J Orofac Orthop
DOI 10.1007/s00056-017-0097-x
ORIGINAL ARTICLE
Effects of malocclusions on facial attractiveness and their
correlations with the divine proportion
Auswirkungen von Malokklusionen auf die Gesichtsattraktivität
und Korrelationen mit den Proportionen des Goldenen Schnitts
Seden Akan1 • Ayse Gul Torgut1 • Hüsamettin Oktay1
Received: 5 April 2016 / Accepted: 21 March 2017
 Springer Medizin Verlag GmbH 2017
Abstract
Purpose The aim of this study was to evaluate the effects
of malocclusions on facial attractiveness and to determine
if it was correlated with the divine proportion.
Methods Standard frontal facial photos were taken from
335 subjects in natural head position. Facial attractiveness
of the subjects was evaluated by 10 dental students using a
10-point visual analog scale (VAS). All of the evaluations
were arranged in order, and 30 attractive subjects with the
highest score and 30 nonattractive subjects having the
lowest score were chosen. On the frontal photos of these
subjects, 13 landmarks were determined and 12 ratios were
measured. Two way ANOVA was used to determine the
effects of malocclusions on facial attractiveness, Student’s
t test was used to compare the facial proportions of the
attractive and nonattractive subjects, and one sample t test
was used to define the relationships between the divine
proportion and facial ratios.
Results No statistically significant difference was found
between malocclusion groups in terms of facial attrac-
tiveness. Of the 12 facial ratios, significant differences
were found between attractive and nonattractive subjects
regarding trichion-menton/nasion-menton, subnasale-men-
ton/stomion-menton, nasion-subnasale/stomion-menton,
nasion-subnasale/nasal width, and trichion-menton/right-
left frontotemporale ratios. All of the ratios except nasion-
subnasale/stomion-menton in the attractive group and
Assistant Professor Seden Akan.
& Seden Akan
sedenakandt@hotmail.com
1 Ergebnisse Zwischen den Gruppen mit Malokklusionen
Department of Orthodontics, School of Dentistry, Istanbul
Medipol University, Atatürk Bulv. No: 27, Unkapanı, Fatih,
Istanbul 34083, Turkey
subnasale-menton/stomion-menton and nasion-menton/na-
sion-trichion in the nonattractive group were found to be
different from the divine proportion.
Conclusions Sagittal skeletal malocclusions evaluated by
ANB angle are not effective on facial attractiveness. Facial
ratios used in this study have little effect on attractiveness,
and are different from the divine proportion.
Keywords Facial proportion
Divine proportion
Esthetic
perception
Malocclusions
Anthropometry
Zusammenfassung
Ziel Evaluiert werden sollten die Auswirkungen von
Malokklusionen auf die Gesichtsattraktivität. Ferner sollte
bestimmt werden, ob Korrelationen mit dem Goldenen
Schnitt bestehen.
Methoden Von 335 Individuen wurden Standardportrait-
fotos in natürlicher Kopfposition angefertigt. Die
Gesichtsattraktivität wurde von 10 Zahnmedizinstudenten
mit einer 10-Punkte-VAS (visuelle Analogskala) bewertet
und in eine Rangfolge geordnet. Die 30 attraktivsten
Individuen mit den höchsten und die 30 nichtattraktiven
Individuen mit den niedrigsten Scores wurden in die Studie
aufgenommen. Auf den en-face Aufnahmen dieser Teil-
nehmenden wurden 13 Referenzpunkte und 12 Verhält-
niswerte bestimmt. Um die Effekte von Malokklusionen
auf die Gesichtsattraktivität zu evaluieren, wurde
eine Varianzanalyse (ANOVA) durchgeführt, zum Ver-
gleich von attraktiven und nichtattraktiven Individuen der
Student-t-Test und zur Definition der Beziehungen zwi-
schen Goldenem Schnitt und fazialen Verhältniswerten der
Einstichproben-t-Test.
fand sich kein statistisch signifikanter Unterschied hin-
sichtlich der Gesichtsattraktivität. Signifikante Unterschiede
123

zwischen den attraktiven und nichtattraktiven Teilnehmen-
den wurden bei den folgenden der 12 Verhältnisse in den
Gesichtsproportionen ermittelt: Trichion-Menton/Nasion-
Menton, Subnasale-Menton/Stomion-Menton, Nasion-Sub-
nasale/Stomion-Menton, Nasion-Subnasale/Nasenbreite
und Trichion-Menton/rechts-linke frontotemporale
Verhältnisse. Alle Verhältniswerte – mit Ausnahme von
Nasion-Subnasale/Stomion-Menton in der Gruppe mit
attraktiven und Subnasale-Menton/Stomion-Menton und
Nasion-Menton/Nasion-Trichion in der Gruppe mit nicht-
attraktiven Teilnehmenden – erwiesen sich als nicht den
Proportionen des Goldenen Schnitts entsprechend.
Schlussfolgerungen Sagittale skelettale Malokklusionen,
evaluiert mittels ANB-Winkel, haben keine Auswirkung
auf die Gesichtsattraktivität. Die in dieser Studie unter-
suchten fazialen Verhältnisse stehen nicht im Zusammen-
hang mit Attraktivität und unterscheiden sich von den
Proportionen des Goldenen Schnitts.
Schlüsselwörter Gesichtsproportionen
Goldener
Schnitt
Ästhetische Wahnehmung
Malokklusionen

Anthropometrie
Introduction
In common orthodontic practice, the treatment goal is to
produce an ideal occlusion with a full complement of teeth,
and this would, it was believed, produce optimal facial
esthetics. At this point, a question has arisen about whether
attractive people always have a normal or ideal dentofacial
relationship. Facial esthetics can be defined as an appre-
ciation of beauty and attractiveness. Judgments about facial
attractiveness are complex and vary greatly between indi-
viduals and different cultures, as stated in Margaret
Hungerford’s classic statement, ‘‘Beauty is in the eye of the
beholder’’ [12]. Although it is still a subjective evaluation,
in several groups, mutual appreciation indicates the pres-
ence of similar characteristics in people’s esthetic
perceptions.
Limited soft tissue esthetic evaluations through
cephalometric radiographic records gave rise to a quest for
numerical and proportional evaluations using photographic
records [3, 7, 9, 23, 27, 33]. Photographic records have
some advantages such as they are cheaper and allow better
assessment of facial harmony [24]. However, standardiza-
tion in obtaining facial photographs became necessary to
create scientific measurements [3, 9]. With this purpose,
the natural head position (NHP) has been used effectively
because it is a standardized and reproducible position
[7, 21].
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S. Akan et al.
Facial attractiveness is an essential part of social inter-
action. Most orthodontic and orthognathic procedures
involve marked esthetic changes. Thus, orthodontists
should evaluate their patients from both the frontal and
lateral views. Many authors [2, 26] have reported the
importance of esthetics from the frontal view, and
orthodontists have shifted their focus from the sagittal
plane to the frontal plane when evaluating their patients
and planning and assessing orthodontic treatments; this is
because the patients generally consider themselves in terms
of beauty from the front or three-quarter profile, almost
never in profile [15].
Because of the variations among gender and ethnic and
racial groups, the use of proportional measurements for
photographs is more useful for the study of facial esthetics
compared to using absolute values in numerical facial
analysis [17]. The divine proportion has existed from all
eternity in mathematics and in the physical universe, but
precise information is not available as to when humankind
first discovered and applied it. Throughout history, it was
most likely rediscovered many times. The concept of the
‘‘divine proportion’’ concept is expressed as the ratio of large
and small and its value is ‘1.618’; that is, the smaller part is
62% of the size of the larger. In orthodontics, Ricketts
evaluated the divine proportion in relation to facial attrac-
tiveness for the first time and reported that facial esthetics
should be based on a scientific basis rather than a personal
perception basis [27, 28]. Ricketts’s articles appear to be key
publications in the fields of orthodontics and oral surgery for
facial esthetics [16]. Afterward, Baker and Woods [3] and
Shell and Woods [33] were unable to establish significant
correlations between changes in the divine proportion and
esthetic rating after orthognathic treatment. Thus, they stated
that there was little or no relationship between the divine and
esthetic proportions. However, as there is great interest in the
divine proportion as a measure of facial esthetics in general,
and since several authors still consider the divine proportion
to be an important factor in facial esthetics, there is still a
need to evaluate the relationship between facial esthetics and
divine proportions [13, 16].
The importance of malocclusions to facial esthetics has
been described by many authors [25, 29]. Some of them
have evaluated esthetics by manipulating photographs
through the computer, and they have discovered that faces
with aligned teeth were significantly more attractive than
those which did not possess this feature [25]. Others
assessed the malocclusion types of the selected attractive
people in terms of the divine ratio [29].
Until now, an analysis of the relationship between facial
esthetics as perceived by a panel of judges and the divine
The effects of malocclusions on facial attractiveness
proportion has never been performed in individuals with
skeletal malocclusion. The purposes of this study were to
• Assess the impact of sagittal skeletal relationships on
facial attractiveness and
• Compare the facial proportions of the most attractive
and nonattractive subjects with each other and with the
divine proportion.
Materials and methods
In the present study, which was approved by the insti-
tutional ethical board (108400987-96-85), 335 subjects
of Caucasian origin (133 males, 202 females; mean age
15.72 ± 4.03 years) were randomly selected from 490
untreated individuals who applied to the Department of
Orthodontics, School of Dentistry at Istanbul Medipol
University. The power analysis showed that 279 subjects
were sufficient for this study [a = 0.05; f(effect
size) = 0.25; power (1-b error probability) = 0.95]. To
compensate for possible dropouts during the trial, we
decided to enroll more subjects. Inclusion criteria were
no previous history of orthodontic treatment, tooth
extraction except for third molars, cosmetic surgery on
the face, and craniofacial syndrome. Facial photographs
were taken from all subjects using the Olympus D 720,
4.2–42.0 mm macro lens in a natural head position, and
they were standardized using biometric photograph
templates created for female and male individuals
through superimposition at the facial midline and orbital
line (Fig. 1). Color images of all the subjects were
converted to grayscale using the Adobe Photoshop pro-
gram (CS4 version 7.0) to eliminate beauty interferers
such as skin and hair color, and they were then randomly
placed into a PowerPoint presentation to be displayed to
the judges. The exposure time of each photo was set at
10 s.
Preorthodontic cephalometric records of each patient
were assessed, and the patients were classified into differ-
ent malocclusion groups according to their ANB angles
(ANB angle = 0–4, skeletal Class I;[4, skeletal Class II;
\0, skeletal Class III) and Wits appraisals. The numbers
of subjects in Class I, II, and III skeletal malocclusion
groups were 174, 125, and 36, respectively. Descriptive
values of the groups according to ANB angles and Wits
appraisals are shown in Table 1.
In the first part of the study, the panel of judges con-
sisted of 10 Caucasian students who were beginning their
dental education (8 women and 2 men with a mean age of
20.85 ± 1.43). The students were well informed about the
procedures and the 10-point visual analog scale (VAS).
The jury watched the PowerPoint presentation in a silent
and comfortable room, and they scored the 335 subjects
from 1 (least attractive) to 10 (most attractive) according to
their own preferences. The VAS form used in the present
study is shown in Fig. 2.
In the second part, the mean VAS scores of the subjects
were determined, and they were arranged in order
according to their absolute values. The 30 most attractive
subjects with the highest scores and the 30 least attractive
subjects with the lowest scores were chosen from the
sample, and these children were used for further analyses.
In order to determine the divine proportions of the attrac-
tive and nonattractive subjects, 13 landmarks and 12 linear
measurements were used on the photographs (Fig. 3;
Table 2). The measurements were carried out using ImageJ
software (version 1.44; National Institutes of Health,
Bethesda, MD, USA).
Data analysis was performed using the SPSS software
package program (SPSS for Windows, version 16.0, SPSS
Inc., Chicago, IL, USA). Two-way ANOVA was used for
the statistical evaluation of the VAS scores between the
groups. Student’s independent samples t test was used for
comparison of the ratios of attractive and nonattractive
subjects, and one-sample t test was used for comparison of
the divergence amounts of the ratios from the divine pro-
portion in both groups. A p B 0.05 values were accepted as
significant.
Results
Descriptive data and comparison results of the panel
assessment are presented in Table 3 and Fig. 4. As can be
seen from this table, there was no significant difference in
terms of facial attractiveness between skeletal relationship
(p = 0.407) and gender (p = 0.884) groups. Distribution of
the most attractive and nonattractive subjects to the skeletal
malocclusion groups and the comparison results of their
scores are shown in Table 4. Although no statistically sig-
nificant difference was found between the malocclusion and
gender groups in both attractive and nonattractive subjects,
the majority of the nonattractive and attractive subjects were
in Class II, Class I, and Class III groups, respectively.
Statistical data and comparison results of attractive and
nonattractive subjects regarding facial ratios are presented
in Table 5. Of the 12 ratios, R2 (Tr-Me/Na-Me), R4 (Sn-
Me/St-Me), R5 (Na-Sn/St-Me), R11 (Na-Sn/Right-Left lat.
nasal), and R12 (Tr-Me/Ftr-Ftl) showed statistically sig-
nificant differences between attractive and nonattractive
subjects.
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 S. Akan et al.

Fig. 1 Frontal photographs and their standardizations with biometric templates

Abb. 1 Standardisierung der en-face Aufnahmen mit biometrischen Templates

The results of one sample t test indicating the diver-
gence of facial ratios from the divine proportion are shown
in Table 6 and Fig. 5. Only one ratio (R5; Na-Sn/St-Me)
was identical to the divine proportion of 1.618 in the
attractive subjects, and two ratios (R4; Sn-Me/St-Me and
R6; Na-Me/Na-Tr) in the nonattractive subjects. All of the
other ratios in both groups were statistically different from
1.618 (p \ 0.05).
Discussion
It has been generally accepted that orthodontic tooth
movement can alter facial esthetics. Since orthodontists
are interested in facial beauty, they need to know how
orthodontic tooth movement affects existing facial bal-
ance [2]. According to orthodontists, sagittal malocclu-
sion and facial beauty are interdependent concepts [35].
It has been suggested that when teeth are aligned and
occlusion is corrected to osseous cephalometric stan-
dards, optimal facial esthetics will be obtained [36].
However, this fact does not necessarily imply that a
good dentofacial relationship can give facial attractive-
ness to the subjects, as there may be numerous attractive
patients who do not present a perfect Class I craniofacial
and occlusal relationship [10].
Physical appearance has important effects on human
self-esteem, and previous studies [2, 35] have shown that
attractive people leave a better first impression than less
attractive subjects even when they have malocclusions.

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The effects of malocclusions on facial attractiveness

Tab. 1 Descriptive values of the groups according to ANB angles

and Wits appraisals
Tab. 1 Deskriptive Werte der Gruppen nach ANB-Winkel und Wits-
Appraisal
N Mean SD Min Max

ANB
Class I
Female 109 1.50 0.90 0 4
Male 65 1.60 1.01 0 4
Class II
Female 73 7.48 1.89 5 14
Male 52 7.54 2.03 5 13
Class III
Female 20 -3.45 1.67 -7 -1
Male 16 -3.94 2.74 -12 -1
Total 335 3.20 3.98 -12 14
Wits
Class I
Female 109 0.99 0.70 0 2
Male 65 1.03 0.73 0 3
Class II
Female 73 3.85 1.00 3 7
Male 52 3.88 0.96 3 6
Class III
Female 20 -2.25 1.12 -5 -1 Fig. 3 Landmarks used in this study. Tr trichion, Na nasion, Ftr
Male 16 -2.69 1.82 -8 -1 frontotemporale right, Ftl frontotemporale left, Med cant medial
Total 335 1.70 2.17 -8 7 canthus, Lat Na lateral nasal, Sn stomion, Chi cheilion, Me menton
Abb. 3 In der Studie verwendete Referenzpunkte. Tr Trichion, Na
Nasion, Ftr Frontotemporale rechts, Ftl Frontotemporale links, Med
cant medialer Kanthus, Lat Na Alare, Sn Stomion, Chi Cheilion, Me
Menton

mentioned above. A panel of judges was constituted

Fig. 2 The visual analog score (VAS) form used in present study
Abb. 2 In der Studie verwendete visuelle Analogskala (VAS)
Frontal facial photos have often been used in research
studies because they are easy to standardize and, more
importantly, the subjects always see themselves and
other subjects from the front or in three-quarter profile,
almost never in profile [30]. For this reason, the esthetic
concept should be reconsidered especially before
orthognathic surgical operations in which esthetic cor-
rection is the main purpose. Some studies [35, 36] have
evaluated facial esthetics using profile images in the
literature. In the present study, facial attractiveness was
evaluated using frontal facial photos for the reasons
from 10 Caucasian students beginning dental education
(8 women and 2 men). As they are continuing with a
basic medicine education, they do not have any knowl-
edge of esthetic and cephalometric evaluation or of
facial proportions. For this reason, the panel of students
was thought to be objective. In the present study, the
panel of judges consisted of more women than men.
Some studies [6, 11] have shown that the gender of
panel members was not decisive for their ratings in the
literature. However, it has also been shown that women
are less critical than men in another study [34].
One of the aims of the present study was to evaluate
whether attractive subjects always possessed an ideal
craniofacial relationship. The results showed that 43% of
the most attractive subjects with the highest scores had a
skeletal Class I relationship, 43% had a skeletal Class II,
and 14% had a skeletal Class III. As for the nonattrac-
tive subjects with the lowest scores, the percentage
distributions of the subjects in the skeletal Class I, II,

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 S. Akan et al.

Tab. 2 Ratios analyzed in the present study

Tab. 2 In der Studie analysierte Verhältnisse
Numerator Denominator
Tr-Sn: Na-Me: Sn-Me: St-Me: Na-Tr: Right–left Right–left Ftr- Right–left
height of morphological height of height of forehead Cheilion: lat nasal: Ftl: med canth:
the upper height of the the lower the heigt mouth nose width face Inter-eye
face face face mandible width width width

Tr-Me: R1 R2 R12
physiognomical
height of face
Tr-Sn: height of R3
the upper face
Na-Me: R6
morphological
height of the
face
Sn-Me: height of R4
the lower face
St-Me: height of
the mandible
Med cant-Me: R7
eye–chin
distance
Na-Sn: nose R5 R11
height
Right–left R8
cheilion: mouth
width
Right–left lat
nasal: nose
width
Ftr-Ftl: face width R9 R10

and III groups were 30, 50, and 20, respectively. The
ANOVA results showed that the malocclusion groups
and gender differences had no effect on facial attrac-
tiveness. In other words, attractive subjects might not
always have a Class I skeletal relationship. Recently,
Rodrı́guez et al. [29] evaluated attractive subjects with a
Class I molar relationship, and they concluded that
attractive patients did not always have a Class I molar
relationship. Although similar results were obtained in
the present study, it has been noted that skeletal classi-
fication by ANB angle was used in the present study, as
dental malocclusions may have been affected by local
factors such as tooth size and shape, dental caries,
extractions, and missing teeth as well as skeletal
relationship.
There is no universal standard for facial attractiveness
no matter what race, age, gender, or other variables are
considered. In the literature, several studies regarding the
assessment of facial attractiveness are available. Many
of them have reported that facial attractiveness was a
subjective perception, changing according to cultural
differences from community to community [4, 5, 18].
Matoula and Pancherz [20] investigated skeletofacial
morphology of attractive and nonattractive subjects and
found that attractive females had a larger ANB angle and
Wits appraisal, causing a more convex soft tissue profile.
As a result, they concluded that the attractiveness of a
face could hardly be explained by objective parameters.
In the present study, although not statistically significant,
the results also showed a slight tendency for males to be
judged better than females in the Class III group and for
females to be judged more attractive in the Class II
group. This phenomenon could be accepted as a com-
mon social trend, and it was also discovered by Macı́as-
Gago et al. [19] who stated that attractive females tended
to fall into Class II, whereas males tended to fall into
Class III.
The second aim of this study was to evaluate whether
there was a difference between the ratios of attractive and
nonattractive faces and whether they were identical to the

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The effects of malocclusions on facial attractiveness

divine proportion. Angle [1] claimed that beautiful faces (Table 4). Only the R2 ratio (Tr-Me/Na-Me) was higher in
are compatible with divine proportion, and Ricketts [27] attractive faces, while R4 (Sn-Me/St-Me), R5 (Na-Sn/St-
found a relationship between the divine proportion and Me), R11 (Na-Sn/Right-Left lat. nasal), and R12 (Tr-Me/
facial beauty in young women. The results of the present Ftr-Ftl) ratio values were higher in nonattractive faces.
study showed that 5 of the 12 ratios were different in Ferrario et al. [8] and Sforza et al. [32] suggested that a
attractive and nonattractive faces at a statistically signifi- large forehead, a small nose, a wide face, and a large mouth
cant level. Other ratios were similar in both groups were common characteristics for a better esthetic appear-
ance. However, it has been accepted that there was a low
relationship between the two dimensional ratios and angles
Tab. 3 Descriptive statistics and ANOVA results of visual analog
and facial attractiveness [16, 31].
scale (VAS) scores of total sample
Tab. 3 Deskriptive Statistik und ANOVA-Ergebnisse der VAS (vi- It is highly interesting that most of the ratios inves-
suelle Analogskala)-Scores beim gesamten Kollektiv tigated in this study differ from the divine proportion.
N Mean SD Min Max One ratio in attractive subjects and the two ratios in
nonattractive subjects are identical to the divine pro-
Class I portion. These results are compatible with those of
Female 109 3.77 1.02 1.30 6.50 previous studies [24, 29, 31], which could not find any
Male 65 3.73 0.96 2.10 5.50 similarity between attractive people’s ratios and the
Total Cl I 174 3.99 0.99 1.30 6.50 golden ratio. As opposed to our findings, Ricketts [27]
Class II and Kawakami et al. [14] observed that the human face
Female 73 3.92 1.36 1.50 7.80 has several structures in the golden proportion relating to
Male 52 3.43 1.15 1.10 6.70 esthetic perception.
Total Cl II 125 3.71 1.29 1.10 7.80 As a result, it may be said that attractive faces may
Class III not present the divine proportion or vice versa [3], and
Female 20 3.24 1.16 1.80 6.00 thus the primary goal of orthodontic treatment should
Male 16 3.70 1.38 2.10 7.10 not involve making the patient’s craniofacial measure-
Total Cl III 36 3.44 1.14 1.10 7.80 ments close to the divine proportion [33]. The following
Total 335 3.71 1.14 1.10 7.80 statement belonging to Holdaway [10] explains this truth
very well, ‘‘It would be very difficult to correct the
Fgender 0.021, p 0.884; Fmalocclusion 0.902, p 0.407; Fgender and malocclu-
sion interact 2.874, p 0.058
malocclusion without losing something in the way of
SD standard deviation, Cl class facial beauty.’’ He also claimed that not everyone had an
ideal occlusion even in a sample of beauty queens.

Fig. 4 Graphical presentation

of the panel assessment ratios of
the malocclusions. Cl class
Abb. 4 Graphische Darstellung
des Panels zum Assessment der
Malokklusionen. Cl Klasse

123
 S. Akan et al.

Tab. 4 Descriptive statistics and ANOVA results of visual analog Tab. 5 Descriptive statistics and comparison results of the ratios
scores (VAS) of attractive and nonattractive subjects computed in the two groups
Tab. 4 Deskriptive Statistik und ANOVA-Ergebnisse der VAS (vi- Tab. 5 Deskriptive Statistik und errechnete Ergebnisse des Ver-
suelle Analogskala)-Scores von attraktiven und nichtattraktiven gleichs der Verhältnisse in den beiden Gruppen
Teilnehmenden
Ratio Attractive Nonattractive p
N Percentage Mean SD Min Max
Mean SD Mean SD
Nonattractive (30)
R1 1.481 0.570 1.515 0.084 0.079
Class I
R2 1.477 0.710 1.407 0.717 0.000***
Female 6 20 1.88 0.34 1.30 2.20
R3 2.100 0.269 1.939 0.367 0.057
Male 3 10 2.13 0.06 1.10 2.20
R4 1.479 0.077 1.616 0.362 0.048*
Total Cl I 9 30 2.01 0.18 1.10 2.20
R5 1.613 0.159 1.798 0.439 0.035*
Class II
R6 1.482 0.169 1.596 0.265 0.052
Female 8 26.7 1.85 0.24 1.50 2.20
R7 2.703 0.196 2.818 0.649 0.359
Male 7 23.3 1.70 0.35 1.10 2.20
R8 1.395 0.100 1.360 0.132 0.257
Total Cl II 15 50 1.80 0.23 1.10 2.20
R9 1.886 0.132 1.882 0.211 0.931
Class III
R10 3.071 0.188 3.008 0.219 0.238
Female 4 13 2.05 0.17 1.80 2.20
R11 1.749 0.127 1.921 0.282 0.003**
Male 2 7 2.10 0.00 2.10 2.20
R12 1.892 0.104 1.961 0.128 0.027*
Total Cl III 6 20 2.07 0.14 1.80 2.20
Attractive (30) SD standard deviation
Class I * p B 0.05; ** p B 0.01; *** p B 0.001
Female 9 30 5.93 0.35 5.50 6.50
Male 4 13 5.48 0.05 5.40 5.50
Total Cl I 13 43 5.65 0.18 5.40 6.50 Tab. 6 Descriptive statistics and results of one sample t test indi-
Class II cating the divergence of ratios from the divine proportion
Tab. 6 Deskriptive Statistik und Ergebnisse des Einstichproben-t-
Female 11 36 6.07 0.81 5.40 7.80
Tests zur Darstellung der Abweichung von Verhältnissen im Gesicht
Male 2 7 6.10 0.85 5.50 6.70 von denen des Goldenen Schnitts
Total Cl II 13 43 6.08 0.82 5.40 7.80
Ratio Attractive Nonattractive
Class III
Female 2 7 5.85 0.21 5.70 6.00 Mean SD p Mean SD p
Male 2 7 6.35 1.06 5.60 7.10 R1 1.481 0.570 0.001 1.515 0.084 0.001
Total Cl III 4 14 6.01 1.01 5.60 7.10 R2 1.477 0.710 0.001 1.407 0.717 0.001
For nonattractive group; Fgender 0.193, p 0.665; Fmalocclusion 3.190, R3 2.100 0.269 0.001 1.939 0.367 0.001
p 0.059; Fgender and malocclusion interact 1.381, p 0.271. For attractive R4 1.479 0.077 0.001 1.616 0.362 0.973*
group; Fgender 0.006, p 0.938; Fmalocclusion 1.053, p 0.365; Fgen- R5 1.613 0.159 0.877* 1.798 0.439 0.033
der and malocclusion interact 0.947, p 0.402
R6 1.482 0.169 0.001 1.596 0.265 0.654*
SD standard deviation, Cl class
R7 2.703 0.196 0.001 2.818 0.649 0.001
R8 1.395 0.100 0.001 1.36 0.132 0.001
R9 1.886 0.132 0.001 1.882 0.211 0.001
According to him, a Miss America had a slightly con-
R10 3.071 0.188 0.001 3.008 0.219 0.001
cave skeletal pattern, a runner-up Miss Universe had a
R11 1.749 0.127 0.001 1.921 0.282 0.001
less prominent chin, and a Miss Virginia had a Class II
R12 1.892 0.104 0.001 1.961 0.128 0.001
malocclusion. This knowledge shows that each human
face is individually determined, carrying information * p C 0.05
that allows the identification of the single person [32].
Even among attractive faces, there are a variety of facial
characteristics that do not repeat the same standard [22]. facial attractiveness, and moreover, the divine proportion
The results of the present study indicate that sagittal is not a standard for esthetic perception. Consequently, it
skeletal malocclusions do not have any effect on frontal can be said that ‘‘beauty is subjective.’’

123
The effects of malocclusions on facial attractiveness
Fig. 5 Graphical presentation
of the divergence of facial ratios
from the divine proportion
Abb. 5 Graphische Darstellung
der Abweichungen der fazialen
Verhältniswerte von den
Goldenen-Schnitt-Proportionen
Conclusions
The results of this study can be summarized as follows:
• Most of the investigated ratios showed no statistically
significant difference between attractive and nonattrac-
tive subjects.
• Nearly all investigated facial ratios diverged greatly
from the divine proportion.
• Sagittal skeletal malocclusions determined by the ANB
angle have no effect on the subjects’ frontal facial
attractiveness.
Compliance with ethical guidelines
Conflict of interest S. Akan, A.G. Torgut, and H. Oktay declare that
they have no conflicting interests.
Ethical approval All procedures performed in this study involving
human participants were in accordance with the ethical standards of
the Istanbul Medipol University institutional research committee
(with the number of 108400987-96-85) and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants
included in the study.
Funding This study was not funded by any company or commitee.
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