CRANIOMAXILLOFACIAL DEFORMITIES / SLEEPDISORDERS / COSMETIC SURGERY

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A Cross-Sectional Study Examining 60
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7 Andrews’ Analysis in Caucasian and 62
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9 Q2 African 65
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11 Q7 Andrew A. Bertot, DMD, MD,* ,R Chad W. Dammling, DDS, MD,y 67
12 Nada M. Souccar, DMD,z Patrick J. Louis, DDS, MD,x 68
13 Q5 Guihua Zhai, PhD,k and Brian E. Kinard, DMD, MD{ 69
14 70
Background: Andrews’ analysis is a commonly utilized instrument to aid in esthetic positioning of the
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anteroposterior position of the maxillomandibular complex; however, there is limited data regarding use
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in non-Caucasian subjects.
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18 Purpose: The purpose of this study was to document laypersons preferences of anteroposterior posi- 74
19 tion of the maxillomandibular complex in relation to Andrews’ lateral profile analysis in African American 75
20 (AA) and Caucasian subjects. 76
21 Study Design, Setting, Sample: A cross-sectional study was implemented to evaluate the esthetics of 77
22 AA and Caucasian subjects. Photographs were taken and simulated with anteroposterior maxillomandib- 78
23 ular complex positioning in varying relationships to Andrews’ goal anterior line limit. A survey was then 79
24 designed to select the preferred simulation of the facial profile of each subject. 80
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Independent Variable: The independent variable was the race of the study subjects.
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27 Main Outcome Variable: The main outcome was the layperson’s preferred lateral facial profile for each 83
28 subject. 84
29 Covariates: The covariates included age, race, sex, education level, income, of the laypersons. 85
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Analyses: A proportion test was used to decide which profile was preferred. Logistic regression ana-
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lyses were conducted to assess the association between the preference and respondent demographics.
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P < .05 was considered significant.
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34 Results: A total of 264 surveys were distributed, and 250 complete surveys were utilized (response 90
35 rate = 95%). Respondents were majority male (51.2%), aged 35-44 (37.2%), college-educated (57.2%), earn- 91
36 ing between $20,000 and $50,000 annually (44%), and identified as Caucasian (77.2%). For the female sub- 92
37 jects, the respondents preferred +4 and + 6 mm anterior to goal anterior line limit with 54.2% for the 93
38 Caucasian and 65.9% for the AA subjects (difference = 11.7%; 95% CI:2.7 to 20.7%; P = .008). For the males, 94
39 47.4% of the respondents chose 0 mm and +2 mm for the AA subject, while only 24.9% preferred +2 mm 95
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41 R
US/CA OMS resident. Conflict of Interest Disclosures: None of the authors have any 97
42 *Resident-in-Training, Department of Oral and Maxillofacial relevant financial relationship(s) with a commercial interest. 98
43 Surgery, University of Alabama at Birmingham School of Dentistry, Address correspondence and reprint requests to Dr Kinard: Asso- 99
44 Birmingham, AL. ciate Professor, Department of Oral Maxillofacial Surgery, Associate 100
45 yPrivate Practice, Carolina Centers for Oral and Facial Surgery, Professor, Department of Orthodontics, University of Alabama Bir- 101
46 Raleigh, NC. mingham, School of Dentistry, 1919 7th Ave S, SDB 419, Birming- 102
47 zAssistant Professor, Department of Orthodontics, School of ham, AL 35294-0007; e-mail: [email protected] 103
48 Dentistry, University of Alabama at Birmingham, Birmingham AL. Received June 25 2024 104
49 xChairman and Professor, Department of Oral and Maxillofacial Accepted August 20 2024 105
50 Surgery, University of Alabama at Birmingham School of Dentistry, Ó 2024 Published by Elsevier Inc. on behalf of the American Association of Oral 106
51 Birmingham AL. and Maxillofacial Surgeons 107
52 kCenter for Clinical and Translational Science, University of 0278-2391/24/00789-4 108
53 Alabama at Birmingham, Birmingham AL. https://doi.org/10.1016/j.joms.2024.08.059
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54 {Associate Professor, Department of Oral and Maxillofacial 110
55 Surgery, Department of Orthodontics, University of Alabama at 111
56 Birmingham School of Dentistry, Birmingham, AL. 112

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113 for the Caucasian male (difference = 22.5%; 95% CI: 13.8 to 31.1%; P < .0001). Respondent demographics 169
114 were not found to influence selection. 170
115 Conclusion and Relevance: The preferred facial profile as judged by laypersons differs between Cauca- 171
116 sian and AA subjects when defined through Andrews’ analysis. 172
117 Ó 2024 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial 173
118 Surgeons 174
119 J Oral Maxillofac Surg -:1-9, 2024 175
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122 Oral and maxillofacial surgeons and orthodontists his- of the maxillomandibular complex from 6 mm anterior 178
123 torically have utilized cephalometric analysis for or- to 6 mm posterior to the goal anterior limit line for 179
124 thognathic surgery treatment planning. Despite each subject; 3) Obtain layperson opinions of 180
125 common use, the lateral cephalometric analysis has preferred simulated facial profile for each subject. 181
126 proven to have limited efficacy in predicting esthetic Our hypothesis was that the preferred facial profile 182
127 changes for orthognathic surgery.1-5 Ferrario et al as judged by laypersons differs between Caucasian and 183
128 demonstrated that standard cephalometric AA subjects when defined through Andrews’ analysis. 184
129 classification criteria do not reliably correlate to 185
130 actual differences in facial morphology.6 Additionally, Materials and Methods 186
131 cephalometric norms vary among ethnicities and 187
132 sexes making the generalized use of cephalometric STUDY DESIGN 188
133 analysis for orthognathic planning difficult.7-11 A cross-sectional study was developed using 4 sub- 189
134 In addition to the use of cephalometric analysis for jects who were previously evaluated at the University 190
135 orthognathic surgery treatment planning, direct visual of Alabama at Birmingham School of Dentistry Ortho- 191
136 examination including lip length, nasolabial and labio- dontic Clinic. Two males and 2 females were selected; 192
137 mental angles, Andrews’ lateral profile analysis, and one AA and one Caucasian, respectively. 193
138 surgeon preference may also be utilized.12 Andrews’ All individuals had normal maxillary incisor inclina- 194
139 lateral profile analysis aids in planning the anteroposte- tion and class I skeletal and dental relationships. No 195
140 rior positioning of the maxillomandibular complex in subject had undergone orthognathic surgery nor was 196
141 relation to the forehead with the subject in natural actively being evaluated for orthognathic surgery. 197
142 head position.13,14 Andrews’ six keys to orofacial har- Lateral facial photographs were taken of each study 198
143 mony state that the ideal position of the maxilloman- participant in adjusted natural head position.20,21 An- 199
144 dibular complex in anteroposterior dimension drews’ analysis was completed and the GALL was 200
145 correlates with the maxillary central incisors vertically marked for each subject.15 201
146 between the forehead midpoint and soft tissue Regardless of the baseline position of their maxilla, 202
147 glabella.13,15 Andrews’ analysis has been validated for 7 different treatment simulations were provided for 203
148 esthetic anteroposterior positioning of the maxillo- each subject utilizing Dolphin Imaging (Patterson 204
149 mandibular complex as judged by both laypersons Dental; Saint Paul, MN). Maxillary incisor position of 205
150 and clinicians.1,12,14,16,17 the maxillomandibular complex was simulated to be 206
151 Previous studies have reported the preferred either posterior or anterior to GALL at 6, 4, 2, 207
152 esthetic profile in Caucasian subjects, with the maxil- 0, +2, +4, +6 millimeters. The position of the chin 208
153 lary incisors being either coincident with goal anterior and mandible were moved concordant to the maxil- 209
154 line limit (GALL) in males or up to 4 mm anterior to lary movement to maintain class I occlusion. Addition- 210
155 GALL in females.1 The preferred anteroposterior posi- ally, no vertical, or occlusal plane changes in the 211
156 tioning of the maxillary incisors relative to GALL has maxillomandibular complex were performed. 212
157 been less clearly defined in other ethnicities. As a A population-based survey study was then designed 213
158 result, optimal AP position of the maxillary incisors for laypersons in order to select the preferred lateral 214
159 relative to GALL may not be transferable between facial simulation (most esthetic) for each subject. 215
160 different ethnicities.18,19 The 7 photographs for each participant were then 216
161 The purpose of this study was to document layper- formatted without any markings. The survey was 217
162 sons preferred anteroposterior positioning of the max- created using Qualtrics (Silver Lake; Seattle, WA) via 218
163 illomandibular complex in relation to Andrews’ lateral institutional licensing. The study population was gath- 219
164 profile analysis in both African Americans (AAs) and ered via Mechanical Turk (mTurk) crowdsourcing plat- 220
165 Caucasians. form (Amazon Inc; Seattle, WA) and remained open for 221
166 Specifically, our aims were to 1) identify 4 subjects, 12 days (January 20, 2024, to February 1, 2024) in or- 222
167 2 AAs (female and male), and 2 Caucasians (female and der to collect 250 complete responses. This survey 223
168 male), with Class I occlusion; 2) simulate positioning was limited to mTurk respondents (raters) who had 224

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225 a minimum 95% approval rating and resided in the computer-based internet browser or mobile device 281
226 USA. A series of demographic questions about each internet browser. 282
227 rater preceded the survey, which included their age, 283
228 sex, race, and level of income. Additionally, there 284
229 were a set of control questions dispersed within the DATA COLLECTION METHODS/DATA ANALYSIS 285
230 demographic questions to ensure thoughtful participa- After the collection of 250 complete surveys, the 286
231 tion in the survey (raters were asked to solve a simple survey was closed and no new responses were taken. 287
232 math problem and state the month of the year in The preferred position for each subject was deter- 288
233 which they were completing the survey). The respon- mined using the following approach. The number of 289
234 dents were then asked to select the most preferred respondents choosing different distances for each sub- 290
235 simulated lateral facial profile for each subject (Fig ject was counted and ranked to decide the most 291
236 1A-D) in a simple multiple choice format. esthetic photograph as a reference photograph. 292
237 Survey respondents were excluded if they did not Then a proportion test was used to compare the per- 293
238 answer the control questions correctly. Each survey centage for choosing another photograph with the 294
239 respondent was provided information detailing the percentage for choosing the most esthetic one. If the 295
240 purpose of this research study and the parameters of comparison result was not significant and the absolute 296
241 their involvement. Participants were prevented from percentage difference was within 5%, that photograph 297
242 completing the survey more than once. Each respon- was also considered ‘‘most esthetic’’. 298
243 dent was compensated $2 to complete the 5-minute Using the Cochran-Mantel-Haenszel test, the associ- 299
244 survey. The survey was accessible by means of a ation was assessed between race of the participant 300
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278 FIGURE 1. Participant lateral facial photographs. The snapshots are displayed as they were on the survey. A-G represent 6 mm, 4 mm, 334
279 2 mm, 0 (GALL), 2 mm, 4 mm, 6 mm, respectively, for each series of photographs. 335
280 Bertot et al. ---. J Oral Maxillofac Surg 2024. 336

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337 (the primary predictor) and each of other covariates Table 1. PARTICIPANT DEMOGRAPHICS
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338 including sex, education, income and age. Then, a 394
339 bivariate logistic regression was done to assess if Variable n = 250 (%) 395
340 each variable affects the selection of the ‘‘most 396
341 esthetic’’ position. In this model, whether a responder Sex (male) 128 (51.20) 397
342 chose the ‘‘most esthetic’’ position is the dependent bi- Age 398
343 nary variable and each covariate as the independent 18-24 2 (0.80) 399
344 variable. After that, a multivariate logistic regression 25-34 33 (13.20) 400
345 was performed. In this model, the dependent binary 35-44 93 (37.20) 401
45-54 62 (24.80)
346 variable remained the same, but all covariates 402
55-64 43 (17.20)
347 were included. >65 17 (6.80)
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348 Statistical analyses were performed with SAS 9.4 Education 404
349 software (SAS Institute, Cary, NC). All tests were High school/GED 65 (26.00) 405
350 two-sided, and significance was set at P < .05 for all Technical certificate 13 (5.20%) 406
351 comparisons. Institutional review board approval College 143 (57.20) 407
352 was obtained through the University of Alabama, Bir- Post-graduate degree 29 (11.60) 408
353 mingham (300011030). Annual income 409
354 <$20,000 42 (16.80) 410
355 $20,000-50,000 110 (44.00) 411
Results $50,000-100,000 76 (30.40)
356 412
>$100,000 22 (8.80)
357 Two hundred and sixty four surveys were submitted 413
Ethnicity
358 throughout the survey process. Fourteen surveys were African American 17 (6.80)
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359 excluded due to an incorrect or unanswered control Caucasian 193 (77.20) 415
360 question with a final sample size of 250 respondents. Asian/Asian American 21 (8.40) 416
361 The respondents were most commonly male Hispanic 13 (5.20) 417
362 (51.2%), aged 35-44 (37.2%), college educated Middle Eastern 0 (0.00) 418
363 (57.2%), earning between $20,000 and $50,000 annu- Other 2 (0.80) 419
364 ally (44%), and identified as Caucasian Prefer not to answer 4 (1.60) 420
365 (77.2%) (Table 1). Bertot et al. ---. J Oral Maxillofac Surg 2024. 421
366 For the female subjects, the respondents preferred 422
367 incisor-GALL +4 and +6 mm with 54.2% for the Cauca- 423
368 sian female subject and 65.9% for the AA female sub- maxillomandibular complex in relation to Andrews’ 424
369 ject, respectively (difference = 11.7%; 95% CI: 2.7 to lateral profile analysis in both AA and Caucasian sub- 425
370 20.7%; P = .008, Fig 2A, Table 2). Additionally, 20.8% jects. The authors hypothesized that the preferred 426
371 of the respondents chose +2 mm for the Caucasian fe- facial profile as judged by laypersons would differ be- 427
372 male, but only 8.9% chose +2 mm for the AA female tween Caucasian and AA subjects when defined 428
373 (difference = 11.9%; 95% CI: 5.3 to 18.5%; P = .002, through Andrews’ analysis. 429
374 Fig 2A, Table 2). The results of the study document that layperson re- 430
375 For the AA male, the respondents chose 0 mm spondents prefer lateral facial profiles for both Cauca- 431
376 (24.1%), followed by +2 mm (23.2%) as the most sians and AAs females at 4 and 6 mm anterior to GALL, 432
377 preferred lateral profile. In contrast, only +2 mm and for males the preferred lateral facial profile is 433
378 (24.9%) was preferred for the Caucasian male (differ- closer to GALL (0 mm and +2 mm for AA and +2 mm 434
379 ence = 22.5%; 95% CI: 13.8 to 31.1%; P < .0001, Fig for Caucasian). No respondent demographic was 435
380 2B, Table 2). found to influence preferred simulated lateral 436
381 Respondent race was not significantly associated facial profile. 437
382 with other covariates (Table 3). In addition, no signifi- Previous studies have reported preferred esthetic 438
383 cant association was found between the selection of profile in Caucasian subjects, with the maxillary inci- 439
384 the preferred position and any covariate (Table 4). sors being up to 4 mm anterior to GALL in females 440
385 The selection was not significantly associated with and coincident with GALL in males.1 Our results 441
386 race after controlling for other covariates including agreed with the previous study1 for the female sub- 442
387 sex, education, income and age (Table 5). jects with anterior GALL distances (+4 mm 443
388 and +6 mm) preferred as 54.3 and 66.0% (P = .008) 444
389 of the responders made this choice for the Caucausian 445
Discussion
390 and AA female, respectively. This difference was 446
391 The purpose of this study was to report laypersons caused by different opinions towards +2 mm to 447
392 opinions of preferred anteroposterior position of the GALL. While 20.8% of the respondents chose +2 mm 448

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FIGURE 2. Incisor-goal anterior limit line (GALL) ratings for the female (A) and male (B) subjects. The bar indicates the upper limit of 95% con-
485 fidence interval of each percentage. 541
486 Bertot et al. ---. J Oral Maxillofac Surg 2024.
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487 543
488 544
489 545
490 for the Caucasian female, only 8.9% chose +2 mm for posterior positioning of the maxillomandibular com- 546
the AA female (P = .0002) (Table 2). For the Caucasian plex was unfavorable in all subjects.
491 547
male, our results showed +2 mm was most preferred These findings are in contrast to the original An-
492 548
with 0 mm, +4 mm and +6 mm considered acceptable, drews’ analysis protocol which states the ideal posi-
493 549
but the previous study1 preferred 0 mm and 4 mm. tion of the maxillomandibular complex in
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Our results expressed a wide and continuous range anteroposterior position correlates with the maxillary
495 551
of acceptance for Caucasian male, making 4 mm an central incisors vertically between the forehead
496 552
497 unlikely choice. Zero mm and + 2 mm (47.4%) domi- midpoint and soft tissue glabella in Caucasians.13,15 553
498 nated for AA male, but only +2 mm (24.9%) was Our findings are comparable to research comparing 554
preferred for Caucasian male (P < .001). Our results esthetics with the upper incisor to soft tissue plane
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showed similar preference regarding sex regardless also known as the Barcelona Line.22 The Barcelona
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of race. Laypeople preferred increased anterior posi- Line is comparable to Andrews’ analysis as it also is a
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tioning (+4 mm and +6 mm) for the females while true vertical line at the soft tissue nasion compared
502 558
they chose (0 mm and +2 mm for AA and +2 mm for to the glabella. These findings also generally found a
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Caucasian) for the males. In contrast, retrusive antero- more protrusive middle third (0-4 mm anterior,
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561 Table 2. SURVEY RESULTS

617
562 618
563 Probability of Not 619
564 GALL Frequency Percent Choosing the Most 620
565 Subject Distance (mm) Chosen(n) Chosen (%) Popular (GALL) P Value 621
566 622
567 AA female 6 2 0.81 0.02 <.0001 623
568 4 6 2.43 0.07 <.0001 624
569 2 19 7.69 0.22 <.0001 625
0 35 14.17 0.40 <.0001
570 626
2 22 8.91 0.25 <.0001
571 4 76 30.77 0.87 .29
627
572 6 87 35.22 1 628
573 AA male 6 11 4.49 0.19 <.0001 629
574 4 20 8.16 0.34 <.0001 630
575 2 25 10.20 0.42 <.0001 631
576 0 59 24.08 1 632
577 2 57 23.27 0.97 .83 633
578 4 31 12.65 0.53 .001 634
579 6 42 17.14 0.71 .06 635
580 Caucasian female 6 4 1.63 0.05 <.0001 636
4 7 2.86 0.09 <.0001
581 637
2 16 6.53 0.22 <.0001
582 0 34 13.88 0.46 <.0001
638
583 2 51 20.82 0.69 .02 639
584 4 59 24.08 0.80 .13 640
585 6 74 30.20 1 641
586 Caucasian male 6 15 6.12 0.25 <.0001 642
587 4 11 4.49 0.18 <.0001 643
588 2 25 10.20 0.41 <.0001 644
589 0 43 17.55 0.70 .04 645
590 2 61 24.90 1 646
591 4 45 18.37 0.74 .08 647
6 45 18.37 0.74 .08
592 648
593 Note: Incisor-GALL distances and the frequency chosen for each are listed above. The probability of not choosing the most pop- 649
594 ular photo was calculated for each of the 4 subjects by dividing the number of choices for a particular incisor-GALL distance over 650
595 the number of choices for the most popular one. 651
596 Bertot et al. ---. J Oral Maxillofac Surg 2024. 652
597 653
598 and +4 mm anterior group) were the most esthetic. AA respondents (<7%) and other minorities. As such, 654
599 Similar to previous studies though, all patients evalu- these results may not be generalizable. However, the 655
600 ated and all evaluators were Caucasian. demographic make-up of our respondent population 656
601 The findings of this study allow for greater flexibility is similar to that of other studies that have conducted 657
602 for esthetic maxillary positioning for patients that are similar surveys.23-25 Another limitation is that the 658
603 already anterior to or at their GALL. This also allows study relied upon computer-aided surgical simulation 659
604 for greater confidence in maxillomandibular advance- of lateral facial profiles.26,27 As a result, these simula- 660
605 ment cases where esthetics must also be taken into tions may not adequately reflect the true soft tissue 661
606 consideration when planning to concomitantly in- changes that would occur during surgery. Despite 662
607 crease posterior airway space. Additionally, this data this, the application of this facial morphing software 663
608 provides us information regarding the preferred lateral has proven to be reliable for testing esthetic prefer- 664
609 facial profile in terms of Andrews’ Analysis for AAs. ences.28 A strength of the paper is that it surveyed lay- 665
610 Despite these findings, the authors believe that addi- persons, and therefore better reflects the opinions of 666
611 tional research is required given our limited number of the greater population rather than those of the 667
612 AA evaluators. While the survey was available to clinicians. 668
613 anyone within the Amazon mTurk environment within In summary, survey respondents consistently 669
614 the United States, representing a random sample of preferred lateral facial photographs of both AAs and 670
615 layperson evaluators, there were a limited number of Caucasian females at the incisor-GALL position 671
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673 Table 3. CHARACTERISTICS OF THE RESPONDENTS BY RACE

729
674 730
675 Race 731
676 732
677 Characteristics Categorization AA Asian Caucasian Hispanic P Value 733
678 734
Sex Female 11 (64.7%) 8 (38.1%) 94 (48.7%) 4 (30.8%) .23
679 735
Male 6 (35.3%) 13 (61.9%) 99 (51.3%) 9 (69.2%) -
680 736
Education <High school 1 (5.88%) 0 (0%) 12 (6.22%) 0 (0%) .15
681 High school 3 (17.7%) 2 (9.5%) 56 (29.0%) 2 (15.4%) - 737
682 College 11 (64.7%) 13 (61.9%) 107 (55.4%) 8 (61.5%) - 738
683 >College 2 (11.8%) 6 (28.6%) 18 (9.3%) 3 (23.1%) - 739
684 Income <20K 4 (23.5%) 2 (9.5%) 33 (17.1%) 3 (23.1%) .18 740
685 20-50K 9 (52.9%) 5 (23.8%) 86 (44.6%) 7 (53.9%) - 741
686 50-100K 4 (23.5%) 9 (42.9%) 58 (30.1%) 2 (15.4%) - 742
687 >100K 0 (0%) 5 (23.8%) 16 (8.3%) 1 (7.7%) - 743
688 Age 18-24 0 (0%) 1 (4.8%) 0 (0%) 0 (0%) .23 744
689 25-34 1 (5.9%) 3 (14.3%) 25 (13.0%) 4 (30.8%) - 745
35-44 4 (23.5%) 13 (61.9%) 65 (33.7%) 8 (61.5%) -
690 746
45-54 8 (47.1%) 2 (9.5%) 51 (26.4%) 0 (0%) -
691 747
55-64 4 (23.5%) 0 (0%) 37 (19.2%) 1 (7.7%) -
692 >65 0 (0%) 2 (9.5%) 15 (7.8%) 0 (0%) - 748
693 749
694 Note: Variables are reported as the frequency and percentage relative to the column attribute. Cochran-Mantel-Haenszel test was 750
695 used to calculate P value. 751
Abbreviation: AA, African-American.
696 752
Bertot et al. ---. J Oral Maxillofac Surg 2024.
697 753
698 754
699 755
700 Table 4. RESULTS OF BIVARIATE LOGISTIC REGRESSION ANALYSIS OF THE ASSOCIATION BETWEEN THE PREFERENCE 756
701 AND EACH COVARIATE FOR EACH SUBJECT 757
702 758
703 AA Female AA Male Caucasian Female Caucasian Male 759
704 Variable OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P
760
705 761
706 Race (vs Hispanic) .50 .91 .91 .73 762
707 AA 0.26 (0.04-1.56) 1.04 (0.24-4.41) 0.76 (0.18-3.24) 0.71 (0.12-4.30) 763
708 Asian 0.36 (0.06-2.11) 0.72 (0.18-2.92) 0.78 (0.20-3.12) 1.67 (0.34-8.07) 764
709 Caucasian 0.33 (0.07-1.52) 1.02 (0.33-3.15) 1.01 (0.33-3.09) 1.07 (0.28-4.06) 765
710 Gender (vs male) .46 .94 .29 .95 766
711 Female 1.22 (0.72-2.07) 1.02 (0.62-1.69) 1.32 (0.79-2.18) 1.02 (0.57-1.83) 767
712 Education (vs 1) .92 .40 .29 .86 768
713 2 1.34 (0.39-4.63) 0.39 (0.11-1.31) 3.00 (0.84-10.8) 0.83 (0.23-3.06) 769
714 3 1.15 (0.36-3.70) 0.57 (0.18-1.81) 2.71 (0.80-9.23) 0.70 (0.20-2.42) 770
4 1.02 (0.27-3.93) 0.58 (0.15-2.21) 1.83 (0.46-7.31) 0.59 (0.13-2.58)
715 771
Income (vs 1) .34 .55 .13 .98
716 2 0.73 (0.33-1.58) 1.11 (0.54-2.29) 0.61 (0.29-1.25) 1.03 (0.45-2.37)
772
717 3 0.57 (0.25-1.30) 1.60 (0.74-3.44) 1.02 (0.47-2.19) 1.05 (0.43-2.54) 773
718 4 1.36 (0.41-4.52) 1.47 (0.52-4.15) 1.61 (0.54-4.76) 1.20 (0.37-3.89) 774
719 Age (vs > 65) .39 .30 .36 .83 775
720 18-24 0.04 (0.02-2.55) 0.03 (0.01-4.28) 0.02 (0.01-3.52) 0.02 (0.01-1.74) 776
721 25-34 0.84 (0.25-2.83) 1.37 (0.39-4.84) 0.64 (0.20-2.11) 0.88 (0.22-3.54) 777
722 35-44 1.59 (0.53-4.78) 2.01 (0.65-6.17) 1.29 (0.46-3.63) 1.18 (0.35-3.98) 778
723 45-54 0.79 (0.26-2.40) 2.18 (0.68-6.92) 1.73 (0.59-5.12) 0.80 (0.22-2.88) 779
724 55-64 0.80 (0.25-2.59) 3.53 (1.05-11.9) 1.50 (0.48-4.65) 1.46 (0.40-5.33) 780
725 Note: Dependent variable: whether each respondent chose the ‘‘most esthetic image’’; Independent variable: each covariate. 781
726 Abbreviations: AA, African-American; CI, Confidence Interval; Education, 1-Technical certificate, 2-High school/GED, 3- 782
727 College, 4-Post-graduate degree; Income, 1- <20K, 2- 20-50K, 3- 50-100K, 4- >100K; OR, Odds Ratio; P, P value. 783
728 Bertot et al. ---. J Oral Maxillofac Surg 2024. 784

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785 Table 5. MULTIVARIATE LOGISTIC REGRESSION ANALYSIS OF THE ASSOCIATION BETWEEN THE PREFERENCE AND ALL
841
786 COVARIATES FOR EACH SUBJECT 842
787 843
Q6 AA Female AA Male Caucasian Female Caucasian Male
788 844
789 845
OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P
790 846
791 Race (vs Hispanic) .64 .95 .82 .65 847
792 AA 0.31 (0.05-2.05) 0.79 (0.17-3.62) 0.51 (0.11-2.39) 0.69 (0.11-4.45) 848
793 Asian 0.37 (0.06-2.38) 0.69 (0.16-2.96) 0.59 (0.14-2.54) 1.79 (0.35-9.16) 849
794 Caucasian 0.35 (0.07-1.75) 0.87 (0.27-2.86) 0.71 (0.22-2.36) 0.98 (0.24-3.92) 850
795 Gender (vs male) .11 .71 .17 .91 851
796 Female 1.60 (0.90-2.87) 0.90 (0.52-1.56) 1.48 (0.85-2.59) 1.04 (0.55-1.95) 852
797 Education (vs 1) .81 .27 .20 .80 853
798 2 1.57 (0.43-5.74) 0.30 (0.08-1.07) 2.73 (0.72-10.3) 0.79 (0.21-3.06) 854
799 3 1.26 (0.37-4.29) 0.46 (0.14-1.54) 2.52 (0.70-9.00) 0.66 (0.18-2.38) 855
4 0.99 (0.22-4.39) 0.46 (0.11-1.98) 1.20 (0.26-5.48) 0.50 (0.10-2.47)
800 856
Income (vs 1) .28 .61 .08 .98
801 857
2 0.81 (0.36-1.86) 0.88 (0.41-1.91) 0.62 (0.29-1.33) 1.01 (0.42-2.43)
802 3 0.66 (0.28-1.57) 1.36 (0.60-3.10) 1.12 (0.49-2.56) 1.04 (0.41-2.65) 858
803 4 2.04 (0.54-7.78) 1.18 (0.37-3.83) 2.26 (0.65-7.88) 1.29 (0.34-4.83) 859
804 Age (vs > 65) .35 .27 .64 .84 860
805 18-24 0.05 (0.02-2.23) 0.03 (0.01-4.91) 0.02 (0.01-2.97) 0.02 (0.01-1.95) 861
806 25-34 0.98 (0.27-3.58) 1.41 (0.37-5.31) 0.80 (0.22-2.88) 0.93 (0.22-4.00) 862
807 35-44 1.81 (0.57-5.72) 2.05 (0.64-6.57) 1.41 (0.46-4.27) 1.20 (0.34-4.23) 863
808 45-54 0.81 (0.25-2.62) 2.35 (0.70-7.87) 1.78 (0.56-5.65) 0.88 (0.23-3.35) 864
809 55-64 0.85 (0.25-2.91) 3.91 (1.10-14.0) 1.59 (0.47-5.34) 1.63 (0.42-6.31) 865
810 Note: Dependent variable: whether each respondent chose the ‘‘most esthetic image’’; Independent variable: all covariates. 866
811 Abbreviations: AA, African-American; CI, Confidence Interval; Education, 1-Technical certificate, 2-High school/GED, 3- 867
812 College, 4-Post-graduate degree; Income, 1- <20K, 2- 20-50K, 3- 50-100K, 4- >100K; OR, Odds Ratio; P, P value. 868
813 Bertot et al. ---. J Oral Maxillofac Surg 2024. 869
814 870
815 871
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