title: Outcome of combined orthodontic-surgical treatment in a United Kingdom university dental institute.
abstract: BACKGROUND
  This retrospective observational cohort study evaluated effectiveness of combined orthodontic-orthognathic surgical treatment in a UK University Dental Institute.
  
  
  METHODS
  Patients were identified from a database maintained prospectively throughout a 5-year period of observation. Demographic and clinical data included age, malocclusion, Index of Treatment Need, Index of Orthognathic Functional Treatment Need, orthodontist, surgeon, surgical procedure and treatment-time. Peer Assessment Rating (PAR) scores were generated from pre- and post-treatment dental study casts by a single calibrated examiner.
  
  
  RESULTS
  One hundred and sixty two subjects began treatment during the period of observation, 92 completed, 14 elected to discontinue before surgery and 56 remained in treatment. Outcome data were available for 73, 16 males and 57 females (mean age 23.28 [SD, 7.92] years). Within this sample, 33 (45.2%) presented with class II division 1, 6 (8.2%) with class II division 2 and 34 (46.6%) with class III malocclusion. Isolated maxillary and mandibular surgery was carried out in 3 (4.1%) and 24 cases (32.8%), respectively; bimaxillary surgery was performed in 46 (63.1%). Mean total treatment time in fixed appliances was 920.28 days (30.7 months). Mean pre-treatment PAR score was 39.09 [SD, 9.42] and post-treatment 5.86 [SD, 4.25] with a mean 83.7% PAR score reduction, representing a greatly improved occlusal result. Kruskal-Wallis testing found no evidence of any relationship between independent variables and percentage PAR reduction; however, surgeon identity did significantly influence treatment length (P = 0.007).
  
  
  CONCLUSIONS
  This investigation demonstrates that in terms of static occlusion combined orthodontic-orthognathic surgery is effective in correcting severe malocclusion.
authors.affiliation: a Department of Orthodontics , King's College London Dental Institute , London SE1 9RT , UK.
authors.forename: Georgina
authors.initials: G
authors.lastname: Cartwright
authors.affiliation: a Department of Orthodontics , King's College London Dental Institute , London SE1 9RT , UK.
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Wright
authors.affiliation: a Department of Orthodontics , King's College London Dental Institute , London SE1 9RT , UK.
authors.forename: Joyti
authors.initials: J
authors.lastname: Vasuvadev
authors.affiliation: a Department of Orthodontics , King's College London Dental Institute , London SE1 9RT , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Akram
authors.affiliation: b Department of Maxillofacial Surgery , King's College Hospital NHS Foundation Trust , London SE5 9RS , UK.
authors.forename: Christoph
authors.initials: C
authors.lastname: Huppa
authors.affiliation: b Department of Maxillofacial Surgery , King's College Hospital NHS Foundation Trust , London SE5 9RS , UK.|c Department of Oral and Maxillofacial Surgery , University of North Carolina at Chapel Hill , NC 27516 , USA.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Matthews
authors.affiliation: d University of Bristol, School of Oral and Dental Sciences , Bristol BS1 2LY , UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Sherriff
authors.affiliation: a Department of Orthodontics , King's College London Dental Institute , London SE1 9RT , UK.
authors.forename: Martyn T
authors.initials: MT
authors.lastname: Cobourne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000628:therapy*; D009971:Orthodontics, Corrective; D018024:Peer Review, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D014495:Universities; D055815:Young Adult
keywords: IOFTN; IOTN; Orthognathic surgery; PAR score; orthodontics; outcome