Consistency of orthodontic treatment decisions relative to diagnostic records Unae Kim Han, DMD, MPH, MS," Katherine W. L. Vig, BDS, D. Orth., FDSRCS(Eng,), MS, b Jane A. Welntraub, DDS, MPH, = Peter S. Vig, BDS, PhD, D. Orth., FDSRCS(Eng.), n and Charles J. Kowalski, PhD ° Farmington Hills and Ann Arbor, Mich., and Chapel Hill, N.C. The purpose of this study was to evaluate how incremental information obtained from different types of diagnostic records contributes to the determination of orthodontic treatment decisions. Pretreatment records of 57 orthodontic patients were assessed by five orthodontists who were part-time faculty members and also in private practice. This sample consisted of dental school orthodontic patients who had Class II malocclusions and included patients at three different dental developmental stages. The following diagnostic records were used: study models (S), facial photographs (F), a panoramic radiograph (P), a lateral cephalogram (C), and its tracing (r). Five combinations of diagnostic records were presented to the orthodontists in the following sequence: (1) S;(2) S + F;(3) S + F + P;(4) S+ F+ P+ C;and(5) S+ F + P+C +T. The simultaneous interpretation of all diagnostic records (S + F + P + C + T) was used as the "diagnostic standard." There was a diagnostic standard for each of the patients and for each of the orthodontists. The diagnostic standard was achieved: (1) S = 54.9%, (2) S + F = 54.2%, (3) S + F + P = 60.9%, and (4) S + F + P + C = 59.9%. Thus, in a majority of cases (55%), study models alone provided adequate information for treatment planning, and incremental addition of information from other types of diagnostic records made smal~ differences. (AM J ORTHOD DENTOFAC ORTHOP 1991 ;100:212-9.) There has recently been a proliferation in the diagnostic and treatment regimens available in orthodontics. The battery of diagnostic tests include study models mounted on semiadjustable articulators, types of jaw tracking, TMJ tomograms, and other pre- sumably necessary devices. Most of these modalities are suggested and used on the basis of clinical expe- rience and personal preference. Their clinical efficacy has not been validated, as yet by the orthodontic spe- cialty. Likewise the probabilities of the expected treat- ment outcomes have not been assessed. In medicine the escalating cost of the nation's health care has resulted in cost containment and methods to assess the efficacy of treatment alternatives. ',~ The field This work was supported by USPHS, NIH/NIDR grants DE 06881 and DE 08714. =In private practice, Farmington Hills, Mich. bAssoeiate Professor and Chairman, Department of Orthodontics, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa. CAssistantProfessor, Department of Dental Ecology, School of Dentistry, Uni- versity of North Carolina, Chapel Hill. dAss0eiate Dean of Research, University of Pittsburgh School of Dental Med- icine, Pittsburgh, Pa. °Professor, Department o f Biologic and Materials Sciences, School of Dentistry, The University of Michigan, Ann Arbor. 811/23631 212 of clinical epidemiology or "clinimetrics" has been de- veloped to evaluate the efficacy of treatments and di- agnostic tests. Clinical epidemiology combines bio- statistics, epidemiology, clinical decision analysis, risk-benefit analysis, cost-benefit analysis, and cost- effectiveness analysis. It is concerned with the study of groups of patients to provide evidence on which to base clinical decisions in health care? Although these techniques have been applied in medicine 3"5 and in some areas of dentistry, ~'~ they have not been widely applied in orthodontics. 9 Diagnosis in orthodontic practice includes the clas- sification of malocclusion, and currently emphasis is being directed toward a comprehensive synthesis of information. Proffit and Ackerman ~° advocate the "problem-oriented" approach to orthodontic diagnosis that was originally developed in medicine to provide a rational approach to diagnosis." The decision-making process in orthodontic diagnosis and treatment planning involves (1) the recognition of the characteristics of malocclusion and dentofacial deformity, (2) the defi- nition of the nature or cause of the problem, and (3) the design of a treatment strategy based on the specific needs of the patientl Fundamental to this process is the acquisition of relevant information to form a data base.