Treatment difficulty and treatment outcome in orthodontic care

SUMMARY The influence of perceived treatment difficulty on the outcome of and investment in orthodontic treatment was studied in 19-year-old individuals treated by general practitioners or specialists within the totally subventioned Swedish system for orthodontic care. A total of 313 individuals were evaluated according to treatment outcome and treatment investment. About one-quarter of the treatments evaluated were classified as easy, onequarter as moderately difficult, and one-half as difficult. The perceived treatment difficulty was on a group basis associated with the pretreatment need. The treatment outcome became less favourable and the treatment investment more expensive the greater the perceived difficulty. More than one-quarter of the treatments provided by general practitioners were classified as difficult compared with three-quarters of those provided by specialists. The outcomes were, in general, more favourable for specialist treatments than for those provided by general practitioners, although the individuals treated by specialists, on the average, were classified as more difficult than those provided by general practitioners. Easy treatments were found to be extremely cost-effective and should be carried out when possible. General practitioners should preferably treat uncomplicated cases, and an increased use of fixed appliances would be desirable in the treatment of moderately difficult treatments. Difficult cases should be treated exclusively by specialists. Cases with little need or benefit of treatment, or a poor prognosis should be given low treatment priority, and patients and parents should in these cases be informed about the small expected benefit and risks involved.