The consistency of orthodontic diagnosis and treatment planning.

摘要

Introduction. The cephalometric radiograph has been a staple in orthodontic diagnosis and treatment planning since its introduction by Broadbent in 1931. Many analyses have been created by which to compare skeletal and dental relationships. Little research has been performed evaluating how valuable a cephalometric radiograph is in diagnosing and treatment planning orthodontic patients with consistency. Purpose. The aim of this study was to focus on the value that orthodontists place on cephalometric radiographs when diagnosing and treatment planning on two separate occasions. Materials and methods. Ten faculty members from SLU CADE were chosen at random to evaluate 65 sets of orthodontic records excluding the cephalometric radiograph. Each participant evaluated 11 of the 65 total records, of which 6 had been treated by that doctor, and the remaining 5 by none of the participants. A questionnaire of various skeletal questions and treatment plan options was applied to each case. The responses to each case treated by the participants (named "internal data") were analyzed separate from the 5 universal cases (named "external data") providing two sets of data. Skeletal relationships were calculated for external data only in order to compare evenly between the participants. Consistency of questionnaire responses was based on Kappa agreement measures and rates >0.60 were deemed statistically significant. Results. All internal data with regards to planning the use of auxiliary appliances, the decision to extract, and if surgical treatment was indicated came back at least substantially consistent to the original treatment plans. Estimating the patients' skeletal classification, planning the use of an auxiliary appliance, and whether surgical treatment was indicated were consistently significant for the external data. Conclusions. Based on these findings it can be concluded that orthodontists are confident in diagnosing and treatment planning without the use of a cephalometric radiograph and are consistent in their treatment plan decisions for cases they have treated in the past. However, there is little consistency of treatment plan decisions between doctors for cases treated by an unknown orthodontist. Finally, skeletal-dental relationships cannot be determined without access to a cephalometric radiograph.