Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
BMC Oral Health. 2020 Nov 10;20(1):312. doi: 10.1186/s12903-020-01300-6.
Recent years have witnessed a remarkable evolution of clear aligner technology and clear aligners are becoming more and more versatile in treating orthodontic patients. The aim of this study was to develop an objective evaluation system for assessing clear aligner treatment difficulty.
A total of 120 eligible patients (100 patients for developing and testing the evaluation system and 20 patients for validating this system) were recruited in this retrospective cross-sectional study. Based on clinical data (dental models, radiographs and photographs), complexity levels of cases were evaluated by two experts and regarded as the gold standard. Difficulty scores were determined through an evaluation system encompassing three domains (dental model analysis, radiographic examinations and clinical examinations). The reliability of the evaluation system was examined through analyzing the agreement between complexity levels and difficulty scores. Moreover, multivariable linear regression test was used to examine the independent association of each variable (e.g. overbite and crowding) with the complexity level.
The results revealed that the assessment of treatment difficulty by this objective evaluation system substantially matched the gold standard (R = 0.80). The multivariable regression test revealed that complexity level was significantly associated with difficulty score (p < 0.001), age (p = 0.015), tooth extraction (p < 0.001), treatment stage (p < 0.01) and the number of difficult tooth movement (p = 0.005). This objective evaluation system elaborated in this study was viable and reliable in appraising clear-aligner treatment difficulty in clinical practice.
We suggest orthodontists and general practitioners use this objective evaluation system (CAT-CAT) to appraise clear aligner treatment difficulty and to select appropriate clear aligner patients.
近年来，透明牙套技术取得了显著的发展，在治疗正畸患者方面变得越来越多样化。本研究旨在开发一种客观的评价系统来评估透明牙套治疗的难度。
本回顾性横断面研究共纳入 120 名符合条件的患者（100 名患者用于开发和测试评估系统，20 名患者用于验证该系统）。基于临床数据（牙模、X 光片和照片），由两位专家评估病例的复杂程度，并将其作为金标准。通过一个包含三个领域（牙模分析、X 光检查和临床检查）的评估系统确定难度评分。通过分析复杂程度和难度评分之间的一致性来检验评估系统的可靠性。此外，还使用多变量线性回归检验来检验每个变量（如深覆合和拥挤）与复杂程度的独立关联。
结果表明，该客观评估系统对治疗难度的评估与金标准高度吻合（R=0.80）。多变量回归检验显示，复杂程度与难度评分显著相关（p<0.001），与年龄（p=0.015）、拔牙（p<0.001）、治疗阶段（p<0.01）和困难牙齿移动的数量（p=0.005）也显著相关。本研究中详细阐述的这种客观评估系统在评估临床实践中透明牙套治疗难度方面是可行和可靠的。
我们建议正畸医生和全科医生使用这种客观的评估系统（CAT-CAT）来评估透明牙套治疗的难度，并选择合适的透明牙套患者。
