Orthodontics is dentistry's oldest specialty. Unfortunately, in its nearly 100 years of existence, the orthodontic research establishment has never troubled to examine the comparative impact of its various treatment strategies on African-American patients. The research proposed here is designed, therefore, to describe and compare the short- and long-term dental, skeletal, aesthetic, and functional outcomes and efficacy of the two major sets of treatment alternatives commonly employed in the treatment of malocclusion: 1) adolescent fixed-appliance therapy, extraction versus non-extraction, and 2) orthodontics versus surgery in adults. Because of the non-specific character of malocclusion, the elective nature of treatment, and the in-equality of risk among treatments (e.g., surgery and orthodontics), ethical, prospective trials would, of necessity, be severely limited in scope. The present research, therefore, will employ a """"""""retrospective-prospective"""""""" design in which great pains are taken to control the types of bias that often compromise case-control studies: selection will be independent of outcome and will employ discriminant analysis to define prognostic sub-groups of known treatment susceptibility - those for whom there is empirical evidence of uncertainty and those who were susceptible only to a single treatment. This approach will serve to control susceptibility bias and thus will mimic many of the most desirable features of prospective, randomized trials. In so doing, it will permit clinically meaningful comparisons between pairs of logical alternatives (e.g., extraction versus non- extraction edgewise or adult orthodontics versus surgery). Additionally this approach will support comparisons with earlier data from white patients (e.g., between European- and African-American sub-groups with comparable facial morphology within a given treatment). Finally, the resulting data will provide insight into the perceived utility to the patient of the various treatment outcomes and the anatomical bases for the esthetic preferences of both European- and African-American adolescents and adults.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Research Project (R01)
Project #
5R01DE008716-07
Application #
2130173
Study Section
Oral Biology and Medicine Subcommittee 1 (OBM)
Project Start
1988-08-01
Project End
1998-09-29
Budget Start
1994-09-30
Budget End
1995-09-29
Support Year
7
Fiscal Year
1994
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Dentistry
Type
Schools of Dentistry
DUNS #
791277940
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Bowman, S J; Johnston Jr, L E (2000) The esthetic impact of extraction and nonextraction treatments on Caucasian patients. Angle Orthod 70:10-Mar
Scott, S H; Johnston Jr, L E (1999) The perceived impact of extraction and nonextraction treatments on matched samples of African American patients. Am J Orthod Dentofacial Orthop 116:352-60
Johnston Jr, L E (1999) Bearbaiting in dentistry: a specialty under siege. Alpha Omegan 92:14-8
Johnston Jr, L E (1998) The value of information and the cost of uncertainty: who pays the bill? Angle Orthod 68:99, 101-2
Johnston Jr, L E (1998) A comparative analysis of Class II treatments: a retrospective/prospective alternative. Clin Orthod Res 1:142-6
Hagler, B L; Lupini, J; Johnston Jr, L E (1998) Long-term comparison of extraction and nonextraction alternatives in matched samples of African American patients. Am J Orthod Dentofacial Orthop 114:393-403
McKnight, M M; Daniels, C P; Johnston Jr, L E (1998) A retrospective study of two-stage treatment outcomes assessed with two modified PAR indices. Angle Orthod 68:521-4;discussion 525-6
Johnston Jr, L E (1998) Growth and the Class II patient: rendering unto Caesar. Semin Orthod 4:59-62
Lai, M; McNamara Jr, J A (1998) An evaluation of two-phase treatment with the Herbst appliance and preadjusted edgewise therapy. Semin Orthod 4:46-58
Johnston Jr, L E (1996) Functional appliances: a mortgage on mandibular position. Aust Orthod J 14:154-7

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