Evaluation of psychological effects of orthodontic treatment vs. orthognathic surgery: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the psychological impact of orthodontic treatment (OT) versus orthognathic surgery (OST). A systematic review was conducted in accordance with PRISMA guidelines, using the PICOS framework to define the inclusion criteria for comparing the psychological impact of orthodontic treatment (OT) versus orthognathic surgery (OST). Searches were performed across PubMed, MEDLINE, EMBASE, PsychInfo, CINAHL, and CENTRAL databases for studies published between 2014 and 2025. A meta-analysis was performed on OT and OST studies reporting mean and standard deviation from the OHIP-14 questionnaire. A separate meta-analysis was performed for OST studies using OQLQ. 15 studies satisfied the predetermined inclusion criteria. OT was associated with improvements in OHRQoL over the course of treatment. These changes became more evident at later follow-up points. OST provided more immediate and pronounced OHRQoL improvements, particularly in psychosocial dimension such as self-esteem and social interactions. The OHIP-14 meta-analysis (ten studies) showed a mean OHRQoL improvement of 9.66 points, with high heterogeneity (I² = 97.91%) and no significant difference between OT and OST. The OQLQ meta-analysis (six studies) showed a 19.50 point improvement (I² = 96.80%) in psychological outcomes. Variability was attributed to differences in study design, tools, and patient characteristics. Both OST and OT improve OHRQoL, although through different mechanisms and timelines. OST offers faster psychological benefits. OT provides slower gains with less psychological discomfort, especially with aligners. Personalized pre-treatment education is essential and further research is needed to explore long-term psychosocial outcomes.