ORIGINAL ARTICLE Assessing treatment outcomes for a graduate orthodontics program: Follow-up study for the classes of 2001-2003 Kristin Knierim, a W. Eugene Roberts, b and James Hartsfield, Jr c Knoxville, Tenn, and Indianapolis, Ind Introduction: Based on an initial 3-year study (1998-2000) of clinical outcomes, specific changes were made in the clinical protocol in the orthodontic clinic at Indiana University, Indianapolis, Ind. To evaluate these adjustments, a follow-up study with the same methods assessed the clinical outcomes for the next 3 years (2001-2003). Methods: The 3 changes introduced in 2000 were assessment of prefinish records, education of residents about previous outcomes, and more frequent practice evaluations by the program director. The American Board of Orthodontics (ABO) objective grading system (OGS) and a supplemental comprehensive clinical assessment (CCA) were used to evaluate the results for all patients completed by the classes of 2001 through 2003 (n = 437). Results: The mean ABO OGS, CCA, and combined scores were 25.19  11.16, 4.38  2.74, and 29.57  13.01, respectively. A progressive improvement was noted from 2001 to 2003. The ABO OGS and the combined scores were significantly (P .001) improved in 2001 through 2003 compared with 1998 through 2000. The CCA score tended to improve, but it was not significantly different. Significant improvements were seen for maxillary and mandibular first order, mandibular second order, mandibular third order, overjet, occlusal contacts, occlusal relationships, and root angulations (P .001). As with the previous study, excessive treatment times correlated with worse clinical outcomes. Conclusions: Changes imple- mented by the graduate program were effective for improving treatment outcomes. Cast scores were more amenable to improvement than other more comprehensive outcomes. (Am J Orthod Dentofacial Orthop 2006;130:648-55) M onitoring treatment progress for an orth- odontics program or a private practice is important for assuring quality control. Iden- tifying problems is essential for developing strategies to efficiently improve clinical outcomes. 1 The most effec- tive way to assess treatment quality is a quantitative outcome assessment. In the words of Abei et al, 2 “evidence-based decision making has become a hall- mark of 21st century health care, and this trend has placed a premium on quantitative measure of treatment outcome.” The occlusal index 3,4 and the peer assessment rating (PAR) 5-8 have been used for measuring orthodontic outcomes. However, the occlusal index is tedious and is more appropriate for scoring pretreatment rather than posttreatment records. 9 The PAR index is more reli- able, but it is not very sensitive 10 and does not adequately assess minor discrepancies in tooth position. 9 The American Board of Orthodontics (ABO) intro- duced the objective grading system (OGS) 9 for assess- ing posttreatment dental casts and panoramic radio- graphs; it has become widely accepted. 1,2,11-14 Before the introduction of this grading system, clinicians had no reliable method for grading their own casts. A primary reason that cases failed the Phase III (clinical) examination in the past was inadequate finished occlu- sions. 15,16 Since implementation of the OGS, the num- ber of cases that received passing grades for the ABO’s Phase III has greatly improved. 17 The ABO also created the OGS to encourage clinicians to use it “at any time to determine if one is producing ‘board-quality’ results.” 9,11 Board quality is broadly defined. When evaluating dental casts, Casko et al 9 stated that a cast scoring more than 30 points during the clinical section of the board certification process usually fails. Further clarification stated that a score of 20 is generally passing, and 26 is a borderline out- come. 2 With regard to “board-quality” results in uni- versity programs, Yang-Powers et al 11 and Pinskaya et al 1 reported that ABO scores less than 30 are achieved a Private practice, Knoxville, Tenn. b Jarabak professor, Director of Graduate Orthodontics, Section of Orthodon- tics, School of Dentistry, Indiana University, Indianapolis, Ind. c Professor, Director of Oral-facial Genetics, Section of Orthodontics, School of Dentistry, Indiana University, Indianapolis, Ind. Reprint requests to: Dr W. Eugene Roberts, Section of Orthodontics, School of Dentistry, Indiana University, 1121 W Michigan St, Indianapolis, IN 46202; e-mail, werobert@iupui.edu. Submitted, July 2005; revised and accepted, July 2006. 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.07.014 648