Interceptive versus Comprehensive Orthodontics in Medicaid Patients: An Ongoing RCT

Objectives: Interceptive orthodontics (IO) is proposed to increase low-income children's access to orthodontics. This report presents data from an ongoing randomized clinical trial comparing IO to comprehensive orthodontics (CO) in Medicaid patients. Methods: 168 children (9.3±1.5 years) with Medicaid eligible malocclusions were randomized to IO followed by observation (OBS) or OBS followed by CO. Casts at pre-treatment (T1), following IO/OBS (T2) and following CO/OBS (T3) were scored for the Peer Assessment Rating (PAR); Index of Complexity, Outcome and Need (ICON); and Handicapping Labiolingual Deviation (HLD) by calibrated examiners. Group and time-specific trends are presented using means and 95% confidence intervals. Further formal statistical tests are deferred until all subjects complete the trial. Results: PAR and ICON improved from T1 to T2 with IO (30.7±1.8 to 15.4±2.2; 75.2±3.5 to 45.0±4.5, respectively) but did not change with OBS (31.4±2.0 to 33.0±2.5; 73.5±3.3 to 72.6±4.3). Between T2 and T3, neither measure changed with IO (15.4±2.2 to 15.6±2.8; 45.0±4.5 to 48.1±6.1); but both improved with CO (33.0±2.5 to 11.7±4.1; 72.6±4.3 to 36.4±7.9). The percent with “medical necessity” by Washington State HLD criteria showed reduction between T1 and T2 followed by stabilization at T3 in the IO group (92%-18%-26%), and no reduction T1-T2 in the CO group, but reduction at T3 (94%-89%-23%). Based on ICON scores, 98% of patients in both groups needed orthodontics at T1. At T2, 46% post-IO and 93% post-OBS subjects needed treatment. At T3, 51% of IO/OBS and 36% of CO/OBS patients still had need. Between T1 and T3, 40% of IO and 62% of CO children displayed improvement according to ICON scores. Conclusion: These interim data suggest IO provides malocclusion improvement and reduces medical necessity into the permanent dentition. CO may provide slightly more patients with desired improvement, but at greater cost. NIH Grant U54 DE14254