The Influence of Patient, Practitioner, and Dentofacial Characteristics on Recommendations and Acceptance of Treatment Plans for Anterior Open Bite in Adults
Choi, Kelly Weikert
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Introduction: A wide variety of treatment modalities have been employed over the years to treat anterior open bite (AOB) in adults, but there is little reliable evidence to support the primacy of any particular method. Additionally, we know very little about how patient factors affect clinical decision making for adult AOB. The purpose of this study is to explore how practitioner, patient, and dentofacial characteristics are associated with treatment decisions in adult AOB treatment across the United States. Methods: Study participants were recruited from the practices of National Dental Practice-based Research Network dentists. Participants consisted of practitioners and their adult patients in active treatment for AOB that met the inclusion/exclusion criteria. Practitioners completed questionnaires including questions about demographics, preferred techniques for treating open-bites, and study patient dentofacial characteristics. Patients were given a questionnaire that asked about chief complaints, treatment goals and expectations, and reasons for selecting a treatment plan. Initial pre-treatment cephalograms were collected for each patient and were traced to obtain patient dentofacial characteristics. The association of each of the dentofacial, patient, and practitioner characteristics with different treatment recommendations were ascertained using Chi-square tests for categorical variables. For patient cephalometric variables (including OB, SN-MP, ANB), ANOVA was performed. For the dentofacial domain, logistic regression analyzed the dichotomous outcome of surgery most recommended treatment plan vs. no surgery. Results: A total of 68 practitioners and 199 adult patients participated in the investigation. A statistically significant mean difference was detected among practitioners prescribing TADs based on where they attended dental school (36% foreign trained recommend TADs often vs. 5% US trained, p=0.002) and based on their race (5% Caucasian providers “often prescribe” TADs, while 24% of Asian practitioners “often prescribe”; p=0.03). Patient acceptance was not associated with age or education level but was influenced by insurance coverage. When a patient did not have medical insurance that covered surgical costs, the acceptance rate for a surgical plan was much lower (47.7%) than when they did have coverage for the procedure (78.6%, p=0.009). Mandibular plane angle, initial overbite, and molar classification were all independently associated with a surgical recommendation. Conclusions: This study found several interesting associations between practitioner, patient, and dentofacial characteristics and treatment recommendations.
- Dentistry