Posttreatment Peer Assessment Rating Scores Research Articles

Comparison of maxillary anterior tooth movement between Invisalign and fixed appliances

This research project aimed to compare the number of maxillary incisors and canine movement between Invisalign and fixed orthodontic appliances using artificial intelligence and identify any limitations of Invisalign. Sixty patients (Invisalign, n= 30; braces, n= 30) were randomly selected from the Ohio State University Graduate Orthodontic Clinic archive. Peer Assessment Rating (PAR) analysis was used to indicate the severity of the patients in both groups. To analyze the incisors and canine movement, specific landmarks were identified on incisors and canines using an artificial intelligence framework, two-stage mesh deep learning. Total average tooth movement in the maxilla and individual (incisors and canine) tooth movement in 6 directions (buccolingual, mesiodistal, vertical, tipping, torque, rotation) were then analyzed at a significance level of α= 0.05. Based on the posttreatment Peer Assessment Rating scores, the quality of finished patients in both groups was similar. In maxillary incisors and canines, there was a significant difference in movement between Invisalign and conventional appliances for all 6 movement directions (P<0.05). The greatest differences were with rotation and tipping of the maxillary canine, along with incisor and canine torque. The smallest statistical differences observed for incisors and canines were crown translational tooth movement in the mesiodistal and buccolingual directions. When comparing fixed orthodontic appliances to Invisalign, patients treated with fixed appliances were found to have significantly more maxillary tooth movement in all directions, especially with rotation and tipping of the maxillary canine.

Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners.

This retrospective two-centre study aimed to evaluate the occlusal outcomes in patients undergoing orthognathic surgery with clear aligners. A retrospective chart review and occlusal outcomes for 15 patients (10 females and five males) with different types of dentofacial deformities in the anteroposterior, vertical and transverse dimensions, who underwent orthognathic surgery in conjunction with clear aligners were evaluated. Weighed Peer Assessment Rating (PAR) index scores of the pre-treatment and post-treatment digital models were used to assess initial complexity, final occlusal outcomes and degree of improvement with surgery and clear aligners. The mean post-treatment PAR score was 3.5± 2.54, which was a statistically significant improvement from the pre-treatment PAR score of 27.63 ± 12.09, an 87% improvement was achieved. All subcategories of the PAR index showed statistically significant improvement except for midline assessment component. Occlusal outcomes with aligners showed great improvement as indicated with the PAR index scores. Orthognathic surgical cases can be treated efficiently with aligners and future studies should compare occlusal outcomes between orthognathic surgical patients treated with clear aligners and those treated with fixed appliances.

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&lt;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.

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.

Effectiveness of lingual versus labial fixed appliances in adults according to the Peer Assessment Rating index.

The purpose of this study was to compare the effectiveness of lingual treatment and labial fixed appliances in the treatment of adult orthodontic patients. We conducted a retrospective study of 72 patients. The Peer Assessment Rating (PAR) index was measured at the start (T0) and end (T1) of treatment. Significant differences between treatment means were determined by means of analysis of variancewith the Bonferroni correction or with the use of Fisher exact test. The lingual group had a mean pretreatment age of 28.6±6.7years, and the labial group had a pretreatment age of 26.6±9.5years. This difference was statistically not significant. The mean pre- and posttreatment PAR scores in the labial group were 22.9±6.2 and 2.1±2.3, respectively, and the mean pre- and posttreatment PAR scores in the lingual group were 26.5±8.3 and 2.3±2.5. There were no significant differences between the treatment groups. Lingual and labial appliances produced similar reductions in PAR scores. There was no difference in the posttreatment PAR scores between the lingual and labial treatment groups. Further studies involving larger sample sizes and longer follow-up periods are required to confirm the results obtained.

The Scottish Orthodontic Peer Review project: the outcome of treatment and standard of record keeping by orthodontic specialist practitioners in Scotland.

Assess occlusal outcomes of treatment and clinical record keeping in specialist practice in Scotland. A retrospective cohort study. Specialist practices in Scotland. Specialist orthodontists in Scotland. Every specialist practitioner in Scotland (51) was invited to take part in the peer review project with 38 (76%) enrolled. Scotland was split into four geographical areas, and each practitioner matched with a colleague from the same area. Practitioners took one day to visit their colleague and score 30 consecutively treated NHS cases using the Peer Assessment Rating (PAR) index. They also assessed the quality of the records taken. Practitioners then swapped roles and assessed their partner's occlusal outcomes and records. The mean pretreatment PAR score was 28.6 (SD 3.5). Mean posttreatment PAR score was 3.5 (SD 1.2). Mean reduction in PAR score was 25.1 (SD 3.8). Mean percentage PAR score reduction was 87.7% (SD 3.7%). Overall record keeping scores were written records 100%, study models 99.5%, Orthopantomogram radiograph 99.2%, photographs 86.3%, medical history 75% and consent 40.8%. Occlusal outcomes achieved by specialist practitioners in Scotland were of a high standard. They maintained a good standard of clinical record collection in most areas examined.

Improvement in Peer Assessment Rating scores after nonextraction, premolar extraction, and mandibular incisor extraction treatments in patients with Class I malocclusion.

Different treatment protocols implemented for correction of Class I malocclusion aim at achieving ideal occlusal characteristics. This study was planned to evaluate the improvement in the occlusal characteristics of Class I patients treated with nonextraction (NE), all first premolar extractions (PME), and mandibular incisor extraction (MIE) as assessed by the percentage of improvement in Peer Assessment Rating (PAR) scores. This retrospective cross-sectional study was conducted on the pretreatment and posttreatment dental casts of 108 subjects with Class I malocclusion. The total sample was divided into 3 equal groups according to the treatment protocol implemented: NE, PME, and MIE. The mean pretreatment and posttreatment PAR scores, and the percentages of improvement were compared among the 3 treatment modalities using Kruskal-Wallis and post-hoc Dunnett T3 tests. The mean percentages of improvement in the PAR score were 75.8%±25.8% in the NE group, 73.1%±19.4% in the PME group, and 70.6%±24.1% in the MIE group. There was no significant difference (P=0.351) in the percentages of improvement in PAR scores among the 3 treatment modalities. However, the mean pretreatment and posttreatment PAR scores varied significantly (P<0.001) in the 3 groups. The average pretreatment and posttreatment PAR scores were highest in the MIE group and lowest in the NE group. The comparable percentages of improvement in PAR scores among the 3 groups denote that equivalent occlusal corrections were achieved in Class I patients treated with the NE, PME, and MIE protocols.

Orthodontic treatment stability predictors: A retrospective longitudinal study.

To examine medium- to long-term orthodontic treatment stability and its possible association with certain variables. In a retrospective longitudinal study of 70 postretention patients, the Peer Assessment Rating (PAR) index was measured at the start (T1) and end (T2) of treatment and between 4 and 10 years afterwards (T3). The stability was considered absolute when the T2 and T3 values were identical and relative when the difference was within the ±5 range. Among the 70 patients, 65.8% were female and 34.2% were male. Their mean age was 14.5 years. The mean treatment length was 2.4 years. The mean retention phase was 3.3 years. The mean pre- and posttreatment PAR scores were 29.8 (T1) and 6.3 (T2). The mean T1-T2 difference was 23.6. The mean T2-T3 difference was -0.39. Within the study, 7.1% presented absolute stability and 68.6% presented relative stability. Lower anterior segment alignment and overbite were the most unstable occlusal features and tended to worsen. Fixed retainer (odds ratio [OR] 0.31; 95% confidence interval [CI] 0.10-0.98) as a protective factor and years without retention (OR 1.32; 95% CI 1.03-1.68) as a risk factor are predictor variables of instability in the case of lower anterior segment alignment. The PAR value at the end of treatment (OR 1.29; 95% CI 1.08-1.54) and extractions (OR 4.76; 95% CI 1.05-21.6) before treatment are predictors for midline instability.

Adult orthodontics in the absence of orthognathic treatment: a hospital perspective

To examine adult orthodontic treatment within two hospital settings and ascertain whether any factors have a statistically significant effect on treatment outcomes. A retrospective observational study. Through the analysis of hospital case notes, variables relating to adult patients undergoing orthodontic treatment that did not involve orthognathic surgery between 1991 and 2008 at the Eastman Dental and Croydon University Hospitals, were studied. In addition, a proportion of study models were Peer Assessment Rating (PAR) scored to determine treatment outcome. Females accounted for 76·2% of the adults studied, with a mean age of 31·24 years. The most commonly presenting malocclusion was a class II division 1 incisor relationship on a class II skeletal base, with over half of all patients studied having missing teeth upon presentation. The mean treatment length was 2·29 years. Only the type of orthodontic treatment (orthodontic-only or multidisciplinary) and/or the presence of a crowded upper labial segment had a statistically significant effect on treatment outcomes, as measured by PAR scores. This study has highlighted demographical and treatment trends from a cohort of adult patients studied within two hospital orthodontic departments. It also illustrates that a crowded upper labial segment and the type of treatment provided has a statistically significant effect on post-treatment PAR scores.

Correlation between body mass index and orthodontic treatment outcome

To determine whether there is a correlation between body mass index (BMI), patient cooperation, and treatment success during multibracket (MB) appliance therapy. All adolescent MB patients started and finished between 2007 and 2010 were analyzed. The pretreatment BMI was calculated and negative file entries such as bad oral hygiene, missed appointments, and appliance breakage were recorded. According to the number of negative entries, cooperation was classified as good, bad, or poor. Additionally, the treatment duration and the number of appointments were recorded. For the evaluation of treatment success, the pretreatment and posttreatment PAR (peer assessment rating) scores were measured. Of the 77 subjects, 61 had a normal BMI (79.2%) and 16 were considered overweight (20.8%). Whereas 51.7% of the normal-weight children had a good cooperation, only 25% of the overweight patients cooperated sufficiently. Consequently, the number of patients exhibiting bad or poor cooperation was higher in the overweight group (37.5% bad, 37.5% poor) than in the normal-weight group (30.6% bad, 17.7% poor). Patients with an increased BMI had a slightly longer treatment duration (21.4 months) and needed more appointments (19.9) than their normal-weight peers (18.9 months, 18.1 appointments). The PAR (peer assessment rating) score reduction, however, was comparable (normal BMI: 17.8 points, 64.0%; increased BMI: 15.2 points, 65.3%). In the present study, children with increased BMI did not cooperate as well during MB therapy as their normal-weight peers, but the treatment outcome was comparable in the two groups.

Orthodontic treatment--improvement and standards using the peer assessment rating index.

This article is aimed at assessing the orthodontic treatment outcome in an accredited graduate orthodontic clinic in the United States, using the original Peer Assessment Rating (PAR) Index. A sample of 100 pre- and posttreatment study models was randomly selected from the clinic model storage. One investigator assessed all the components of the PAR Index. Descriptive statistics and Scheffe test were used to analyze the data. The mean weighted PAR point reduction was 22.11, and mean percentage reduction was 86.20. "Greatly improved" conditions were seen in 50% of patients while 47% accounted for the "improved category." Only 3% belonged to the "worse or no different" group. Statistically significant differences were observed between the three improvement groups for weighted pre- and posttreatment PAR scores, reduction, and percentage reduction. The results indicated an excellent improvement of the patients, with patients being treated to a high standard and a great proportion of patients with a clear need for treatment.

Effect of early treatment on stability of occlusion in patients with Class II malocclusion

The purpose of this study was to evaluate the effect of early treatment on the stability of occlusion in patients with Class II malocclusions. The peer assessment rating (PAR) index was used to evaluate changes in occlusion after treatment of subjects treated in 1 phase or 2 phases. This study was a prospective, randomized, controlled clinical trial. Dental casts were obtained from the participants, who were randomized into 3 phase-1 early treatment groups: bionator, headgear/bite plane, or observation. Phase 2 consisted of continued treatment of the bionator and the headgear/biteplane subjects and comprehensive treatment of the observation subjects. PAR scores were obtained for 208 subjects at end of treatment; 173 (83%) had at least 1 follow-up visit, with a median follow-up time of 5.0 years. PAR scores were calculated for each subject at key treatment and posttreatment time points. Linear mixed-effect models were used to evaluate the impact of phase-1 treatment group, years posttreatment, end of treatment PAR score, and other covariates that could affect stability on the posttreatment PAR score. Factors significantly affecting posttreatment PAR scores were PAR score at end of treatment (P <.0001), years posttreatment (P =.0064), and PAR score at the start of phase 2. Although phase-1 treatment was not statistically significant, those with early treatment had lower PAR scores at the start of phase 2 than the observation subjects (means [SD]: bionator 17.5 [7.4], headgear/biteplane 15.3 [7.0], observation 22.2 [8.6], P <.0001). Thus, early treatment had an indirect effect. Factors that affect posttreatment PAR score stability include PAR score at the end of treatment, years posttreatment, and PAR score at the start of phase-2 treatment. The early treatment modalities have limited positive impact on posttreatment stability PAR scores in Class II malocclusion patients due to their effect on PAR scores at the start of phase-2 treatment.

Influence of the quality of the finished occlusion on postretention occlusal relapse

In this study, we aimed to evaluate the influence of the quality of the finished occlusion on postretention occlusal stability. The sample comprised 87 patients with Class I malocclusion, treated with extraction of the 4 first premolars and edgewise mechanics; they were divided into 2 groups, according to the quality of their finished occlusions. Group 1 included 44 subjects (23 boys, 21 girls) with posttreatment peer assessment rating (PAR) scores from 0 to 5. The mean pretreatment age was 13.74 years (SD 2.14). The mean treatment time was 1.92 years (SD 0.57), the mean retention time was 1.75 years (SD 0.96), and the mean time of posttreatment evaluation was 5.17 years (SD 1.82). Group 2 included 43 subjects (22 boys, 21 girls) with posttreatment PAR scores greater than 5. The mean initial age was 13.34 years (SD 1.35). The mean treatment time was 2.20 years (SD 0.66), the mean retention time was 1.77 years (SD 0.78), and the mean posttreatment evaluation was 5.47 years (SD 1.60). The PAR and the Little irregularity indexes were measured on the dental casts at pretreatment, posttreatment, and postretention. Intergroup comparisons were made with independent t tests, and the Pearson correlation coefficient was applied to the PAR score for the whole sample at the times evaluated. Well-finished patients had lower posttreatment and postretention PAR scores and greater changes during the treatment and posttreatment periods than did the poorly finished patients. For the Little irregularity index, the only difference between the groups was at the posttreatment stage; group 1 had a smaller irregularity score than group 2. The correlation coefficients showed that the greater the treatment changes, the smaller the posttreatment PAR score and the greater the relapse. But the higher the posttreatment PAR score, the higher the postretention PAR score. It was concluded that the greater the quality of the orthodontic finished occlusion, the greater are the treatment changes and the amount of relapse and the better is the occlusal status at the postretention stage in Class I malocclusion treated with 4 premolar extractions.

Clinical assessment of orthodontic outcomes with the peer assessment rating, discrepancy index, objective grading system, and comprehensive clinical assessment

The purpose of this study was to quantitatively assess orthodontic treatment outcomes in postgraduate orthodontic clinics at Okayama University (OU) and Indiana University (IU). Using the peer assessment rating (PAR) index, the discrepancy index (DI), the American Board of Orthodontist's objective grading system (OGS), and the comprehensive clinical assessment (CCA), we evaluated pretreatment and posttreatment records of 72 patients from OU and 54 patients from IU. The average pretreatment PAR score with United Kingdom weighting was 32 for OU subjects and 28 for IU subjects. Differences in maxillary and mandibular buccal alignment between schools were statistically significant ( P < .01). The posttreatment PAR scores were 7 for OU and 4 for IU. The difference in overjet between schools was statistically significant ( P < .05). The mean DI scores were 19 for OU and 17 for IU. OU patients scored significantly more DI points for crowding and mandibular plane angle compared with IU patients ( P < .05). On the other hand, they lost significantly fewer DI points for overbite and occlusion compared with IU patients ( P < .05). The mean OGS scores were 34 for OU and 33 for IU. Buccolingual inclination and overjet scores were significantly higher in OU patients compared with IU ( P < .05). The mean CCA score was approximately 4 points for both OU and IU. These data suggest that these indexes are useful for comparing treatment outcomes between clinics. They were able to identify specific problems in treating Asian patients.

Orthodontic treatment outcome in a First Nations population in Alberta, Canada: A comparative study

The primary objective of this study was to determine whether there was a significant difference in the degree of improvement after orthodontic treatment between a sample of First Nations orthodontic patients and a control sample of non-First Nations orthodontic patients. The secondary objective was to determine whether there was a difference in the severity of malocclusions being treated in a sample of the First Nations patients compared with a control sample of the non-First Nations patients. Several factors that might affect treatment outcome, such as missed appointments, treatment duration, oral hygiene, extractions, dental classification, and geographic location, were also studied. A sample of 60 First Nations patients and a control group of 60 non-First Nations patients between the 11 and 18 years of age who had been treated with full fixed orthodontic appliances were evaluated. The weighted peer assessment rating (PAR) index was applied to pretreatment and posttreatment study models to address the study's main objectives. The results showed that the First Nations group had greater PAR scores pretreatment than did the controls, and their weighted PAR scores improved more with treatment. Posttreatment PAR scores were similar between the 2 groups. In addition to First Nations status, only extractions and geographic location affected PAR improvement scores. (Am J Orthod Dentofacial Orthop 2002;121:396-402)