Judging orthodontic treatment complexity.

OBJECTIVE: The aim of the present study was to investigate possible relations between anticipated overall treatment complexity (AOTC) of an orthodontic case and malocclusion characteristics. METHODS: Two groups of orthodontists (groups A and B) were asked to define perceived treatment complexity (PTC) of orthodontic cases based on 16 characteristics of malocclusion by means of a questionnaire. Each question was answered on a six-point ordinal scale, with one "not applicable" option (score 0). Group A was also asked to give the AOTC of the specific case on a five-point ordinal scale. The index of orthodontic treatment need (IOTN) score of the specific cases as well as the malocclusion characteristics were assessed by one author. RESULTS: There is a significant relationship between IOTN and AOTC (p< 0.0001), 22% of variability is explained by differences in IOTN. Adding objective characteristics of malocclusion to explain AOTC does not significantly increase the explained variability (p = 0.086). In judging interobserver agreement, a weighted Kappa of 0.60 for group A and 0.56 for group B was found. The weighted Kappa for agreement in AOTC equals 0.06. CONCLUSION: The relation between IOTN and AOTC was found to be significant. Moderate agreement on PTC among observers and a low level agreement regarding AOTC were found in the present study.

Judging orthodontic treatment complexity

Objective: The aim of the present study was to investigate possible relations between anticipated overall treatment complexity (AOTC) of an orthodontic case and malocclusion characteristics. Methods: Two groups of orthodontists (groups A and B) were asked to define perceived treatment complexity (PTC) of orthodontic cases based on 16 characteristics of malocclusion by means of a questionnaire. Each question was answered on a six-point ordinal scale, with one "not applicable" option (score 0). Group A was also asked to give the AOTC of the specific case on a five-point ordinal scale. The index of orthodontic treatment need (IOTN) score of the specific cases as well as the malocclusion characteristics were assessed by one author. Results: There is a significant relationship between IOTN and AOTC (p< 0.0001), 22% of variability is explained by differences in IOTN. Adding objective characteristics of malocclusion to explain AOTC does not significantly increase the explained variability (p = 0.086). In judging interobserver agreement, a weighted Kappa of 0.60 for group A and 0.56 for group B was found. The weighted Kappa for agreement in AOTC equals 0.06. Conclusion: The relation between IOTN and AOTC was found to be significant. Moderate agreement on PTC among observers and a low level agreement regarding AOTC were found in the present study.

Objetivo: o objetivo do presente estudo foi investigar possíveis relações entre a previsão da complexidade geral do tratamento (AOTC, Anticipated Overall Treatment Complexity) de um caso ortodôntico e as características da má oclusão. Métodos: dois grupos de ortodontistas (Grupo A e Grupo B) foram orientados a definir, por meio de um questionário, sua percepção da complexidade do tratamento (PTC, Perceived Treatment Complexity) de casos ortodônticos, com base em 16 características da má oclusão. Cada questão foi respondida em uma escala ordinal de seis pontos, com a opção "não aplicável" (nota 0) disponível. Pediu-se ao Grupo A que também determinasse, em uma escala ordinal de cinco pontos, a AOTC de cada caso. A nota relativa ao índice de necessidade de tratamento ortodôntico (IOTN,Index of Orthodontic Treatment Need) de casos específicos e as características das más oclusões foram avaliadas por um dos autores. Resultados: existe uma relação significativa (p < 0,0001) entre o IOTN e a AOTC. Diferenças no IOTN são a causa de 22% da variabilidade. Adicionar características objetivas da má oclusão para explicar a AOTC não aumentou significativamente essa variabilidade mencionada (p = 0,086). Ao se avaliar a concordância interexaminadores, foram encontrados valores de Kappa ponderado de 0,60 para o Grupo A e 0,56 para o Grupo B. O valor de Kappa ponderado para a concordância quanto à AOTC foi de 0,06. Conclusão: a relação encontrada entre o IOTN e a AOTC foi considerada significativa. Verificou-se uma moderada concordância interexaminadores com relação à PTC, e um baixo nível de concordância com relação à AOTC.

Cephalometric appraisal of post-treatment tooth eruption: a 20 year follow-up study.

AIM: To assess the amount of tooth eruption that occurs during 20 years after completion of orthodontic treatment and analyse possible correlations with age and mandibular growth pattern present. MATERIALS AND METHODS: A retrospective longitudinal cephalometric investigation of dento-alveolar changes was performed in 72 patients (50 women and 22 men). Two lateral cephalograms, taken at the end of orthodontic treatment and on average 20 years later, were available for each subject. The mean age at the beginning of the observation period was 21.5 years and the mean observation period was 19.7 years. Changes in the cephalometric measurements were evaluated statistically. RESULTS: For all parameters, there is evidence for an increase in tooth eruption parameters during the 20 year interval. Furthermore, a significant difference in change was found between different growth patterns for all parameters. For the majority of the parameters, the increase is higher for subjects being younger at the end of orthodontic treatment. There is no evidence for a difference in change between males and females. CONCLUSION: Continued tooth eruption readily occurs after termination of orthodontic treatment in all patients. There is a correlation between the mandibular growth pattern present and the amount of tooth eruption in posterior and anterior regions in both the mandible and the maxilla after completion of the orthodontic treatment. These changes are more pronounced in patients treated orthodontically during adolescence.

Impact of self-esteem and personality traits on the association between orthodontic treatment need and oral health-related quality of life in adults seeking orthodontic treatment.

OBJECTIVE: The aim of this study was to investigate whether an association exists between orthodontic treatment need and oral health-related quality of life (OHRQoL) and whether this association is moderated by self-esteem (SE) and/or personality traits. MATERIALS AND METHODS: In this cross-sectional study comprising 189 adults (55 males and 134 females) aged 17 or older (mean age 31.3 years), the OHRQoL was scored by the use of the shortened version of the Oral Health Impact Profile-14 (OHIP-14). The Rosenberg self-esteem scale was used to evaluate SE, and the Dutch adaptation of the Neuroticism Extraversion Openness Five-Factor Inventory was used to assess personality profiles. Need for treatment was defined by the Index of Orthodontic Treatment Need. Spearman correlations, Mann-Whitney U-tests, and regression models were used to analyse the data. RESULTS: There is a modest to weak association between treatment need (Dental Health Component and aesthetic component) and OHRQoL as measured by the total OHIP-14 score (ρ = 0.21, P = 0.01216; ρ = 0.18, P = 0.02960, respectively). A significant, yet modest to weak, association between SE and the total OHIP-14 score was found (ρ = -0.34, P = 0.00057). Moreover, significant associations were found for the total OHIP-14 score and neuroticism and extraversion. Significant associations can be found between SE and all personality traits. CONCLUSIONS: There was a significant association between orthodontic treatment need and OHRQoL. Moreover, a significant association can be found between SE and OHRQoL, as well as certain personality traits and OHRQoL. No evidence was found that SE or personality traits moderate the association between OHRQoL and treatment need.

Normative and self-perceived orthodontic treatment need in 11- to 16-year-old children.

OBJECTIVES: To examine the relationship between normative and self-perceived treatment need assessed by different measures, comprising two Oral Health-Related Quality of Life (OHRQoL) scales. SUBJECTS AND METHODS: This cross-sectional observational study comprised 386 children aged 11-16 years registered for a first consultation at the Orthodontic Department of the University Hospitals of Leuven (Belgium). Normative treatment need was assessed by the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The children completed questionnaires comprising the Child Perceptions Questionnaire (CPQ11₋14) and the Oral Aesthetic Subjective Impact Scale (OASIS). They also scored the AC of IOTN themselves. Spearman correlations, Mann-Whitney U-tests and signed-rank tests, a Bland-Altman plot, and an intra-class correlation were used to analyze the data. RESULTS: Significant, yet weak correlations (maximum ρ = 0.23 for the CPQ emotional well-being domain) were found between normative orthodontic treatment need (IOTN AC) and most of the OHRQoL measures. Similarly, between the IOTN AC scores of the expert and the IOTN AC ratings given by the child a significant correlation (ρ = 0.37, P < 0.0001) was found, but with very poor agreement (95 per cent limits of agreement -4.3, 5.1). For the DHC of IOTN, only a relation was found with the AC child (ρ = 0.20, P = 0.0001). CONCLUSIONS: These results suggest that the commonly used IOTN as a clinical assessment tool for orthodontic treatment need should be reinforced by OHRQoL measures, like the OASIS, expressing patients' perceived treatment need.

Changes in oral health-related quality of life reports in children during orthodontic treatment and the possible role of self-esteem: a follow-up study.

OBJECTIVES: As a continuation of a baseline study on oral health-related quality of life (OHRQoL) and the role of self-esteem (SE), the aim of this research is to investigate the changes in OHRQoL reports in children during orthodontic treatment and the influence of SE. SUBJECTS AND METHODS: This longitudinal study comprised 109 children (50 boys and 59 girls) aged 11-16 years, all receiving orthodontic treatment. Questionnaires were administered at baseline and at follow-up (1 year after start of orthodontic treatment). OHRQoL was assessed by the child perception questionnaire (CPQ). The Dutch adaptation of the Harter's Self-Perception Profile for Adolescents was used to assess SE and the Index of Orthodontic Treatment Need defined the need for treatment. The questionnaires also included questions related to motivation for treatment. Spearman correlations, Wilcoxon signed rank tests and Mann-Whitney U-tests were performed. RESULTS: A significant increase in total CPQ score was found during orthodontic treatment. This increase was also significant for the subdomains functional limitations, oral symptoms, and social well-being, whereas for the subdomain emotional well-being a non-significant decrease in CPQ score was found. Children with high SE at baseline showed significantly lower variability in OHRQoL measures at follow-up. CONCLUSIONS: OHRQoL deteriorates in children during orthodontic treatment. There is evidence that SE can be a protective factor in OHRQoL during orthodontic treatment.