Comparison of Treatment Outcome Assessment for Class I Malocclusion Patients: Peer Assessment Rating versus American Board of Orthodontics-Objective Grading System

Long-term occlusal changes and patient satisfaction in patients treated with and without extractions: 37 years after treatment

INTRODUCTION

The objective of this research was to evaluate the treatment outcomes, long-term occlusal changes, and patient satisfaction after 37 years of nonextraction and extraction treatments.

METHODS

Fifty-seven patients with Class I and Class II malocclusion were divided into 2 groups. Group 1 included 16 patients treated with nonextraction therapy, with mean initial (T1), final (T2), and long-term posttreatment (T3) ages of 13.2, 15.0, and 50.3 years, respectively. Mean treatment time (T2 - T1) and long-term follow-up time (T3 - T2) were 1.8 and 35.2 years, respectively. Group 2 included 41 patients treated with extraction of 4 first premolars, with mean ages at T1, T2, and T3 of 13.3, 15.6, and 53.6 years, respectively. Mean treatment (T2 - T1) and long-term follow-up (T3 - T2) times were 2.3 and 37.9 years, respectively. The Peer Assessment Rating (PAR) index and Objective Grading System (OGS) indexes were evaluated at T1, T2, and T3 stages. The subjects also answered an online questionnaire regarding esthetic and occlusal self-perception at T3. Intergroup comparison was performed with t tests.

RESULTS

The PAR index improved with treatment and similarly worsened at T3 for both groups. OGS scores were close to the passing score at T2 for both groups. The nonextraction group presented worse OGS scores at T3 than the extraction group. Nonextraction patients perceived more changes in alignment over time, but overall satisfaction was similar.

CONCLUSIONS

The PAR index improved with treatment, and the PAR and OGS scores showed a significant increase, indicating great occlusal changes in the long-term stage. The nonextraction group showed more occlusal changes and perceived more changes in their alignment over time, but overall patient satisfaction was similar in both groups.

Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses

Background

The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear.

Objective

This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment.

Search methods

Eight databases were searched without limitations in April 2019.

Selection criteria

Randomized or matched non-randomized studies.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment was done independently in triplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality.

Results

A total of 11 studies (4 randomized/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6–16.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2–2.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies.

Conclusions

Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces.

Registration

PROSPERO (CRD42019131589).

Outcomes of comprehensive fixed appliance orthodontic treatment: A systematic review with meta-analysis and methodological overview

Objective

The aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics.

Methods

Nine databases were searched up to October 2016 for prospective/retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated.

Results

A total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3–30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6–25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results.

Conclusions

The findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances.

The Improvement and Completion of Outcome index: A new assessment system for quality of orthodontic treatment

Objective

Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system―the Improvement and Completion of Outcome (ICO) index―to evaluate the outcome of orthodontic treatment.

Methods

Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or −1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful.

Results

Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values.

Conclusions

Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.