Consistency of orthodontic extraction decisions

Ten orthodontists having completed specialist training, examined on two occasions 1 month apart, the complete pre-treatment records of 60 Class II division 1 patients representing the full range of dental malocclusion severity. At each session the orthodontist recorded whether their proposed treatment involved extractions. The level of agreement both between and within the orthodontists was evaluated with the Kappa statistic. Data analysis revealed that the level of agreement within the examiners was good, however the between examiner agreement was poor. It appeared that the orthodontists were applying different criteria in terms of the extraction decision and this has implications for orthodontic patients.