Baumrind S, Korn E L, Boyd R L, Maxwell R
Department of Growth and Development, Radiology and Orthopedic Surgery, University of California, San Francisco, USA.
Am J Orthod Dentofacial Orthop. 1996 Mar;109(3):297-309. doi: 10.1016/s0889-5406(96)70153-1.
As part of an ongoing prospective clinical trial of conventional orthodontic treatment, the decision making patterns of a representative group of orthodontic clinicians were examined. Data were available for 148 subjects (100 adolescents and 48 adults) who had presented at the University of California San Francisco Graduate Orthodontic Clinic requesting treatment for correction of a Class I or Class II malocclusion. The records for each subject were evaluated independently by each of five members of the clinical faculty, making available a total of 740 independent patient evaluations. With regard to the primary decision as to whether extraction or nonextraction treatment was to be preferred, agreement among clinicians was higher than had been anticipated. In almost two thirds of the cases, the decisions of all five clinicians were in agreement as to whether extraction or nonextraction was the preferred treatment modality. (This figure included 59 cases of complete agreement for extraction therapy (40%) and 38 cases of complete agreement for nonextraction therapy (26%)). In only 51 cases (34%), did the reviewing clinicians disagree as to whether extraction or nonextraction was the preferred modality of treatment. The clinicians were also asked to indicate their opinions as to whether orthognathic surgery was likely to be a part of the ultimate treatment course for each individual subject. Nine percent of the 740 patient evaluations contained a clinician judgement that surgery would be a probable or definite component of the orthodontic treatment plan. For 29% of the adult subjects (14 cases) and 23% of the adolescent subjects (23 cases), one or more of the five examining clinicians believed that adjunctive surgical intervention would probably or definitely be appropriate. These high values were unexpected, particularly because the sample had been prescreened by a single clinician to exclude subjects who might require orthognathic surgery. Clinician agreement of Angle classification was also evaluated. Disagreements were observed in 14 adult subjects (29%) and 27 adolescent subjects (27%). Little association was observed between clinician agreement on Angle classification and clinician agreement on whether or not to extract.
作为一项正在进行的常规正畸治疗前瞻性临床试验的一部分，对一组具有代表性的正畸临床医生的决策模式进行了研究。数据来自148名受试者（100名青少年和48名成年人），他们在加利福尼亚大学旧金山分校正畸研究生诊所就诊，要求治疗I类或II类错牙合畸形。临床教员的五名成员分别对每个受试者的记录进行独立评估，共进行了740次独立的患者评估。关于首选拔牙治疗还是不拔牙治疗的主要决策，临床医生之间的一致性高于预期。在近三分之二的病例中，所有五名临床医生对于拔牙还是不拔牙是首选治疗方式的决定是一致的。（这一数字包括59例拔牙治疗完全一致的病例（40%）和38例不拔牙治疗完全一致的病例（26%））。在仅51例病例（34%）中，审查临床医生对于拔牙还是不拔牙是首选治疗方式存在分歧。临床医生还被要求指出他们对于正颌手术是否可能成为每个个体最终治疗过程一部分的看法。在740次患者评估中，9%包含临床医生认为手术将是正畸治疗计划中可能或确定组成部分的判断。对于29%的成年受试者（14例）和23%的青少年受试者（23例），五名检查临床医生中的一名或多名认为辅助性手术干预可能或肯定是合适的。这些高比例是出乎意料的，特别是因为样本已经由一名临床医生预先筛选，以排除可能需要正颌手术的受试者。还评估了临床医生对安氏分类的一致性。在14名成年受试者（29%）和27名青少年受试者（27%）中观察到分歧。在临床医生对安氏分类的一致性与是否拔牙的一致性之间几乎没有关联。
