Prediction of final treatment for class III malocclusion of patients with oral clefts

To evaluate the value of predicted treatment plans interpreted from a previously developed Formula for Orthodontics and Surgery Prediction (FOSP) in patients with cleft lip and/or palate (CLP).

Orthodontic treatment records were collected of 105 non-syndromic CLP patients between the ages of 5 and 29 years, having Class III malocclusions of varying severity. Three cephalometric values from pre-treatment lateral cephalometric radiographs were determined for use with the FOSP. A receiver operating curve (ROC) was used to identify the optimal cut-off score for classifying predicted treatment needs, whether orthodontics alone or orthognathic surgery. The clinical merit of using the FOSP was determined by comparing predicted plans with actual treatments.

The predictive value using a cut-off score of 0.6475 from the FOSP-for recommending the final treatment provided--was correctly classified for 79 subjects (75.2%). Sensitivity and specificity of the FOSP for prediction of the need for orthognathic surgery were 68.1% (52.9%-80.9%) and 81.0% (68.6%-90.1%), respectively.

The FOSP can be used for early treatment prediction and counseling, and for more objectively specifying the type of orthodontic treatment for CLP patients. Other sources of information-such as evaluation of psychological and socioeconomic status, and patient's wishes-are still necessary for finalizing the treatment plan.