Plate fixation of extra-oral subcondylar ramus osteotomy for correction of mandibular prognathism: clinical aspects and short term stability.

AIM: The present study describes an extra-oral approach for subcondylar oblique ramus osteotomy using stable fixation for setback of the mandible. The aim was to investigate the incidence of neurosensory disturbances of the mandibular nerve, evaluate facial scar appearance, and assess skeletal stability following the procedure. METHODS: Forty-two consecutive patients with mandibular prognathism were operated upon using the subcondylar oblique ramus osteotomy and plate fixation. The patients were followed up for 6 months following surgery. Intra-operative and postoperative complications, neurosensory function, and facial scar characteristics were recorded. Lateral cephalograms were available immediately before operation, and immediately after operation and 6 months postoperatively. Skeletal stability was based on cephalometric assessment. RESULTS: Among the 19 patients operated earliest, neurosensory disturbances were recorded in five individuals at the 6 month follow-up. In the subsequent group of 23 patients, no disturbances were reported. All but two patients were not concerned about the facial scar 6 months postoperatively. Mean anterior relapse at the 6 month follow-up was 0.5 mm, representing 9% of the surgical setback. CONCLUSION: Extra-oral subcondylar oblique ramus osteotomy with plate fixation is a stable procedure with a low incidence of neurosensory disturbances if the osteotomy is placed well behind the mandibular foramen. Facial scar appearance was rarely a matter of concern to the patients.

Factors influencing the predictability of soft tissue profile changes following mandibular setback surgery.

The objective of this cephalometric study was to assess long-term changes in the soft tissue profile following mandibular setback surgery and investigate the presence of factors that may influence the soft tissue response to skeletal repositioning. The subjects enrolled were 80 consecutive mandibular prognathism patients operated with bilateral sagittal split osteotomy and rigid fixation. Lateral cephalograms were taken at 6 occasions: immediate presurgical, immediate postsurgical, 2 and 6 months postsurgical, and 1 and 3 years postsurgical. The subjects were grouped according to gender and magnitude of setback. Ratios of soft tissue to hard tissue movements were calculated for the subgroups. Females generally demonstrated greater ratios than males with a statistically significant difference for the upper lip and chin (P < .05). Postsurgical alterations in the profiles were more predictable in patients with larger setbacks compared to patients with smaller ones. Skeletal relapse had a profound influence on long-term profile changes. Based on these findings, it is proposed that the database used in prediction software be adjusted to account for such factors in an attempt to improve the accuracy of computerized treatment simulations.

Soft tissue profile changes following mandibular advancement surgery: predictability and long-term outcome.

The objectives of this cephalometric study were to assess long-term changes in the soft tissue profile following mandibular advancement surgery and to investigate the relationship between soft tissue and hard tissue movements. The sample consisted of 61 patients treated consecutively for mandibular retrognathism with orthodontic therapy combined with bilateral sagittal split osteotomy and rigid fixation. Lateral cephalograms were taken on 6 occasions: immediately before surgery, immediately after surgery, 2 and 6 months after surgery, and 1 and 3 years after surgery. Postsurgical changes in the upper and the lower lips and the mentolabial fold were more pronounced among low-angle cases compared with high-angle cases. In accordance with other studies, the soft tissue chin and the mentolabial fold were generally found to follow their underlying skeletal structures in a 1:1 ratio. Because of the strong influence skeletal relapse has on soft tissue profile changes, alternative ratios of soft tissue-to-hard tissue movement that accounted for mean relapse were also generated. It is suggested that if a more realistic long-term prediction of the postsurgical soft tissue profile is desirable, then ratios incorporating mean relapse should be used rather than estimates based on a 1:1 relationship.

Mandibular advancement surgery in high-angle and low-angle class II patients: different long-term skeletal responses.

The objective of this cephalometric study was to compare skeletal stability and the time course of postoperative changes in high-angle and low-angle Class II patients after mandibular advancement surgery. The subjects were 61 consecutive mandibular retrognathism patients whose treatment included bilateral sagittal split osteotomy and rigid fixation. The patients were divided according to the preoperative mandibular plane angle; the 20 patients with the lowest mandibular plane angle (20.8 degrees +/- 4.9 degrees ) constituted the low-angle group, while the 20 cases with the highest mandibular plane angle (43.0 degrees +/- 4.0 degrees ) represented the high-angle group. Lateral cephalograms were taken on 6 occasions: immediately before surgery, immediately after surgery, 2 and 6 months after surgery, and 1 and 3 years after surgery. Results demonstrated that the high-angle and low-angle groups had different patterns of surgical and postoperative changes. High-angle patients were associated with both a higher frequency and a greater magnitude of horizontal relapse. While 95% of the total relapse took place during the first 2 months after surgery in the low-angle group, high-angle patients demonstrated a more continuous relapse pattern, with a significant proportion (38%) occurring late in the follow-up period. Possible reasons for the different postsurgical response are discussed.

Obstructive sleep apnea: a canonical correlation of cephalometric and selected demographic variables in obese and nonobese patients.

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of body mass index (BMI): 43 nonobese (BMI < 30 kg/m2) and 57 obese (BMI > or = 30 kg/m2) patients. A comprehensive cephalometric analysis with a multivariate statistical method was performed in order to define the different principal components (PCs) of cervico-craniofacial skeletal and upper airway soft tissue morphology in each group and how they contributed to selected elements of the patient demographic data, ie, apnea-hypopnea index (AHI), nocturnal oxyhemoglobin saturation, and BMI. Thirty cephalometric variables of cervico-craniofacial skeletal morphology were reduced to 8 PCs describing 84.4% and 85.4% of the total variance in obese and nonobese OSA patients, respectively. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs describing 84.4% and 85.9% of the total variance in obese and nonobese OSA patients, respectively. Twenty cephalometric variables of upper airway soft tissue morphology were reduced to 7 PCs describing 89.5% and 84.6% of the total variance in obese and nonobese OSA patients, respectively. For further analysis of PCs, a stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of the posterior pharyngeal airway space (PASmin) and AHI. PASmin accounted for 95.3% (obese OSA group) and 74.3% (nonobese OSA group) with 7 PCs and AHI for 46% with 3 PCs in both groups. Three canonical variables and their correspondents with different loadings were established differently for both OSA groups. A canonical correlation successfully clarified the complexity of simultaneous relationship of the relevant variables. These analyses are proved useful to demonstrate the relationship of cervico-craniofacial skeletal and upper airway soft tissue morphology and selected demographic data. This lays down a basis for understanding the complicated pathogenic components of obese and nonobese OSA patients.

Obstructive sleep apnoea: multiple comparisons of cephalometric variables of obese and non-obese patients.

BACKGROUND: Pathogenesis of obstructive sleep apnoea (OSA) is complex and not yet fully understood. Several factors contribute to OSA severity. Obesity is believed to play an important role. Nevertheless, not all OSA patients are obese. Therefore, the different features that cause nocturnal upper airway obstruction in obese and non-obese OSA patients could be expected. PURPOSE: To investigate the different components of cervico-craniofacial skeletal and upper airway soft tissue morphology among obese OSA, non-obese OSA patients and the controls. PATIENTS: One hundred male OSA patients were classified into two groups on the basis of body mass index (BMI) as obese (BMI > or = 30 kg/m2) and non-obese (BMI < 30 kg/m2). Consequently, 57 obese and 43 non-obese OSA patients were examined and compared with a control group of 36 healthy males. STUDY DESIGN: A comprehensive cephalometric analysis of cervico-craniofacial skeletal and upper airway soft tissue morphology was performed. Sixty-eight cephalometric variables were compared among the three groups by one way analysis of variance with Bonferroni's test. RESULTS: Both OSA groups had aberrations of cervico-craniofacial skeletal as well as upper airway soft tissue morphology when compared with the controls. These anatomic deviations were confined to cervico-craniofacial skeletal structures in the non-obese OSA patients, whereas the obese OSA patients had more abnormalities in the upper airway soft tissue morphology, head posture and position of the hyoid bone. CONCLUSION: The findings imply that there should be different treatment regimens for the two subgroups of OSA patients. Cephalometric analysis together with various considerations of BMI is highly recommended as one of the most important tools in diagnosis and treatment planning for OSA patients.

Outcome of a scheme for specialist orthodontic care.

With the purpose of examining the outcome of specialist orthodontic care on a population level (Halland, Sweden), a random sample of previously treated 19-year-olds (n=118) was clinically examined and interviewed. Thirty-three per cent of the cohort (n=1554) had received treatment, and mean treatment time was 19 months requiring 20 visits. Changes in occlusion were assessed using the PAR Index applied to dental study casts representing the pre- and post-treatment and follow-up (19 years) condition. The subjects' responses to questions addressing their past and present attitudes to dental appearance and orthodontic treatment were combined to represent "orthodontic concern", at the pre-treatment stage and at 19 years of age. A mean reduction in weighted PAR scores of 83% was observed from pre-treatment to post-treatment, whereas at follow-up, the net improvement was 69%. A significant shift in attitudes was observed, as 72% of the individuals expressed orthodontic concern pre-treatment compared to less than 10% at 19 years. The improvement obtained was similar to other studies on outcome of orthodontic treatment provided by specialist orthodontists. Compared to most PAR-studies providing information about orthodontic services, the present scheme appeared to be efficient on the assumption that duration of treatment and number of visits are expressions of costs.

Outcome of a scheme for orthodontic care: a comparison of untreated and treated 19-year-olds.

The organization of the orthodontic service within the Public Dental Health Service in the southern part of the county of Halland, Sweden is described, and data for the provision of treatment are presented. The aim of this study was to examine the outcome of this service by studying the prevalence of malocclusion and residual need, as well as attitudes to treatment in previously treated and untreated individuals. Three samples of 19-year-olds were established: patients treated by specialists (n=132), patients treated by general practitioners (GP) (n=132), and untreated individuals (n=492). All samples were examined clinically, and radiographs, photographs, and study casts were obtained from the two treated groups. Attitudes to own teeth and orthodontic treatment were recorded by use of questionnaires. Deviant occlusal traits were recorded, and all the individuals were categorised according to a treatment need index. Generally, good occlusal conditions were observed in all samples. More deviant traits were observed in individuals that had been treated by GPs, and significant differences were observed for overjet, overbite, and crowding compared to the other samples. The majority of individuals belonged to the little/no treatment need index categories. Of those treated by GPs, one third belonged to the moderate (22%) or urgent (11%) need categories. About 10% reported dissatisfaction with their dental appearance, but only 2% expressed a desire for (further) orthodontic treatment.

Obstructive sleep apnea (OSA): a cephalometric analysis of severe and non-severe OSA patients. Part II: A predictive discriminant function analysis.

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of apnea-hypopnea index (AHI) as severe (AHI > or = 50) and non-severe (AHI < 50). A comprehensive cephalometric analysis of cervicocraniofacial skeletal and upper airway soft tissue morphology was performed in 51 non-severe and 49 severe OSA patients. In addition, a multivariate statistical method (principal component, analysis and predictive discriminant analysis) was performed to identify the components that could correctly differentiate the severe from the non-severe OSA patients. Eight principal components (PCs) of cervicocraniofacial skeletal morphology, 4 PCs of hyoid bone position and head posture, and 7 PCs of upper airway soft tissue morphology, together with the selected demographic variables, were deduced to formulate a linear canonical discriminant function. The equation of a 9-variable model was generated as follows: PDF score = 4.127 - 0.144 (Body Mass Index) - 0.376 (PC1.1) + 0.311 (PC1.4) + 0.214 (PC1.5) + 0.075 (PC 2.1) - 1.309 (PC2.3) + 0.708 (PC3.2) - 0.059 (PC3.3) + 0.609 (PC3.6). The cutoff score was -0.03899. The overall rate of correct classification was 83%. The results showed that Body Mass Index and 8 other PCs contributed significantly to the OSA severity. These analyses are proven to be a useful adjunctive diagnostic tool to select optimal treatment regimens for OSA patients with varying degrees of severity.

Obstructive sleep apnea (OSA): a cephalometric analysis of severe and non-severe OSA patients. Part I: Multiple comparison of cephalometric variables.

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups, on the basis of Apnea-Hypopnea Index (AHI), as severe (AHI > or = 50) and non-severe (AHI < 50). A comprehensive cephalometric analysis of cervicocraniofacial skeletal morphology and upper airway soft tissue morphology was performed in 51 non-severe OSA patients, 49 severe OSA patients, and 36 controls with the purpose of examining the different features among these 3 groups. Sixty-eight cephalometric variables were compared among these 3 groups by 1-way analysis of variance with post hoc Bonferroni test. The results showed that both OSA groups had aberrations of cervicocraniofacial skeletal morphology and upper airway soft tissue morphology versus the controls. Severe OSA patients demonstrated increased maxillo-mandibular retrognathism, with a high mandibular plane angle resulting from increased anterior lower facial height and decreased posterior lower facial height, versus the non-severe OSA group. The craniocervical extension, forward head posture, inferiorly positioned hyoid bone, and the enlarged and elongated soft palate and upright tongue posture were more exaggerated as well. These findings imply that there should be different treatment regimens for the 2 subgroups of OSA patients to achieve treatment success. Cephalometric analysis is therefore highly recommended to verify the aberrant cervicocraniofacial morphology in severe and non-severe OSA patients.

Long-term stability of mandibular setback surgery: a follow-up of 80 bilateral sagittal split osteotomy patients.

The objective of this cephalometric study was to evaluate skeletal stability and time course of postoperative changes in 80 consecutive mandibular prognathism patients operated with bilateral sagittal split osteotomy (BSSO) and rigid fixation. Lateral cephalograms were taken on 6 occasions: immediately preoperative, immediately postoperative, 2 and 6 months postoperative, and 1 and 3 years postoperative. The results indicate that BSSO with rigid fixation for mandibular setback is a fairly stable clinical procedure. Three years after surgery, mean relapse at pogonion represented 26% of the surgical setback (19% at point B). Most of the relapse (72%) took place during the first 6 months after surgery. Clockwise rotation of the ascending ramus at surgery with lengthening of the elevator muscles, though evident in this study and apparently responsible for the early horizontal postoperative changes, does not seem to be associated with marked relapse. Changes occurring in some of the younger patients between 1 and 3 years postoperatively are likely to be manifestations of late mandibular growth.

Stability of extraoral vertical ramus osteotomy: plate fixation versus maxillomandibular/skeletal suspension wire fixation.

The objective of this cephalometric study was to evaluate skeletal stability and time course of postoperative changes in 2 groups of mandibular prognathism patients following extraoral oblique vertical ramus osteotomy (VRO). One group (n = 22) received maxillomandibular fixation and skeletal suspension wires (MMF group) for a period of 8 weeks. In the other group (n = 22), the segments were rigidly fixed with plates and the patients were allowed to function immediately after surgery. Lateral cephalograms were taken on 5 occasions: immediately presurgical, immediately postsurgical, 8 weeks postsurgical, 6 months postsurgical, and 1 year postsurgical. During the first 8 weeks after surgery, the MMF group demonstrated posterior movement of the mandible, with an increase in mandibular plane angle, shortening of the rami, and dental compensations. Upon release of MMF and skeletal suspension wiring, a small anterior relapse tendency was observed, but the net setback 1 year after surgery was still greater than the actual surgical setback. In the plate fixation group, postoperative changes were mainly in the form of a small anterior relapse tendency in the range of 10% of the surgical setback. The results indicate that the use of plate fixation with VRO, while eliminating the inconvenience for the patient of several weeks of MMF and preventing the early side effects observed in the MMF group, also resulted in a more predictable surgical procedure, with excellent stability 1 year after surgery.

Residual need in orthodontically untreated 16-20-year-olds from areas with different treatment rates.

Knowledge concerning residual orthodontic need among individuals who have passed the age at which orthodontic treatment is normally provided, is important in the discussion of guidelines for the provision of care. The purpose of the present study was to examine and compare orthodontic need (objective and subjective) in cohorts of orthodontically untreated individuals from areas with various treatment rates. A total of 250 individuals, aged 16-20 years, comprised four samples representing cohorts from areas in Norway with low, medium, and high treatment rates. The occlusion was assessed according to a treatment need index (NOTI) from clinical and radiographic records, and dental cast measurements. Attitudes were assessed from questionnaires addressing satisfaction with dental arrangement, desire for treatment, and value placed upon well-aligned teeth. A significant decrease in occurrence of normative need (P < 0.001) and reported dissatisfaction (P < 0.05) was observed in samples representing increasing treatment rates. Dissatisfaction was completely eliminated among individuals from the high treatment rate area. Although a significant association between severity of malocclusion and desire for treatment existed within samples, this was not reflected in a corresponding trend for a decrease in desire across the samples. Well-aligned teeth seemed to be taken for granted among individuals from the area with a high treatment rate. From the present observations, a 'correct' level of treatment provision could not be identified.

The provision and outcome of orthodontic services in a Norwegian community: a longitudinal cohort study.

In a systematic child dental care system, professionals, consumers, and purchasers have a common interest in ensuring that provision and outcome of orthodontic care fulfill the goals of the service and the public's expectations. The purpose of this prospective study was to examine whether treatment was in fact provided to children with a normative treatment need, and also to assess the outcome of treatment. The baseline data were established for a sample of 83 11-year-olds before decisions about orthodontic treatment had been made, by recording the individuals' orthodontic concern as reported in questionnaires and their occlusal condition according to an index of orthodontic treatment need (NOTI). At re-examination at the age of 16 years, it was also recorded whether the individual had received orthodontic treatment. Most individuals (83%) with a normative need had been treated as well as some individuals without need but who had expressed orthodontic concern. Treatment had resulted in occlusal improvement ('health gain') in most patients, and generally this improvement paralleled a decrease in concern. The goals of the orthodontic service seem to have been fulfilled to the extent that residual treatment need was infrequent. The high treatment rate (63%) and standard may explain why all individuals, both treated and untreated, expressed satisfaction with their dental appearance at 16 years of age.

Patient-centered evaluation of orthodontic care: a longitudinal cohort study of children's and parents' attitudes.

As health services are adapted to meet consumers' needs, patient-centered evaluation of quality of care as well as informed consent to treatment decisions become increasingly important concepts in orthodontics. In an attempt to assess the orthodontic service in a region, this study focused on attitudes among children and their parents. The attitudes were recorded both before and after the period in which orthodontic treatment is usually carried out. Changes in children's and parents' attitudes were applied to measure outcome of care, and to evaluate the relevance of informed consent in decisions about treatment. Seventy-nine family units were interviewed with the use of questionnaires when the child was 11 years of age and again at 16 years. Both orthodontically treated and untreated subjects were included. Responses to questions about satisfaction with dental appearance and desire for treatment were transformed to a score for orthodontic concern. A significant decrease in the concern score was observed over the 5-year period among the treated subjects, and the care system apparently identified and provided treatment to the majority of those children concerned at 11 years. Intra-unit disagreement in concern was observed among 25% of the child/parent units at the 11-year stage, whereas at 16 years nearly all units agreed. Informed consent as a tool to ensure patients' autonomy when decisions about treatment are made did not appear to be negatively affected by conflicting attitudes between children and their parents.

Duration of orthodontic treatment involving orthognathic surgery.

The purpose of this study was to analyze factors influencing the duration of treatment in a sample of patients treated by a combined orthodontic/orthognathic surgery approach. Presurgical and postsurgical treatment times were assessed for 315 patients processed through an orthognathic team over a 7-year period. The median total treatment duration for all patients was 21.9 months, the median presurgical duration was 15.4 months, and the median postsurgical duration was 5.9 months. Treatment involving extractions resulted in significantly increased presurgical and total treatment times. Treatments performed in the university clinic showed reduced presurgical duration and increased postsurgical duration compared to treatments carried out by specialists outside the university. Presurgical, postsurgical, and total treatment times were significantly reduced when the orthodontist had treated 10 or more patients during the period. An earlier regimen of orthodontic treatment did not appear to have a significant effect on treatment duration.

Obstructive sleep apnea: a principal component analysis.

A principal component analysis was performed on the cephalometric variables of 100 male obstructive sleep apnea (OSA) patients. Thirty cephalometric variables of cervicocraniofacial skeletal morphology were reduced to 8 principal components (PCs), which described 83.2% of the total variance. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs, which described 85.5% of the total variance. Twenty cephalometric variables of upper airway soft tissue were reduced to 7 PCs, which described 83.7% of the total variance. These PCs described the actual characteristics of the OSA patients examined. For further analysis of PCs, stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of posterior pharyngeal airway space (PASmin) and the Apnea-Hypopnea Index (AHI). Seven PCs accounted for 79.4% of the variance of PASmin and 3 PCs accounted for 37.6% of the variance of AHI. Both principal component analysis and multiple regression analysis provide multivariate data analysis that is very useful in sorting out and clarifying the complexity of the interrelated cervicocraniofacial skeletal morphology and upper airway soft tissue in OSA patients.

Validity of the Demirjian method for dental age estimation when applied to Norwegian children.

Dental age was studied in a sample of 261 Norwegian children by using the maturity standards of Demirjian & Goldstein (1976) to examine the applicability of these standards as a reference for overall dental maturity in a Norwegian population. The sample comprised 128 boys and 133 girls included in 'the Oslo Growth Material', from whom orthopantomograms (total, 783) had been longitudinally obtained, with intervals of about 3 years and covering 3 age spans (5.5-6.5 years, 8.5-9.5 years, and 11.5-12.5 years), each divided into 3 half-year age groups. Reliability was analyzed by repeated assessments of 134 of the radiographs, and the overall mean difference between duplicate dental age determinations was 0.5 months for intra- and 1.8 months for inter-examiner comparisons. The Norwegian children were generally somewhat advanced in dental maturity compared with the French-Canadian reference sample. Among the boys the mean difference between dental age and chronologic age varied in the different age groups from 1.5 to 4.0 months. Among the girls the difference increased with age, varying from 0 to 3.5 months in the younger age groups (5.5 to 9.0 years) and from 4.5 to 7.5 months in the age groups 9.5 years and above. The variability in individual dental age was marked and increased with age. For the older age groups 95% of the individual age estimates were within +/-2 years of the real age. The applied standards appear to be adequate for studying dental age in groups of children from a Norwegian population. Given the considerable individual variation in dental maturity, estimation of chronologic age in individual children should be supplemented by other indicators of biologic maturity.

Lay attitudes to dental appearance and need for orthodontic treatment.

In provision of advice about aesthetic treatment need, visual stimuli as a tool in communication may have some advantages compared with verbal descriptions, in particular when children are addressed. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need is an illustrated scale for rating of dental attractiveness developed in the UK and based on lay adults' ratings of dental photographs. This scale has also been recommended for use in patient education. The purpose of the present study was to establish a sociocultural standard of reference for Norway related to the AC, in order to examine the applicability of the scale as a tool in patient information. Samples of 137 children, 126 of their parents and 98 young adults were shown the 10 photographs comprising the AC. The subjects were asked to assess the photographs for dental attractiveness and orthodontic treatment need on a four-category rating scale. The findings indicated that, in general, photographs with an increasing scale point were rated as increasingly more unattractive. The majority (80-100 per cent) of the parents and young adults rated the five photographs on the unattractive end of the scale to be in need of treatment. The children were significantly less critical in their aesthetic judgements. Photographs representing borderline need, identified for these groups to be scale points 5 and 6, have a potential in guiding patients and parents in making informed decisions about aesthetic treatment need.

A longitudinal study on subjective and objective orthodontic treatment need.

The purpose of the study was to analyse changes in professionally-defined need and self-perceived need between the ages of 12-20 years. In 1985, occlusion and perceived need for treatment were recorded in 306 12-year-olds (born 1973) living in five communes in Finnmark, the most northern part of Norway. In 1993-94, 271 of the individuals were traced through the Norwegian Central Person Register and invited in letters to attend a clinical examination and an interview. A total of 80 individuals responded, with a mean age of 20.7 years. Professionally-defined need was assessed according to the Need for Orthodontic Treatment Index (NOTI) which is used by the Norwegian Health Insurance System for reimbursement of treatment costs. Change in category of need between 12-20 years was used as a measurement of health gain. Perceived need was measured by the individuals' responses to a question about desire for treatment. Individuals who received treatment (n = 22) showed an improvement in occlusion (health gain) corresponding on average to one category of need. The occlusal status of the untreated individuals was unchanged. All the individuals that desired treatment at 12 years of age (n = 15) did not want treatment at 20, and they were satisfied with their dental arrangement. Most of these individuals had received treatment, but a few with minor malocclusions had at age 12 been informed about the small objective need and refrained from treatment. All the individuals that wanted treatment at 20 years of age, 29 per cent of the total sample, had not desired treatment at 12 years of age. The results underline the importance of information and education during orthodontic counselling of potential patients.