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The duration of orthodontic treatment with and without extractions: A pilot study of five selected practices

Authors
Journal
American Journal of Orthodontics and Dentofacial Orthopedics
0889-5406
Publisher
Elsevier
Publication Date
Disciplines
  • Logic
  • Medicine

Abstract

Abstract Contemporary orthodontic practice is diverse, both in the variety of clinical problems treated and in the methods used. Practices differ with respect to their patient composition as well as in many variables relative to treatment protocols. Such heterogeneity makes it difficult to make valid generalizations concerning the characteristics of orthodontic treatment procedures or outcomes; yet data and methods are required for assessment of issues of efficacy and utility. The frequency of orthodontic extractions is an objective criterion that distinguishes practices and may also be related to differences in treatment outcome variables, such as duration. Following a telephone survey to estimate extraction rates in the practices of 238 Michigan orthodontists, five practices with very high or low reported rates were chosen for this pilot study. Our primary aim was to determine whether a systematic relationship existed between the relative frequency of extraction treatments and the duration of active appliance therapy. Records of 438 patients from these practices were examined. The extraction rates of the practices ranged from a low of 25% to a high of 84%. Treatment duration was affected by several variables, such as the number of arches treated, the number of treatment phases, and the practice selected. When the data for all five practices were pooled, and all of the extraction versus nonextraction treatments were compared, the mean durations of treatment were 31.2 and 31.3 months, respectively. Data from individual practices, however, indicated that extraction treatment in each of the practices was of longer duration than nonextraction therapy. These differences in duration were 3.0, 6.6, 2.4, 3.0, and 7.3 months in the five practices. The pooling of all extraction and nonextraction cases evidently obscures the effect of other variables that contribute to treatment duration and indicates the need for a larger and more representative sample of practices, as well as the use of multivariate statistical analyses of appropriate “power,” to derive unambiguous inferences with respect to the effect of the extraction decision on treatment duration specificially and efficacy in general. This pilot study thus provides initial estimates of ranges in treatment duration and variability in orthodontic practices with high and low rates of extraction, it also illustrates the use of stepwise regression to clarify the effect that some frequent clinical decisions may have on the length of active orthodontic treatment and reveals the need for further studies. (A M J O RTHOD D ENTOFAC O RTHOP 1990;97:45-51.)

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