THE DECISION TO EXTRACT .1. INTERCLINICIAN AGREEMENT

As part of an ongoing prospective clinical trial of conventional ortho dontic treatment, the decision making patterns of a representative gro up of orthodontic clinicians were examined. Data were available for 14 8 subjects (100 adolescents and 48 adults) who had presented at the Un iversity of California San Francisco Graduate Orthodontic Clinic reque sting treatment for correction of a Class I or Class II malocclusion. The records for each subject were evaluated independently by each of f ive members of the clinical faculty, making available a total of 740 i ndependent patient evaluations. With regard to the primary decision as to whether extraction or nonextraction treatment was to be preferred, agreement among clinicians was higher than had been anticipated. In a lmost two thirds of the cases, the decisions of all five clinicians we re in agreement as to whether extraction or nonextraction was the pref erred treatment modality. (This figure included 59 cases of complete a greement for extraction therapy (40%) and 38 cases of complete agreeme nt for nonextraction therapy (26%)). In only 51 cases (34%), did the r eviewing clinicians disagree as to whether extraction or nonextraction was the preferred modality of treatment. The clinicians were also ask ed to indicate their opinions as to whether orthognatic surgery was li kely to be a part of the ultimate treatment course for each individual subject. Nine percent of the 740 patient evaluations contained a clin ician judgement that surgery would be a probable or definite component of the orthodontic treatment plan. For 29% of the adult subjects (14 cases) and 23% of the adolescent subjects (23 cases), one or more of t he five examining clinicians believed that adjunctive surgical interve ntion would probably or definitely be appropriate. These high values w ere unexpected, particularly because the sample had been prescreened b y a single clinician to exclude subjects who might require orthognathi c surgery. Clinician agreement of Angle classification was also evalua ted. Disagreements were observed in 14 adult subjects (29%) and 27 ado lescent subjects (27%). Little association was observed between clinic ian agreement on Angle classification and clinician agreement on wheth er or not to extract.