Prospective, multi-center study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom.

INTRODUCTION: The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom. METHODS: The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded. RESULTS: At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy. CONCLUSIONS: This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial.

INTRODUCTION: The aim of this study was to evaluate the effectiveness of early orthodontic treatment with the Twin-block appliance for the treatment of Class II Division 1 malocclusion. This was a multi-center, randomized, controlled trial with subjects from 14 orthodontic clinics in the United Kingdom. METHODS: The study included 174 children aged 8 to 10 years with Class II Division 1 malocclusion; they were randomly allocated to receive treatment with a Twin-block appliance or to an initially untreated control group. The subjects were then followed until all orthodontic treatment was completed. Final skeletal pattern, number of attendances, duration of orthodontic treatment, extraction rate, cost of treatment, and the child's self-concept were considered. RESULTS: At the end of the 10-year study, 141 patients either completed treatment or accepted their occlusion. Data analysis showed that there was no differences between those who received early Twin-block treatment and those who had 1 course of treatment in adolescence with respect to skeletal pattern, extraction rate, and self-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental occlusion. CONCLUSIONS: Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.