An exploratory study of the cost-effectiveness of orthodontic care in seven European countries.

This study investigated the orthodontic treatment of 429 consecutive patients [172 male (40.1 per cent) and 257 female (59.9 per cent)] carried out by 10 orthodontic specialist practitioners in seven European countries [two in the Czech Republic (A and B), two in Germany (A and B), Italy, Latvia, Lithuania, and Netherlands, and two in Slovenia (A and B)]. The median age of the patients at the start of treatment was 13.0 years (minimum 7.3 years maximum 50.3 years). The patients had a range of malocclusions and the majority (97 per cent) were treated with upper and lower fixed appliances. Real exchange rates were calculated using purchasing power parity (PPP) indicators to allow cross-border comparisons of costs. The Index of Complexity, Outcome and Need (ICON) was used to measure the effectiveness of treatment and cost per ICON point reduction to compare cost-effectiveness of orthodontic treatment between practitioners in different European countries. The median cost per ICON point reduction for all the cases treated was 57.69 euro. The median cost per ICON point reduction varied greatly between practitioners from 21.70 euro (Lithuania) to 116.62 euro (Slovenia A). Analysis of variance and Tukey post hoc tests showed the differences in cost-effectiveness between the practitioners to be statistically significant (P<0.001). The cost per ICON point reduction is a simple and effective method of comparing cost-effectiveness between orthodontic practitioners in different countries.

Cone beam computed tomography: a useful tool in orthodontic diagnosis and treatment planning.

The aim of this article is to make clinicians aware of the use of cone beam computed tomography (CBCT) within the field of orthodontics. The paper describes five cases each one illustrating the improved diagnostic yield using CBCT over conventional radiography thus facilitating the appropriate treatment planning of patients.

Orthodontic extrusion: an interdisciplinary approach to patient management.

UNLABELLED: Root fractures that occur at the cervical margin do not always heal predictably, even following a period of splinting. This often leaves margins either sub-gingival or sub-crestal. This provides an unsatisfactory situation for restoring the remaining root as restorations will impinge on the biological width. Provided a root is long enough to support a post crown, then orthodontic extrusion to provide sufficient supra-gingival tooth tissue is a useful treatment option to consider. A review of the literature on orthodontic extrusion is considered in conjunction with a case report of the management of a young male who fractured a canine and lateral incisor whilst playing cricket. CLINICAL RELEVANCE: Trauma to upper anterior teeth is frequently seen in practice. One treatment option in the management of sub-crestal cervical root fractures is orthodontic extrusion, rather than removal of the tooth.

League tables for orthodontists.

The aim of this study was to explore the complexities in constructing league tables purporting to measure orthodontic clinical outcomes. Eighteen orthodontists were invited to participate in a cost-effectiveness study. Each orthodontist was asked to provide information on 100 consecutively treated patients. The Index of Complexity, Outcome, and Need (ICON) was used to assess treatment need, complexity, and outcome prior to, and on completion of, orthodontic treatment. The 18 orthodontists were ranked based on achieving a successful orthodontic outcome (ICON score less than or equal to 30) and the uncertainty in both the success rates and rankings was also quantified using confidence intervals. Successful outcomes were achieved in 62 per cent of the sample (range 19-94 per cent); four of the 18 orthodontists failed to achieve more than a 50 per cent success rate. In developing league tables, it is imperative that factors such as case mix are identified and accounted for in producing rankings. Bayesian hierarchical modelling was used to achieve this and to quantify uncertainty in the rankings produced. When case mix was taken into account, the four with low success rates were clearly not as good as the top four performing orthodontists. League tables can be valuable for the individual orthodontist, groups of orthodontists, payment/insurance agencies, and the public to enable informed choice for orthodontic provision but must be correctly constructed so that users can have confidence in them.

Measuring the cost, effectiveness, and cost-effectiveness of orthodontic care.

AIM: To determine the relative effectiveness and cost-effectiveness of orthodontic treatment per case in one "fee for item" and two different types of salaried orthodontic clinics. SUBJECTS AND METHODS: This prospective study recruited a random sample of six self-employed orthodontists (fee-for-item) and six orthodontists from both hospital and community clinics (salaried services). One hundred patients were followed to completion of orthodontic care. Questionnaires were employed to determine cost of treatment from the clinicians' and patients' points of views. Four cost-effectiveness models were developed. RESULTS: Complete records of outcome were available for 1,087 patients, but only 789 had complete data on costing. Three of the four cost-effectiveness models indicated similar rankings for the 18 clinicians. The most cost-effective service was provided by clinicians working in community clinics, followed by clinicians working in hospitals, then self-employed clinicians. The preferred cost-effective model takes into consideration the initial need and successful outcome of orthodontic treatment. CONCLUSION: Cost-effectiveness models have been developed to quantify the performance of individual clinicians working in self-employed and salaried clinics. Costs and effectiveness of the clinicians in each clinical setting show considerable variation.

The orthodontic and surgical management of Zimmerman-Laband syndrome.

Zimmermann-Laband syndrome (ZLS) is a rare autosomal disorder characterized by gingival fibromatosis, abnormalities of the nose and/or ears, hypoplasia of the nails or terminal phalanges of the hands and feet, hyperextensibility of joints, hepatosplenomegaly, hirsutism, and intellectual disability. The characteristics of the syndrome are highly variable and complicated. This paper reports a case of ZLS and the clinical manifestations encountered in relation to the current available literature. The comprehensive management of the patient's dentition is described, focusing on the orthodontic and surgical considerations clinicians should be aware of when treating patients with the syndrome.

Incidental findings arising with cone beam computed tomography imaging of the orthodontic patient.

Cone beam computed tomography (CBCT) of orthodontic patients is a diagnostic tool used increasingly in hospital and primary care settings. It offers a high-diagnostic yield, short scanning times, and a lower radiation dose than conventional computed tomography. This article reports on four incidental findings-that appear unrelated to the scan's original purpose-arising in patients for whom CBCT was carried out for orthodontic purposes. It underlines the need for complete reporting of the data set.