Dentofacial deformities can significantly impact an individual's quality of life, affecting facial aesthetics, self-esteem, and overall well-being. The combined orthognathic surgery-orthodontic treatment is the preferred approach for correcting moderate-to-severe deformities. However, patient satisfaction following orthognathic surgery remains a crucial outcome measure, influenced by various factors, including the type of malocclusion, surgical procedure, and demographic characteristics. This systematic review aimed to synthesize the available evidence regarding patient satisfaction following orthognathic surgery, exploring the effects of the type of malocclusion, surgical procedure, age, and gender on satisfaction rates, addressing a gap left by previous outdated reviews. A comprehensive literature search was conducted across multiple databases, including PubMed®, Scopus®, Web of Science™, and Embase®. Eligibility criteria were defined using the PICOS (population, intervention, comparison, outcomes, and study design) framework. Cochrane's ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions) tool was employed for non-randomized intervention studies within clinical controlled trials to assess the risk of bias. In parallel, a revised version of the Newcastle-Ottawa scale determined the methodological quality of cohort and cross-sectional studies. Sixteen studies were analyzed, revealing satisfaction levels ranging from 83% to 100%. Findings indicate that class III malocclusion patients report higher satisfaction than class II patients and satisfaction varies based on surgical type, with bimaxillary procedures generally yielding better outcomes. While most studies found no significant correlation between satisfaction and demographic factors such as age and gender, some suggested younger patients may express higher satisfaction and that female patients might report lower satisfaction levels. The review highlights the importance of effective patient communication and expectation management in achieving optimal satisfaction outcomes in orthognathic surgery. Limitations such as memory bias and methodological diversity across studies restrict the ability to perform meta-analyses, underscoring the need for further research in this area.
Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.