Adult orthodontic therapy: extraction versus non-extraction.

This study addresses the problem of randomization of subjects with respect to an irreversible aspect of treatment strategy, namely, the extraction of teeth. The investigation includes both prospective and retrospective components. The data presented focus on clinician decision-making. Of the 1321 potential subjects for whom records were taken, 250 met the inclusion criteria. Of these subjects, 82 declined to participate and 20 were dropped because of difficulty in obtaining five independent evaluations of their records within a reasonable time frame. Thus, the final sample contained 148 subjects. Approximately one-third of the subjects in the sample are adult, somewhat more than half are female, and Class I malocclusions outnumber Class II malocclusions by a count of 95 to 53. Patterns of agreement and disagreement among five clinicians include: a) agreement/disagreement on the primary decision whether or not to extract: the data reveal a strong tendency towards consensus among the clinicians; b) agreement/disagreement on extraction pattern in patients in whom the clinician believes that extraction is indicated: the clinicians tended strongly to agree on extraction pattern; c) agreement/disagreement on the need for adjunctive orthognathic surgery: decisions favoring surgery were more common and more 'definite' than 'probable' in the adult cohort than in the adolescent cohort but this tendency was not as strong as had been anticipated; d) agreement/disagreement concerning Angle classification: disagreements were more common than had been anticipated; and e) differences among the individual clinicians as to their ratios of extraction/non-extraction decisions: overall, clinicians opted for extraction less frequently in the adolescent cohort than in the adult cohort (55 vs. 66%). Because the data are drawn from actual clinical experience, the conclusions involve a number of assumptions and their generalizability should be evaluated.

RCT Entities:   Population Interventions Outcomes