Objective assessment of the influence of malocclusion and orthodontic devices on facial and smile esthetics in laypeople via eye-tracking technology: A systematic review of clinical studies.

BackgroundUnderstanding patients' psychological, anatomical, and functional needs helps clinicians identify issues affecting smile aesthetics, improving orthodontic outcomes and quality of life.ObjectivesThis review examined laypeople's esthetic perceptions of malocclusion and orthodontic appliances via eye-tracking technology, considering gender and professional background influences.MethodsA systematic search was conducted in PubMed, Web of Science, Ovid MEDLINE, and ProQuest. Risk of bias (RoB) was assessed using the Joanna Briggs Institute tools. Data on eye fixation metrics and subjective ratings were descriptively synthesized.ResultsAmong 7009 studies, 27 met inclusion criteria (11 high, 10 moderate, and 6 low RoB) with variable methodologies. Ethnic and cultural factors were rarely considered. The eyes received the most attention in facial aesthetics. However, severe malocclusion and orthodontic appliances redirected gaze to the mouth, while attractive facial features mitigated this effect. Laypeople were more tolerant of malocclusion than dental professionals, who were more sensitive to malocclusion deviations. Facial esthetic perception revealed gender-related differences, where females focusing more on the eyes and males on the mouth and nose.ConclusionsMalocclusion and orthodontic appliances affect esthetic perception by altering gaze patterns. Integrating eye-tracking technology into orthodontic practice can improve patient satisfaction by aligning treatments with esthetic expectations.