Changes in orthodontic treatment patterns within one orthodontic practice over a 15 year period

Time series analysis of patients seeking orthodontic treatment at Seoul National University Dental Hospital over the past decade

Objective

This paper describes changes in the characteristics of patients seeking orthodontic treatment over the past decade and the treatment they received, to identify any seasonal variations or trends.

Methods

This single-center retrospective cohort study included all patients who presented to Seoul National University Dental Hospital for orthodontic diagnosis and treatment between January 1, 2005 and December 31, 2015. The study analyzed a set of heterogeneous variables grouped into the following categories: demographic (age, gender, and address), clinical (Angle Classification, anomaly, mode of orthodontic treatment, removable appliances for Phase 1 treatment, fixed appliances for Phase 2 treatment, orthognathic surgery, extraction, mini-plate, mini-implant, and patient transfer) and time-related variables (date of first visit and orthodontic treatment time). Time series analysis was applied to each variable.

Results

The sample included 14,510 patients with a median age of 19.5 years. The number of patients and their ages demonstrated a clear seasonal variation, which peaked in the summer and winter. Increasing trends were observed for the proportion of male patients, use of non-extraction treatment modality, use of ceramic brackets, patients from provinces outside the Seoul region at large, patients transferred from private practitioners, and patients who underwent orthognathic surgery performed by university surgeons. Decreasing trends included the use of metal brackets and orthodontic treatment time.

Conclusions

Time series analysis revealed a seasonal variation in some characteristics, and several variables showed changing trends over the past decade.

Orthodontic care in an insured population in Washington: demographic factors

Few studies have used insurance claims data to investigate demographic factors related to orthodontic care. This study sought to describe age and sex distributions in a large, insured population in Washington. Additionally, the demand for orthodontic care was evaluated with respect to county population, and the impact of the availability of orthodontists was investigated. All orthodontic claims in 2001 were retrieved from the Washington Dental Service database, along with associated provider and patient information. A total of 102,984 claims were included in this study. A large percentage of subjects (86%) were less than 20 years old, with most patients in their early teens. Overall, about 64% of all orthodontic patients were female. The demand for orthodontic treatment was the highest in the counties with the largest populations. Although there was considerable variation in the data, the number of orthodontic claims submitted by general dentists tended to decline as the availability of orthodontists increased.

Discontinued orthodontic treatment in the general dental services of England and Wales (1990-1991)

Relevant feature of a sample of discontinued treatments were investigated, including status at the start and at the time of discontinuation. In a comparison between two discontinued groups, those patients who simply failed to return tended to have lower pretreatment PAR scores, and were more likely to have received non-extraction treatments in which removable appliances were employed. However, when discontinued treatments were compared to completed treatments undertaken in 1987/8, the completed cases were only reduced by two further PAR points.

The Consultant Orthodontists Group survey of hospital waiting lists and treated cases

A questionnaire sent to all U.K. hospital orthodontic consultants resulted in an 88 per cent response rate. The average waiting time for initial consultation was 31.6 weeks for routine cases and 3.6 weeks for urgent cases. The average waiting time for out patient treatment was 68.7 weeks for routine cases and 7.5 weeks for urgent cases. Nearly 33 per cent of hospitals used the Dental Health Component of the Index of Orthodontic Treatment need (IOTN) as a guide to placing patients on waiting lists. 'Urgency' and 'Complexity' were used more frequently than indices. Sixty-nine per cent of hospitals exclude some categories of malocclusion from treatment in their departments. A prospective survey reported on 2480 completed treatments over a six week period and there was an average discontinuation rate of 9.2 per cent of all cases finished during the period. Comparison of the completed and discontinued groups revealed few significant treatment-related factors. There was some evidence that the more senior and experienced the operator, the less the rate of discontinuation. A greater rate of discontinuation was seen in removable appliance cases when compared with fixed appliance cases.

An evaluation of the views of general dental practitioners who have participated in an extended orthodontic training scheme

A questionnaire was sent to 255 dental practitioners who had participated in an extended orthodontic training scheme, incorporating formal teaching and supervised clinical sessions over a period of not less than 24 months. The response of the practitioners was good; 78 per cent of the forms returned were suitable for analysis. Overall, the practitioners responded favourably to the schemes and felt that they had been of benefit to their clinical practice. The majority undertook more orthodontic treatment as a result and on average, fixed appliances were used in half of these treatments.

Non-completion of active orthodontic treatment

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services. Four years after the commencement of the study, 207 patients had completed active treatment and 50 had non-completed during active treatment. This gave an overall non-completion rate (NCR) of 19.5 per cent for the study. Of the 50 patients who did not complete treatment during active treatment 23 (46 per cent) non-completed during the first 6 months of active treatment. A predictive model of non-completion of active orthodontic treatment (NCT) over time is suggested.

Non-completion of active orthodontic treatment

This paper reports a retrospective study of patient factors which might be associated with failure to complete orthodontic treatment in a hospital and in a specialist practice. Case records of patients commencing treatment were examined and targeted for further investigation by mailed questionnaires. There was a statistically significant difference in the discontinuation rate between the two groups of patients. Precise reasons for the differences could not be isolated, but did not appear to be related to the age of the patient at the start of treatment.

A study of adult orthodontic patients and their treatment

This retrospective epidemiological study was undertaken to assess factors related to adult orthodontic treatment and to identify any associated trends. Case records of all patients (676) aged 18 years or over at the start of active orthodontic treatment at the Eastman Dental Hospital, London were examined. Variables associated with patients and their treatment (age, sex, source of referral, malocclusion, type of appliance, and interdisciplinary treatment including orthognathic surgery) were studied and the data analysed statistically. Findings revealed that the number of adult patients undergoing orthodontic treatment has increased significantly, especially since 1985. The age of the patients treated was also found to increase in recent years. The percentage of female patients (72 per cent) Class III malocclusions (21.6 per cent) and Class III skeletal bases (26.2 per cent) was higher than found in studies on children. Most of the treatments required fixed appliances and over half involved interdisciplinary treatment, with an increase in the percentage of orthognathic surgical cases. Surgery was significantly more common in males (P less than 0.01) and highly significantly associated with Class III malocclusions and skeletal III bases (P less than 0.001). Twenty-five per cent of adult patients were found to have had a previous course of orthodontic treatment though these patients were not significantly different from adult patients presenting for the first course of treatment.

The Barry Project--a three-dimensional assessment of occlusal treatment change in a consecutively referred sample: the incisors

The serial occlusal changes for a consecutively referred sample of malocclusion from a Welsh town are presented. The patients were assigned to one of four treatment regimes (meant to represent those commonly used in the U.K.) and treated to a rigid protocol. Twenty-five per cent of the cases were reviewed by an eight clinician panel. No bias in the original assignments was found although there was considerable interobserver variation. At defined pretreatment, post-treatment, and post-retention stages, records were collected and the study casts quantitatively measured using a reflex metrograph and an occlusal analysis programme. The results found for the overjet, overbite, crown inclination, and crown angulation are presented and discussed.

Discontinuation of orthodontic treatment: a study of the contributing factors

The article reports on a project to determine the percentage of orthodontic patients who failed to complete orthodontic treatment at the Eastman Dental Hospital, London, and to identify factors that appeared to influence this. Records of patients who had undergone active orthodontic treatment which concluded either with successful completion, or early termination due to poor attendance, inadequate oral hygiene, or appliance maintenance, were studied and analysed statistically.

Changes in the complexity of orthodontic treatment for patients referred to a teaching hospital

The records of 200 orthodontic patients accepted for treatment by the Orthodontic Department of the Bristol Dental Hospital in 1977 were compared with 200 taken on in 1985 in order to determine whether there had been any change in the proportion of referred cases requiring more complex procedures. Within each sample, cases were categorized as follows: (a) suitable for removable appliance treatment by an undergraduate or general practitioner; (b) requiring simple one arch fixed appliance treatment such as might be attempted by a general practitioner after a period of further training; (c) needing specialist treatment such as full multibracketed fixed appliances or orthognathic surgery. It was found that there had been no change in the proportions of simple and complex cases referred during the 8-year period although the proportion of patients now receiving complex treatment had increased greatly. Possible explanations and implications are discussed.

Future manpower requirements for orthodontics undertaken in the General Dental Service

The fall in the number of births in England and Wales which took place between 1964 and 1977 is beginning to have an effect on the present-day demand for orthodontic treatment. Using the best available data a mathematical model has been used to predict the likely demand for orthodontic treatment in the General Dental Services of England and Wales from now until 2008. This suggests that there is likely to be a sharp decline in the number of new orthodontic patients presenting for treatment at practices limited to orthodontics during the next 5 years. The recent expansion in the number of places available for postgraduate study of orthodontics makes it extremely unlikely that the position will improve significantly thereafter. There can be little doubt that we are now producing too many orthodontic specialists even allowing for the increase in manpower which might be required to satisfy a future demand for higher standards of treatment.

The development of removable appliances in the United Kingdom

The evolution since 1900 of the removable orthodontic appliance is described. The effects upon this evolution of political and economic events, the introduction of new materials and the British approach to orthodontic treatment are discussed. Present opinion favours the increased use of fixed appliances but it seems likely that removable appliances will still be suitable in about half those cases requiring active treatment.

Some aspects of orthodontic specialist practice in the United Kingdom

A questionnaire sent to orthodontic specialist practitioners provided information about the nature of specialist practice, the training of specialist practitioners and the patterns of treatment within orthodontic practices. Specialists are now undergoing more extensive postgraduate training and the use of fixed appliances is increasing. General dental practitioners are referring larger numbers of patients to orthodontic specialist practitioners. Several factors will soon be operating to encourage a raising of treatment standards in British orthodontics, namely a falling birth rate, an increased interest in dentistry by the general public and the availability of an increased number of well-trained orthodontic specialist practitioners. Some form of official recognition for the specialist practitioner role is now desirable whilst the historical model for delivery of orthodontic care defined at the inception of the National Health Service in in urgent need of revision.

The casual attender

Patterns of casual attenders at a teaching hospital over a 17-week period are analysed and show that fixed appliances are more prone to problems than removable appliances, and younger patients tend to break appliances more frequently than older patients.

An investigation into factors influencing the amount of orthodontic treatment attempted by the recent graduates of two dental schools

A questionnaire was sent to Bristol and Guy's Dental Graduates who had been qualified for between 3 and 5 years. This showed that three-quarters of those who were currently in general dental practice had treated six or more orthodontic patients since qualification. A fifth claimed to have treated more than 45. An important factor in determining whether a practitioner carries out orthodontic treatment himself, or refers patients to a specialist, is the confidence he has in his own ability to adjust and monitor orthodontic appliances. The convenience of alternative orthodontic services would appear to have no influence in such decisions.