Four types of orthognathic patient; metamorphosizers, pragmatists, shedders, and evolvers


Abnormalities of the jaws and dentition that may constitute a hazard to the maintenance of oral health, and interfere with general well-being of the individual by adversely affecting dentofacial aesthetics, mandibular function, or speech can be defined as dentofacial deformities.  Treatment ( orthognathic ) usually involves combination of orthodontic and surgical treatment.  Satisfaction rates are usually high, but the reasons the minority who are dissatisfied are poorly understood.

The aim of this study was to evaluate qualitatively orthognathic patients’ expectations of the outcome of orthognathic treatment and to develop a useful clinical guide for the management of the different types of expectations.

This was a qualitative study involving semi-structured in-depth one-on-one interviews with patients with dentofacial deformities. Patients of any ethnicity age16 years or older about to start orthognathic treatment to correct a dentofacial deformity were recruited from new-patient clinics. All interviews were conducted by a trained researcher and were exploratory and interactive in form.

A purposeful sample of eighteen adult patients( 18 to 40 years old) were interviewed ( 9 female/9male). Most were Caucasian and six were from the black and minority ethnic group.  A Framework approach was taken to data management and analysis

They found  that participants’ expectations could be divided broadly into 2 main categories:

  • expectations of actual physical changes and
  • expectations of the effects that these physical changes would indirectly have on them (nonphysical changes).

In addition, a typology of patients, based on expectations, was identified, whereby patients could be classified as

  • metamorphosizers,
  • pragmatists,
  • shedders, or
  • evolvers,

There were also other implications and suggestions for practice.

They concluded

 These findings represent a new insight into the complex issues of managing patient expectations and satisfaction. The clinical relevance of identifying expectations is not just to ration treatment or identify those who will make good or bad candidates for treatment, but to be able to offer them additional support to enhance satisfaction with the outcome. This highlights the need for a qualitative methodology to complete the full circle of evidence-based practice.


Ryan FS, Barnard M, Cunningham SJ. What Are Orthognathic Patients’ Expectations of Treatment Outcome-A Qualitative Study. J Oral Maxillofac Surg.2012 Feb 22. [Epub ahead of print] PubMed PMID: 22364859.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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