Orthodontic camouflage: Authors’ response

Abstract

Our article emphasizes 2 things: 1.Adult Class II patients who are candidates for orthodontic treatment alone are, and must be, different from those selected for combined orthodontic treatment and orthognathic surgery. Milder problems can be treated with orthodontic retraction of protruding maxillary incisors, but severe problems require surgery to reposition at least 1 jaw. It would be unethical to set up a study in which Class II patients were assigned at random to surgery or orthodontic treatment. No review committee would approve such a project, and it is highly unlikely that patients would consent to random assignment. The patients in this study were offered surgical or orthodontic treatment as deemed appropriate by clinical faculty at UNC, using their best judgment as to whether orthodontic treatment alone would succeed. No patient who required surgery for a satisfactory outcome had orthodontic treatment instead, and as we document in the article, the surgery patients had more severe problems.2.The long-term (>5 year) outcome of orthodontic treatment alone can and should be evaluated in the same way as the long-term outcome of surgical treatment. This requires 2 types of data: dental and skeletal stability, and the patients’ evaluation of the outcome. At this point, the long-term stability of surgical treatment is better documented in the literature than orthodontic outcomes, and patient perceptions rarely have been studied as an outcome of orthodontic treatment. Our study shows that these orthodontics-only patients, who were selected for that treatment based on the characteristics of their problems, compare favorably with the surgery patients from both perspectives.There are 2 extreme views of orthodontic camouflage of Class II problems in patients who are too old for successful growth modification. The first, to which Dr Kessel seems to subscribe, holds that, unless nonextraction orthodontic treatment would be satisfactory, surgery is the only appropriate treatment. The second, best labeled as the self-serving insurance-company fallacy, is that moving teeth to better occlusion is satisfactory treatment for any patient, regardless of skeletal characteristics. Neither of the extreme views is correct.With the strong emphasis many clinicians have placed recently on nonextraction orthodontic treatment, however, perhaps it is useful to note the successful long-term outcome of orthodontic extraction in well-selected Class II patients. Our article emphasizes 2 things: 1.Adult Class II patients who are candidates for orthodontic treatment alone are, and must be, different from those selected for combined orthodontic treatment and orthognathic surgery. Milder problems can be treated with orthodontic retraction of protruding maxillary incisors, but severe problems require surgery to reposition at least 1 jaw. It would be unethical to set up a study in which Class II patients were assigned at random to surgery or orthodontic treatment. No review committee would approve such a project, and it is highly unlikely that patients would consent to random assignment. The patients in this study were offered surgical or orthodontic treatment as deemed appropriate by clinical faculty at UNC, using their best judgment as to whether orthodontic treatment alone would succeed. No patient who required surgery for a satisfactory outcome had orthodontic treatment instead, and as we document in the article, the surgery patients had more severe problems.2.The long-term (>5 year) outcome of orthodontic treatment alone can and should be evaluated in the same way as the long-term outcome of surgical treatment. This requires 2 types of data: dental and skeletal stability, and the patients’ evaluation of the outcome. At this point, the long-term stability of surgical treatment is better documented in the literature than orthodontic outcomes, and patient perceptions rarely have been studied as an outcome of orthodontic treatment. Our study shows that these orthodontics-only patients, who were selected for that treatment based on the characteristics of their problems, compare favorably with the surgery patients from both perspectives. There are 2 extreme views of orthodontic camouflage of Class II problems in patients who are too old for successful growth modification. The first, to which Dr Kessel seems to subscribe, holds that, unless nonextraction orthodontic treatment would be satisfactory, surgery is the only appropriate treatment. The second, best labeled as the self-serving insurance-company fallacy, is that moving teeth to better occlusion is satisfactory treatment for any patient, regardless of skeletal characteristics. Neither of the extreme views is correct. With the strong emphasis many clinicians have placed recently on nonextraction orthodontic treatment, however, perhaps it is useful to note the successful long-term outcome of orthodontic extraction in well-selected Class II patients.