Our long range goal is to objectively evaluate orthodontic treatment. A shorter range goal is to develop the methods to make this assessment. Toward this end, five studies are planned to investigate 1. the diagnostic process, orthodontic records and treatment decisions; 2. clinicians' perceptions of severity, difficulty, goals and expectations; 3. patients concerns, aversions, expectations and satisfaction with outcomes; 4. attributes of treatment relative to efficacy, and 5. to conduct a randomized clinical trial. Subsets of this project will evaluate aspects of orthodontics ranging from diagnosis, to outcome. The diagnostic and treatment planning decision process will be analyzed. How information conditions treatment decisions will be determined. Attributes of treatment process and outcome variables, besides traditional measures of morphologic change are needed to compare the efficacy of alternative treatment strategies. Methods will be developed, and tested, and will incorporate additional factors such as: (a) time, cost, discomfort and other attributes of treatment, and (b) determination of patients' expectations and orthodontists' pretreatment goals, and their respective satisfaction with outcomes. Finally the methods developed will be applied to a randomized clinical trial of 240 children with Class II division 1malocclusions to compare the efficacy of three treatment options. Orthodontics is unique among dental specialties in that it deals with normal biologic variations rather than pathology, and hence is elective in terms of need, and inevitably subjective in citeria used to assess prevalence, severity, treatment success or indeed what constitutes optimum care. Controversies therefore are common and substantially similar to some analogous issues in medicine. According to the best estimates, over 2 million Americans embark on orthodontic treatment annually, at a cost in excess of $6 billion. There is a current trend for increasing demand and utilization of orthodontic services which is likely to continue. Concurrent with increased numbers of providers, there has also occurred a proliferation of treatment approaches, options and techniques. All have their adherents, and are enthusiastically promoted as being effective, viable and generally adequate treatment methods. But unlike other health- care specialties, no aspect of orthodontics has yet been evaluated to yield data on efficacy. Although the methods of clinimetrics (i.e. the measurement of clinical performance, using principles of clinical epidemiology), are well established and have been successfully applied in medicine and other dental specialties, they remain to be adapted for a systematic evaluation of orthodontics. By quantifying outcomes, issues pertaining to the efficacy of orthodontics will be clarified using clinical decision analysis. Such a methodologic approach should contribute to an understanding of what constitutes """"""""better"""""""" treatment, and help to make informed decisions about alternative treatments.
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