Peer Assessment Rating Index Research Articles

Using artificial intelligence to determine the influence of dental aesthetics on facial attractiveness in comparison to other facial modifications.

Facial aesthetics is a major motivating factor for undergoing orthodontic treatment. To ascertain-by means of artificial intelligence (AI)-the influence of dental alignment on facial attractiveness and perceived age, compared to other modifications such as wearing glasses, earrings, or lipstick. Forty volunteering females (mean age: 24.5) with near perfectly aligned upper front teeth [Aesthetic Component scale of the Index of Orthodontic Treatment Need (AC-IOTN) = 1 and Peer Assessment Rating Index (PAR Index) = 0 or 1] were photographed with a standardized pose while smiling, in the following settings (number of photographs = 960): without modifications, wearing eyeglasses, earrings, or lipstick. These pictures were taken with natural aligned dentition and with an individually manufactured crooked teeth mock-up (AC-IOTN = 8) to create the illusion of misaligned teeth. Images were assessed for attractiveness and perceived age, using AI, consisting of a face detector and deep convolutional neural networks trained on dedicated datasets for attractiveness and age prediction. Each image received an attractiveness score from 0 to 100 and one value for an age prediction. The scores were descriptively reviewed for each setting, and the facial modifications were tested statistically whether they affected the attractiveness score. The relationship between predicted age and attractiveness scores was examined with linear regression models. All modifications showed a significant effect (for all: P < 0.001) on facial attractiveness. In faces with misaligned teeth, wearing eyeglasses (-17.8%) and earrings (-3.2%) had an adverse effect on facial aesthetics. Tooth alignment (+6.9%) and wearing lipstick (+7.9%) increased attractiveness. There was no relevant effect of any assessed modifications or tooth alignment on perceived age (all: <1.5 years). Mean attractiveness score declined with predicted age, except when wearing glasses, in which case attractiveness was rated higher with increasing predicted age. Alignment of teeth improves facial attractiveness to a similar extent than wearing lipstick, but has no discernable effect on perceived age. Wearing glasses reduces attractiveness considerably, but this effect vanishes with age.

American Board of Orthodontics (ABO) Discrepancy Index and peer assessment rating (PAR) index with models versus photographs

BackgroundThe objectives of this study were to determine whether rating systems, such as the Peer Assessment Rating (PAR) and the American Board of Orthodontics Objective Grading System (ABO-OGS) can be applied to intraoral photographs. MethodsModels and photographs of 50 cases were graded by 4 raters, and a 20% repeat of randomized cases was completed 2 weeks later. Intraclass correlation coefficients (ICCs) were used to assess inter- and intra-rater agreements, as well as the level of agreement between the ratings on models and photographs. ResultsThe intra- and inter-rater agreements were considered good to excellent. The paired mean difference (model minus photo) for the PAR index and the ABO Discrepancy Index as a total was 2.405 and 1.156, respectively. Overjet was the subdomain that produced the highest differences between photos and models. The ABO- Discrepancy Index method on photographs was more reliable than the PAR index when grading pre-treatment and more-severe malocclusions. ConclusionsBoth methods can be used, but the choice depends on the purpose of the evaluation, and on consideration of the weaknesses and strengths of each relating to its use on photographs.

Quality of Life Before and After Orthodontic Treatment in Adult Patients with Malocclusion: A Quasi-experimental Study

Introduction: In adult patients seeking orthodontic treatment, some common reasons include unesthetic appearance and functional impairment such as difficulty in speaking or breathing. Thus, malocclusion and orthodontic care have become a Quality of Life (QoL) issue. Aim: To investigate the oral health-related quality of life in adults before and after orthodontic treatment. Materials and Methods: This quasi-experimental study was conducted in Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore, India over a 2 year period from December 2014 to October 2016. Finally, 34 patients were included in the study. Longitudinal data which included OHRQoL(Oral Health-Related Quality of Life) and study casts for assessing the outcome by the Peer Assessment Rating (PAR) index was collected from two periods: (i) pretreatment data (T1), and (ii) post-treatment data (T2) collected 1 month after fixed orthodontic appliance debonding. Pretreatment and post-treatment Oral Health Impact Profile (OHIP-14) and PAR scores were compared using Paired t-test. Correlations between occlusal indices (PAR) and OHRQoL (OHIP-14) were determined by Spearman’s rank correlation coefficient. Results: Total of 42 patients were included in the study, out of which 34 patients responded to the questionnaire in which 11 were males and 23 females in the age range 18-30 years. From pre to postorthodontic treatment mean OHIP-14 summary score had significantly improved (score reduced) from 30.3 to 16.0. Similarly, mean PAR scores had reduced from 17.62 to 3.44. Significant correlation (p-value<0.05) existed between improvement in OHRQoL scores and improvement in occlusion after orthodontic treatment. Conclusion: The present study concluded that there was an improvement in oral health following fixed orthodontic treatments which were associated with changes in OHRQoL, PAR scores and changes in occlusion.

Does quality of orthodontic treatment outcome influence post-treatment stability? A retrospective study investigating short-term stability 2 years after orthodontic treatment with fixed appliances and in the presence of fixed retainers.

The present study aimed to evaluate stability 2years after orthodontic treatment and to investigate the influence of various pre-treatment and post-treatment prognostic factors on stability. Consecutive patients treated with full fixed appliance and retained with fixed retainers were retrospectively assessed for eligibility. Digital models were analysed at treatment start (T0), end of treatment (T1) and 2years post-treatment (T2). The Peer Assessment Rating (PAR) index, Little's Irregularity Index (LII), arch width and length, overjet, overbite and presence of unexpected post-treatment changes were assessed. Multiple regression analyses were conducted to model the relationship of all outcomes with several prognostics simultaneously. The sample consisted of 287 subjects (mean treatment time: 25.1months, standard deviation [SD] 7.5; mean post-treatment follow-up: 27.5months, SD 6.1) with a mean weighted PAR score of 29.5 (SD 8.6) at T0, 1.8 (SD 2.9) at T1 and 3.2 (SD 3.6) at T2. At T1, 95% of the subjects had a perfect LII versus 86% at T2. An increased LII at T1 correlated with increased LII and PAR changes from T1 to T2. PAR at T1 as well as overjet at T0 was a significant prognostic factor for PAR at T2. At T2, five cases (1.7%) showed unexpected post-treatment changes related to fixed retainers. Short-term post-treatment stability with fixed retainers was very good. Prognostic factors for stability included LII and PAR at T1, suggesting that high-quality treatment outcome in the presence of fixed retainers may ensure post-treatment stability.

Malocclusion severity and its associations with oral health-related quality of life in an adult population.

SummaryAimThe aim of this study was to investigate malocclusion severity and its associations with oral health-related quality of life (OHRQoL) among middle-aged adults.Materials and methodsThe study material consisted of 1786 subjects from the Northern Finland Birth Cohort 1966 who attended dental and oral examination as part of the 46-year-old follow-up study. Malocclusion severity was assessed using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating index (PAR) from digital 3D dental models. Participants also answered a questionnaire including the Oral Health Impact Profile (OHIP-14) and a question on their satisfaction with occlusal function. Differences between malocclusion severity groups were evaluated for both genders separately. For adjusted models, multivariate Poisson regression models were conducted.ResultsIn this study population, 31.3% had great or very great orthodontic treatment need according to DHC and the mean PAR total score was 22.05. The most severe malocclusions were associated with OHRQoL, especially the psychosocial and handicap dimensions, and satisfaction with occlusal function. There was a significant difference between genders, men having more severe malocclusion but women reporting more OHRQoL impacts.ConclusionOne third of the study population were considered to have severe malocclusion. There was an association between malocclusion severity and OHRQoL in adult population, particularly in women.

Comparison of 2 Invisalign tray generations using the Peer Assessment Rating index

This study aimed to establish if there is a significant difference in effectiveness between 2 generations of Invisalign trays in terms of Peer Assessment Rating (PAR) score reduction for finished patients from a graduate orthodontic clinic. Forty-five pretreatment and posttreatment patients treated with the previous Invisalign material and 49 pretreatment and posttreatment patients treated with SmartTrack material were scored using the Peer Assessment Rating (PAR) index. Both groups were controlled for initial weighted PAR score, age, gender, and treatment time. The 2 generations were compared in regard to absolute reduction, percent reduction, and great improvement in PAR score. The mean absolute reduction in weighted PAR score between the groups was not statistically significant (P=0.526). The mean percent reduction in weighted PAR score between the groups was not statistically significant (P=0.210). The proportion of great improvement between the groups was not significant (P=0.526). Only 6 of the 8 components of occlusion had enough variation to be modeled. An absolute reduction in unweighted PAR score was not significantly different between the groups for maxillary anterior alignment, overjet, or mandibular anterior alignment (P=0.996, 1.000, and 0.114, respectively). Percent reduction in unweighted PAR score was not significantly different between the 2 groups for an anteroposterior, overbite, or transverse (P=1.000, 1.000, and 1.000, respectively) relationships. Our study indicates that both generations of Invisalign aligners improved the malocclusion to a similar degree according to the PAR index. Patient-centric benefits of SmartTrack aligner should also be considered by the provider.

Patient reported experiences and treatment outcomes of orthodontic patients treated within secondary care settings in the South West of England during the COVID-19 pandemic.

To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic. Two-phase multicentre service evaluation. Secondary care orthodontic departments in the South West of England. Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic. A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days. During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.

Malocclusion and oral health-related quality of life among young Danish adults. Is there a difference between subjects who received orthodontic treatment during adolescence and subjects without treatment need? A cross-sectional study

Objectives To evaluate and compare malocclusion traits and oral health-related quality of life (OHRQoL) between untreated young adults assessed to have no orthodontic treatment need during childhood, and young adults treated orthodontically during childhood. In addition, to investigate the relationship between malocclusion and OHRQoL. Materials and methods One hundred undergraduate students were screened for eligibility. Subjects had intraoral scans and completed OHIP-14 questionnaires. Angle molar relationship, overjet, overbite, arch length and width, Little's Irregularity Index (LII), Peer Assessment Rating (PAR) index and Dental Aesthetic Index (DAI) scores were assessed. Unpaired t-tests were used to compare outcomes between treated and untreated subjects. Multiple regression analyses were conducted to model the relationship between OHIP-14 and several prognostics simultaneously. Results Ninety-six subjects were included (mean age ± SD = 23.7 ± 1.8 years): 41 treated and 55 untreated. The untreated subjects had significantly higher LII (p = .02), PAR (p = .01), DAI (p < .01) and overbite (p = .03). The treated subjects had significantly larger inter-canine and inter-premolar distances. No relationship was found between OHIP-14 and LII, PAR, DAI, age, gender and presence/absence of previous orthodontic treatment. However, the DAI score was significantly correlated with the OHIP-14 functional limitation domain. Conclusions Untreated subjects had significantly higher LII, PAR and DAI scores than the treated subjects. DAI score was significantly correlated with the OHIP-14 functional limitation domain.

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

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.

Measuring orthodontic treatment impact: Description or judgment, challenge or result

Determination of improvement in orthodontic treatment may depend on the measurement method used and the purpose. Improvement after orthodontic treatment (from T1 to T2 [beginning to end of treatment]) was assessed 3 ways from a set of 98 patient records: (1) calculated by subtracting judges' assessments at T2 from T1 for records presented in random order, (2) judged as a holistic impression viewing T1 and T2 records side by side, and (3) determined from proxies (American Board of Orthodontics Discrepancy Index, the American Board of Orthodontics Objective Grading System, and the Peer Assessment Rating index). High levels of intramethod consistencywere observed, with intraclass correlation coefficient clustering around an intraclass correlation coefficient of 0.900, and distributions were normal. Calculated and judged improvements correlated at r=0.606. Calculated or judged improvements were correlated at a lower level with proxies. Calculated improvement was significantly associated with "challenge" (T1) scores and judged improvement associated with "results" (T2) scores. Common method bias was observed, with higher correlations among similar indexes than among indexes at the same time that used various methods. Relative to differences in Peer Assessment Rating scores, calculated improvement overestimated low scores and underestimated high ones. The same effect, but statistically greater, was observed using direct judgment of improvement. These findings are consistent with decision science and measurement theory. In some circumstances, such as third-party reimbursement and research, operationally defined measures of occlusion are appropriate. In practice, the determination of occlusion and improvement are best performed by judgment that naturally corrects for biases in proxies and incorporates background information.

Validity and Reproducibility of the Peer Assessment Rating Index Scored on Digital Models Using a Software Compared with Traditional Manual Scoring.

The aim of this study was to assess the validity and reproducibility of digital scoring of the Peer Assessment Rating (PAR) index and its components using a software, compared with conventional manual scoring on printed model equivalents. The PAR index was scored on 15 cases at pre- and post-treatment stages by two operators using two methods: first, digitally, on direct digital models using Ortho Analyzer software; and second, manually, on printed model equivalents using a digital caliper. All measurements were repeated at a one-week interval. Paired sample t-tests were used to compare PAR scores and its components between both methods and raters. Intra-class correlation coefficients (ICC) were used to compute intra- and inter-rater reproducibility. The error of the method was calculated. The agreement between both methods was analyzed using Bland-Altman plots. There were no significant differences in the mean PAR scores between both methods and both raters. ICC for intra- and inter-rater reproducibility was excellent (≥0.95). All error-of-the-method values were smaller than the associated minimum standard deviation. Bland-Altman plots confirmed the validity of the measurements. PAR scoring on digital models showed excellent validity and reproducibility compared with manual scoring on printed model equivalents by means of a digital caliper.

Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate.

To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate. Retrospective assessment using the Peer Assessment Rating (PAR) index. Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center. One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances. Fixed orthodontic appliance treatment and orthognathic surgery when required. The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs. One hundred two patients' study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments. These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.

Temporomandibular disorders in prospective orthodontic patients.

To determine the prevalence and severity of temporomandibular disorders (TMDs) in prospective orthodontic patients. The association between TMDs and malocclusion severity as well as the impact of TMDs on oral health-related quality of life (OHRQoL) were also examined. A total of 350 consecutive patients seeking orthodontic treatment were invited to participate in the study. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), while malocclusion severity and OHRQoL were evaluated using the Peer Assessment Rating (PAR) index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data were analyzed using chi-square, Kruskal-Wallis, and Mann-Whitney U tests and Spearman's correlation (P < .05). Of the 350 patients, 164 consented to participation. Data from 26 participants were excluded because of incomplete entries, and that from 138 subjects (mean age 21.02 ± 5.45 years) were examined. TMD-related symptoms were present in two-thirds of the subjects, with 20.3% experiencing moderate/severe TMDs. While no significant difference in PAR scores were observed between the group with no TMDs and those with TMDs, subjects with TMDs had significantly higher OHIP-14 summary/domain scores than those without TMDs. Although a moderately strong correlation was observed between the FAI and summary OHIP-14 scores (rs = 0.57), no association was observed between FAI and PAR index scores. The prevalence of TMD-related symptoms in prospective orthodontic patients was high, emphasizing the importance of screening the masticatory system before initiating orthodontic therapy. Although the presence of TMDs was not associated with malocclusion severity, it had a significant negative impact on OHRQoL.

Cancer survivors present significantly lower long-term stability of orthodontic treatment: a prospective case-control study.

SummaryBackground/ObjectivesThe aim of the study was to compare the stability of orthodontic treatment in cancer survivors who had been treated with cytotoxic drugs with a generally healthy control group.Materials/MethodsThe study included 52 cancer survivors treated orthodontically and 52 healthy control subjects matched for age, gender, and malocclusion. The weighted Peer Assessment Rating (w-PAR) index, the Index of Complexity, Outcome and Need (ICON) were assessed before treatment, after the treatment, and at the 3-year follow-up. Patients Satisfaction Score was assessed after the treatment and at the 3-year follow-up. A repeated analysis of variance test was used to check the statistical significance between the scores.ResultsIdeal occlusion was achieved in all patients. The mean w-PAR and ICON values were significantly reduced in both groups after the end of the orthodontic treatment with no significant differences between the groups regarding the obtained results. However, after the 3-year follow-up, only the cancer survivors’ group presented statistically significant (P < 0.001) increase of the w-PAR and ICON values comparing to the values obtained at the end of the treatment. There was no significant change in Patients’ Satisfaction Score within 3 years after treatment.LimitationsThe limited size of the study sample as well as different types of oncological diagnoses could have had an impact on the final results of the study.Conclusions/ImplicationsPrevious cytotoxic drug treatment significantly decreases the stability of orthodontic treatment among the cancer survivors, particularly within first 12 months after the end of the treatment.

Orthodontic Treatment and Healthcare Goals: Evaluation of Multibrackets Treatment Results Using PAR Index (Peer Assessment Rating).

Background: The evaluation of orthodontic treatment outcomes using an objective method is important in order to maintain high treatment quality and final healthcare of patients. It allows professionals and university students to raise the level of the therapy. The aim of this study was to assess the orthodontic treatment outcomes in an Italian postgraduate School of Orthodontics using Peer Assessment Rating (PAR) Index. Methods: A sample of 50 patients treated in a postgraduate program was randomly selected. PAR index was used to assess pre-treatment and post-treatment study casts by two different examiners. The influence of different variables such as gender, treatment method, and need for extraction was statistically analyzed. Results: The average numerical reduction of PAR between the beginning and the end of the treatment was 18.74 (CI 95% 16.53–20.95), while the percentage reduction was 94.8% (CI 95% 91.91–97.68). All cases improved: 8% of patients resulted in the improved category, while 92% of them were in the greatly improved group. Conclusions: According to PAR index, the results showed that patients received a high-standard therapy. None of the factors studied influenced significantly the treatment outcomes.

Factors associated with the stability of compensatory orthodontic treatment of Class III malocclusion in the permanent dentition

This study aimed to assess the stability of compensatory treatment of Class III malocclusion in permanent dentition. Thirty-six patients (21 women and 15 men; mean age, 20years) with Class III malocclusion were subjected to the compensatory treatment of permanent dentition and followed up for at least 3years after orthodontic treatment (T3). Multivariate Poisson regression was performed to assess the influence of clinical, cephalometric, and dental cast variables at the beginning (T1) and the end of treatment on the stability of Class III malocclusion. Overjet changed from -0.25mm (-3 to 0.5mm) at T1 to 1.4mm (1-2.5mm) at the end of treatment and 0.8mm (0-1.5mm) at T3. Clinical relapse (overjet<1mm and/or canine Class III relations) was observed in 11 patients (30.6%). Patients treated with extraction of mandibular premolars (risk ratio [RR]=2.13×10-07, P<0.001), with better orthodontic end outcomes (RR=1.16, P=0.009) and which had lower maxillary incisor inclination at T1 (RR=1.08, P=0.035) showed a lower risk of relapse. Demographic (sex, age), clinical (length of treatment and posttreatment, number of treatment phases, time of Class III elastics), cephalometric (SNA, SNB, ANB, Wits appraisal, SNGoGn, IMPA), and dental cast (peer assessment rating index and arch dimensions) variables were not significantly associated with clinical relapse at T3. The stability of compensatory treatment of Class III malocclusion in permanent dentition is multifactorial, with few predictive variables. Patients treated with extraction and better orthodontic finishing had a lower risk of relapse, whereas larger maxillary incisor inclination at baseline increased the risk of relapse.

Outcome quality of Class II division 1 Herbst-multibracket appliance treatment: influence of pretreatment Class II severity and skeletal maturity.

No reliable predictive factors for treatment (Tx) success and outcome quality in Class II:1 Tx have been identified yet. To assess the influence of pre-Tx Class II severity and skeletal maturity on outcome quality after Herbst-multibracket appliance (MBA) Tx. All Class II:1 patients who completed Herbst-MBA Tx between 1986 and 2014 at University of Giessen, Germany. Pre-Tx (T0), post-Tx (T1), and (if available) post-retention (≥24 months; T2) study casts were evaluated using the Peer Assessment Rating (PAR) index and the Ahlgren scale. Three occlusal severity (mild, moderate, and severe) and four skeletal maturity (pre-peak, peak, post-peak, and adult) subgroup categories were defined. Four hundred eight-five patients (age at T0: 14.4 ± 3.2 years) could be evaluated; post-retention (T3) data were available for 230 patients. For the total sample, the median PAR score was 32.4 ± 8.85 at T0, 8.0 ± 4.52 at T1, and 8.8 ± 5.11 at T2. Very low correlations between the subgroup categories (occlusal severity/skeletal maturity) and PAR-score reduction were detected both during Tx (r = 0.12/r = 0.05) and the total observation period (r = 0.17/r = 0.03). The overall outcome quality according to Ahlgren was: 17.0% excellent, 34.8% good, 43.8% acceptable, 2.2% unacceptable, and 2.2% not assessable. The association with the subgroup categories was: p = 0.019 (occlusal severity)/p = 0.820 (skeletal maturity). Retrospective study design with follow-up data was not available from all subjects and no data from untreated controls. Tx was performed by several physicians using different kind of MBAs. Class II:1 Herbst-MBA Tx is an effective and successful Tx approach irrespective of pre-Tx skeletal maturity but dependent-to a certain extent-on Class II severity. Thus, when considering a Herbst appliance for Class II correction, neither of the two variables should considerably limit the indication.

Class II Division 1 malocclusion treatment with extraction of maxillary first molars: Evaluation of treatment and post-treatment changes by the PAR Index.

ObjectiveTo investigate occlusal result and post‐treatment changes after orthodontic extraction of maxillary first permanent molars in patients with a Class II division 1 malocclusion.Setting and SampleRetrospective longitudinal study in a private practice, with outcome evaluation by an independent academic hospital. Ninety‐six patients (53 males, 43 females) consecutively treated by one orthodontist with maxillary first permanent molar extraction were studied, divided into three facial types, based on pre‐treatment cephalometric values: hypodivergent (n = 18), normodivergent (n = 21) and hyperdivergent (n = 57).MethodsOcclusal outcome was scored on dental casts at T1 (pre‐treatment), T2 (post‐treatment) and T3 (mean follow‐up 2.5 ± 0.9 years) using the weighted Peer Assessment Rating (PAR) Index. The paired sample t test and one‐way ANOVA followed by Tukey's post hoc test were used for statistical analysis.ResultsPAR was reduced by 95.7% and 89.9% at T2 and T3, respectively, compared with the start of treatment. The largest post‐treatment changes were found for overjet and buccal occlusion. Linear regression analysis did not reveal a clear effect (R‐Square 0.074) of age, sex, PAR score at T1, incremental PAR score T2‐T1, overjet and overbite at T1, and facial type on the changes after treatment (incremental PAR score T3‐T2).ConclusionsThe occlusal outcome achieved after Class II division 1 treatment with maxillary first permanent molar extractions was maintained to a large extent over a mean post‐treatment follow‐up of 2.5 years. Limited changes after treatment were found, for which no risk factors could be discerned.

Long-term occlusal changes and patient satisfaction in patients treated with and without extractions: 37 years after treatment

The objective of this research was to evaluate the treatment outcomes, long-term occlusal changes, and patient satisfaction after 37years of nonextraction and extraction treatments. Fifty-seven patients with Class I and Class II malocclusion were divided into 2 groups. Group 1 included 16 patients treated with nonextraction therapy, with mean initial (T1), final (T2), and long-term posttreatment (T3) ages of 13.2, 15.0, and 50.3years, respectively. Mean treatment time (T2 - T1) and long-term follow-up time (T3 - T2) were 1.8 and 35.2years, respectively. Group 2 included 41 patients treated with extraction of 4 first premolars, with mean ages at T1, T2, and T3 of 13.3, 15.6, and 53.6years, respectively. Mean treatment (T2- T1) and long-term follow-up (T3 - T2) times were 2.3 and 37.9years, respectively. The Peer Assessment Rating (PAR) index and Objective Grading System (OGS) indexes were evaluated at T1, T2, and T3 stages. The subjects also answered an online questionnaire regarding esthetic and occlusal self-perception at T3. Intergroup comparison was performed with t tests. The PAR index improved with treatment and similarly worsened at T3 for both groups. OGS scores were close to the passing score at T2 for both groups. The nonextraction group presented worse OGS scores at T3 than the extraction group. Nonextraction patients perceived more changes in alignment over time, but overall satisfaction was similar. The PAR index improved with treatment, and the PAR and OGS scores showed a significant increase, indicating great occlusal changes in the long-term stage. The nonextraction group showed more occlusal changes and perceived more changes in their alignment over time, but overall patient satisfaction was similar in both groups.

Quality of Life Assessment in Patients with Malocclusion Undergoing Orthodontic and Orthognathic Treatment.

IntroductionThe objective of this study was to assess pre-treatment quality of life and the relevant clinical variables in adult patients with malocclusion in order to improve orthodontic treatment strategies.MethodsThe study was conducted in 240 consecutive adult patients with malocclusions divided into two groups: patients for whom an orthodontic treatment plan was considered, and patients for whom an orthognathic treatment plan was selected. Patients were examined between December 2015 and February 2017, at the School of Dental Medicine, University of Belgrade. Malocclusion severity was recorded using the Peer Assessment Rating index pre-treatment score. Skeletal malocclusion parameters were measured using lateral cephalometric radiographs. Quality of life was assessed by means of a generic questionnaire (Medical Outcomes Study Short Form-36 (SF-36)), and the disease-specific Orthognathic Quality of Life Questionnaire (OQLQ).ResultsThere were significant differences in the mean values of the OQLQ domain scores between orthodontic and orthognathic patients. Patients for whom orthodontic treatment was planned had statistically significantly lower scores in comparison to those for whom orthognathic treatment was planned. This was the case in all OQLQ domains except for “Awareness of facial deformity”. Statistically significant correlations (p<0.05) were presented between OQLQ scores and following demographic and clinical variables: gender, age, malocclusion severity, maxillary and mandibular sagittal, maxillary vertical, and lower incisor positions, intermaxillary angle, and the Beck Depression Inventory and Beck Anxiety Inventory levels. The independent predictors for the planning of orthodontic and orthognathic treatment in patients with malocclusion were two OQLQ domains, “Facial aesthetics” and “Awareness of facial deformity”, as well as total OQLQ score, after adjustment for demographic characteristics, skeletal parameters, anxiety and depression.ConclusionsOur findings suggest that patients for whom orthodontic treatment was planned demonstrated better quality of life according to the OQLQ scores in comparison to those for whom orthognathic therapy was planned.