IADR Abstract Archives
Orthodontists and Oral Surgeons' Clinical Decisions in Borderline Class III Orthodontic - Orthognathic Surgery Cases
Objectives: Orthodontic - orthognathic surgical cases are managed conjointly by orthodontists and oral surgeons and their respective specialist trainees. The study aimed to determine the decision making patterns, level of agreement, factors influencing decision making among expert orthodontists, expert oral surgeons, novice orthodontists and novice oral surgeons in managing borderline Class III orthodontic - orthognathic surgery cases.
Methods: A cross - sectional questionnaire study involving 55 clinicians stratified into the four groups was conducted. The subjects assessed six borderline cases and responded on whether each case required orthognathic surgery and whether the case can be managed alone by orthodontic camouflage approach. The patient parameters used to assess the limits of orthodontic camouflage were recorded.
Results: Variable decision making patterns were observed among the clinicians with poor inter and intra - clinician agreement. Clinical experience and dental specialty did not significantly influence clinicians’ clinical decisions. However, a trend was observed with the percentages of oral surgeons indicating surgery substantially higher than the percentages of orthodontists. On the other hand, the percentages of orthodontists indicating camouflage were substantially higher than the percentages of oral surgeons. The study identified nine patient parameters most commonly used to assess whether a Class III malocclusion can be managed by orthodontic camouflage. Of all the parameters studied, molar relationship, gingival biotype and alveolar ridge thickness were more frequently used by the orthodontists but not the oral surgeons to make the assessment (p<0.05). ANB angle, Wits appraisal, maxillary - mandibular length ratio, molar relationship and soft tissue pogonion to zero meridian line were important parameters that influenced clinicians’ decision in determining the limits of orthodontic camouflage (p<0.05) in at least one of the Class III cases.
Conclusions: There were variable clinical decisions and generally little inter and intra - clinician agreement among the clinicians in managing borderline orthodontic - orthognathic surgery cases
Methods: A cross - sectional questionnaire study involving 55 clinicians stratified into the four groups was conducted. The subjects assessed six borderline cases and responded on whether each case required orthognathic surgery and whether the case can be managed alone by orthodontic camouflage approach. The patient parameters used to assess the limits of orthodontic camouflage were recorded.
Results: Variable decision making patterns were observed among the clinicians with poor inter and intra - clinician agreement. Clinical experience and dental specialty did not significantly influence clinicians’ clinical decisions. However, a trend was observed with the percentages of oral surgeons indicating surgery substantially higher than the percentages of orthodontists. On the other hand, the percentages of orthodontists indicating camouflage were substantially higher than the percentages of oral surgeons. The study identified nine patient parameters most commonly used to assess whether a Class III malocclusion can be managed by orthodontic camouflage. Of all the parameters studied, molar relationship, gingival biotype and alveolar ridge thickness were more frequently used by the orthodontists but not the oral surgeons to make the assessment (p<0.05). ANB angle, Wits appraisal, maxillary - mandibular length ratio, molar relationship and soft tissue pogonion to zero meridian line were important parameters that influenced clinicians’ decision in determining the limits of orthodontic camouflage (p<0.05) in at least one of the Class III cases.
Conclusions: There were variable clinical decisions and generally little inter and intra - clinician agreement among the clinicians in managing borderline orthodontic - orthognathic surgery cases