Factors associated with orthodontist's decision to indicated orthodontic camouflage or orthognathic surgery in skeletal class III malocclusions without growth.

BACKGROUND

The therapeutic decision depends on a complex set of factors related to both the patient and the professional.

AIM: To determine the factors associated with the orthodontist's decision to prescribe orthodontic camouflage or orthognathic surgery in skeletal Class III malocclusions without growth.

MATERIALS AND

METHODS

An online survey was conducted with 271 orthodontists. The validity and reliability of a 16-question questionnaire were determined, and submission links were generated using SurveyMonkey software. The instrument was distributed via social media and email, achieving an 80% response rate. Pearson's chi-squared test and binomial logistic regression was used.

RESULTS

All factors evaluated were considered important in the treatment decision (p<0.001). The gonial angle was a significant risk factor (OR:5.36; 95%CI:1.53-18.72; p=0.009), as was anterior crossbite (OR:49.14; 95%CI:2.61-92.59; p=0.009). Occlusal stability (OR:0.01; 95%CI:0.00-0.29; p=0.009), third molar position and space (OR:0.14; 95%CI: 0.07-0.30; p<0.001) were protective factors. The orthodontist's experience of up to 10 years (OR:0.12; 95%CI:0.04-0.36; p<0.001), up to 40 years (OR:0.22; 95%CI:0.08-0.60; p=0.003), along with training through courses or internships (OR:0.08; 95%CI:0.04-0.18; p<0.001) or a second specialty (OR:0.37; 95%CI:0.15-0.93; p=0.035), also acted as protective factors. The proposed model has a moderately good fit (p=0.400).

CONCLUSIONS

Orthodontic camouflage is the most common treatment option for Class III malocclusion. The gonial angle and anterior crossbite predispose to orthognathic surgery; while occlusal stability, the presence and spacing of the lower third molar, along with greater professional experience and surgical training, are associated with a lower likelihood of indicating surgery.