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Stuart I. Robb, DDS, MS,a Cyril Sadowsky, BDS, MS,b Bernard J. Schneider, DDS, MS,b and Ellen A.
BeGole, PhDc
Chicago, Ill
The purpose of this investigation was to compare the effectiveness and duration of orthodontic treatment in
adults and adolescents with a valid and reliable occlusal index. Another aim was to evaluate variables that
may influence the effectiveness and duration of orthodontic treatment in general. Pretreatment and
posttreatment study models were scored using the Peer Assessment Rating Index. The difference in scores
between pretreatment and posttreatment stages reflects the degree of improvement and therefore the
effectiveness of treatment. Variables that reflect patient compliance were recorded from written treatment
records from three private orthodontic practices. The sample consisted of 32 adults (mean age, 31.3 years)
and 40 adolescents (mean age, 12.9 years), all of whom had four premolars extracted as part of the
treatment strategy. The results indicated that there were no statistically significant differences (P > .05)
between adults and adolescents regarding treatment effectiveness (occlusal improvement) and treatment
duration. Multiple regression techniques revealed that the number of broken appointments and appliance
repairs explained 46% of the variability in orthodontic treatment duration and 24% of the variability in
treatment effectiveness. Furthermore, orthodontic treatment of the buccal occlusion and overjet explained
46% of the variability in treatment duration. (Am J Orthod Dentofacial Orthop 1998;113:383-6)
Adults make up approximately 20% of the The purpose of this study was to compare ortho-
average orthodontists patient load.1 Conventional wis- dontic treatment effectiveness and duration between
dom maintains that adult treatment when compared adults and adolescents. Another aim was to assess vari-
with traditional adolescent treatment is more difficult ables that may influence the effectiveness and duration
and takes longer to complete. The literature perpetuat- of treatment.
ing this myth is usually based on the clinical impres-
sions of practitioners without objective data.2-5 Further- REVIEW OF THE LITERATURE
more, traditional thinking purports that compromised The PAR index is an occlusal index that has been
results may be necessary leading to less ideal treatment shown to be valid and reliable.6,7 The index scores the
in adults than in their adolescent counterparts.5 maxillary anterior alignment, buccal occlusion, overjet,
Recently, the Peer Assessment Rating (PAR) Index overbite, and midline discrepancies. Each of these indi-
was developed to provide a numeric summary for the vidual components are then weighted and summed; the
occlusal relationships found in a dentition.6 The score total score reflects the severity and treatment difficulty
provides an estimate for the severity and treatment dif- for the particular malocclusion. This index can be used
ficulty of a particular malocclusion.7 The difference in as an outcome measure for the degree of improvement
scores between pretreatment and posttreatment stages by assessing the difference in scores between pretreat-
reflects the degree of improvement and therefore the ment and posttreatment study models.6,7
effectiveness of treatment. The histologic differences in the periodontal struc-
tures of adults and adolescents have been compared
both before and after tooth movement.8 In the adoles-
From the Department of Orthodontics, University of Illinois at Chicago, College
of Dentistry. cent, the supporting tissues of the teeth appear to be in
aThis article is based on research submitted by Dr Robb as partial fulfillment of a state of proliferation; there are large numbers of
the requirements for the Degree of Master of Science in Oral Sciences in the connective tissue cells and an extensive blood supply
Graduate College of the University of Illinois at Chicago, 1996.
bProfessor, Department of Orthodontics, University of Illinois at Chicago. even before orthodontic tooth movement. Adults, on
cAssociate Professor of Biostatistics, University of Illinois at Chicago. the other hand, appear to be in a state of rest, the
Reprint requests to: Cyril Sadowsky, BDS, MS, University of Illinois at Chica- alveolar bone is more dense, cell populations are
go, 801 S Paulina, Chicago, IL 60612
Copyright 1998 by the American Association of Orthodontists. reduced, and there is less vascularity. After the initia-
0889-5406/98/$5.00 + 0 8/1/87105 tion of tooth movement, it takes about 2 weeks for
383
384 Robb et al American Journal of Orthodontics and Dentofacial Orthopedics
October 1998
Adults and adolescents in this sample had similar skeletal relationships, facial profile, self-perception,
malocclusions with respect to severity and treatment and the lack of iatrogenic complications. Unfortunate-
difficulty at the start of treatment and at the end of ly, measures of this type that are accurate, valid, and
treatment. There were no differences between the reliable have not yet been developed for assessing such
groups with respect to the effectiveness or duration of variables.7 Furthermore, the PAR index may be limited
treatment. in its ability to distinguish fine details in dental rela-
The histologic differences during orthodontic tooth tionships with reference to an idealized outcome.20
movement have revealed a 2-week delay in adults to
reach a state of cellular proliferation.8 This delay has CONCLUSION
been used by many authors to explain why, in their On the basis of the results of this study of adult and
opinion, adult treatment is less effective and takes adolescent patients with predominantly Class I maloc-
longer.2-5 It is important to note that this delay is prob- clusions and treated with the extraction of four premo-
ably of no clinical importance over a 30-month period. lars, the following conclusions may be drawn:
Studies contrasting the dentoskeletal changes in
1. There were no statistically significant differences (P >
adults and adolescents with Class II Division 1 maloc-
.05) between adults and adolescents with respect to
clusions have revealed that adult treatment does not treatment effectiveness or treatment duration.
necessarily take longer, the average treatment times in 2. The number of broken appointments and appliance
both groups being comparable at 2.5 years.9,10 repairs explained 46% of the variability in orthodontic
Variables that reflect patient compliance, the num- treatment duration and 24% of the variability in treat-
ber of broken appointments, and appliance repairs play ment effectiveness.
an important role in treatment effectiveness (24% of 3. Furthermore, orthodontic treatment of the buccal
the variability) and the duration of treatment (46% of occlusion and overjet explained 46% of the variability
the variability). The majority of the variability still in treatment duration.
remains unexplained, however, the important contribu-
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