Comparison of children's dentofacial esthetic perception by two- and three-dimensional methods of observation

Background: This study aimed to compare the dentofacial esthetic perception of children using two-dimensional (2D) and three-dimensional (3D) methods of observation. Methods: A total of 176 children aged 6–13 years were included in the study after obtaining parental consent and child assent. Participants were asked to evaluate a set of five two-dimensional (2D) intraoral photographs, which were displayed individually on a computer screen. Additionally, three-dimensional (3D) digital dental models obtained using an intraoral scanner (TRIOS, 3Shape®, Copenhagen, Denmark) were presented in video format, showing a 180-degree rotation of each model. Both the presentation sequence (whether 2D or 3D was viewed first) and the order of the individual cases within each modality were randomly assigned for every participant to minimize potential order-related bias. For both the 2D photographs and the 3D videos, participants were instructed to rate the esthetic appearance using a 0–10 Numeric Rating Scale (NRS), where 0 indicated “least attractive” and 10 indicated “most attractive”. Results: Normal dental alignment obtained the highest score for 3D (boys: 6.59 ± 0.29, girls: 6.27 ± 0.30) and 2D (boys: 8.40 ± 0.23, girls: 8.16 ± 0.25) compared with other alignment types. In nearly all cases, 2D images received significantly higher ratings than 3D models, demonstrating a clear modality effect. Boys provided higher scores than girls across all conditions (p < 0.001). Conclusions: Children’s esthetic judgments differed substantially between 2D and 3D representations. Higher ratings for 2D images may reflect greater perceptual familiarity, more complete visual information, and reduced cognitive load for young viewers. These findings highlight the need to consider visualization format when communicating dental esthetic conditions to pediatric patients.

Esthetic perception; Dental esthetics; 2D; 3D; Intraoral scan; Children

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