Download Duration of Combined Orthodontic-Orthognathic Treatment A. C

Duration of Combined Orthodontic‐Orthognathic Treatment
A. C. Dunbar, G. T. McIntyre, S. Laverick. Dundee Dental Hospital and Ninewells Hospital, Dundee
Background
•Date of start of Orthodontic treatment
(T0)
•Last appliance activation prior to
surgery (T1)
•Date of surgery (T2)
•Start of post-surgical orthodontic
treatment (T3)
•Removal of the appliance (T4)
Patients requiring orthognathic surgery
(Fig.1) combined with orthodontics
represent a significant portion (7%) of
the cases treated by Consultant
Orthodontists in the UK1. A number of
studies have shown that patients value
thorough
communication
and
information about treatment prior to
commencing orthodontic-orthognathic
treatment2-4. If this is not done
adequately patient satisfaction can be
reduced, patients can feel depressed
and consent may not be valid5.
•A Wilcoxon two sample test found that
the total treatment time for patients
presenting with a class II malocclusion
was statistically significantly longer than
that for patients presenting with a class III
malocclusion (P<0.05).
Discussion
•All patients have an appointment on
the multidisciplinary clinic to determine
their readiness for surgery. It may be
more appropriate to schedule this
earlier. This may help reduce the delay
(2.5 months on average) from the end
of pre-surgical orthodontic treatment to
the surgery itself.
•Results show that class II patients ’
total treatment duration is statistically
significantly longer than class III
patients. This reflects the longer
treatment
time
required
to
decompensate class II patients.
•Although not statistically significant; the
mean duration for extraction cases was
less than non-extraction cases. It was
anticipated that extraction cases take
longer due to the need for space
closure; however decompensation may
be easier if extractions are carried out.
These data were entered into Excel
(Microsoft, Redmond, California) and
the mean durations of the different
treatment stages were calculated. This
was done with the assumption that
each month has 30 days.
Results
•Age: mean age at beginning of
treatment was 23.0; 24.9 at surgery
•Gender: 32 male; 66 female
Figures
2
and
3
illustrate
malocclusions and procedures
Malocclusions
I
II
III
8%
37%
55%
Fig. 1
Aims
To investigate:
yPre-surgical treatment time
yTime from end of pre-surgical
orthodontics to surgery
yTime from surgery to beginning of
post-surgical orthodontics
yPost-surgical orthodontic treatment
time
yTotal treatment time
Fig. 2
Surgical Procedures
Maxillary
Bimaxillary
22%
54%
24%
Conclusion
•The mean duration of orthodonticorthognathic
treatment
in
NHS
Tayside
is
Fig. 3
•41% of patients completed treatment currently 34 months and only 41% of
patients
currently
complete
treatment
within 30 months
within 30 months.
•Mean treatment duration 34.1 months
•Patients presenting with a Class II
Figure 4 shows the mean duration of malocclusion take longer to complete
treatment than those presenting with a
treatment stages
Class III malocclusion.
Treatment Stage Durations
40
•Patients are therefore not receiving
appropriate information regarding the
34.1
35
likely duration of orthodontic-orthognathic
treatment completion.
30
Duration (Months)
Standard
90% of patients should have their
entire combined orthodontic-surgical
treatment completed within 30 months
Process
This retrospective audit assessed all
98 patients undergoing orthodonticorthognathic treatment at Dundee
Dental Hospital and Perth Royal
Infirmary where surgery was carried
out at Ninewells Hospital (Dundee)
between
1January
2006
to
31December 2010.
The following information was gathered
from casenotes:
•Age at beginning of treatment and at
surgery
•Gender
•Malocclusion
•Surgical procedure
•Extraction/non-extraction
Mandibular
Changes to Clinical Practice
Patients should be booked on the
multidisciplinary planning clinic 1 year
after the start of pre-surgical orthodontic
treatment for an anticipated surgical date
to be determined.
25
References
24.5
1.
20
2.
15
10
7.6
5
4.
2.5
0.4
0
Start→Last
Pre-surgery
Duration (Months)
3.
24.5
Last Presurgery→
Surgery
2.5
Surgery→
Post-surgery
Post-surgery
Ortho→ End
Ortho
0.4
7.6
Total
treatment
34.1
Treatment Stage
Fig. 4
5.
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Flanary CM, Barnwell Jr GM, Alexander JM. Patients
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88: 137–145.
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Maxillofac Surg 1996; 34: 210–213.
Jones JW. A medico-legal review of some current UK
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