Richmond S, Daniels C P
Department of Child Dental Health, University Dental Hospital, University of Wales College of Medicine, Heath Park, Cardiff, United Kingdom.
Am J Orthod Dentofacial Orthop. 1998 Feb;113(2):180-5. doi: 10.1016/s0889-5406(98)70290-2.
An international survey has been undertaken to assess variation in professional assessment of orthodontic treatment need. Ninety-seven orthodontists from nine countries examined a standard sample of 240 dental study casts to judge the need for orthodontic treatment in terms of dental health, dental esthetics, and deviation from normal. Participants also indicated their assessment of treatment complexity and whether they would recommend treatment. Practitioners' subjective assessments were found to be only moderately reliable overall. Of the cases examined, 76% [corrected] obtained a consensus of 80% or greater on the need for treatment. Logistic regression equations were derived to explain the observed variation in treatment decisions. It was found that occlusal traits from the dental casts were highly predictive of the treatment decision, and that the practitioners' country of origin and payment methods are important influences on prescribing behavior. The treatment decisions were predicted with an accuracy of 84% by using occlusal score values for the dental esthetics, the degree of upper arch crowding, the presence of crossbite, the anterior overbite, and the buccal segment sagittal relationship. It is suggested that these traits may form the basis for an internationally validated index of treatment need for use in clinical audit and orthodontic research.
一项国际调查已开展，旨在评估正畸治疗需求专业评估中的差异。来自九个国家的97名正畸医生检查了240个标准牙科模型样本，以从牙齿健康、牙齿美观以及与正常情况的偏差方面判断正畸治疗的需求。参与者还表明了他们对治疗复杂性的评估以及是否会推荐治疗。总体而言，从业者的主观评估仅具有中等可靠性。在所检查的病例中，76%[校正后]在治疗需求方面获得了80%或更高的共识。推导了逻辑回归方程来解释观察到的治疗决策差异。研究发现，牙科模型的咬合特征对治疗决策具有高度预测性，并且从业者的原籍国和支付方式对开处方行为有重要影响。通过使用牙齿美观的咬合评分值、上牙弓拥挤程度、反咬合的存在、前牙覆合以及颊侧段矢状关系，治疗决策的预测准确率为84%。建议这些特征可构成用于临床审计和正畸研究的国际验证治疗需求指数的基础。
