Orthodontists' perceptions of the need for orthognathic surgery in patients with Class II Division 1 malocclusion based on extraoral examinations.

Introduction: The purpose of this study was to establish the influence of soft-tissue profile values on the decision of orthodontists to recommend orthognathic surgery for patients with Class II Division 1 malocclusion.

Methods: A questionnaire containing 40 profile photographs of adults with Class II Division 1 malocclusion was sent to all 256 consultant orthodontists in the United Kingdom asking for a "yes" or "no" response to the question: "Based on the profile view of this patient, would you treat this patient using an orthognathic surgical approach?" A soft-tissue analysis was carried out on each photograph, and multi-level logistic regression was used to investigate factors that affect the decision to recommend surgery.

Results: The response rate was high: 208 of 256 questionnaires (81.