Decision analysis to optimize the outcomes for Class II Division 1 orthodontic treatment

Selection of the treatment method of choice in orthodontics is usually a question of the clinician's personal preference and is generally based on subjective criteria. Orthodontic treatment of malocclusions is unlike treatment of a disease and hence terms such as success and failure are relative and undefined. Ideally, both patients and providers should be able to arrive at treatment decisions that have the greatest potential for optimum outcomes at minimal cost and risks. This article applies the method of decision analysis to demonstrate how policy choices between "one-stage" or "two-stage" treatment of Class II Division 1 malocclusions for children between 11 and 14 years old can be based on objective criteria. A decision tree was designed to yield the value of payoffs, or outcomes, at each of the possible terminal nodes, and the probability of each payoff. Both positive (ie, improvement in malocclusion) and negative (ie, extraction of teeth and long treatment duration) attributes of outcomes were considered, and numerical values, or "utilities," were assigned to each outcome. For this model, one-stage nonextraction treatment yields the highest probability of maximum benefit. Further applications of decision analysis to resolve clinical uncertainties in orthodontics are discussed.