Treatment acceptance in adult anterior open bite patients: a national network study

Abstract

Introduction: Modern orthodontists have a variety of treatment techniques and appliances at their disposal to treat anterior open bite malocclusions. Patients are often involved in decisions regarding their treatment. It is largely unknown which aspects patients take into consideration when choosing an orthodontic treatment plan. The aim of this study is to investigate orthodontic treatment plan acceptance by adults with anterior open bite in the United States and to identify associations between treatment plan acceptance and practitioner demographics, patient demographics, and dentofacial characteristics. Methods: A prospective, observational 3.5-year cohort study enrolled the patients of 91 National Dental Practice-based Research Network orthodontists and dentists who routinely perform orthodontic treatment. 345 adult patients were ultimately included in the sample population. Practitioners filled out forms regarding their personal and practice demographics. They also recorded patient dentofacial characteristics and listed their recommended treatment plans. Patients answered survey questions regarding their demographics, treatment goals, treatment plan accepted, and if applicable, reasons for not accepting the most highly recommended treatment plan. Univariate and regression models were performed to see if there were any associations between the responses and likelihood of accepting the most highly recommended treatment plan. Results: Overall, the most highly recommended treatment plan for adult patients with anterior open bite was accepted 78% of the time. Of the patients recommended to have surgery, 60% accepted the plan. Patients with a history of prior orthodontic treatment (p=0.01) and a concave profile (p=0.02) were more likely to accept the most highly recommended overall treatment plan. When a patient had insurance covering orthognathic surgery, they were more likely to accept a surgical treatment option (p=0.002). Patients with severe crowding were less likely to accept a surgical treatment plan (p=0.006). The most common reasons for declining the most recommended plans were not wanting jaw surgery, and considering the treatment to be too invasive, risky, and/or costly. Conclusions: Generally, patient acceptance decreases with increasing invasiveness of the proposed options. Prior orthodontic treatment, concave profile, and insurance covering orthognathic surgery were significant predictors of accepting the most highly recommended treatment plan. About 40% of patients who were recommended orthognathic surgery as the best treatment plan declined that option.