Khamashta-Ledezma Leila, Collier Jonathan, Sharma Pratik K, Ali Nayeem
Orthodontics, King's College London and St George's Hospitals, London, United Kingdom.
Br J Oral Maxillofac Surg. 2012 Sep;50(6):537-40. doi: 10.1016/j.bjoms.2011.11.005. Epub 2011 Dec 5.
This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11-26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.
这项基于问卷的前瞻性研究旨在确定在正颌联合诊所就诊的患者中曾接受过正畸治疗的患者的发生率，并评估这对他们拟议的手术治疗产生的影响（如有）。纳入了在三个月期间在伦敦两家医院的诊所接受不同治疗阶段的连续患者的同期和历史数据。总共有22/56名患者（39%）曾接受过正畸治疗，其中10名（45%）患者的正畸治疗对当前治疗管理产生了不良影响。这些影响包括正畸医生可进行的牙齿移动范围减小（8/23，35%）、不必要的拔牙（5/23，22%）以及术前正畸治疗时间延长（5/23，22%）。之前开始正畸治疗的中位年龄为13.5岁（范围11 - 26岁）。近三分之一的患者报告称，他们的转诊医生未告知他们可能需要正畸和手术联合治疗。该研究表明应改进初步评估。应告知患者并防止他们接受可能限制未来手术治疗的正畸治疗，否则他们可能不得不面临反复且延长的正畸治疗、意外手术以及手术治疗结果的潜在限制。这可以通过对所有从业者的培训和教育以及制定转诊指南来实现。
