Peer Assessment Rating Scores Research Articles

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.

Peer Assessment Rating (PAR) scoring of cleft patients treated within a regional cleft centre in the United Kingdom.

To assess static occlusal outcomes for patients with cleft lip and/or palate (CLP) and cleft palate (CP) managed within a UK Regional Cleft Service and to compare with previously published Peer Assessment Rating (PAR) scores from a non-cleft population of patients treated within a UK consultant-led hospital service. Retrospective multicentre study. Eight orthodontic hospital units within the Spires Cleft Service, UK. Patients born with CLP or CP between 1985 and 1995 treated within the service. Patients were assigned to groups by cleft type and whether they were treated by orthodontics only or a combination of orthodontics and orthognathic surgery. PAR was recorded before and after treatment from study models. Data were collected for 171 patients included in the study. Median pre-treatment PAR was 42 and post-treatment 11. Median percentage change in PAR for all patients was 73%, although 12% of cleft patients had a PAR improvement that was worse or no different. Median change in PAR score was 71% for those treated with orthodontics only and 83% for those who had an osteotomy. Median PAR improvement for those treated with orthodontics only was 73% in the cleft lip group, 77% in the CP group, 66% in the unilateral CLP group and 53% in the bilateral CLP group. Median pre- and post-treatment PAR for the cleft group was higher and PAR reduction lower than those published for non-cleft patients. These data demonstrate high severity of malocclusion, complexity of orthodontic treatment and difficulty in achieving an ideal static occlusion for cleft patients. If PAR is to be used to assess orthodontic outcomes in cleft patients the findings of this study should be considered. A higher proportion of cases are likely to be classed as 'worse or no different', and a lower percentage change will be expected.

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.

Efficiency and outcome quality of Herbst-Multibracket appliance therapy in Class II:2 patients.

The aim of this retrospective investigation was to generate representative data on the efficiency and outcome quality of Class II:2 Herbst-Multibracket appliance (Herbst-MBA) treatment. All Class II:2 patients who had started Herbst-MBA treatment at the study centre since 1986 were included. Study casts from before treatment, after Herbst-MBA treatment, and (if available) after ≥24 months of follow-up were evaluated using standard occlusal variables, the Peer Assessment Rating (PAR)-Index, and the Ahlgren-Scale. During treatment, the pre-treatment PAR score was reduced from 23.6 ± 7.66 to 5.6 ± 3.85 (n = 192); during the follow-up period, a slight increase to 6.0 ± 3.60 occurred (n = 127). The percentage of patients who could be assigned to the PAR category 'greatly improved' was 30% after treatment and 33% after follow-up; only 1%, respectively, 2% had to be assigned to the category 'worse/no different'. The outcome ratings according to the Ahlgren-Scale revealed 20% excellent, 32% good, 46% acceptable, and 2% unsuccessful results. Retrospective study design with follow-up data not available from all subjects and no data from untreated controls. Herbst-MBA is an efficient treatment approach in orthodontic care of Class II:2 malocclusions. High-quality results (mean/median PAR score: 5.6/5.0) with very good short-term stability (2.2 years' follow-up) were achieved. Unfortunately, no appropriate control group or groups, where other treatment approaches had been applied, exist.

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.

A cross-sectional evaluation of the impact of Class II Division 1 malocclusion in treated and untreated adolescents on oral health–related quality of life

The relationship between malocclusion, orthodontic treatment, and oral health-related quality of life (OHRQOL) is complicated, with some traits, such as increased overjet, having a potentially greater adverse effect on an adolescent's OHRQOL. The aim of this study was to evaluate the impact of malocclusion and orthodontic treatment on OHRQOL in adolescents presenting with Class II Division 1 malocclusion and explore the relationship between OHRQOL using a condition-specific and generic instrument and occlusal outcome. Two groups of adolescents were recruited from a United Kingdom university hospital: a pretreatment group of adolescents with Class II Division 1 malocclusion and a treated (posttreatment) group whose Class II Division 1 malocclusion had been corrected. Self-reported OHRQOL was assessed using the malocclusion impact questionnaire (MIQ) and the short form of Child Oral Health Impact Profile questionnaires. Occlusion severity and outcome were assessed using Peer Assessment Rating scores. A total of 241 participants (106 male; 135 female) were recruited. MIQ scores differed significantly between the pretreatment and posttreatment groups, with scores being 11.35 times lower posttreatment than pretreatment, after adjusting for age and sex (95% confidence interval, -17.28 to -5.42; P<0.001). Females had higher total MIQ scores by 2.6 (95% confidence interval, 0.38 to 4.82), which was statistically significant (P=0.022). There was a moderate correlation between MIQ and Peer Assessment Rating scores, but this relationship strengthened when omitting the global MIQ questions (Spearman's correlation coefficient, 0.59). Increased overjet was associated with impaired OHRQOL using a condition-specific measure. A deeper understanding of associations between malocclusion, orthodontic treatment, and OHRQOL would benefit from longitudinal evaluation.

Does observational study on the effectiveness of the Twin Blocks overestimate or underestimate the results? A comparative analysis of retrospective samples versus randomized controlled trial

Class II malocclusion is one of the most common orthodontic problems. The Twin Block appliance has proven to be the most popular appliance for the correction of these malocclusions. Although randomized controlled trials (RCTs) on the Twin Block appliance have reported the changes to be mainly dentoalveolar, several nonrandomized studies have reported a significant skeletal improvement in these patients. Hence, the aim of this study was to compare the effectiveness of Twin Block appliance evaluated using an RCT or retrospectively selected cases (RSC) for the treatment of Class II Division 1 malocclusion in an adolescent population. This was a retrospective study. The results for an RCT were selected from a UK Class II multicenter study. Sixty-three patients from the trial were included. This group was matched with retrospectively selected Class II cases treated with a Twin Block functional appliance and their results submitted for Membership in Orthodontics examination in the United Kingdom, from four centers. The primary outcome was skeletal measurement ANB (A point, nasion, B point). Secondary outcomes included final peer assessment rating (PAR) scores and final overjet. Intrarater reliability of measurements was assessed. Independent samples t-test was carried out to look at the difference between the groups. The reliability assessment showed excellent agreement for all measurements. The data were normally distributed. There was a statistically significant difference favoring the RSC group for final overjet (mean difference [MD]=1.068, 95% confidence interval [CI] -0.67 to 1.47, P=0.000) and final PAR (MD=4.0, 95% CI -0.79 to 5.5, P=0.000). There was no significant difference in the scores for final ANB (MD=0.34, 95% CI -0.39 to 1.07, P=0.33). The RSCs show significantly improved overjet and PAR scores at the end of treatment and no statistically significant difference for skeletal change. The study raises the question of a potential role of observational studies in evaluating the effect of an intervention in orthodontics.

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.

Occlusal and Functional Improvement of Patients With Midfacial Hypoplasia Corrected Using Intraoral Tooth-Borne Mid-Maxillary Osteodistractors at Teaching Hospital-Karapitiya, Sri Lanka

Mid-maxillary osteodistraction (MMOD) is a novel technique. This study seeks to assess the occlusal and functional improvement of patients with midfacial hypoplasia secondary to cleft lip and palate. This was done as a retrospective study at the Regional Cleft Centre of the Teaching Hospital-Karapitiya (THK). A total of 81 patient records were accessed on those who underwent MMOD with a tooth-borne intraoral device from January 1, 2007, to December 31, 2016, at THK. Records of the patients included pre- and post-treatment lateral cephalograms, study models, speech assessments, and photographs. An advancement ranging from 5 to 12 mm (mean, 8.14 mm) was achieved in all patients; 80% (n = 63) and 87.65% (n = 71) showed improvement in consonant production and quality of speech. These were statistically significant (P < .05). With regard to the Peer Assessment Rating score assessing the occlusal improvement, 97.6% showed an improvement whereas only 2 patients showed no improvement. There was a significant improvement in sella (S), nasion (N), and point A (SNA) angle; point A, the nasion, and point B (ANB) angle; and the maxillary length over the treatment period (P < .05). The change in the ANB angle and maxillary length significantly differed between genders with males having a comparatively higher improvement. The profile improvements were noteworthy on the profile photographs. This relatively novel approach to maxillary advancement by maxillary distraction using a combined surgical and modified orthodontic technique has proven to be successful. This protocol and the technique have improved function, occlusion, and the aesthetics.

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.

Occlusal characteristics in facial pain cases and controls – 12-year follow-up of the Northern Finland Birth Cohort (NFBC) 1966

ABSTRACT Objective: The purpose of this study was to investigate the occlusal characteristics in Finnish adults at 12-year follow-up based on the Northern Finland Birth Cohort 1966 (NFBC1966) subjects. Methods: The occlusal analyses were performed at ages 34 and 46 years of facial pain cases (n = 52) and controls (n = 49) by two different methods. Results: At 12-year follow-up, a significant decrease in upper anterior segment peer assessment rating (PAR) score was found in the controls, indicating improvement in teeth alignment. In facial pain cases, left lateral occlusal relationship and midline asymmetry were significantly decreased. Occlusal asymmetry and overjet were significantly increased. In controls, the left canine showed a more normal occlusal relationship, cuspid asymmetry was changed, and midline asymmetry was significantly decreased. Conclusion: During a 2-year period, occlusal asymmetry and overjet increased significantly in facial pain cases, while occlusal relationship showed more normal characteristics in controls.

A comparison of conventional vs automated digital Peer Assessment Rating scoring using the Carestream 3600 scanner and CS Model+ software system: A randomized controlled trial

A prospective randomized study was undertaken to compare conventional study model-based manual Peer Assessment Rating (PAR) scoring with computer-based automated scoring using scanned study models or intraoral scanning. The sample consisted of 67 patients, mean age 15.03 (range 11-37) years. Sixty-seven patients underwent alginate impression-taking and intraoral scanning (CS 3600; Carestream Dental, Stuttgart, Germany) at a single appointment in a randomized order. For each patient, a weighted PAR score was calculated manually by a calibrated examiner using study models and a PAR ruler (conventional group), and automatically using Carestream Dental CS Model+software and data from scanned study models (indirect digital group) or intraoral scans (direct digital group). All procedures were timed, and each patient completed a binary questionnaire relating to their experience. There were no significant differences between methods for calculated mean weighted PAR score (P=0.68). Mean (standard deviation) chairside time for impression-taking was 5.35 (± 1.16) minutes and for intraoral scanning, 7.76 (± 2.76) minutes (P<0.05). Mean (standard deviation) times taken to calculate weighted PAR scores were 2.86 (± 0.96), 5.58 (± 2.33), and 4.58 (± 2.18) minutes for conventional, indirect digital, and direct digital groups, respectively (P>0.05). A total of 61 patients (91%) preferred intraoral scanning to impression-taking. Automated PAR scoring using cast study models or intraoral scanning is valid, though both methods take longer than conventional scoring. Patients prefer intraoral scanning to impression-taking. ClinicalTrials.gov (NCT03405961). The protocol was not published before study commencement.

Assessment of orthodontic treatment outcome using Peer Assessment Rating (PAR) index among patients with non-syndromic unilateral cleft lip and palate.

OBJECTIVE:To evaluate the orthodontic treatment outcome among patients with non-syndromic unilateral cleft lip and palate using the Peer Assessment Rating (PAR) index.MATERIALS AND METHODS:The retrospective study comprised a sample of 80 patients with unilateral cleft lip and palate (39 males and 41 females) with complete pretreatment and posttreatment orthodontic records. The patients were divided into two groups according to the treatment modalities. Group 1 (n = 55), nonsurgical (consisted of patients treated with comprehensive orthodontics) and Group 2 (n = 25), surgical (with presurgical orthodontics followed by maxillary advancement orthognathic surgery). PAR score was evaluated on pretreatment and posttreatment study models for both groups.RESULTS:The mean percentage change for the weighted PAR score of Group 1 and Group 2 was 76.79 ± 20.27% and 82.37 ± 11.38%, respectively. Out of the total sample of 80 cases; 62 (77.5%) cases were “greatly improved,” 16 (20%) cases were “improved,” and 2 (2.5%) showed “worse/no improvement.” Nearly 72.5% of cases in Group 1 and 88% in Group 2 were greatly improved.CONCLUSIONS:The reduction in PAR score in both groups was satisfactory as more than 70% of the patients were in the greatly improved category. The results of the PAR index revealed a high occlusal outcome of orthodontic treatment rendered by the department for patients with unilateral cleft lip and palate.