Multidisciplinary assessment of orthodontic treatment outcome for the adult mutilated dentition

Abstract

Orthodontic treatment in the adult is not new. Until lately, the challenges of treating the adult patient kept their numbers low. Over the last thirty years, however, there has been a steady increase in the prevalence of adults seeking orthodontic treatment. Many adults present with a mutilated dentition that often require a multidisciplinary approach for optimal treatment outcomes. Currently, guidelines for the evaluation of adult orthodontic treatment outcomes do not exist. The purpose of this study was to determine which factors are considered most important for the evaluation of the quality of adult orthodontic treatment outcome of patients with a mutilated dentition by practicing orthodontists, periodontists, and restorative dentists. In this study, orthodontists, periodontists, and restorative dentists examined the records of ten adult patients in the mutilated dentition who received orthodontic treatment at Temple University in the Department of Orthodontics. This study was approached from both a quantitative and qualitative perspective. Two surveys were used to collect the data. One survey used a visual analogue scale to measure the overall result, occlusion, buccal bone height, periodontal health, restorability, case difficulty, and the amount of influence of the American Board of Orthodontics (ABO) standards when judging the cases. A second survey was used to determine if the examiner was ABO certified and asked a series of open-ended questions related to orthodontic treatment outcome. Based on the data collected, the following conclusions were drawn: 1. Orthodontists, periodontists, and restorative dentists are consistent in their rating of orthodontic treatment outcome. 2. Periodontists and restorative dentists rate overall case finish and posttreatment occlusion higher than orthodontists. 3. When evaluating case finish, orthodontists tend to blend what is optimal as described by the guidelines of the American Board of Orthodontics with what is reasonably achievable for the patient. 4. Orthodontists, periodontists, and restorative dentists rate the following five factors to be most important when evaluating orthodontic treatment outcome: esthetics, occlusion, restorability, periodontal health, and stability. 5. Orthodontists, periodontists, and restorative dentists rate esthetics as the most important factor to use for evaluating orthodontic treatment outcome. The data suggest that adult patients with mutilated dentitions can pursue orthodontic treatment and achieve an excellent result. Teamwork among all dental specialists providing treatment is essential for multidisciplinary treatment. Treatment goals among all providers must be aligned to reach the ultimate treatment goals.