[Efficacy of orthodontic treatment according to the Peer Assessment Rating index].Ann Acad Med Stetin. 2003; 49:335-51.AA
The work deals with assessment of orthodontic treatment using the Peer Assessment Rating (PAR) index. The objective was to rate the results of orthodontic treatment in the following groups: 1. All patients seen at the Department of Orthodontics, Pomeranian Academy of Medicine; 2. Patients treated by individual dentists at the Department of Orthodontics, Pomeranian Academy of Medicine; 3. Patients with distocclusion; 4. Patients treated with fixed appliances. 1. Rating in patients treated at the Department of Orthodontics, Pomeranian Academy of Medicine Mean reduction in PAR for all patients treated at the Department of Orthodontics was 70%. On this basis, the efficiency of treatment in this group can be termed as high, with 18% of patients classified to "marked improvement", 73% of patients to "improvement" and 9% to "deterioration--no change" groups. This reduction in PAR index is a good result in comparison with published data. 2. Rating in patients treated by individual dentists at the Department of Orthodontics, Pomeranian Academy of Medicine Reduction in PAR ranged from 48% to 83%, depending on the dentist concerned. Orthodontist A achieved the highest reduction (83%), while orthodontists C and E achieved lowest reduction (64% and 48%, respectively). Analysis of patients treated by orthodontists A and C demonstrated that the median PAR for orthodontist A was higher by 5 points than for orthodontist C. 80 malocclusions treated by orthodontist A were difficult to manage. Besides, treatment by orthodontist A was approximately 4 months shorter than by orthodontist C. Patients of orthodontist A had approximately two visits less than patients of orthodontist C. Average costs of treatment for orthodontist A were approximately PLN 500 lower than costs for orthodontist C. In 25% of patients of orthodontist A "marked improvement" was achieved as opposed to only 17% of for orthodontist C. 3. Rating in patients with distocclusion The most significant improvement in this group was achieved with Lehman's appliance (84%). Significant improvement was also noted in patients treated with a two-arch fixed appliance (82%). The lowest reduction in PAR was observed in patients treated with one-arch fixed appliance (64%). High efficiency of treatment with Lehman's appliance or with two-arch fixed appliance in patients with distocclusion is comparable with published results. 4. Rating in patients treated with fixed appliances Patients treated with two-arch fixed appliance achieved higher reduction in PAR than patients treated with one-arch fixed appliance. The main criterion was overcrowding of lower incisors. Results show that treatment with two-arch fixed appliance, in spite of lack of overcrowding of lower incisors, improves the efficiency of treatment. Patients treated with two-arch fixed appliance achieved better qualitative and quantitative results than patients treated with one-arch fixed appliance. In effect, the former patients were managed more effectively. The following conclusions were drawn: 1. The efficiency of treatment at the Department of Orthodontics, Pomeranian Medical University, was high; 2. The efficiency of treatment by orthodontists at the Department of Orthodontics, Pomeranian Medical University, was high; 3. Treatment efficacy for patients with distocclusion was highest with Lehman's appliance and with two-arch fixed appliance; 4. Although costs of treatment were reduced with one-arch fixed appliance, efficiency was lower than for two-arch fixed appliance. Moreover, it is necessary to: 5. Treat abnormalities of occlusion affecting the esthetics of bite, but also abnormalities with importance for normal occlusion that the patient is not aware of, like abnormalities in buccal segments, compression of lower incisors, marked overbite and centerline shift; 6. Control right and left buccal occlusion to the same extent; 7. Treat both jaws using removable and fixed appliances.