What factors might affect the success of fixed appliance therapy in adolescent patients? part 2

The operator dependent factors that might affect orthodontic outcome include:

Hospital orthodontic departments are often involved in the training of orthodontic clinicians, which may lead to any one patient receiving treatment from multiple operators. A study which looked at the effect of such practice on treatment efficiency and outcome found that, on average, treatment duration was extended by around 8.43 months as a result of multiple operators.¹ Reassuringly, the standard of orthodontic treatment, as assessed by the change in PAR score, was unaffected. There do not appear to be any published data on the possible effect of the transfer of patients from one department or practice to another on the treatment duration, but it could be expected to increase both the total time in treatment and the number of appointments required to complete treatment.

There is some conflicting evidence as to whether orthodontic treatment takes longer within different clinical settings. No significant difference in treatment duration was found between similar cases within a private orthodontic practice and a university setting in Memphis, USA.² However, in another US study, this time in Boston, treatment was found to take longer in private orthodontic practice compared with a hospital setting, even after controlling for confounding factors such as pre-treatment age, gender, race, initial malocclusion and increased number of treatment stages.³ Possible reasons for this observed difference could be related to the method of funding between the two US systems, with fees being spread over a longer time period within private practice. The occlusal outcome, measured using change in PAR scores, was judged to be similar between the two treatment settings.