Self-esteem in university students according to orthodontic treatment need (ICON) and angle classification: a...

Orthodontic malocclusion may affect both functional and psychosocial aspects of health; however, its relationship with global self-esteem in young adults remains unclear. This study aimed to compare self-esteem levels according to orthodontic treatment need as assessed by the Index of Complexity, Outcome, and Need (ICON) and Angle classification among university students.

A cross-sectional study was conducted between April and December 2024 among university students. A total of 290 participants were initially recruited, and 269 were included in the final analysis (198 females, 92 males; mean age: 21.8 ± 2.3 years). Participants were recruited from different faculties through voluntary participation. Self-esteem was assessed using the validated Turkish version of the Rosenberg Self-Esteem Scale (RSES; 10 items, 4-point Likert scale). Orthodontic status was evaluated through intraoral examination by a single calibrated orthodontist using the ICON (treatment-need cutoff ≥ 43) and Angle classification (Class I, II/1, II/2, III). Intra-examiner reliability was high for both ICON and Angle assessments (κ = 0.91 and 0.89, respectively). Data were anonymized and analyzed using non-parametric statistical tests (Mann-Whitney U and Kruskal-Wallis H tests).

A total of 269 valid responses were analyzed, yielding a mean ± SD RSES score of 32.04 ± 5.13. No statistically significant difference in self-esteem was observed between ICON-defined treatment-need groups (U = 7168.00, r = 0.048, p = 0.446). However, a small but statistically significant difference was observed among Angle classifications (H = 13.10, η² = 0.038, p = 0.004). The RSES demonstrated high internal consistency (Cronbach's α = 0.869).

Self-esteem was not significantly associated with orthodontic treatment need as defined by ICON, while only minimal differences were observed across Angle classifications. These findings suggest that objective measures of malocclusion may have a limited influence on global self-esteem among university students. Future studies incorporating broader sociodemographic variables may provide a more comprehensive understanding of the psychosocial impact of malocclusion.