Adult orthodontic therapy: extraction versus non-extraction

Area of Science:

• Dentistry
• Orthodontics
• Clinical Decision-Making

Background:

• Randomization in treatment planning, particularly for irreversible procedures like tooth extraction, presents challenges.
• Clinician decision-making in orthodontics involves complex factors influencing treatment strategy.

Purpose of the Study:

• To analyze clinician agreement and disagreement on tooth extraction decisions and related treatment aspects.
• To investigate patterns of consensus and variability in orthodontic treatment planning.

Main Methods:

• A retrospective and prospective study involving 148 subjects with complete orthodontic records.
• Analysis of treatment decisions made by five independent clinicians regarding extraction, extraction patterns, orthognathic surgery, and Angle classification.
• Evaluation of inter-clinician agreement and disagreement rates.

Main Results:

• Strong consensus was observed among clinicians regarding the primary decision to extract teeth and the extraction pattern when indicated.
• Clinician agreement on the need for adjunctive orthognathic surgery was less pronounced, especially between adult and adolescent cohorts.
• Disagreements were more frequent concerning Angle classification than anticipated.
• Clinicians extracted teeth less frequently in adolescent cohorts compared to adult cohorts.

Conclusions:

• While clinicians generally agree on extraction necessity and patterns, variability exists in complex decisions like orthognathic surgery and classification.
• The findings highlight the influence of patient cohort (adult vs. adolescent) on treatment decisions.
• Generalizability of conclusions requires consideration of the assumptions inherent in clinical data analysis.