Abstract
AIMS: To investigate the effect of a changing antero-posterior (A-P) and/or transverse buccal segment relationship on orthodontic decision-making and analyse for differences in practice, dependent on level of experience.METHODS: Fifteen clinical scenarios were represented with digital dual arch study models in STL and JPEG file formats, distributed via an online survey. Fifty-five participants completed the survey resulting in a total of 825 responses for analysis.
RESULTS AND DISCUSSION: 74.5% of participants were on National Specialist lists, 83.6% were UK-based, 50.9% were female. Highly experienced clinicians (>15 years of orthodontic practice) were the largest group, (58.2%). There was considerable inter-clinician variability in decision-making and extraction choices. Non-extraction plus dual-arch fixed appliances featured most commonly amongst treatment plans. There was a statistically significant increase in extraction strategies in the 0-5 years of experience group (χ2 test of independence - Pearson residual 3.0, p=0.013). The presence of a ½ to ¾ unit Class II was a key tipping point for clinicians to initiate an extraction strategy to aim for a Class II A-P buccal segment relationship treatment goal. Molar distalisation was unpopular and more likely to be carried out using temporary anchorage devices than headgear. A-P anchorage was managed predominantly with inter-maxillary elastics. The presence of any transverse discrepancy (edge to edge or complete buccal crossbite) led clinicians to initiate maxillary expansion orientated strategies.
CONCLUSION: The study demonstrated large inter-clinician variability in decision making. It elucidated key diagnostic ‘tipping points’ at which treatment decisions alter with changing antero-posterior and transverse buccal segment relationships as well as differences in decision making with level of experience.
Date of Award | 2 Dec 2021 |
---|---|
Original language | English |
Awarding Institution |
|
Supervisor | Peter V Fowler (Supervisor), Nicola E Atack (Supervisor) & Tony Ireland (Supervisor) |