Indian Journal of

Dental Research ISSN: 0970 - 9290

Volume: 19 / Issue: 1 / January - March 2008

CONTENTS
Editorial
Authorship
B Sivapathasundharam ........................................................................................................................................................................ 1

Original Research
Effect of chemical surface treatments and repair material on transverse strength of repaired acrylic denture resin
Mahroo Vojdani, Sakineh Rezaei, Lila Zareeian ................................................................................................................................... 2
Intrusion in implant-tooth-supported fixed prosthesis: An in vitro photoelastic stress analysis
Murali Srinivasan, Padmanabhan TV .................................................................................................................................................... 6
Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery:
A retrospective study
Vinod Narayanan, Shankar Guhan, Sreekumar K, Ashok Ramadorai .................................................................................................. 12
The effect of post-core and ferrule on the fracture resistance of endodontically treated maxillary central incisors
Sendhilnathan Dakshinamurthy, Sanjna Nayar .................................................................................................................................... 17
The effect of ibuprofen on bleeding duringperiodontal surgery
Shiva Prasad BM, Vijaya M, Sridhara B Reddy, Sudhir R Patil, Nagaraj B Kalburgi ............................................................................. 22
In vitro evaluation of antibacterial activity of an herbal dentifrice against Streptococcus mutans and
Lactobacillus acidophilus
Yogesh Kumar Vyas, Maheep Bhatnagar, Kanika Sharma ................................................................................................................... 26
Effect of three commercial mouth rinses on cultured human gingival fibroblast: An in vitro study
Flemingson, Emmadi Pamela, Ambalavanan N, Ramakrishnan T, Vijayalakshmi R ............................................................................ 29
The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesions
Mini Saluja, Vandana KL ...................................................................................................................................................................... 36

Review Articles
Platelet-rich fibrin: Evolution of a second-generation platelet concentrate
Sunitha Raja V, Munirathnam Naidu E ................................................................................................................................................. 42
Malignant melanoma of the oral cavity: A review of literature
MS Hashemi Pour ................................................................................................................................................................................ 47
Dentistry and Ayurveda - IV: Classification and management of common oral diseases
Sunita Amruthesh ............................................................................................................................................................................... 52

Case Reports
Odontogenic myxoma of maxilla
Sivakumar G, Kavitha B, Saraswathi TR, Sivapathasundharam B ........................................................................................................ 62
Ewings sarcoma of the maxilla
Vikas Prasad B, Ahmed Mujib BR, Bastian TS, David Tauro P ............................................................................................................. 66
Two-rooted mandibular second premolars: Case report and survey
Prakash R, Nandini S, Suma Ballal, Sowmya N Kumar, Kandaswamy D ............................................................................................. 70
Histochemical and polarization microscopic study of two cases of vegetable/pulse granuloma
Manjunatha BS, Kumar GS, Vandana Raghunath ................................................................................................................................ 74
Central giant cell granuloma of the anterior maxilla
Amar A Sholapurkar, Keerthilatha M Pai, Auswaf Ahsan ..................................................................................................................... 78

Symposium Report
ISDR International symposium on research priorities in Dental Science and technology in Asia and Africa
M Rahamatulla ..................................................................................................................................................................................... 83

Journal Reviews
Einstein A, Sathyakumar M .................................................................................................................................................................. 85
Book Review ................................................................................................................................................................................ 51

Indian J Dent Res, 19(1), 2008 Copyright 2008 by Editor-in-chief, IJDR 88

ORIGINAL RESEARCH

Self-assessment of facial form oral function and psychosocial

function before and after orthognathic surgery:
A retrospective study

Vinod Narayanan, Shankar Guhan, Sreekumar K, Ashok Ramadorai

Department of Oral and ABSTRACT

Maxillofacial Surgery, Saveetha
University, 162, P. H. Road, Orthognathic surgery is a well-accepted treatment for patients with skeletal discrepancies. The
Velappanchavadi, Chennai - 600
077, India
primary motivation of many patients who seek orthognathic surgery is esthetics and not for
correction of functional disability. The treatment is incomplete if the surgeon attempts to correct
the physical deformity alone without adequate understanding and regard for the emotional
framework. The purpose of this study is aimed at patients self-perceptions of facial form oral
function and psychosocial function before and after orthognathic surgery. Fifty patients were
included in the study, of which 21 were used as control. Twenty-two questions were asked to
evaluate the problem in all four areas as mentioned earlier. Each question takes a score from
one to five. In group I, the internal consistency of each scale indicates moderate to high internal
reliability, ranging from = 0.71 for general health to = 0.88 for psychosocial problem. In
group II, except for functional problems, the internal consistency of each scale has moderate
to high reliability. The psychological wellbeing of an orthognathic surgery patient is enhanced
by careful preoperative counseling regarding the expected surgical treatment objectives, the
operative course, and the expected postoperative sequelae. Patients who undergo orthognathic
Received : 11-12-06 surgery readily accept the changes in their postoperative appearance and are satisfied with
Review completed : 21-05-07 achieved results.
Accepted : 25-05-07
PubMed ID : Key words: Facial form, oral function, orthognathic surgery, psychosocial function

The human face can tell us about personal attributes, the
sex, race, age, physical tness, as well as changes in emotion
and his or her self-concept. Facial anomalies may negatively
affect body image and self-concept. Orthognathic surgery is
well accepted for patients with skeletal discrepancies.[1] The
goal of treatment is to maximize patient benet, and hence
the clinician must know what is really important to the
patient. A clinicians effectiveness in providing the human
side of treatment depends on understanding a variety of
personal factors, such as personal history, family and cultural
background, values, bias, attitudes, and emotional responses.
Dentofacial defects are extremely prominent and, unlike other
physical handicaps, cannot be easily disguised.[2] The primary
motivation of many patients seeking orthognathic surgery is
esthetics and not correction of functional disability.[3-5] The
treatment is incomplete if the surgeon attempts to correct the
physical deformity alone without adequate understanding
and regard for the emotional framework.[2]
each other are associated with physical attractiveness.[6,7]
Legal interactions, dating, and marriage are found to be
inuenced by physical appearance of the involved persons.[8-
10]
Literature supports that the improvement in appearance
brought about by maxillofacial surgery is associated
with improvement in psychosocial adjustment.[11] The
postoperative dissatisfaction is not necessarily related to the
surgical skill of the surgeon; it results primarily from failure
of communication between the surgeon and patient.[12,13]
Accordingly, in order to minimize the risk of unwanted
outcome and maximize the benet of orthognathic surgery,
it is important that the goals and expectations of the patient
are realistic and achievable.
The purpose of this study is aimed at patients self-
perceptions of facial form, oral function and psychosocial
function before and after orthognathic surgery. These values
are compared with those of the non-patient controls.

School is one of the stages where teachers rate attractive MATERIALS AND METHODS
children more favorably, and childrens preferences for
Correspondence:
The addresses of 50 patients who were operated during the
Dr. Vinod Narayanan, period 2002-2003 were collected, and they were called for a
E-mail: vinodnarayan@vsnl.net review and for lling the questionnaire [Figure 1]. Out of 50
Indian J Dent Res, 19(1), 2008 12
Facial form oral function after orthognathic surgery Vinod, et al.

QUESTIONNAIRE
Name:
Age:
Sex:
Patient number:
Address:
Treatment particulars:
Pre and post surgical orthodontics:
Before surgery After surgery
1. Chewing 1 2 3 4 5 1 2 3 4 5
2. Biting into foods 1 2 3 4 5 1 2 3 4 5
3. Fitting your back teeth together 1 2 3 4 5 1 2 3 4 5
4. Fitting your front teeth together 1 2 3 4 5 1 2 3 4 5
5. Speech 1 2 3 4 5 1 2 3 4 5
6. Swallowing 1 2 3 4 5 1 2 3 4 5
7. Pain in the teeth 1 2 3 4 5 1 2 3 4 5
8. Pain in the muscles around the mouth 1 2 3 4 5 1 2 3 4 5
9. Popping and clicking of the jaw joint 1 1 2 3 4 5 1 2 3 4 5
10. Pain and soreness in front of ear 1 2 3 4 5 1 2 3 4 5
11. Sinus problems 1 2 3 4 5 1 2 3 4 5
12. Appearance of the teeth 1 2 3 4 5 1 2 3 4 5
13. Facial profile 1 2 3 4 5 1 2 3 4 5
14. General appearance 1 2 3 4 5 1 2 3 4 5
15. General health 1 2 3 4 5 1 2 3 4 5
16. Feeling about self 1 2 3 4 5 1 2 3 4 5
17. Socializing with friends and family 1 2 3 4 5 1 2 3 4 5
18. Performance in school or work 1 2 3 4 5 1 2 3 4 5
19. Being out in public 1 2 3 4 5 1 2 3 4 5
20. Headaches 1 2 3 4 5 1 2 3 4 5
21. Sleeping 1 2 3 4 5 1 2 3 4 5
22. Appetite 1 2 3 4 5 1 2 3 4 5
Scale: 1-very much a problem, 2-somewhat a problem, 3-so-so, 4-relatively easy, 5-very easy

Figure 1: Questionnaire

patients, 19 patients came in person to ll the questionnaire.
For the rest of the patients, the questionnaire was sent
through post. Totally 21 patients lled the questionnaire
and belonged to group I category.
The control group was used to compare the patients
responses. The control group consisted of comparably aged
adults who have moderate to severe skeletal deformity and
were not seeking surgical correction for various reasons.
Most of the patients in this group opted for orthodontics.
Totally 21 patients were used as control and belonged to
group II category.
Out of 21 patients in group I, 8 patients were below 20 years
of age and 13 were above 20 years. In group II category,
10 patients were 20 years or below, and 11 patients were
above 20 years. There are 7 male patients and 14 female
patients in group I, and 11 male and 10 female patients in
group II controls.
In group I, only few patients underwent presurgical
orthodontics, and most of them were in post-surgical
orthodontic phase. The questionnaire was designed to assess
patients perceptions of their problems in four areas (i.e., oral
function, general health, appearance, and inter-personal
relationships) before and after surgery. This questionnaire
for this study was adapted from Prof. H. Asuman Kiyak,
Department of Oral and Maxillofacial Surgery, University
of Washington, Seattle, WA, USA.
Twenty-two questions were asked to evaluate the problem
in all four areas as mentioned earlier. Each question takes a
score from one to ve. One denotes the more negative part
and ve denotes the more positive part. Key was given at the
bottom of the questionnaire. The questionnaire was adapted
to ask the patient to recall how he or she feels before and
after orthognathic surgery.
RESULTS
The rst stage in the statistical analysis of data was to test
the internal consistency and reliability of questionnaire
subscales using Cronbachs alpha.
In group I, the internal consistency of each scale indicates
moderate to high internal reliability, ranging from = 0.71
for general health to = 0.88 for psychosocial problems,
with an exception that general health score for after-surgery
group was = 0.43 [Table 1a]
In group II, except for functional problems, the internal
consistency of each scale has moderate to high reliability
[Table 1b].

13 Indian J Dent Res, 19(1), 2008

Facial form oral function after orthognathic surgery Vinod, et al.

The mean and standard deviation were estimated from the that surgical patients start from a level lower than that of
sample for each study group. Using either Students paired the control groups on the appearance and interpersonal
t-test or Students independent t-test, the mean values were subscales, the benet of treatment on their perceptions
compared appropriately. In the present study, P < 0.05 was about their psychological and physical characteristics can be
considered the level of signicance. clearly seen [Tables 3, 4]. Heldt concluded in his study that
improvement in appearance was by far the most important
DISCUSSION motivating factor in patients who sought orthognathic
surgery.[2] Even if the subjectively evaluated improvement
This study aimed to assess the psychosocial impact of regarding function and health is not consistent with the
orthognathic surgery on patient with maxillo-mandibular objective physical changes, the inuence of positive thinking
discrepancies and, in particular, to identify any psychological regarding these factors is equally important in comparing
benet from each surgery. Zarrinkelk et al. compared the these results with that reported in the literature. We see
morphology and function of patients with combined vertical higher levels of perceived improvement in the current
maxillary excess (VME) and mandibular retrognathia patient sample. Hiyak concluded that fatigue, loss of
with those of the controls. They conrmed that VME and vigor, moderate level of tension, and depression are seen
retrognathic patients suffer from substantial deciencies in immediately following surgery. Anger and hostility reaches
their oro-motor function.[14] its lowest levels in the immediate postsurgical stage and
reaches its peak level after 4-6 weeks.[17] Kobayashi et al.
The results from the problems questionnaire indicate a evaluated masticatory efciency spectrophotometrically.
perceived improvement from the period before surgery to The mean masticatory efciency of the preoperative group
the present in all the four areas examined (oral function, was approximately half that of control group, and the value
health, appearance, and interpersonal relationship) for the postoperative group was slightly higher, but there
[Table 2]. Kiyak et al. reported improved mastication and was no statistical difference between the two groups.[18]
occlusion in patients who underwent the surgery. Most
patients continued to experience minor TMJ problems long In group I (before treatment), patients below 20 years had
after surgery, but this did not affect their satisfaction with more negative feeling as compared to the patients above
outcomes.[15] The level of satisfaction among patients was 20 years in all problem areas. Postsurgically, both groups
higher than the control groups. Vallino concluded in his faired equally [Tables 5, 6]. Statistically, the differences were
study that there is improved sound production particularly less signicant. Presurgically, the male patients worried
in s and z after surgery. Orthognathic defects do not appear
to be associated with voice disorders. Orthognathic surgery Table 3: Comparison of mean scores for problem areas
does not affect voice quality or pitch.[16] In consideration between group-I and group-II before treatment
Variable Mean SD P-value
Table 1a: Results of Cron Bach test in group-I Group I Group II
Functional 3.9 0.9 4.1 0.4 0.31 (NS)
Before treatment After treatment
Psychosocial 2.5 1.1 3.5 1.2 0.005 (Sig)
Total 0.82 0.80
Appearance 1.9 1.0 2.8 0.8 0.002 (Sig)
Functional 0.76 0.81
General health 4.4 0.7 4.8 0.3 0.03 (Sig)
Psychosocial 0.84 0.88
Appearance 0.84 0.77
General health 0.71 0.43
Table 4: Comparison of mean scores for problem areas
between group-I and group-II after treatment
Table 1b: Results of Cron Bach test in group-II Variable Mean SD P-value
Total 0.64 Group I Group II
Functional 0.14 Functional 4.7 0.4 4.1 0.4 <0.0001 (Sig)
Psychosocial 0.90 Psychosocial 4.8 0.4 3.5 1.2 <0.0001 (Sig)
Appearance 0.50 Appearance 4.6 0.5 2.8 0.8 <0.0001 (Sig)
General health 0.61 General health 4.8 0.2 4.8 0.3 0.60 (NS)

Table 2: Mean, SD and test of significant of mean change Table 5: Comparison of mean scores for problem areas
between before and after treatment area specific in group-I between age group 15-20 years and >20 years in group-1
Variable Mean SD P-value before treatment
Before After Change Variable Mean SD P-value
treatment treatment Age 15-20 Age >20
Functional 3.9 0.9 4.7 0.4 0.8 0.8 <0.0001 (Sig) Functional 3.8 0.9 3.9 0.8 0.67 (NS)
Psychosocial 2.5 1.1 4.8 0.4 2.3 1.2 <0.0001 (Sig) Psychosocial 2.2 1.0 2.7 1.2 0.36 (NS)
Appearance 1.9 1.0 4.6 0.5 2.8 1.4 <0.0001 (Sig) Appearance 1.5 0.5 2.1 1.3 0.17 (NS)
General health 4.4 0.7 4.8 0.2 0.4 0.7 0.02 (Sig) General health 4.1 0.9 4.7 0.3 0.07 (NS)

Indian J Dent Res, 19(1), 2008 14

Facial form oral function after orthognathic surgery Vinod, et al.

much about their appearance [Tables 7, 8]. Frost in his females faired better than males. Male patients had more
study explored the motivation levels and problems shared negative feelings about their appearance [Table 10].
by adult orthognathic surgery patients over the age of 25.
Women had depression more often than men but were Perceived support for patients decision to orthognathic
more enthusiastic about the nal results of the procedure. surgery would affect patient satisfaction or a function
He concluded that patients who were more positive toward of whoever providing the support. Patients who were
the procedure and more satised with the results were more satised with orthognathic surgery would perceive
those who were better informed and who thought they others to have favorable opinions of their postoperative
had a good system of communication with the orthodontist, appearance.
surgeon, and their respective staffs.[19] In group II controls,
the patients between 15 and 20 years felt that they have General support is important in the immediate postoperative
more functional and health problems as compared with period, while the reactions of signicant others to the
the patients above 20 years but the difference in values patients postoperative appearance inuence the early and
were insignicant. The patients above 20 years had more late postoperative stages. Spouse and close relatives are the
negative feelings about their appearance and faired less most critical to general support, whereas the reactions of
psychologically as compared with patients below the age of additional subgroups, such as relatives, are signicant when
20 years [Table 9]. Statistically, the value does not show any considering reaction to postoperative appearance. From our
signicance between male and female patients in problem study, we understood that patients mental attitude about
areas, such as function and general health. Psychologically, his or her postoperative appearance may be inuenced by
patients postoperative support network. Holman conducted
a prospective longitudinal study to examine the relationship
Table 6: Comparison of mean scores for problem areas
between interpersonal support and patient satisfaction
between age group 15-20 years and >20 years in group-1
after treatment with orthognathic surgery and found that the reactions
Variable Mean SD P-value of the patients support group to his or her postoperative
Age 15-20 Age >20 appearance was found to be highly related to the satisfaction
Functional 4.7 0.4 4.6 0.5 0.42(NS) in both the early and late postoperative stages.[20] Flanony
Psychosocial 4.7 0.4 4.8 0.4 0.70(NS) in her study reported that the leading factor in patient
Appearance 4.7 0.5 4.6 0.6 0.52(NS)
dissatisfaction with surgery is the patients experience of
General health 4.8 0.3 4.9 0.1 0.22(NS)
postoperative surprises.[21]

Table 7: Comparison of mean scores for problem areas In this study, signicant self-concept and personality
between male and female patients in group-1 before improvements have been found in almost all personality
treatment dimensions assessed. Hunt, in all his studies, reported that
Variable Mean SD P-value orthognathic patients experience psychosocial benets as
Male Female a result of orthognathic surgery, including improved self-
Functional 3.8 0.9 3.9 0.9 0.89 (NS)
condence, body and facial image, and social adjustment.[1]
Psychosocial 2.5 1.1 2.4 1.2 0.84 (NS)
Appearance 1.5 0.4 2.0 1.2 0.19 (NS) Terzoudi concludes that orthognathic surgery resulted
General health 4.8 0.3 4.3 0.7 0.04 (Sig) in the subjective estimation of function, appearance,
health and interpersonal relationship that was higher
than that among pretreatment and non-treatment control
Table 8: Comparison of mean scores for problem areas groups.[22]
between male and female patients in group-1 after treatment
Variable Mean SD P-value
The ndings of this study were also supported by Hutton,
Male Female
Functional 4.7 0.4 4.6 0.5 0.65 (NS) Kiyak, Crowell and Laufer.[23,24] They found that a majority
Psychosocial 4.9 0.3 4.7 0.4 0.29 (Sig) of patients have good chance in developing personality, self-
Appearance 4.7 0.5 4.6 0.5 0.77 (NS) condence, boldness, self-consciousness and had improved
General health 4.8 0.19 4.8 0.2 0.79 (NS) relationship with opposite sex postsurgically. Modiq et al.
conclude that patients perceptions after orthognathic
Table 9: Comparison of mean scores for problem areas
between age group 15-20 years and >20 years in group-II Table 10: Comparison of mean scores for problem areas
(control) between male and female patients in group-II (control)
Variable Mean SD P-value Variable Mean SD P-value
Age 15-20 Age >20 Male Female
Functional 4.0 0.3 4.2 0.4 0.11 (NS) Functional 4.0 0.3 4.2 0.4 0.27 (NS)
Psychosocial 4.0 0.9 3.1 1.3 0.08 (NS) Psychosocial 3.0 1.2 4.1 1.0 0.04 (Sig)
Appearance 3.0 0.6 2.6 1.0 0.27 (NS) Appearance 2.5 0.8 3.2 0.8 0.06 (NS)
General health 4.7 0.4 4.8 0.2 0.35 (NS) General health 4.8 0.3 4.8 0.3 0.81 (NS)

15 Indian J Dent Res, 19(1), 2008

Facial form oral function after orthognathic surgery
operations were generally favorable, but there is a need for
improved information to patients during the treatment.[25]
CONCLUSION
The psychological wellbeing of the orthognathic surgery
patients is enhanced by careful preoperative counseling
regarding the expected treatment objectives, the operative
course, and the expected postoperative sequelae. Informed
postoperative psychological and emotional support, if
required, generally leads to a satisfactory result for most
patients.
Most of the patients who undergo orthognathic surgery
readily accept changes in their postoperative appearance
and are satised with the achieved results. Although most
patients report satisfaction with treatment results, unexpected
psychological experiences can occur, and further research is
required to gain additional insight into this complex area.
REFERENCES
1. Hunt OT, Johnston CD, Hepper PG, Burden DJ. The psychological impact
of orthognathic surgery: A systematic review. Am J Orthod Dentofacial
Orthop 2001;120:490-7.
2. Heldt L, Haffke EA, Davis LF. The psychological and social aspects of
orthognathic treatment. Am J Orthod 1982;82:318-28.
3. Flanary CM, Barnwell GM, VanSickels JE, Littlefield JH, Rugh AL.
Impact of orthognathic Surgery on normal and abnormal personality
dimensions: A two year follow up study of 61 patients. Am J Orthod
Dentofacial Orthop 1990;98:313-22.
4. Olson RE, Laskin DM. Expectations of patients from orthognathic
surgery. J Oral Surg 1980;38:283-5.
5. Ostler H, Kiyak HA. Treatment expectations versus outcomes among
orthognathic surgery patients. Int J Adult Orthodont Orthognath Surg
1991;6:247-55.
6. Adams GR. Physical attractiveness research: Towards a developmental
social psychology of beauty. Hum Dev 1977;20:217.
7. Kehle T, Bramble. Teachers expectations: Ratings of student
characteristics. J Exp Educ 1975;31:54.
8. Sigall H, Ostrove N. Beautiful but dangerous: Effects of offender
attractiveness and nature of the crime on juridic judgments. J Pers
Soc Psychol 1971;31:218.
9. Byrne D, Evin C. Continuity between the experimental study of
attraction in real life and computer dating. J Pers Soc Psychol
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Vinod, et al.
1970;16:157.
10. Curran J, Lippold S. The effect of physical attractiveness in attitude
similarities on attraction in dating dyads. J Pers Soc Psychol
1982;9:289.
11. Pertschuk M, Whitaker L. Social and psychological effects of cranio-facial
deformity and surgical reconstruction. Clin Plast Surg 1982;9:297-306.
12. Peterson LJ, Topazian RG. Psychological considerations in corrective
maxillary and midfacial surgery. J Oral Surg 1976;34:157-64.
13. Peterson LJ, Topazian RG. The preoperative interview and psychological
evaluation of the orthognathic surgery patient. J Oral Surg 1974;32:
583-8.
14. Zarrinkelk HM, Throckmorton GS, Ellis E 3rd, Sinn DP. Functional
and morphological changes in Maxillary intrusion and mandibular
advancement surgery. J Oral Maxillofac Surg 1996;54:828-37.
15. Kiyak HA, West RA, Hohl T, McNeill RW. The psychological impact of
Orthognathic surgery: A 9-month follow-up. Am J Orthod 1982;81:
404-12.
16. Vallino LD. Speech, velopharyngeal function, and hearing before
and after orthognathic surgery. J Oral Maxillofac Surg 1990;48:1247-
82.
17. Kiyak HA, McNeill RW, West RA. The emotional impact of Orthognathic
surgery and conventional orthodontics. Am J Orthod 1985;88:224-34.
18. Kobayashi T, Honma K, Nakajima T, Hanada K. Masticatory function in
patients with mandibular advancement before and after orthognathic
surgery. J Oral Maxillofac Surg 1993;51:997-1001.
19. Frost V, Peterson G. Psychological aspects of orthognathic surgery:
How people respond to facial change. Oral Surg Oral Med Oral Pathol
1991;71:538-42.
20. Holman AR, Brumer S, Ware WH, Pasta DJ. The impact of interpersonal
support on patient satisfaction with orthognathic surgery. J Oral
Maxillofac Surg 1995;53:1289-99.
21. Flanary CM. Patients perception of orthognathic surgery. Am J Orthod
Dentofacial Orthop 1985;88:137-45.
22. Lazaridou-Terzoudi T, Kiyak HA, Moore R, Athanasiou AE, Melsen
B. Long-term assessment of psychologic outcomes of orthognathic
surgery. J Oral Maxillofac Surg 2003;61:545-52.
23. Kiyak HA, Zeitler DL. Self-assessment of profile and body image among
Orthognathic surgery patients before and two years after surgery. J Oral
Maxillofac Surg 1988;46:365-71.
24. Laufer D, Glick D, Gutman D, Sharon A. Patient motivation and response
to surgical correction of prognathism. Oral Surg Oral Med Oral Pathol
1976;41:309-13.
25. Modiq M, Anderson L, Wardh I. Patients perception of improvement
after orthognathic surgery: A pilot study. Br J Oral Maxillofac Surg
2006;44:24-7.
How to cite this article: Narayanan V, Guhan S, Sreekumar K, Ramadorai A.
Self assessment of facial form oral function and psychosocial function before
and after orthognathic surgery: A retrospective study. Indian J Dent Res
2008;19:12-6.
Source of Support: Nil, Conflict of Interest: None declared.
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