Barber S, Jawad Z, Hodge T, Bates C
Orthodontic Department, Leeds Dental Institute, Leeds.
Br Dent J. 2017 Mar 10;222(5):368-372. doi: 10.1038/sj.bdj.2017.222.
Introduction The Index of Orthognathic Functional Treatment Need (IOFTN) was developed to measure functional difficulties arising from malocclusions related to facial deformity. The IOFTN is not currently being used to determine suitability for orthognathic treatment, however, it is a useful aid for assessing and referring patients and takes into account functional and facial appearance. This paper aims to evaluate the potential impact of introduction of the IOFTN on the future provision of orthognathic services.Methods Two methods were used to consider the impact of the IOFTN on orthognathic provision. Firstly, a local retrospective audit was undertaken in Leeds Teaching Hospital NHS Trust involving thirty consecutively treated patients, for whom full records were retrieved. Data was collected using a standardised data caption form. Local standards were agreed concerning the need for treatment. Secondly, a systematic search of published studies was completed to assess evidence from across the UK.Results The audit standard, that is, 90% of patients treated with orthognathic surgery should be categorised as grade 4 (great need) or 5 (very great need) using the IOFTN, was fulfilled. The most common reason for seeking treatment related to dental and facial aesthetics and no patients were treated for speech or TMJ problems alone. The systematic review searches identified four suitable records for inclusion in the review, including two audits and two retrospective studies undertaken in secondary care settings across England and Scotland. These studies showed that at least 86% of all participants scored 4 or 5 using the IOFTN.Conclusions The findings from the audit and literature review indicate that referrals from general dentists and acceptance for orthognathic treatment in secondary care is unlikely to be significantly affected by introduction of the IOFTN. Referring dentists may find the IOFTN a useful prompt for determining whether people are suitable for orthognathic treatment.
引言 正颌功能治疗需求指数（IOFTN）旨在衡量由与面部畸形相关的错牙合引起的功能障碍。目前，IOFTN并未用于确定正颌治疗的适用性，然而，它在评估和转诊患者方面是一种有用的辅助手段，同时兼顾了功能和面部外观。本文旨在评估引入IOFTN对未来正颌服务提供的潜在影响。
方法 采用两种方法来考量IOFTN对正颌服务提供的影响。首先，在利兹教学医院国民保健服务信托基金进行了一项局部回顾性审计，涉及30例连续接受治疗的患者，调取了他们的完整记录。使用标准化数据采集表收集数据。就治疗需求达成了局部标准。其次，完成了对已发表研究的系统检索，以评估来自英国各地的证据。
结果 审计标准，即使用IOFTN将90%接受正颌手术治疗的患者归类为4级（极需治疗）或5级（非常急需治疗），得以实现。寻求治疗的最常见原因与牙齿和面部美观有关，没有患者仅因言语或颞下颌关节问题接受治疗。系统评价检索确定了4篇适合纳入评价的记录，包括在英格兰和苏格兰二级医疗机构进行的2项审计和2项回顾性研究。这些研究表明，所有参与者中至少86%使用IOFTN评分为4或5。
结论 审计和文献综述的结果表明，普通牙医的转诊以及二级医疗机构对正颌治疗的接受情况不太可能受到引入IOFTN的显著影响。转诊牙医可能会发现IOFTN在确定人们是否适合正颌治疗方面是一个有用的提示。
