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Editor’s choiceDavid L. Turpin, Editor-in-Chief

Preadolescent orthodontic treatment need: Objective and subjective provider assessments and patient self-reportsElizabeth A. Christopherson, Dan Briskie, and

Marita Rohr Inglehart

As the US government once again activates the State Children’s Health Insurance Program (SCHIP), the den-tal community will again focus on whether unmet orth-odontic treatment need is correlated with the desire for braces. Although this government-sponsored program is designed for basic dental and medical care for children, interest in additional unmet needs might be heightened. It is more important than ever to focus on treatment needs and self-perceptions of all children during preadoles-cence. The ill effects of malocclusion can be psychologi-cal and might be related to esthetic impairment rather than any functional disadvantage. Therefore, the objectives of this study from the University of Michigan were to an-swer these questions: (1) Are providers’ objective and subjective assessments of treatment need correlated? (2) Are preadolescents’ responses concerning smile-related quality of life and desire for braces correlated? (3) Are provider and patient assessments correlated?

Conclusions of this complex study are far-reaching, and you will want to read the entire article. The results showed that 17.1% of children (aged 8–11 years) were objectively diagnosed as having a treatment need, and 16.7% were subjectively assessed as having such a need. However, 60.4% of the children received an orthodontic treatment recommendation. This indicates a need to ex-plore dentists’ decision-making processes concerning re-ferral of preadolescent patients for orthodontic treatment. Patients’ desire for braces was significantly correlated with responses concerning their smile-related quality of life. Although children were quite positive concern-ing their smile evaluations, 46.9% nevertheless wanted braces. It seems that the desire to have braces is deter-mined not only by smile-related quality of life percep-tions, but also by cultural and social considerations. It is worthwhile to note that tooth alignment assessments and

treatment recommendations were significantly correlated with children’s perceptions of their smiles and their de-sire for braces.

The adaptive response of the human dental alveolar process: Correction of a Class I protrusive and mutilated denti-tion, with 32-year follow-upJay Decker

On the day of appliance removal, has a patient ever asked you what his or her teeth will look like in 10, 20, or 30 years? Of course, you might wisely change the sub-ject, but is that always necessary? Seattle orthodontist Jay Decker has always taken excellent pretreatment and post-treatment records. In this fascinating case report (1 of 5 in this issue), he looks at treatment results 32 years later.

The treatment plan for this patient, after her decision to avoid orthognathic surgery, led to the extraction of the maxillary and mandibular first premolars, followed by the eventual extraction of the mandibular first molars and total space closure. Combination high-pull extraoral trac-tion and Class II elastic forces were critical components of the treatment plan, which took 53 months to complete. The extent to which the human dental alveolus can adapt to change is dramatically demonstrated in this patient’s outcome. One could ask whether the dental alveolus on both the labial and lingual surfaces of the anterior teeth, after retraction, was as healthy or healthier after treat-ment. The adaptive response of the alveolus can be seen in the mandibular molar regions. The buccolingual di-mension of the alveolus increased when the mandibular second permanent molars moved into an area of alveo-lar bone that had narrowed after the earlier extractions. Some 32 years posttreatment, the cone-beam computed tomography multi-planar reconstructed images showed normal bone levels in both incisor and molar regions. In hindsight, Dr Decker notes, a somewhat different treatment plan would most likely be developed for this patient today. The main difference would be the inclu-sion of mandibular mini-implants or anchor plates to preclude mandibular first premolar extractions. Lest we forget, Decker concludes, “the immediate and long-term success of this patient’s care was her dedication to suc-cessful completion of a complex treatment plan.”

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Am J Orthod Dentofacial Orthop 2009;135:S80889-5406/$36.00Copyright © 2009 by the American Association of Orthodontists.doi: 10.1016/j.ajodo.2009.01.017