Orthodontists' views of justification for cost of orthognathic surgery

This study evaluated whether orthodontists' treatment of patients was influenced by their perception of the justification for the cost of orthognathic surgery.

A survey of 334 Canadian orthodontists was used to determine what factors influenced views of cost justification.

Approximately 80%, 49%, and 9% of orthodontists perceived cost of surgery to be justified for severely, moderately, and mildly compromised patients, respectively. Whether the compromise was functional or aesthetic did not particularly affect their views. Least experienced orthodontists were more likely than more experienced orthodontists to perceive cost of surgery as justified for patients with moderate functional compromise (P < .01). Most experienced orthodontists were more likely than less experienced orthodontists to perceive cost of surgery as unjustified for patients with moderate aesthetic compromise (P < .01). Orthodontists who did not believe cost of surgery to be justified for patients with mild or moderate compromise tended to recommend orthognathic surgery less frequently than camouflage orthodontics for borderline surgery patients (P < .05).

The findings suggest that costs may be contained by orthodontists rationing surgery on the basis of severity of facial skeletal malrelationship and perception of justification of cost. Less experienced orthodontists are less likely to contain costs for patients with moderate functional and aesthetic compromise. Most experienced orthodontists are less likely to contain costs for patients with severe functional compromise. Patient satisfaction may be affected by rationing, which affects the treatment approach and thus the outcome.