Longitudinal eruptive and posteruptive tooth movements, studied on oblique and lateral cephalograms with implants.

INTRODUCTION: The purpose of this study was to investigate the eruptive and posteruptive tooth displacements of untreated growing subjects longitudinally and the potential connections between posteruptive displacement of the maxillary and mandibular first molars and skeletal facial growth. METHODS: The sample comprised 11 series of right 45° oblique cephalograms and lateral cephalograms of untreated children with metallic implants of the Björk type obtained from the archives of a growth study. Cephalograms generated at approximately 2-year intervals between the ages of 8.5 and 16 years were selected and traced. Superimpositions of serial tracings of oblique cephalograms on stable intraosseous implants were made to determine the displacements of buccal segment teeth in both arches, and superimpositions of serial tracings of lateral cephalograms were used to evaluate growth of the jaws. RESULTS: Continuous mesial tipping of the maxillary molars was observed from 8.5 to 16 years of age, averaging 8.2° ± 5.5° for the first molars and 18.3°± 8.5° for the second molars. Compared with the maxillary molars, the mandibular first molars showed less change in angulation except in the later mixed dentition when more than half of the subjects had accelerated forward tipping of the first molar in the late mixed dentition associated with migration into the leeway space. Average amounts of cumulative eruption from 8.5 to 16 years of age were 12.1 ± 2.1 mm downward and 3.8 ± 1.7 mm forward for the maxillary first molar. The mandibular first molar showed 8.6 ± 2.3 mm of eruption and 4.4 ± 1.9 mm of mesial migration. Peak velocity of vertical eruption of the maxillary and mandibular first molars corresponded to the skeletal vertical growth spurt. The maxillary canines and first premolars showed remarkable and continuous uprighting migration during eruption, averaging 9.5° ± 5.0° and 10.5° ± 6.7°, respectively. However, when they erupted into the occlusion, their changes in angulation reverted to forward tipping. The same tendency was also found in the mandibular canines and first premolars. CONCLUSIONS: Remarkable eruption and migration occur to the teeth of both arches during childhood and adolescence. Rates of first molar eruption during adolescence follow the general pattern of somatic growth. We infer that maintaining the original distal crown angulation of the maxillary molars may be an effective protocol for preservation of anchorage.

Interpreting weightings of the peer assessment rating index and the discrepancy index across contexts on Chinese patients.

Objective: Determine optimal weightings of Peer Assessment Rating (PAR) index and Discrepancy Index (DI) for malocclusion severity assessment in Chinese orthodontic patients. Methods: Sixty-nine Chinese orthodontists assessed a full set of pre-treatment records from a stratified random sample of 120 subjects gathered from six university orthodontic centres. Using professional judgment as the outcome variable, multiple regression analyses were performed to derive customized weighting systems for the PAR index and DI, for all subjects and each Angle classification subgroup. Results: Professional judgment was consistent, with an Intraclass Correlation Coefficient (ICC) of 0.995. The PAR index or DI can be reliably measured, with ICC = 0.959 and 0.990, respectively. The predictive accuracy of PAR index was greatly improved by the Chinese weighting process (from r = 0.431 to r = 0.788) with almost equal distribution in each Angle classification subgroup. The Chinese-weighted DI showed a higher predictive accuracy, at P = 0.01, compared with the PAR index (r = 0.851 versus r = 0.788). A better performance was found in the Class II group (r = 0.890) when compared to Class I (r = 0.736) and III (r = 0.785) groups. Conclusions: The Chinese-weighted PAR index and DI were capable of predicting 62 per cent and 73 per cent of total variance in the professional judgment of malocclusion severity in Chinese patients. Differential prediction across Angle classifications merits attention since different weighting formulas were found.

American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection: Overview of a powerful tool for orthodontic research and teaching.

This article reports on the current status of the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection--an AAOF-supported multi-institutional project that uses the Internet and cloud computing to collect and share craniofacial images and data for orthodontic research and education. The project gives investigators and clinicians all over the world online access to longitudinal information on craniofacial development in untreated children with malocclusions of various types. It also is a unique source of control samples for testing the validity of consensually accepted beliefs about the effects of orthodontic treatment or of failure to treat.

Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients.

INTRODUCTION: Orthodontics in China has developed rapidly, but there is no standard index of treatment outcomes. We assessed the validity of the American Board of Orthodontics Objective Grading System (ABO-OGS) for the classification of treatment outcomes in Chinese patients. METHODS: We randomly selected 108 patients who completed treatment between July 2005 and September 2008 in 6 orthodontic treatment centers across China. Sixty-nine experienced Chinese orthodontists made subjective assessments of the end-of-treatment casts for each patient. Three examiners then used the ABO-OGS to measure the casts. Pearson correlation analysis and receiver operating characteristic curve analysis were conducted to evaluate the correspondence between the ABO-OGS cast measurements and the orthodontists' subjective assessments. RESULTS: The average subjective grading scores were highly correlated with the ABO-OGS scores (r = 0.7042). Four of the 7 study cast components of the ABO-OGS score-occlusal relationship, overjet, interproximal contact, and alignment-were statistically significantly correlated with the judges' subjective assessments. Together, these 4 accounted for 58% of the variability in the average subjective grading scores. The ABO-OGS cutoff score for cases that the judges deemed satisfactory was 16 points; the corresponding cutoff score for cases that the judges considered acceptable was 21 points. CONCLUSIONS: The ABO-OGS is a valid index for the assessment of treatment outcomes in Chinese patients. By comparing the objective scores on this modification of the ABO-OGS with the mean subjective assessment of a panel of highly qualified Chinese orthodontists, a cutoff point for satisfactory treatment outcome was defined as 16 points or fewer, with scores of 16 to 21 points denoting less than satisfactory but still acceptable treatment. Cases that scored greater than 21 points were considered unacceptable.

Randomized clinical trial comparing control of maxillary anchorage with 2 retraction techniques.

INTRODUCTION: The objective of this pilot randomized clinical trial was to investigate the relative effectiveness of anchorage conservation of en-masse and 2-step retraction techniques during maximum anchorage treatment in patients with Angle Class I and Class II malocclusions. METHODS: Sixty-four growing subjects (25 boys, 39 girls; 10.2-15.9 years old) who required maximum anchorage were randomized to 2 treatment techniques: en-masse retraction (n = 32) and 2-step retraction (n = 32); the groups were stratified by sex and starting age. Each patient was treated by a full-time clinic instructor experienced in the use of both retraction techniques at the orthodontic clinic of Peking University School of Stomatology in China. All patients used headgear, and most had transpalatal appliances. Lateral cephalograms taken before treatment and at the end of treatment were used to evaluate treatment-associated changes. Differences in maxillary molar mesial displacement and maxillary incisor retraction were measured with the before and after treatment tracings superimposed on the anatomic best fit of the palatal structures. Differences in mesial displacement of the maxillary first molar were compared between the 2 treatment techniques, between sexes, and between different starting-age groups. RESULTS: Average mesial displacement of the maxillary first molar was slightly less in the en-masse group than in the 2-step group (mean, -0.36 mm; 95% CI, -1.42 to 0.71 mm). The average mesial displacement of the maxillary first molar for both treatment groups pooled (n = 63, because 1 patient was lost to follow-up) was 4.3 ± 2.1 mm (mean ± standard deviation). Boys had significantly more mesial displacement than girls (mean difference, 1.3 mm; P <0.03). Younger adolescents had significantly more mesial displacement than older adolescents (mean difference, 1.3 mm; P <0.02). CONCLUSIONS: Average mesial displacement of the maxillary first molar with 2-step retraction was slightly greater than that for en-masse retraction, but the difference did not reach statistical significance. This finding appears to contradict the belief of many clinicians that 2-step canine retraction is more effective than en-masse retraction in preventing clinically meaningful anchorage loss.

Correlations between cephalometric and photographic measurements of facial attractiveness in Chinese and US patients after orthodontic treatment.

INTRODUCTION: Orthodontists rely on esthetic judgments from facial photographs. Concordance between estimates of facial attractiveness made from lateral cephalograms and those made from clinical photographs has not been determined. We conducted a preliminary examination to correlate clinicians' rankings of facial attractiveness from standardized end-of-treatment facial photographs (Photo Attractiveness Rank) with cephalometric measurements of facial attractiveness made for the same subjects at the same time. METHODS: Forty-five Chinese and US orthodontic clinicians ranked end-of-treatment photographs of separate samples of 45 US and 48 Chinese adolescent patients for facial attractiveness. Separately for each sample, the photographic rankings were correlated with the values of 21 conventional hard- and soft-tissue measures from lateral cephalograms taken at the same visits as the photographs. RESULTS: Among US patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for profile angle, chin prominence, lower lip prominence, and Z-angle, and also with lower values for angle of convexity, H-angle, and ANB. Among Chinese patients, higher rank for facial attractiveness on the photographs was strongly associated with higher values for Z-angle and chin prominence, and also with lower values for angle of convexity, H-angle, B-line to upper lip, and mandibular plane angle. Chinese patients whose %lower face height values approximated the ethnic "ideal" (54%) tended to rank higher for facial attractiveness than patients with either higher or lower values for %lower face height. The absolute values of the correlations for the 7 US measures noted above ranged from 0.41 to 0.59; those of the 7 Chinese measures ranged from 0.39 to 0.49.The P value of the least statistically significant of these 14 correlations was 0.006, unadjusted for multiple comparisons. On the other hand, many cephalometric measures believed by clinicians to be indicators of facial attractiveness failed to correlate with facial attractiveness rank for either ethnicity at even the P <0.05 level, including SN-pogonion angle, lower incisor to mandibular plane angle, and Wits appraisal. CONCLUSIONS: In general, there was less association than expected or desired between objective measurements on the lateral cephalograms and clinicians' rankings of facial attractiveness on sets of clinical photographs.

Comparison of Chinese and US orthodontists' averaged evaluations of "facial attractiveness" from end-of-treatment facial photographs.

INTRODUCTION: This study continues our assessment of agreement and disagreement among 25 Chinese and 20 US orthodontists in the ranking for facial attractiveness of end-of-treatment photographs of randomly sampled growing Chinese and white orthodontic patients. The main aims of this article were to (1) measure the overall pattern of agreement between the mean rankings of US and Chinese orthodontists, and (2) measure the strength of agreement between the rankings of the US and Chinese orthodontists for each patient. METHODS: Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 US patients and 48 Chinese patients. For each patient, a separate mean rank was computed from the responses of each group of judges. Pearson correlations between the mean ranks of the 2 groups of judges were used to measure their overall agreement. Paired and unpaired t tests were used to measure the agreement between the judges of the 2 groups for each patient. RESULTS: The overall agreement between the mean rankings of the US and Chinese judges was very high. For the US patients, the correlation between the Chinese and US judges means was r = 0.92, P <0.0001. For the Chinese patients, the analogous value was r = 0.86, P <0.0001. Agreement between the 2 groups of judges concerning each patient was also generally strong. For two thirds of the patients, the mean ranks of the US and Chinese judges differed by less than 1 unit in a scale of 12. However, for 6 patients considered individually (5 Chinese and 1 US), the assessment of the 2 groups of judges was statistically significantly different at P values ranging from 0.02 to less than 0.0001, even after the Bonferroni correction. CONCLUSIONS: These findings demonstrate that orthodontic clinicians can reliably identify and rank subtle differences between patients, and that differences between judges and between patients can be distinguished at a high level of statistical significance, given appropriate study designs. However, the reasons clinicians give for the differences in their judgments are more difficult to investigate and will require further study.

Reliability of 3D dental and skeletal landmarks on CBCT images.

OBJECTIVES: To quantify reliability of three-dimensional skeletal landmarks and a comprehensive set of dental landmarks in cone-beam computed tomography (CBCT) and to determine the shapes of envelope of error. MATERIALS AND METHODS: Three judges located 31 skeletal landmarks and 60 dental landmarks on the pre- and posttreatment CBCT images of 22 patients. Landmark error was determined by calculating the distance of deviation of landmark locations around their average. Standard deviation and mean radial spherical error were calculated. Scatterplots were constructed to characterize envelope of error. RESULTS: The midline landmarks of the cranial base were highly reliable. Bilateral skeletal landmarks tended to have larger error than midline landmarks. Among the nonconventional landmarks, fronto-zygomatic suture, condyle, and mental foramen showed relatively high reliability. However, foramen spinosum and temporal fossa showed larger errors. Gonion was the least reliable landmark. Most dental landmarks were located more reliably than skeletal landmarks. The highest reliability was found at incisal edges. Mesiobuccal cusp of first molars also showed high reliability. CONCLUSIONS: There were differences in the size and shape of the distributions of errors of different landmarks. Most landmarks showed elongated envelopes. Bilateral structures tended to show greater errors than midline structures. Most dental landmarks were more reliable than skeletal landmarks.

Evaluation of facial attractiveness from end-of-treatment facial photographs.

INTRODUCTION: Orthodontists typically make judgments of facial attractiveness by examining groupings of profile, full-face, and smiling photographs considered together as a "triplet." The primary objective of this study was to determine the relative contributions of the 3 photographs-each considered separately-to the overall judgment a clinician forms by examining the combination of the 3. METHODS: End-of-treatment triplet orthodontic photographs of 45 randomly selected orthodontic patients were duplicated. Copies of the profile, full-face, and smiling images were generated, and the images were separated and then pooled by image type for all subjects. Ten judges ranked the 45 photographs of each image type for facial attractiveness in groups of 9 to 12, from "most attractive" to "least attractive." Each judge also ranked the triplet groupings for the same 45 subjects. The mean attractiveness rankings for each type of photograph were then correlated with the mean rankings of each other and the triplets. RESULTS: The rankings of the 3 image types correlated highly with each other and the rankings of the triplets (P <.0001). The rankings of the smiling photographs were most predictive of the rankings of the triplets (r = 0.93); those of the profile photographs were the least predictive (r = 0.76). The difference between these correlations was highly statistically significant (P = .0003). It was also possible to test the extent to which the judges' rankings were influenced by sex, original Angle classification, and extraction status of each patient. No statistically significant preferences were found for sex or Angle classification, and only 1 marginally significant preference was found for extraction pattern. CONCLUSIONS: Clinician judges demonstrated a high level of agreement in ranking the facial attractiveness of profile, full-face, and smiling photographs of a group of orthodontically treated patients whose actual differences in physical dimensions were relatively small. The judges' rankings of the smiling photographs were significantly better predictors of their rankings of the triplet of each patient than were their rankings of the profile photographs.

. Facial attractiveness: ranking of end-of-treatment facial photographs by pairs of Chinese and US orthodontists.

INTRODUCTION: In this study, we assessed agreement and disagreement among pairs of Chinese and US orthodontists in the ranking for "facial attractiveness" of end-of-treatment photographs of growing Chinese and white orthodontic patients. METHODS: Two groups of orthodontist-judges participated: from the University of the Pacific, School of Dentistry, in California and from Peking University School and Hospital of Stomatology in China. Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 white patients and 48 Chinese patients. Pearson correlations were generated for a total of 1980 rankings by pairs of judges. RESULTS: The resulting correlations ranged from +0.004 to +0.96 with a median of +0.54. Of these, 18.7% were lower than 0.4; 41.0% were lower than 0.5; 68.8% were lower than 0.6; 91.6% were lower than 0.7; and only 8.4% were greater than 0.7. As had been anticipated, correlations between judges were higher when they ranked patients of their own ethnicity than when they ranked patients of different ethnicity, but the differences were smaller than had been expected. The rankings of no pair of judges correlated negatively. This is to say that no pair of judges, whether of the same or different ethnicity, ranked the patients so that those 1 judge tended to find attractive were consistently found unattractive by the other. CONCLUSIONS: The distribution of levels of agreement between pairs of orthodontists did not differ substantially whether the pairs included 2 US orthodontists, 2 Chinese orthodontists, or 1 US and 1 Chinese orthodontist. As might be expected, the pairs of Chinese orthodontists agreed with each other slightly better on average when ranking Chinese patients, and the pairs of US orthodontists agreed with each other slightly better on average when ranking white American patients, but the overall differences were small. These findings appear consistent with the inference that, on average, judgments of "facial attractiveness" by orthodontists at the 2 venues are more similar than had been expected for patients of Chinese and white ethnicity.

Forecasting the timing of peak mandibular growth in males by using skeletal age.

INTRODUCTION: It is generally believed that the orthodontic treatment of a patient with a Class II malocclusion and a small mandible is enhanced by good growth at puberty, so that the timing of peak mandibular growth at puberty becomes of interest. METHODS: To test the belief that skeletal age, whether early, average, or late, can be used to predict the timing of maximum growth of the mandible, whether early, average, or late, the predictive relationship between skeletal age and peak mandibular growth velocity (PMdV) at puberty was evaluated in 94 boys by using their longitudinal records from 4 to 18 years of age. Skeletal age was determined for each subject at ages 9 through 14 by using the method of Greulich and Pyle. RESULTS: At age 9, the Greulich and Pyle measurements predicted that 30 of the 94 subjects would have delayed PMdV equal to or exceeding 1 SD (of the mean age for PMdV), and 10 would have advanced PMdV equal to or exceeding 1 SD. When the actual age of PMdV was determined retrospectively from plots of annual mandibular growth increments, it was found that only 4 of the 30 in the delayed group had actually experienced delays in PMdV, and only 2 of the 10 in the advanced group had experienced accelerated PMdV. CONCLUSIONS: Skeletal age is not a reliable predictor of the timing of PMdV.

Effect of cephalometer misalignment on calculations of facial asymmetry.

INTRODUCTION: In this study, we evaluated errors introduced into the interpretation of facial asymmetry on posteroanterior (PA) cephalograms due to malpositioning of the x-ray emitter focal spot. We tested the hypothesis that horizontal displacements of the emitter from its ideal position would produce systematic displacements of skull landmarks that could be fully accounted for by the rules of projective geometry alone. METHODS: A representative dry skull with 22 metal markers was used to generate a series of PA images from different emitter positions by using a fully calibrated stereo cephalometer. Empirical measurements of the resulting cephalograms were compared with mathematical predictions based solely on geometric rules. The empirical measurements matched the mathematical predictions within the limits of measurement error (x= 0.23 mm), thus supporting the hypothesis. Based upon this finding, we generated a completely symmetrical mathematical skull and calculated the expected errors for focal spots of several different magnitudes. Quantitative data were computed for focal spot displacements of different magnitudes. RESULTS AND CONCLUSIONS: Misalignment of the x-ray emitter focal spot introduces systematic errors into the interpretation of facial asymmetry on PA cephalograms. For misalignments of less than 20 mm, the effect is small in individual cases. However, misalignments as small as 10 mm can introduce spurious statistical findings of significant asymmetry when mean values for large groups of PA images are evaluated.

Dental ethics in a larger context: one point of view.

Since the end of World War II, the practice of dentistry has been largely transformed from a "calling" into a cog in the ever-expanding "Healthcare Industry". In the process, the distinction between professional ethics and the ethics of commerce has been attenuated and, to a large extent, lost. Today's dentist is faced with an inherent conflict between the pledge of the health professional to hold the patient's interests primary (and above all, to do no harm), and the self-protective commercial principle of caveat emptor. Pressures towards commercialism come from the government and the insurance industry, the increasingly unfavorable ratio between professional fees and the cost of production, and the high cost of dental education. Viewed simplistically, much of dentistry today has an outward form resembling commodity production. Recognizing the substantial forces tending to attenuate ethical standards in our profession may aid us in resisting their encroachments.

A retrospective study of Class II mixed-dentition treatment.

OBJECTIVE: To consider the effectiveness of early treatment using one mixed-dentition approach to the correction of moderate and severe Class II malocclusions. MATERIALS AND METHODS: Three groups of Class II subjects were included in this retrospective study: an early treatment (EarlyTx) group that first presented at age 7 to 9.5 years (n = 54), a late treatment (LateTx) group whose first orthodontic visit occurred between ages 12 and 15 (n = 58), and an untreated Class II (UnTx) group to assess the pretreatment comparability of the two treated groups (n = 51). Thirteen conventional cephalometric measurements were reported for each group and Class II molar severity was measured on the study casts of the EarlyTx and LateTx groups. RESULTS: Successful Class II correction was observed in approximately three quarters of both the EarlyTx group and the LateTx group at the end of treatment. EarlyTx patients had fewer permanent teeth extracted than did the LateTx patients (5.6% vs 37.9%, P < .001) and spent less time in full-bonded appliance therapy in the permanent dentition than did LateTx patients (1.7 ± 0.8 vs 2.6 ± 0.7years, P < .001). When supervision time is included, the EarlyTx group had longer total treatment time and averaged more visits than did the LateTx group (53.1 ± 18. 8 vs 33.7 ± 8.3, P < .0001). Fifty-five percent of the LateTx extraction cases involved removal of the maxillary first premolars only and were finished in a Class II molar relationship. CONCLUSION: EarlyTx comprehensive mixed-dentition treatment was an effective modality for early correction of Class II malocclusions.

Current clinical research in orthodontics: a perspective.

This essay explores briefly the approach of the Craniofacial Research Instrumentation Laboratory to the systematic and rigorous investigation of the usual outcome of orthodontic treatment in the practices of experienced clinicians. CRIL's goal is to produce a shareable electronic database of reliable, valid, and representative data on clinical practice as an aid in the production of an improved environment for truly evidence-based orthodontic treatment.

Clinical use of the ABO-Scoring Index: reliability and subtraction frequency.

This study tested the reliability and subtraction frequency of the study model-scoring system of the American Board of Orthodontists (ABO). We used a sample of 36 posttreatment study models that were selected randomly from six different orthodontic offices. Intrajudge and interjudge reliability was calculated using nonparametric statistics (Spearman rank coefficient, Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests). We found differences ranging from 3 to 6 subtraction points (total score) for intrajudge scoring between two sessions. For overall total ABO score, the average correlation was .77. Intrajudge correlation was greatest for occlusal relationships and least for interproximal contacts. Interjudge correlation for ABO score averaged r = .85. Correlation was greatest for buccolingual inclination and least for overjet. The data show that some judges, on average, were much more lenient than others and that this resulted in a range of total scores between 19.7 and 27.5. Most of the deductions were found in the buccal segments and most were related to the second molars. We present these findings in the context of clinicians preparing for the ABO phase III examination and for orthodontists in their ongoing evaluation of clinical results.

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients.

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from -0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R(2)=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R(2)=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

Treatment outcomes in 4 modes of orthodontic practice.

BACKGROUND: This study is a continuation of a previously published report on the outcome of orthodontic treatment provided in offices representing different modes of practice. METHODS: The sample consisted of duplicate pretreatment (T1) and posttreatment (T2) dental casts of 348 patients from traditional private orthodontic practices (5 offices, 134 patients), company-owned practices (5 offices, 107 patients), offices associated with practice-management organizations (2 offices, 60 patients), and general dental practices (2 offices, 47 patients). Methods were used to obtain random, representative samples from each office, starting with lists of patients who were treated consecutively with full fixed orthodontic appliances. The dental casts were measured by 2 independent judges who used the unweighted PAR score. RESULTS: Good interjudge agreement was shown on the initial casts, but the agreement was not as strong on the final casts. CONCLUSIONS: The measurements showed that treatment outcomes were generally satisfactory, although some significant differences between offices and management modes were shown.

Evaluation of Class II treatment by cephalometric regional superpositions versus conventional measurements.

INTRODUCTION: The aims of this study were (1) to evaluate cephalometric changes in subjects with Class II Division 1 malocclusion who were treated with headgear (HG) or Fränkel function regulator (FR) and (2) to compare findings from regional superpositions of cephalometric structures with those from conventional cephalometric measurements. METHODS: Cephalographs were taken at baseline, after 1 year, and after 2 years of 65 children enrolled in a prospective randomized clinical trial. The spatial location of the landmarks derived from regional superpositions was evaluated in a coordinate system oriented on natural head position. The superpositions included the best anatomic fit of the anterior cranial base, maxillary base, and mandibular structures. RESULTS: Both the HG and the FR were effective in correcting the distoclusion, and they generated enhanced differential growth between the jaws. Differences between cranial and maxillary superpositions regarding mandibular displacement (Point B, pogonion, gnathion, menton) were noted: the HG had a more horizontal vector on maxillary superposition that was also greater (.0001 < P < .05) than the horizontal displacement observed with the FR. This discrepancy appeared to be related to (1) the clockwise (backward) rotation of the palatal and mandibular planes observed with the HG; the palatal plane's rotation, which was transferred through the occlusion to the mandibular plane, was factored out on maxillary superposition; and (2) the interaction between the inclination of the maxillary incisors and the forward movement of the mandible during growth. CONCLUSIONS: Findings from superpositions agreed with conventional angular and linear measurements regarding the basic conclusions for the primary effects of HG and FR. However, the results suggest that inferences of mandibular displacement are more reliable from maxillary than cranial superposition when evaluating occlusal changes during treatment.