矫治器（clear tray aligners）。本研究纳入276名年龄介于8至17岁的儿童及青少年作为研究对象，要求其通过视觉模拟评分法（Visual Analog Scale, VAS）对每张图像的美观度进行评分。采用非参数统计方法开展矫治器美观度比较：先通过弗里德曼检验（Friedman's test）进行整体差异性分析，随后辅以邓恩多重比较事后检验（Dunn's multiple comparison post-hoc test）完成组间两两比较。通过斯皮尔曼相关分析（Spearman's correlation analysis）评估矫治器与受试者社会经济地位、年龄、性别及审美感知之间的相关性。
结果：儿童群体对各类正畸矫治器的美观度评分无显著统计学差异，其美观度排序为：带绿色弹性结扎圈的传统金属托槽＞带灰色弹性结扎圈的传统金属托槽＞蓝宝石美学托槽；青少年群体的美观度排序则为：蓝宝石美学托槽＞无附件的透明矫治器＞带绿色弹性结扎圈的传统金属托槽。针对金色正畸托槽及带绿色弹性结扎圈的传统金属托槽，受试者的社会经济地位与其对该类矫治器的审美感知呈显著负相关关系。
结论：金属矫治器被儿童及青少年认为美观性较高，而透明矫治器则被评为美观性较差的矫治方案。审美感知与社会经济地位的相关性分析显示，社会经济水平更高的群体将美观性视为最重要的矫治考量属性。对于经济状况较好的受试者，金色正畸托槽与带绿色弹性结扎圈的传统金属托槽被评为美观性最差的矫治选择。