Original article
Patient- and clinician-perceived need for orthognathic surgery

Presented in June 2004 at the European Orthodontic Congress in Denmark; received the WJB Houston Research Award.
https://doi.org/10.1016/j.ajodo.2004.09.022Get rights and content

Introduction: To better understand why patients believe they need orthognathic treatment, a study was undertaken to examine perceived need for treatment by patients and clinicians. This questionnaire-based study was undertaken at The John Radcliffe Hospital, Oxford, United Kingdom. Subjects and methods: Forty patients were recruited from combined orthodontic-surgical clinics. They were asked to rate their perceived need for treatment based on facial appearance, dental appearance, function, and overall need. Twenty orthodontists and 20 maxillofacial surgeons were asked to rate perceived need for treatment based on the same parameters, using study models and clinical photographs. Ratings were marked on visual analog scales. Results: Significant differences were found between patients and clinicians in perceived need for treatment based on facial appearance (orthodontists compared with patients, P = .023; surgeons compared with patients, P = .001). In addition, maxillofacial surgeons rated a significantly greater overall need for treatment than patients (P = .027), and they rated treatment need based on facial appearance (P = .005) and function (P < .001) significantly higher than orthodontists. Conclusions: Clinicians rated greater need for orthognathic treatment based on facial appearance than did patients. Surgeons also rated greater overall need for treatment than patients. In addition, surgeons rated treatment need based on facial appearance and function significantly higher than orthodontists, but large variations existed in both clinician groups.

Section snippets

Subjects and methods

This was a questionnaire-based study undertaken at John Radcliffe Hospital, Oxford, United Kingdom. Ethical approval was obtained, and all patients consented in writing. Forty consecutive new patients (16 men, 24 women) referred by general dental practitioners, fulfilling the following criteria, were recruited from orthognathic clinics: over 16 years of age, about to undergo orthognathic treatment, no history of orthodontic treatment or facial surgery, and no congenital deformities (eg, clefts)

Results

In general, there was good repeatability among patients. The ICC results were all within the acceptable range, with all values above 0.70. However, the Bland-Altman method highlighted a slight bias in the scoring of dental appearance and overall need for treatment.

In general, clinicians exhibited good repeatability when rating perceived need for treatment based on facial appearance, dental appearance, and function. Repeatability for overall need for treatment was below 0.70 but was still

Discussion

Although the ICC scores for patient repeatability were all high (>.70), the Bland-Altman method highlighted a slight bias for dental appearance and overall need for treatment. This might be a reflection of the small sample size for the repeatability study. In addition, there could be a tendency for patients to modify their scores after considering the initial rating. However, the mean differences in the repeatability study were small compared with those in the main study, and this, considered

Conclusions

The results of this study suggest that:

  • 1

    Orthodontists and maxillofacial surgeons rated a greater need for orthognathic treatment based on facial appearance than patients.

  • 2

    Maxillofacial surgeons rated a greater need for orthognathic treatment based on overall treatment need than patients.

  • 3

    Large variation existed within both the orthodontist and maxillofacial surgeon groups, but neither group appeared to exhibit more variability than the other.

  • 4

    Maxillofacial surgeons rated treatment need based on

References (16)

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