Quality of orthodontic care-Amulticenter cohort study in Germany : Part1: Evaluation of effectiveness of orthodontic treatments and predictive factors.

I Graf,K Reck,U Schumann,T Bartzela,K Höfer,H Christ,D Wiechmann,S Ruf,N C Bock,B Braumann,U Fritz,V Röper,P.-G Jost-Brinkmann,M Wolf

doi:10.1007/s00056-021-00304-3

Abstract

AimsOrthodontic care and its effectiveness have increasingly become the focus of political and public attention in the recent past. Therefore, this multicenter cohort study aimed to report about the effectiveness of orthodontic treatments in Germany and to identify potential influencing factors.MethodsA total of 586 patients from seven German study centers were screened for this cohort study, of which 361 patients were recruited at the end of their orthodontic treatment. Of these, 26 patients had missing study models and/or missing treatment information. Thus, 335 participants were included. The severity of malocclusion was rated using the Peer Assessment Rating (PAR) Index at baseline (T0) retrospectively and—prospectively—after the retention period (T1). Practitioner-, treatment- and patient-related information were analyzed in order to detect potential predictive factors for treatment effectiveness.ResultsStudy participants (202 female and 133 male) were on average 14.8 (standard deviation [SD] ± 6.1) years old at start of active treatment. Average PAR score at T0 was 25.96 (SD ± 10.75) and mean posttreatment PAR score was 3.67 (SD ± 2.98) at T1. An average decrease of total PAR score by 22.30 points (SD ± 10.73) or 83.54% (SD ± 14.58; p < 0.001) was detected. Furthermore, 164 treatments (49.1%) were categorized as ‘greatly improved’ but only 3 treatments (0.9%) as ‘worse or no different’; 81.5% of all cases finished with a high-quality treatment outcome (≤5 PAR points at T1). Logistic regression analyses detected staff experience as a significant predictive factor for high-quality results (odds ratio 1.27, p = 0.001, 95% confidence interval 1.11–1.46).ConclusionThe improvement rate among this selected German cohort indicated an overall very good standard of orthodontic treatment. Staff experience proved to be a predictive factor for high-quality results.

Highlights

Orthodontic care and especially its effectiveness have increasingly become the focus of political and public attention in the recent past
The IGES report came to the conclusion that the dental health benefits of orthodontic treatments currently lack evidence which in turn is no proof against such benefits [15]
Since this study aimed to evaluate a variety of aspects of the quality of orthodontic care in Germany, we included performer-specific variables, i.e., staff experience in years and treatment at a university hospital/private orthodontic practice

Summary

Introduction

Orthodontic care and especially its effectiveness have increasingly become the focus of political and public attention in the recent past. According to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2) by the Robert Koch Institute with a cohort of 15,023 children and adolescents, 25.8% of all 3- to 17-year-old girls and 21.1% of all 3- to 17year-old boys were in active orthodontic treatment between the years 2014 and 2017. During this time span, 13-yearold girls and 14-year-old boys underwent orthodontic treatment most frequently (55.0% and 50.8%, respectively). Population-based data about orthodontic treatment in Germany along with its outcome and effectiveness are lacking

Methods

Results

Conclusion