A COMPARISON OF SURGERY AND ORTHODONTICS IN BORDERLINE ADULTS WITH CLASS-II, DIVISION-1 MALOCCLUSIONS

From a pool of 108 former patients, discriminant analysis was used to identify a homogeneous borderline prognostic subgroup of 27 adult orth odontic and 26 adult surgical Class II patients who, before treatment, were similar with respect to the characteristics on which the orthodo ntic/surgical decision appears to have been based. The fact that some had been treated orthodontically, whereas others had been treated surg ically, was taken as empirical evidence that the patients in this stra tum were equally susceptible to the two treatments and that the actual choice was largely a function of whose office they happened to contac t. The former orthodontic patients were recalled an average of 7.1 yea rs after treatment; the former surgical patients, 4.7 years after surg ery. Each subject was evaluated with respect to skeletal and dental st ability, profile esthetics, and temporomandibular function. Although t here were dramatic differences in the nature of the correction (dental versus skeletal), both groups of patients generally thought that thei r profiles had been improved by treatment. As judged by data generated from visual analogue scales, the mean difference between the orthodon tic and surgical patients' evaluations of their treatments was small a nd nonsignificant. Moreover, the ''borderline'' Class II orthodontic a nd surgical patients showed no significant differences in craniomandib ular function and incisor stability. There was, however, one profound difference between treatments: 3 of the 26 surgical patients underwent extensive relapse, probably as a result of condylar resorption. From the standpoint of estimated probabilities and utilities for the variou s outcomes, the present results imply that orthodontics would be the b etter choice for the borderline adult Class II patient, whereas surger y would be appropriate for the more severely affected patient.