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The decision to extract: Part 1--Interclinician agreement
S Baumrind1, E L Korn, R L Boyd
1Department of Growth and Development, Radiology and Orthopedic Surgery, University of California, San Francisco, USA.
Summary
Orthodontic clinicians showed high agreement on extraction versus nonextraction treatment decisions for Class I and II malocclusions. Unexpectedly, many evaluations suggested orthognathic surgery might be needed, even after prescreening.
Area of Science:
- Dentistry
- Orthodontics
- Clinical Decision-Making
Background:
- Assessing clinician decision-making in orthodontic treatment planning is crucial for understanding treatment variability.
- Prospective clinical trials provide valuable data on treatment patterns and outcomes.
Purpose of the Study:
- To evaluate the decision-making patterns of orthodontic clinicians regarding extraction versus nonextraction treatment for Class I and Class II malocclusions.
- To assess clinician agreement on the need for orthognathic surgery as part of orthodontic treatment.
Main Methods:
- Prospective clinical trial involving 148 subjects (100 adolescents, 48 adults) with Class I or II malocclusions.
- Independent evaluation of each subject's records by five orthodontic faculty members, resulting in 740 total evaluations.
- Assessment of clinician agreement on extraction/nonextraction decisions and the potential need for orthognathic surgery.
Main Results:
- High agreement (nearly two-thirds) among clinicians on extraction versus nonextraction treatment modality.
- Complete agreement for extraction in 40% and nonextraction in 26% of cases; disagreement in 34%.
- Unexpectedly, 9% of evaluations indicated a probable or definite need for orthognathic surgery, particularly in adults (29%) and adolescents (23%), despite initial screening.
Conclusions:
- Clinician agreement on extraction vs. nonextraction is substantial for Class I and II malocclusions.
- A significant proportion of cases, even after prescreening, were identified as potentially requiring orthognathic surgery, highlighting treatment complexity.
- Further research is needed to understand the factors influencing these decisions and their impact on treatment outcomes.