Evaluation of pharyngeal airway space after orthodontic extraction treatment in class II malocclusion integrating with the subjective sleep quality assessment

Orthodontic treatment with premolar extractions is typically used to relieve dental crowding and retract anterior teeth for lip profile improvement. The aim of the study is to compare the changes in regional pharyngeal airway space (PAS) after orthodontic treatment with Class II malocclusion and to identify the correlations between questionnaire results and PAS dimensions after orthodontic treatment. In this retrospective cohort study, 79 consecutive patients were divided into normodivergent nonextraction, normodivergent extraction, and hyperdivergent extraction groups. Serial lateral cephalograms were used to evaluate the patients' PASs and hyoid bone positions. The Pittsburgh Sleep Quality Index and STOP-Bang questionnaire were used for sleep quality evaluation and obstructive sleep apnea (OSA) risk assessment, respectively, after treatment. The greatest airway reduction was observed in hyperdivergent extraction group. However, the changes in PAS and hyoid positions did not differ significantly among three groups. According to questionnaire results, all three groups had high sleep quality and low risk of OSA, with no significant intergroup differences. Moreover, pretreatment-to-posttreatment changes in PAS were not correlated with sleep quality or risk of OSA. Orthodontic retraction with premolar extractions nither exhibit significant reduction in airway dimensions nor increase their risk of OSA.

Effectiveness of the American Board of Orthodontics Discrepancy Index in predicting Treatment Time

AIM

This study was aimed to explore the effect of pretreatment severity of malocclusion on the duration of the treatment using The American Board of Orthodontics discrepancy index (ABO-DI).

MATERIALS AND METHODS

This clinical retrospective study consisted of orthodontics records of 37 patients who were treated with comprehensive fixed orthodontic appliance from 2011 to 2013. The sample of the study was collected so as to exclude, to the maximum possible, the patient cooperation variability by reviewing all patient chart entries. The DI measurements were used to gather the information of the pretreatment and relate it to the time duration of the treatment. Statistical analyses were performed using the chi-square test and Pearson correlation coefficient.

RESULTS

The average treatment time was 24.5 months. The DI scores mean for class I and II was 14.30 and 20.15 respectively. Age and sex did not significantly influence the treatment duration (p > 0.05).

CONCLUSION

The results of this study showed that the ABO-DI could be a useful tool to predict orthodontic treatment time.

CLINICAL SIGNIFICANCE

The ABO-DI can significantly aid in orthodontic treatment time planning.

[Periodontal optimization of the smile: choosing the right moment to achieve a maximum esthetic result]

INTRODUCTION

Today, esthetic enhancement is one of the main reasons why patients seek orthodontic treatment. Governed by the canons of beauty dictated by our society, the smile is a key component in this quest for perfect beauty. Hence, the orthodontist is often the first specialist to be consulted by adolescents, but also, more and more, by adults as well. Using simple tools, the practitioner must be able to make a precise analysis of the patient combining both orthodontic and periodontal examinations with an esthetic periodontal diagnosis.

OBJECTIVES

Using this analysis, the orthodontist must be able to identify his/her patient's periodontal morphotype and assess whether there is a risk of complications during treatment. One of the main complications that may arise is periodontal recession, which can both impact the esthetic result and give rise to patient anxiety, very soon leaving the orthodontist at a loss. If in doubt, it is essential to refer one's patient to the general dentist or to the periodontist.

MATERIALS AND METHODS

In this paper, the authors will describe a didactic decision-making tree, which will assist practitioners in learning how to manage their patients.

DISCUSSION

A synergistic approach to global patient management will ensure an optimal outcome by providing the patient with an appropriate and individualized treatment procedure.

[Possibilities and limits of orthodontico-surgical treatments in case of macrodontia]

INTRODUCTION

Tooth-arch discrepancy is a disproportion between dental volume and bone base. Extraction therapy can be a solution in case of excessive tooth volume and insufficient basal bone length. Techniques including bone distraction popularized by Ilizarov in the fifties allow the increase of the basal arch length in the maxilla as well as in the mandible.

MATERIALS AND METHODS

We will describe the procedure of this dental arch length augmentation since the reflection about the therapeutic plan until the sufficient arch length is obtained and describe the indications of this orthodontic and surgical treatment in case of dental crowding, buccal and labial inclination and functional problems.

DISCUSSION

Distraction is an interesting technique to be considered for the management of macrodontia that allows to get enough basal bone lenght to reach the therapeutic goal.

A comparison of orthodontic treatment outcomes using the Objective Grading System (OGS) and the Peer Assessment Rating (PAR) index

INTRODUCTION

The use of objective criteria is essential to uniformly quantify and measure the severity of malocclusions and the efficacy of different treatment modalities. The Peer Assessment Rating (PAR) index and, more recently, the American Board of Orthodontics Objective Grading System (OGS) were developed to fulfill this need.

AIM

The aim of this retrospective study was to assess and compare treatment outcomes using the UK and US weighted PAR and the OGS.

MATERIALS AND METHODS

The sample consisted of randomly selected records of 50 patients treated by residents in one postgraduate orthodontic clinic. UK and US weightings for the PAR index were applied and compared with OGS.

RESULTS

There was no statistically significant association between the OGS and the PAR index grading systems. Neither the UK nor the US PAR weightings showed statistically significant correlation with the OGS. All cases were 'greatly improved' or 'improved' according to the PAR index, while most cases (62%) failed according to OGS. There was a statistically significant correlation between the unweighted PAR index and the OGS (r = -0.32, p = 0.024). The US and the UK weightings for the PAR were highly correlated (r = 0.90, p < 0.001). Both weighting systems were also highly correlated with the unweighted PAR (p < 0.001). There were no gender differences found in any of the scoring systems.

CONCLUSIONS

The current PAR index cannot replace the OGS for evaluating treatment outcomes. The current OGS cannot detect the improvement achieved in a treated case.

Clinical trials in orthodontics II: assessment of the quality of reporting of clinical trials published in three orthodontic journals between 1989 and 1998

AIMS

To test the hypothesis that the quality of reporting of orthodontic clinical trials is insufficient to allow readers to assess the validity of the trial.

DESIGN

A retrospective observational study.

SETTING

The American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), the British Journal of Orthodontics (BJO) and European Journal of Orthodontics (EJO).

DATA SOURCE

Clinical trials published between 1989 and 1998.

METHOD

A hand search was performed to identify all clinical trials. The concealment of allocation, whether the trial was randomized, double blind, and whether there was a description of withdrawals and dropouts was recorded.

RESULTS

One hundred and fifty-five trial reports were identified of which 4 (2.6%) were adequately concealed, 85 (54.8%) were described as being randomized, 10 (6.5%) as double-blind, and 44 (28.4%) gave a description of withdrawals and drop-outs from the trial. The type of randomization was considered appropriate in 78 (50.3%) reports and in 57 (36.8%) reports the level of blinding was considered appropriate. When assessed for the risk of bias in the reported trials,(1) one trial (0.6%) had a low risk of bias, 17 (11%) a moderate risk, and 137 (88.4%) a high risk.

CONCLUSIONS

In general the quality of reporting orthodontic clinical trials was insufficient to allow readers to assess the validity of the trials. Reporting of clinical trials could be improved by orthodontic journals adopting the CONSORT statement(2,)(3) to ensure that all relevant information is provided.

Severity and outcome assessments of patients undertaking surgical orthodontic treatment

BACKGROUND

Combined orthognathic-orthodontic treatment can be lengthy and expensive. It is therefore important to evaluate the effectiveness of proposed treatment and the likely outcomes.

OBJECTIVES

To determine the demographic and surgical details of patients who received orthognathic-orthodontic treatment at Christchurch Hospital, New Zealand, and to assess treatment using the Severity and Outcome Index (SOI).

METHODS

An observational and retrospective study was conducted of patients who received surgical orthodontic treatment between 2005 and 2012 at Christchurch Hospital. Pre- and post-treatment lateral cephalometric radiographs of 93 patients were evaluated. Seven cephalometric parameters were assessed using the Severity and Outcome Index. A severity score ranged from 0 for the most severe to 7 for the least severe, while the outcome score ranged from 0 for the worst to 7 for the best outcome.

RESULTS

Class II patients had a severity score of 3.4 and the best outcome score of 6.2. Class III patients had a severity score of 3.3 and an outcome score of 6.1. Patients with an anterior open bite (AOB) had the worst severity score of 3.0, and the worst outcome score of 5.9. The overall treatment outcome scores for all groups were statistically significantly greater than the severity scores, which increased from 3.4 to 6.1 (p < 0.05).

CONCLUSIONS

Favourable outcomes were achieved for a group of patients with a high need for treatment. Christchurch Hospital appeared to be treating cases of increased severity and gained better treatment outcomes when compared with a United Kingdom (UK) national audit.

Relationship between pretreatment case complexity and orthodontic clinical outcomes determined by the American Board of Orthodontics criteria

OBJECTIVE

To evaluate the relationship between pretreatment case complexity and orthodontic treatment outcomes.

MATERIALS AND METHODS

The total sample contained 1693 cases (853 females and 840 males, mean age  =  16.3 years) from the archives of postgraduate orthodontic clinics. The complexity of each case was evaluated using the American Board of Orthodontics (ABO) Discrepancy Index (DI), and orthodontic clinical outcomes were evaluated using the ABO Objective Grading System (OGS). Only one investigator evaluated all cases. Multivariate analysis of variance, correlation analysis, and multiple variable regression analysis were used for statistical evaluation (P < .05 as significant).

RESULTS

The mean total DI score was 16.2, and the mean total OGS score was 18. No significant correlation was found between the total DI and the total OGS scores. However, pretreatment overbite, lateral open bite, crowding, buccal posterior crossbite, and other components affected the total OGS score significantly. The highest percentage of passing OGS values was found for cases of medium-level complexity.

CONCLUSION

This retrospective study of university clinical records showed that the posttreatment clinical outcomes were significantly affected from pretreatment case complexity. Posttreatment alignment was affected significantly from pretreatment buccal posterior crossbite and cephalometric values. Similarly, posttreatment buccolingual inclination was affected from pretreatment anterior open bite, occlusion, and other factors. Occlusal contacts were affected significantly from pretreatment lingual posterior crossbite and other factors. In addition, we determined that posttreatment root angulations were affected significantly from pretreatment crowding values.

[Finishing and detailing, stability and harmony]

The finishing and detailing phase, the last stage of active orthodontic treatment, makes it possible to perfect the occlusion, by adhering to criteria defined by various authors and to improve the esthetic result, while achieving the treatment objectives made during the pre-planning phase. The reliability of end of treatment results cannot be ensured without an initial individualized analysis of the risk factors for relapse specific to each patient. It is only after this analysis, that the orthodontist will be able to determine how to comply with these criteria for stability, common in any treatment, and to individually choose and implement reliable procedures. When planning for stability as the treatment objective, orthodontic patients are able to achieve stable alignment. This course of action is the necessary process to help ensure equilibrium and alignment. Eight different methods of alignment, already frequently discussed in the literature, will be described and analyzed in this paper.

SEITO - Stockholm Eastman Index of Treatment Outcome

To obtain high quality in orthodontics; it is important to evaluate the treatment. There are many indices for evaluation of treatment outcome however all of them compare treatment outcome with ideal occlusion. Therefore Stockholm Eastman Index of Treatment Outcome (SEITO) was invented. This index relates the treatment outcome to the treatment goal. SEITO is a morphological index based on criteria from the records including study casts, and/or intra oral photos.

METHOD

The outcome of treatment is related to the treatment goal as stated in the records. Pre-treatment goals are divided into subgroups; overjet, vertical relation anterior/lateral), anterior cross bite, transverse relations, impacted teeth and space crowding/ spacing. Each subgroup is scored; the points are 0, 1, 3 or 5 depending on the severity of the malocclusion. The points for each subgroup are added to give a total sum of treatment goal points. Each post-treatment subgroup above is evaluated. If the treatment goal is fulfilled, the treatment outcome points are equal to the treatment goal points. If not - there is a reduction in the outcome points. Finally the outcome points are expressed as a percentage of the treatment goal points and form a measure of the success of treatment.

CONCLUSION

SEITO index is a simple and quick way to obtain a picture of the quality of treatment outcome, and the only orthodontic index that relates the treatment outcome to the treatment goal.

Efficiency and effectiveness of SureSmile

AIM

To examine the efficiency and effectiveness of the SureSmile process using the standards of the American Board of Orthodontists Objective Grading System (ABO OGS).

METHODS

Three diplomates of the American Board of Orthodontics provided study casts of 62 patients whose orthodontic treatment was consecutively completed. Patients treated using the SureSmile process and a conventional approach were anonymized and randomized prior to independent scoring by two ABO OGS-calibrated examiners.

RESULTS

Intra- and interexaminer reliability was consistent in all components with no differences between examiners (r=0.96, P<.001). The ABO OGS score for the SureSmile patients (mean 26.3) was 4.4 points lower (P<.001) than for those treated conventionally (mean 30.7). Furthermore, treatment with the SureSmile process was shorter (14.7 months vs 20.0 months).

CONCLUSION

The SureSmile process results in a lower mean ABO OGS score and a reduced treatment time than conventional approaches. The approach has great potential to both decrease treatment time and improve quality.

Comparisons of similar patients treated by general dental clinicians and orthodontic specialists. Outcome and economical considerations

The objective of this study was to evaluate and compare orthodontic treatment in two groups of patients in regard to treatment results and costs. One group was treated at a General Dental Clinic (GDC) with removable appliances and the other at a Special Orthodontic Clinic (SOC) using fixed appliances. Both groups had similar malocclusions. All treatment plans were determined bythe same orthodontic specialist. Study models were taken before and after the treatment of the patients. Index of Orthodontic Treatment Need (IOTN-index) was used to determine the extent of treatment needed. Weigthed Peer Assessment Rating (WPAR) was calculated for every model. The percentage of improvement in each group was calculated and results were compared. Chair time and treatment costs extracted from patient records were registered. The group treated at the GDC had initially WPAR 22.2 and the percentage reduction in WPAR 69 was percent.The group from the SOC had initially WPAR 24.0 and was reduced by 81 percent. Treatment costs, with the exception of x-ray analyses, were 56 percent higher for the SOC.The results of the study indicated that it was economically advantageous to treat patients with removable appliances at a GDC, if the patients are sufficiently cooperative.

The excellence challenge in orthodontics: clinical use of an objective grading system for orthodontic cases

OBJECTIVES

The aim of this study was to assess objectively some important factors for an accurate diagnosis and an optimal planning of finishing. The 8 criteria of the ABO "Objective Grading System"(OGS) were evaluated: alignment, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships, interproximal contacts, and root angulation. This study focused on whether this method of evaluation is really applicable and useful in daily clinical practice.

MATERIALS AND METHODS

15 subject (7 males, 8 females), with ages ranging between 8.5 and 55 years, were retrospectively examined. Both pre-treatment and post-treatment criteria were analyzed using the OGS, and measurements were made with the special device as described by the ABO. For each parameter that deviated from normal, 1 or 2 points were subtracted. Descriptive statistics were performed for OGS scores. Additionally, differences between scores for the pre-treatment versus the post-treatment were assessed using Wilcoxon signed-rank test.

RESULTS

All criteria used in the ABO OGS improved after treatment, except occlusal contacts. Alignment, overjet, occlusal relationships and root angulation improved significantly after treatment (p < .05). Marginal ridges, buccolingual inclination, interproximal contacts measurement did not show statistically significant differences between pre-treatment and post-treatment (p > .05).

CONCLUSIONS

Only 3 of 15 examined cases lost 30 points or fewer and would have passed the ABO Phase III examination. Quantitative evaluation of the OGS criteria might help to attain better scores and achieve a more functional and aesthetic outcome. Pre-treatment and post-treatment use of this system can help clinicians to assess treatment difficulties, to set goals and achieve an achieve an objective finishing for completed patients.

[PAR index of adolescents with congenital missing teeth pre- and post-orthodontic treatment]

OBJECTIVE

To assess the outcome of orthodontic treatment for adolescents with congenital missing teeth using the PAR (Peer Assessment Ration) index.

METHODS

The PAR index was adopted to evaluate and compare the teeth arrangement, molar occlusion, overjet, overbite and centerline condition of 20 adolescents with congenital missing teeth before and after orthodontic treatments.

RESULTS

The initial PAR scores and weighted PAR total scores decreased significantly after Orthodontic treatments (P < 0.01), except for the centerline. The PAR total scores decreased by 14.25 +/- 7.91 (80.90% +/- 11.09%). The weighted PAR total scores decreased by 15.45 +/- 8.16 (75.34% +/- 18.41%).

CONCLUSION

PAR index can well reflect the improvement of occlusion characters by orthodontic treatment for adolescents with congenital missing teeth. But further improvement is needed for clinical application.

Invisalign and Traditional Orthodontic Treatment Postretention Outcomes Compared Using the American Board of Orthodontics Objective Grading System

Objective: To compare the postretention dental changes between patients treated with Invisalign and those treated with conventional fixed appliances.

Materials and Methods: This is a comparative cohort study using patient records of one orthodontist in New York City. Two groups of patients were identified that differed only in the method of treatment (Invisalign and Braces group). Dental casts and panoramic radiographs were collected and analyzed using the objective grading system (OGS) of the American Board of Orthodontics (ABO). The cases were evaluated immediately after appliance removal (T1) and at a postretention time (T2), three years after appliance removal. All patients had completed active orthodontic treatment and had undergone at least one year of retention. A Wilcoxon rank sum test was used to evaluate differences in treatment outcomes between the groups for each of the eight categories in the OGS, including four additional subcategories in the alignment category. A Wilcoxon signed rank test was used to determine the significance of changes within each group from T1 to T2.

Results: The change in the total alignment score in the Invisalign group was significantly larger than that for the Braces group. There were significant changes in total alignment and mandibular anterior alignment in both groups. There were significant changes in maxillary anterior alignment in the Invisalign group only.

Conclusions: In this sample for this period of observation, patients treated with Invisalign relapsed more than those treated with conventional fixed appliances.

What are the occlusal outcomes for unilateral cleft lip and palate patients? A national project in the UK

AIM

This national project assessed the orthodontic outcome for unilateral cleft lip and palate (UCLP) patients in the UK.

METHOD

Six consecutively treated fixed appliance cases where orthognathic surgery was not undertaken were assessed using the peer assessment rating (PAR) index on orthodontic study models. These cases were submitted by NHS consultant orthodontists undertaking treatment on patients with cleft lip and/or palate.

SETTING

UK NHS consultant-led hospital service.

RESULTS

The mean reduction in PAR score was 69% + or - 22. The mean start PAR score was 41 + or - 11. The mean end of treatment PAR was 12 + or - 9. The proportion of cases where the score was worse or no different was 7.5%.

CONCLUSION

The mean percentage PAR reduction compares well with other national projects looking at outcome from patients treated in the hospital service. The mean PAR reduction could be used as a benchmark for outcome in UCLP orthodontic treatments in future audit projects and the annual consultant appraisal process.

A 20-year cohort study of health gain from orthodontic treatment: Psychological outcome

INTRODUCTION

Despite the widespread expectation that orthodontic treatment improves psychological well-being and self-esteem, there is little objective evidence to support this. The aim of this study was to compare the dental and psychosocial status of people who received, or did not receive, orthodontic treatment as teenagers.

METHODS

A prospective longitudinal cohort design was adopted. A multidisciplinary research team evaluated 1018 participants, aged 11 to 12 years, in 1981. Extensive assessments of dental health and psychosocial well-being were conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pretreatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up, 337 subjects (30-31 years old) were reexamined in 2001. One-way ANOVA was used to explore differences between the 4 groups (need/no need; treatment/no treatment).

RESULTS

The percentage changes in index of complexity, outcome and need scores for the 4 groups were need/no treatment (12.7%), no need/no treatment (-17.1%), need/treatment (31%), and no need/treatment (-11.4%). Participants with a prior need for orthodontic treatment as children who obtained treatment had better tooth alignment and satisfaction. However, when self-esteem at baseline was controlled for, orthodontic treatment had little positive impact on psychological health and quality of life in adulthood.

CONCLUSIONS

Lack of orthodontic treatment when there was need did not lead to psychological difficulties in later life.

Comparison of surgical and non-surgical methods of treating palatally impacted canines. II. Aesthetic outcomes

BACKGROUND

Palatally impacted maxillary canines may appear unsightly after treatment because of changes in position and colour.

AIM

To determine if palatally impacted canines treated either by surgical exposure and orthodontic repositioning or by creation of space in the arch and unassisted eruption have different aesthetic outcomes.

METHODS

Twenty eight subjects with unilateral palatally impacted canines who had completed orthodontic treatment at least 6 months previously were recruited from three specialist practices. In 14 subjects the canines had been treated by surgical exposure, orthodontic extrusion and repositioning in the arch (SE group) and in the remainder the deciduous canines were extracted and excess space created in the arch for the canines to erupt naturally (OT group). The contralateral canines were used as controls. The mean pretreatment ages of the subjects in the SE and OT groups were 13.5 (SD:1.6) years and 13.5 (SD:1.3) years respectively. The position and colour of the canines were assessed on post-treatment study models and 35 mm slides using the American Board of Orthodontics Objective Grading System (ABO OGS) and subjective appraisal by two orthodontists. Each subject used a semantic scale to rate the aesthetic outcome of treatment.

RESULTS

Sixty four per cent of the treated canines in the SE group were significantly more 'intruded' than the treated canines in the OT group (p = 0.004) and the control canines (p = 0.004). The ABO OGS grades of the canines in the SE and OT groups were similar (p = 0.173). While the assessors detected a lack of labial root torque and gingival margin changes in the canines in the SE group, the subjects in both groups were satisfied with the appearance of the canines post-treatment.

CONCLUSIONS

Palatally impacted canines treated by surgical exposure, extrusion and orthodontic treatment were more likely to be displaced vertically ('intruded') after treatment than palatally impacted canines treated by extraction of the overlying deciduous canines and creation of excess space in the arch. Small occlusal and aesthetic changes detected by the orthodontists, but not the ABO OGS, did not appear to detract from the satisfaction of the subjects with the results of orthodontic treatment.

[Predicting of growth tendency with cephalometry. Cephalometric research comparing orthodontic treatment cases with four premolar extraction]

The Hasund cephalometry gives important information about the position of the mandible and maxilla to each other and to the cranium in horizontal and vertical plane, and about the expecting mandibular growth. The aim of the study was to examine the reliability of the Hasund growth analysis on the basis of cephalogramms. The data of eighteen children having been treated with four premolar extraction in the growing period were compared. At the start of treatments the children's average age was 10 (8.5-11.5) years. Figures from the cephalometry were analysed by an orthodontic diagnostic program. According to our results the predicted growth was justified in 14 cases and contrary mandibular development was found in 4 cases. Beyond the limits of this study we concluded that the Hasund growth analysis gives mainly a reliable prognosis on predicting mandibular development. In diagnostic procedures this analysis should be followed for a successful decision-making in treatment plan. However, during the orthodontic treatment the prognostic results have to be monitored by using further cephalometric evaluations in a time-scales of a year.

Evaluation of orthodontic treatment, retention and relapse in a 5-year follow-up: a comparison of treatment outcome between a specialist and a post-graduate clinic

The aim of this study was to evaluate and compare orthodontic treatment between a specialist clinic and a post-graduate clinic. A long-term follow-up study was done 5 years after orthodontic treatment ended. Eighty-one individuals treated at the Post-graduate clinic at the Department of Orthodontics, University Clinics of Odontology, Göteborg, and 84 individuals treated at the Orthodontic Specialist Clinic in Vänersborg, the county of Västra Götaland were examined. The Peer Assessment Rating (PAR) index was used on pre-, post-treatment and 5-year follow-up study casts. The percentage reduction in weighted PAR (WPAR) scores after treatment and at the 5-year follow up did not differ significantly between the clinics. There were significant higher pre-, post-treatment and 5-year follow-up PAR and WPAR scores in patients from the Specialist Clinic as compared with patients from the Post-graduate Clinic. In the whole sample 97.6% of the patients were improved or greatly improved after treatment and 95.8% were still improved or greatly improved 5 years after treatment. Sixty-seven percent of the patients still had retainers in one or both arches at the 5-year follow-up. The WPAR scores are one factor that indicates the high quality of the treatment process in both clinics. The higher post-treatment PAR scores in the Specialist Clinic may be because a larger number of patients were treated only in one jaw at this clinic.

[Orthodontics for mentally handicapped patients]

The mentally handicapped exhibit a 3 times higher incidence of malocclusions and related functional problems than the general population. In contrast there is little available literature relating to the orthodontic treatment of handicapped patients. Based on published articles on orthodontic treatment of disabled patients the following recommendations can be given. First of all for each patient a 'problem list' should be drawn up, based on the diagnosis. In this list the orthodontic problems are formulated. Additionally, the list makes clear who is responsible for providing services related to orthodontic care, such as oral hygiene and transportation of the patient to the orthodontist. When deciding whether or not orthodontic treatment should be administered to a patient with a mental handicap the same functional and aesthetic considerations as with any other orthodontic case must be taken into account. Furthermore, the severity of the handicap and possible associated psychosocial and medical limitations as well as the extent to which it will be possible to treat the patient have to be considered. Contraindications are a severe mental handicap, inability to remain still in the dental chair, insufficient co-operation of parents/carers, open bite resulting from abnormal oral function, and a mild malocclusion. The orthodontic treatment should aim for an acceptable result, and not for orthodontic perfection.

Orthodontic treatment--improvement and standards using the peer assessment rating index

This article is aimed at assessing the orthodontic treatment outcome in an accredited graduate orthodontic clinic in the United States, using the original Peer Assessment Rating (PAR) Index. A sample of 100 pre- and posttreatment study models was randomly selected from the clinic model storage. One investigator assessed all the components of the PAR Index. Descriptive statistics and Scheffe test were used to analyze the data. The mean weighted PAR point reduction was 22.11, and mean percentage reduction was 86.20. "Greatly improved" conditions were seen in 50% of patients while 47% accounted for the "improved category." Only 3% belonged to the "worse or no different" group. Statistically significant differences were observed between the three improvement groups for weighted pre- and posttreatment PAR scores, reduction, and percentage reduction. The results indicated an excellent improvement of the patients, with patients being treated to a high standard and a great proportion of patients with a clear need for treatment.

An update on the analysis of agreement for orthodontic indices

The training of clinicians in the correct use of commonly used orthodontic indices involves calibration. The level of agreement between the trainee and a standard is assessed both as a measure of reproducibility and the success of training programmes. For the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON), the recommended level of acceptable inter-rater agreement is no more than +/-12 and +/-18, respectively. Many commonly used methods of analysing this type of agreement are inappropriate. The method used in this investigation allows the calculation of limits of agreement, which easily demonstrate any major departures in agreement between trainee scores and standard scores. The basic method assumes that the differences between trainee and standard scores are normally distributed and that there is no relationship between these differences and the magnitude of the index. An extension to this approach is required when the assumptions of the basic method are not upheld. This extension provides a regression-based approach to calculating limits of agreement. The results of this study demonstrate that the assumptions of the basic approach need to be checked for each comparison of trainee versus standard. In addition, regression-based methods are a more accurate means of calculating limits of agreement when these assumptions are not upheld. They also provide more information about bias and the range of disagreement between raters.

Comparison of university and private-practice orthodontic treatment outcomes with the American Board of Orthodontics objective grading system

INTRODUCTION

Treatment outcomes and duration of treatment for patients treated in university graduate orthodontic programs and private orthodontic practices were assessed and compared with the ABO objective grading system.

METHODS

The treatment records of 139 randomly selected adolescents who had received comprehensive orthodontic treatment were examined. Seventy-seven subjects had been treated in 3 postgraduate orthodontic clinics, and 62 had been treated in 3 private orthodontic practices. Pretreatment, all subjects had Class II Division 1 malocclusions and ANB angles equal to or greater than 4 degrees . All patients were treated with premolar extractions. Posttreatment dental casts were measured and scored with the ABO objective grading system.

RESULTS

No significant differences were found between the groups in the alignment, buccolingual inclination, and overjet components. Patients treated in private practice had significantly lower scores for marginal ridge height and occlusal relationship. Patients treated in the university programs had significantly lower scores for occlusal contact and interproximal contact components.

CONCLUSIONS

There was no significant difference in the overall score, thus no significant difference in the overall quality of orthodontic treatment outcome between patients treated in university programs and private practices. However, the university group had a significantly larger sample variance for the overall score. There was no significant difference in the duration of the treatment between patients treated in a university setting and in a private practice.

Visual application of the American Board of Orthodontics Grading System

BACKGROUND

Assessment of treatment outcomes has traditionally been accomplished using the subjective opinion of experienced clinicians. Reduced subjectivity in the assessment of orthodontic treatment can be achieved with the use of an occlusal index. To implement an index for quality assurance purposes is time-consuming and subject to the inherent error of the index. Quality assessment of orthodontic treatment on a routine basis has been difficult to implement in private practice.

OBJECTIVES

To investigate whether a clinician can accurately apply the American Board of Orthodontics Objective Grading System by direct visual inspection instead of measuring individual traits.

METHODS

A random sample of 30 cases was selected, including pretreatment and post-treatment upper and lower study casts and panoramic radiographs. The cases were examined and scored with the standardized measuring gauge according to the protocol provided by the American Board of Orthodontics (ABO). The records were re-examined 6 weeks later and the individual traits scored by visual inspection (VI).

RESULTS

There were no significant differences between the pre- and post-treatment ABO gauge and VI scores.

CONCLUSIONS

This study suggests that occlusal traits defined by the ABO Objective Grading System can be accurately assessed by visual inspection. The VI score provides a simple and convenient method for critical evaluation of treatment outcome by a clinician.

Treatment outcomes in 4 modes of orthodontic practice

BACKGROUND

This study is a continuation of a previously published report on the outcome of orthodontic treatment provided in offices representing different modes of practice.

METHODS

The sample consisted of duplicate pretreatment (T1) and posttreatment (T2) dental casts of 348 patients from traditional private orthodontic practices (5 offices, 134 patients), company-owned practices (5 offices, 107 patients), offices associated with practice-management organizations (2 offices, 60 patients), and general dental practices (2 offices, 47 patients). Methods were used to obtain random, representative samples from each office, starting with lists of patients who were treated consecutively with full fixed orthodontic appliances. The dental casts were measured by 2 independent judges who used the unweighted PAR score.

RESULTS

Good interjudge agreement was shown on the initial casts, but the agreement was not as strong on the final casts.

CONCLUSIONS

The measurements showed that treatment outcomes were generally satisfactory, although some significant differences between offices and management modes were shown.

Clinical assessment of orthodontic outcomes with the peer assessment rating, discrepancy index, objective grading system, and comprehensive clinical assessment

PURPOSE

The purpose of this study was to quantitatively assess orthodontic treatment outcomes in postgraduate orthodontic clinics at Okayama University (OU) and Indiana University (IU).

MATERIAL

Using the peer assessment rating (PAR) index, the discrepancy index (DI), the American Board of Orthodontist's objective grading system (OGS), and the comprehensive clinical assessment (CCA), we evaluated pretreatment and posttreatment records of 72 patients from OU and 54 patients from IU.

RESULTS

The average pretreatment PAR score with United Kingdom weighting was 32 for OU subjects and 28 for IU subjects. Differences in maxillary and mandibular buccal alignment between schools were statistically significant ( P < .01). The posttreatment PAR scores were 7 for OU and 4 for IU. The difference in overjet between schools was statistically significant ( P < .05). The mean DI scores were 19 for OU and 17 for IU. OU patients scored significantly more DI points for crowding and mandibular plane angle compared with IU patients ( P < .05). On the other hand, they lost significantly fewer DI points for overbite and occlusion compared with IU patients ( P < .05). The mean OGS scores were 34 for OU and 33 for IU. Buccolingual inclination and overjet scores were significantly higher in OU patients compared with IU ( P < .05). The mean CCA score was approximately 4 points for both OU and IU.

CONCLUSIONS

These data suggest that these indexes are useful for comparing treatment outcomes between clinics. They were able to identify specific problems in treating Asian patients.

Long-term posttreatment changes measured by the American Board of Orthodontics objective grading system

BACKGROUND

The American Board of Orthodontics (ABO) developed the objective grading system (OGS) to evaluate cases submitted as part of the phase III examination for board certification. This study examines the long-term changes in 6 of the 8 criteria measured by the board, with an emphasis on the relationship between posttreatment results and subsequent improvement or worsening.

MATERIAL

One hundred subjects were randomly chosen from the postretention archives of the Department of Orthodontics at the University of Washington. Pretreatment peer assessment rating (PAR) scores and posttreatment and postretention OGS scores were measured on study casts. The ABO criteria studied were alignment, marginal ridges, buccolingual inclinations, occlusal contacts, occlusal relationships, and overjet. Interproximal contacts and root angulations were not scored.

RESULTS

The mean overall OGS score at posttreatment was 21.5 points. At postretention, this score had improved significantly, by approximately 4 points. When comparing posttreatment scores and long-term changes, similar patterns were seen for all criteria, except alignment; increased posttreatment scores were associated with increased long-term improvement. Well-treated cases tended to deteriorate, and poorly finished cases tended to improve, illustrating a regression to the mean. Alignment was the only criterion associated with a mean long-term worsening, as well as a less predictable pattern of change.

CONCLUSIONS

The results of this study indicate that settling occurs after orthodontic treatment, and that the attainment of perfect occlusal results does not ensure stability.

Performance measures to improve the quality of orthodontic services and control expenditures

One of the most critical and contentious issues for specialist and nonspecialist professionals in the coming decades will be to evaluate the outcomes of health care services. Performance measures are imperative for elective orthodontics, because of the relatively weak evidence that they lead to significant improvements in dental and oral health, occlusal function, and psychological well-being of patients. Such measures are particularly crucial for orthodontic treatment eligible for benefit payments, because they will assure third-party dental insurers that the annual premiums levied from governments (taxes), employers (in lieu of salary increments), and individuals (in lieu of other discretionary expenditures) are well spent (ie, not wasted). Performance measures will also improve the "standards of orthodontic practice," so the continued integrity of the profession is contingent on their development.