Retrospective evaluation of the outcome of orthodontic treatment in adults

Orthodontic treatment in National Dental Centre of Singapore: Trends toward higher proportion of adult patients

Background

Adult patients used to be daunted with the prospect of having fixed appliances to correct malocclusions. However, this has gradually changed and recent literature reported an increasing trend in adults receiving orthodontic treatment. To date, there has been no information regarding the trend of adult orthodontic patients in Singapore.

Objective

The objective of this study was to determine the changes in the proportion of adult patients seeking orthodontic treatment at the National Dental Centre Singapore (NDCS) from 2011 to 2017.

Materials and Methods

The study sample consists of all patients who commenced active orthodontic treatment from 2011 to 2017 at the NDCS. The data collected were analyzed for the number, gender, and proportion of adult orthodontic patients treated annually from 2011 to 2017. Linear-by-linear association test was used to test for any significant linear trend in proportion of adult orthodontic patients over the 7 years. Pearson’s Chi-squared test was used to test for any significant gender differences.

Results

There was a significant increasing linear trend (p = 0.001) in the proportion of adult orthodontic patients from 2011 to 2017. No significant difference (p = 0.770) between the proportions of male and female adults undergoing orthodontic treatment was found. The ages of adults undergoing orthodontic treatment ranged from 21 to 73 years old and majority (48.61%) of them was in the 21–25 years old age range.

Conclusion

There is a rising trend in adults seeking orthodontic treatment at the NDCS from 2011 to 2017. No statistically significant gender difference was observed in this rising trend.

Overjet and Overbite Influence on Cyclic Masticatory Movements: A CT Study

Aim. To determine whether a relationship exists between the linear measurements of overjet and overbite and the interincisal space delimited by the morphology of the upper and lower incisors. Method and Materials. 30 subjects (age range from 14.1 to 34.8 years, with a median age of 23.5 years and sex ratio F/M: 5/10) with overjet and overbite equal to 2 mm were selected from a group of 381 individuals with a full and well-aligned dentition, no previous dental treatment, and no signs or symptoms indicative of temporomandibular disorder. Computed Tomography images of vinyl polysiloxane impressions of the 30 subjects' anterior teeth were acquired. The interincisal space was defined as Immediate Overjet Angle and was calculated on the Computed Tomography images. Results. Although the 30 subjects presented overlapping measures of overjet and overbite, the values of the Immediate Overjet Angles were different in a range of a minimum value of 12° and a maximum value of 54°. Conclusion. This study reveals that (1) only 30 (7.9%) of the 381 individuals considered have values of overjet and overbite equal to 2 mm and (2) the Immediate Overjet Angle values of the 30 subjects are not related to the values of overjet and overbite.

Orthodontic treatment need in a Spanish young adult population

Objectives: Orthodontic treatment need has often been assessed in child populations, but few studies employing internationally-recognized indices have been conducted in adult or young adult populations. The aim of this study was to determine the orthodontic treatment need of a young adult population in Spain by means of the Dental Aesthetic Index (DAI), the Index of Orthodontic Treatment Need (IOTN) and the need perceived by the patients. Study design: A cross-sectional epidemiological study was conducted in a broad, representative sample of 671 adults aged between 35 and 44 years using health centers in the Valencia Region of Spain, following the recommendations of the World Health Organization (WHO). Results: Orthodontic treatment was required by 31.3% of the sample according to the DAI and 19.2% according to the IOTN (DHC). The orthodontic treatment need perceived by the patients was 21.1%. On relating treatment need to different variables, significant differences in patient perception were encountered by gender, as women perceived a greater need (23.9%) than men (14.4%). Significant differences in previous orthodontic treatment history were found between middle/high (15%) and low (9%) social class and between secondary/tertiary (14%) and primary (3.3%) education. Conclusions: There was no agreement between the treatment need assessed objectively by the indices and that perceived by the patient, or between the indices themselves. The decision to undergo orthodontic treatment can depend on socioeconomic and psychological factors and on values and principles that do not easily lend themselves to objective measurement.

Key words:Orthodontics, epidemiology, adult, malocclusion.

Adult orthodontics--who's doing what?

OBJECTIVES

To estimate the number of adults currently being treated by specialist orthodontists in the UK, both within the National Health Service (NHS) and privately, together with the factors relating to adults undergoing orthodontic treatment, their malocclusions and details of treatment undertaken.

DESIGN

Self-administered postal questionnaire.

PARTICIPANTS AND SETTING

All individuals entered on the General Dental Council's Specialist List in Orthodontics, registered within the UK.

METHODS

A questionnaire was sent to all those on the General Dental Council's Specialist List in Orthodontics to ascertain the numbers of adult patients being treated by specialist orthodontists and factors relating to their treatment. This included age and gender of adults being treated, sources of referral, type of orthodontic treatment carried out, disciplines involved in multidisciplinary treatment, appliance types used and issues which practitioners felt affected adult treatment. Adults undergoing orthognathic treatment were excluded from this study.

RESULTS

The questionnaire yielded a response rate of 70%. Those respondents working in combined hospital/university posts treated the largest proportion of adults within the NHS and those working in specialist orthodontic practice treated the largest number privately. Within 1 year, the estimated mean number of adult cases started by specialist orthodontists within the NHS was 20.9 and privately was 28.2. The majority of adults treated were reported to be within the 26-35 year age group. Most adult patients were referred for orthodontic treatment by their general dental practitioners and over 70% of treatment provided was orthodontic-only. Adults' concerns regarding the appearance of orthodontic appliances was quoted by orthodontists as being the most commonly occurring potentially complicating factor with regards to both NHS and private treatment.

CONCLUSIONS

Although there are reports in the literature that the number of adult orthodontic patients is increasing, there are no comprehensive figures regarding the number of adults previously treated within the NHS and privately in the UK to compare our data with. This paper presents initial data relating to practitioners' estimates of the numbers of adults being treated in the UK.

Patients' perceptions, treatment need, and complexity of orthodontic re-treatment

The aim of the present study was to investigate the subjective perception and objective treatment need and complexity of patients seeking orthodontic re-treatment. One hundred subjects (66 females, 34 males, age 26.7+/-8.2 years) seeking re-treatment were asked to complete a questionnaire which was constructed based on pilot interviews with 15 patients. The questions focussed on treatment experiences, retention procedures following the first course of treatment, and expectations of and motivations for re-treatment. A visual analogue scale (VAS 0-10) was used. The 're-treatment' group was matched with an untreated control group by age, gender, and the first consultation date. The study models of both groups were scored with the Index of Complexity, Outcome, and Need (ICON). Analysis of variance was used for across-time comparisons of VAS scores of patient's perception of their dental appearance, paired t-test for comparisons of the motivation VAS scores between the first treatment and re-treatment, and Mann-Whitney test for comparisons between the re-treatment and control groups. Eighty-eight patients (26.3+/-8.4 years) completed the questionnaire. After the initial treatment, 36 per cent of the patients did not have any retention measures. The mean VAS scores for dental aesthetics at the start and end of the initial treatment were 2.3+/-2.1 and 6.6+/-2.7, respectively. The scores for the present situation and expected results of re-treatment were 4.1+/-2.7 and 8.8+/-1, respectively. These scores differed significantly from each other. Seventy-nine pairs of models were matched for evaluation of treatment need and complexity. The mean ICON scores of the re-treatment group were significantly lower than the controls (45+/-21 versus 57+/-24), the aesthetic component being the main contributing factor to this difference (25+/-16 versus 36+/-18). Both groups showed a treatment need (ICON>43), with the untreated controls having a relatively higher complexity. These results indicate that patients seeking re-treatment had a good perception of dental aesthetics, strong motivation, and an objective treatment need.

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.

Comprehensive clinical evaluation as an outcome assessment for a graduate orthodontics program

To supplement the American Board of Orthodontics (ABO) objective grading system (OGS) for posttreatment dental casts and panoramic radiographs, a comprehensive clinical assessment (CCA) method was developed to assess facial form, dental esthetics, vertical dimension, arch form, periodontium preservation, root resorption, and treatment efficiency. The sum of the CCA and the ABO OGS scores was defined as the clinical outcome. To determine a 3-year baseline for treatment outcomes in a graduate orthodontic program, the posttreatment records of 521 consecutive patients were evaluated. The mean ABO OGS score for the entire sample was 34.4 points: 32.4, 33.1, and 37.8 points for 1998, 1999, and 2000, respectively. The mean CCA score for the entire sample was 4.67 points: 2.96, 5.13, and 6.15 points for 1998, 1999, and 2000, respectively. Corresponding ABO OGS and CCA scores showed a progressive decrease in the quality of finished cases that was associated with a treatment time increase from 28.9 to 39.3 months. Overall, longer active treatment times resulted in a diminished clinical outcome, primarily due to "patient burn-out." Scoring of all finished cases is an effective means for determining clinical outcomes. However, the data suggest that, in initiating a clinical grading program, it is important to establish a multiyear baseline. Patients who are progressing well in treatment tend to be finished by the time the current class graduates, and the problem patients are transferred. Because long treatment times are associated with diminished clinical outcomes, it is often in the best interest of the uncooperative patient to terminate treatment rather than extend active mechanics in an attempt to achieve a better result.

Development of a treatment outcome standard as a result of a clinical audit of the outcome of fixed appliance therapy undertaken by hospital-based consultant orthodontists in the UK

Bristol's much-publicised cardiac surgery problems and subsequent enquiry(1) have drawn attention to the need for audit of treatment outcomes throughout all hospital specialties. Patient anxiety, government policy and the desire of the professions to re-establish public confidence, have further encouraged changes to the system. For medical and dental specialties, such challenges have already been taken up by the Royal Colleges with the establishment of clinical effectiveness committees. Hospitals have modified their procedures and, for consultants, yearly appraisal is already a reality. The Orthodontic Clinical Effectiveness Working Party of the Royal College of Surgeons of England (now the Clinical Effectiveness Committee of the British Orthodontic Society) set up this audit to measure the outcome of fixed appliance treatment and to establish a benchmark for the standard of treatment to be expected from a consultant orthodontist. This paper describes how the audit was carried out, presents the findings and goes on to discuss some of the wider issues involved in audit, clinical governance and appraisal. The Consultant Orthodontists Group of the British Orthodontic Society funded this audit and the results and data set of dental casts remain their property.

Evaluation of the peer assessment rating (PAR) index as an index of orthodontic treatment need

The need for orthodontic treatment has an objective component based on occlusal traits and a subjective component based on the esthetic impact of the occlusion. An occlusal index that measures the objective deviation from normal or ideal occlusion might be sufficient to mirror the subjective opinion of orthodontists about treatment need. The objective of this study was to determine whether the American (US) and United Kingdom (UK) weightings of the peer assessment rating (PAR) index are valid instruments with which to determine treatment need. Fifteen orthodontists rated the need for orthodontic treatment of 170 casts. Their collective decision was compared with the PAR value for the cast determined by a calibrated examiner. A range of suggested treatment cutoff points from the literature was used to generate receiver operating characteristic (ROC) curves and optimized cutoff points. The cutoff points were 17 for both the US PAR and the UK PAR, and sensitivity, specificity, and kappa were 92%, 86%, and 0.77 for the US PAR and 92%, 89%, and 0.80 for the UK PAR. The area under the ROC curve was 97% for the US PAR and the UK PAR. Both the US PAR and the UK PAR scores were excellent predictors of orthodontic treatment need as determined by a panel of orthodontists. An occlusal index used to measure deviation from normal or ideal occlusion might perform as well as indexes of treatment need in predicting orthodontists' evaluations of treatment need.