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Early from Seoul, South Korea, Dr. Choi joined me for a conversation on her recent article that she coauthored in the American Journal of Orthodontics and Dentofacial Orthopedics titled: Prediction of long-term success of orthopedic treatment in skeletal class III malocclusions. Trying to predict a treatment outcome that is relies heavily on patient characteristics is a difficult endeavor. She outlines the work they did done in the study in this interview. I hope you enjoy the conversation! Chiraz Guessaier, CDA Oasis Manager |
Highlights
- The authors investigated the long-term success of orthopedic treatment in skeletal Class III malocclusions, established a model to predict its long-term success, and verified previously reported success rates and prediction models.
- Fifty-nine patients who underwent successful facemask treatment and were followed until growth completion were evaluated. After completion of growth, the patients were divided into successful and unsuccessful groups according to overjet, overbite, and facial profile.
- Pretreatment cephalometric measurements were compared between groups, and logistic regression analysis was used to identify the predictors of long-term success.
- Four previously published articles were selected to verify the success rate and predictability of the prediction models with regard to our patient sample. Results: The treatment success rate was 62.7%. The AB-mandibular plane angle, Wits appraisal, and the articular angle were identified as predictors.
- The success rates differed according to success criteria and patient characteristics. The prediction models proposed by the 4 previous studies and our study showed similar predictabilities (61.0%-64.4%) for our patient sample. The predictability for the unsuccessful group was low.
- Our results suggest that no particular method or factor can predict the long-term success of orthopedic treatment for skeletal Class III malocclusion.
Full Interview ( 4.41″)
When I started specialty practice 30 years ago, I told parents of Class III kids that our chances were 60/40 in favour of avoiding surgery. Over the years I’m getting closer to 90/10. My protocol has always been maxillary expansion (if for no other reason than to activate sutures) and protraction headgear.
I think a key element is start as early as you can (5 or 6 yrs if the child is emotionally ready) and be prepared to “rinse and repeat” – again around 8-9 if necessary – and then again around 11-12 if necessary (there is some older research from a decade or 2 ago that shows positive changes with protraction around 11-12). Once they’re teens it’s too late.
I try to make parents understand that it’s not something you can just fix; you start as early as you can, and be prepared within those age constraints to have to do additional protraction depending on how they grow.
On an anecdotal experiential basis, I’d have to agree with the speaker – Class IIIs are NOT predictable at all. They can grow out from underneath you, or grow an asymmetry or whatever. But for me early intervention and being prepared to repeat at discrete time points has worked out pretty well over my career.