Changes in the pattern of patients receiving surgical-orthodontic treatment

Abstract

Introduction: The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century.

Methods: Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations.

Results: Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century.

Conclusions: A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients.

Fig 1

The expected and actual percentages of patients who sought evaluation in the University of North Carolina Dentofacial Clinic, 1979–1989. Patients with Class II problems (mandibular deficiency) were underrepresented in the clinic population compared with their prevalence in the general population, Class III patients (maxillary deficiency or mandibular prognathism) were overrepresented, and long-face patients were greatly overrepresented.

Fig 2

Overjet (Class II) and reverse overjet (Class III) in the US population, 1989–1991. Most of those with extreme deviation from the ideal and some but not all with severe deviation would be candidates for orthognathic surgery.

Fig 3

Open-bite and deepbite relationships in the US population, 1989–1991. As with overjet, those with the most severe deviation from ideal would be candidates for orthognathic surgery.

Fig 4

Orthodontic treatment need by severity of the problem for white, black, and Hispanic (Mexican American) youths aged 12 to 17 years, 1989–1991, and the percentage of each group who reported receiving orthodontic treatment. The prevalence of severe and very severe problems (IOTN grades 4 and 5) was nearly twice as great in blacks than either whites or Hispanics.

Fig 5

Data for the prevalence of Class I, Class II, and Class III patients evaluated in the University of North Carolina Dentofacial Clinic in 2-year increments in 1979 and 1980 to 1997 and 1998. Class I patients with no anteroposterior discrepancy were largely seeking correction of asymmetry, but this group also included some long-face patients. The percentage of Class II patients declined slowly but steadily; the percentages of Class III and Class I patients fluctuated but showed no sustained change.

Fig 6

Expected vs actual percentages of Class II, Class III, long-face, and asymmetry patients having surgery at the University of North Carolina. The data for 1984 through 1996 were taken from the study of Bailey et al. Note the decline in the percentage of Class II surgeries from 1996 through 2000 to 2006 through 2010, and the increase in Class III. The percentage of long-face patients also increased in the most recent group, and the asymmetry percentage declined slightly.