Original article
Orthodontists' perceptions of the need for orthognathic surgery in patients with Class II Division 1 malocclusion based on extraoral examinations

https://doi.org/10.1016/j.ajodo.2012.02.020Get rights and content

Introduction

The purpose of this study was to establish the influence of soft-tissue profile values on the decision of orthodontists to recommend orthognathic surgery for patients with Class II Division 1 malocclusion.

Methods

A questionnaire containing 40 profile photographs of adults with Class II Division 1 malocclusion was sent to all 256 consultant orthodontists in the United Kingdom asking for a “yes” or “no” response to the question: “Based on the profile view of this patient, would you treat this patient using an orthognathic surgical approach?” A soft-tissue analysis was carried out on each photograph, and multi-level logistic regression was used to investigate factors that affect the decision to recommend surgery.

Results

The response rate was high: 208 of 256 questionnaires (81.3%). Intraexaminer reliability of the photographic analysis method with a Bland-Altman plot showed good (95% CI) limits of agreement for each measurement. Consultants who carried out more orthognathic surgery treatment were more likely to recommend surgery. Secondary analysis with a logistic regression model indicated that 80% of the consultants would recommend surgery if B-point was more than or equal to −14.1 mm posterior to the true vertical through subnasale (95% CI, −29.9 to −10.9 mm), the facial profile angle was less than or equal to 148.9° (95% CI, 6.7° to 151.1°), pogonion to true vertical through subnasale was more than or equal to −12.0 mm (95% CI, −48.7 to −8.6 mm).

Conclusions

The facial profile angle and the positions of soft-tissue pogonion and B-point are useful clinical guides for planning treatment for adults with Class II Division 1 malocclusion.

Section snippets

Material and methods

Ethical approval was approved by the Leeds East Ethics Committee (08/H1306/96), and research and development approval was granted from Leeds Teaching Hospitals NHS Trust, Bradford Teaching Hospitals NHS Foundation Trust, and York Teaching Hospitals NHS Trust in the United Kingdom.

The patients were drawn from new patient clinics in York District Hospital and Leeds Dental Institute. Forty patients were recruited with Class II Division 1 malocclusions exhibiting wide variations in degree of

Results

Of the 256 booklets sent, 208 were returned, giving a response rate of 81.3%. Of the 208 returned, 5 were incomplete with at least 1 piece of data missing. All returned booklets were included in the analysis. Of the booklets that were returned, 97% were fully completed.

Of the 208 (63%) consultants, 131 were male and 77 were female (37%). Information about the years that the consultants qualified as orthodontists was grouped and showed that the over 40% of them qualified between 1991 and 2000,

Discussion

Key soft-tissue profile values, indicating a possible need for orthognathic surgical treatment in patients with Class II Division 1 malocclusions, were identified (position of B-point, facial profile angle, and position of pogonion).

The more orthognathic patients a consultant orthodontist treats per year, the more likely he or she is to recommend surgery. Neither the sex nor the year of qualification of the consultant seemed to affect this decision.

The decision to take the photographs with the

Conclusions

  • 1.

    The photographic analysis in this study is a valid and reproducible method of assessing the patient's soft-tissue profile.

  • 2.

    The more orthognathic patients a consultant orthodontist treats per year, the more likely he or she is to recommend surgery. Neither the consultant's sex nor the year of qualification seemed to affect this decision.

  • 3.

    If soft-tissue B-point is more than or equal to −14.1 mm (95% CI, −21.3 to −9.2 mm) posterior to the true vertical through subnasale, then 80% of the consultant

The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.

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Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.