Measuring orthodontic treatment impact: Description or judgment, challenge or result

Area of Science:

• Orthodontics
• Dental Research
• Clinical Measurement

Background:

• The assessment of orthodontic treatment success can be influenced by the chosen measurement methodology and its intended application.
• Objective measures and subjective evaluations are commonly used to gauge treatment effectiveness.

Purpose of the Study:

• To compare different methods for assessing improvement in orthodontic treatment.
• To evaluate the correlation between calculated, judged, and proxy-based assessments of orthodontic treatment outcomes.

Main Methods:

• Ninety-eight patient records were assessed using three distinct methods: calculation based on sequential judge scores, holistic side-by-side judgment, and proxy indices (American Board of Orthodontics Discrepancy Index, American Board of Orthodontics Objective Grading System, Peer Assessment Rating).
• Intramethod consistency was evaluated using intraclass correlation coefficients.
• Correlations between different assessment methods were analyzed.

Main Results:

• High intramethod consistency was found (intraclass correlation coefficient ≈ 0.900).
• Calculated and judged improvements showed moderate correlation (r = 0.606) but lower correlation with proxy indices.
• Method bias was evident, with similar index types showing higher correlations.
• Both calculated and judged improvements demonstrated systematic biases relative to the Peer Assessment Rating index, with judgment showing a greater effect.

Conclusions:

• While operationally defined measures are suitable for specific contexts like research or reimbursement, clinical judgment is superior for practical assessment of orthodontic occlusion and improvement.
• Clinical judgment inherently accounts for biases present in proxy measures and integrates broader contextual information.
• Findings align with decision science and measurement theory principles regarding subjective and objective assessments.