The decision to extract .2. Analysis of clinicians' stated reasons for extraction
The decision to extract .2. Analysis of clinicians' stated reasons for extraction
复制标题
DOI：
10.1016/s0889-5406(96)70121-x
复制
发表时间：
1996-04-01
影响因子：
3
通讯作者：
Maxwell, R
中科院分区：
文献类型：
--
作者：
Baumrind, S;Korn, EL;Maxwell, R
在最近报道的一项研究中，由 5 名经验丰富的临床医生（从 14 人组成的小组中抽取）独立评估了一项随机临床试验中每位受试者的治疗前记录，该试验涉及 148 名接受正畸治疗的 I 类和 II 类错牙合患者。对于每个具体病例是否需要拔牙的决定，临床医生之间的一致意见高于预期。为了提高我们对临床医生如何决定是否提取的理解，现在对从 148 名完整样本中随机选出的 72 名受试者的记录进行了更详细的检查。在其中 21 例中，所有五名临床医生都决定不拔牙进行治疗。其余51个案例中，有202个决策可供提取（31个一致决策案例和20个分歧决策案例）。临床医生总共列举了 469 个理由来支持这些决定。 49% 的拔牙决定中，拥挤被认为是首要原因，其次是门牙突出 (14%)、需要矫正轮廓 (8%)、II 级严重程度 (5%) 和获得稳定结果 (5%)。当每位临床医生决定时将所有拔牙原因作为一个整体考虑时，73% 的决定提到了拥挤，35% 提到了切牙前突，27% 提到了需要矫正轮廓，15% 提到了 II 级严重程度，9% 提到了治疗后稳定性。牙齿尺寸异常、中线偏差、生长潜力降低、覆盖严重程度、现有轮廓的维持、咬合闭合的愿望、牙周问题和预期合作不良总共占首要原因的 12%，并且在 54% 的决策中被提及，这意味着这些考虑因素在决策过程中发挥着重要作用（即使是次要的）。综合起来，只有不到 20% 的案例提到了所有其他原因。至少在这个样本中，临床医生重点关注与外观相关的因素，这些因素可以通过对面部和牙齿的表面结构进行物理检查来定性确定。他们似乎主要使用研究模型和面部照片上可用的指标，而相对较少使用仅在头颅照片上可用的信息或涉及专业正畸理论应用的信息。
In a recently reported study, the pretreatment records of each subject in a randomized clinical trial of 148 patients with Class I and Class II malocclusions presenting for orthodontic treatment were evaluated independently by five experienced clinicians (drawn from a panel of 14). The clinicians displayed a higher incidence of agreement with each other than had been expected with respect to the decision as to whether extraction was indicated in each specific case. To improve our understanding of how clinicians made their decisions on whether to extract or not, the records of a subset of 72 subjects randomly selected from the full sample of 148, have now been examined in greater detail. In 21 of these cases, all five clinicians decided to treat without extraction. Among the remaining 51 cases, there were 202 decisions to extract (31 unanimous decision cases and 20 split decision cases). The clinicians cited a total of 469 reasons to support these decisions. Crowding was cited as the first reason in 49% of decisions to extract, followed by incisor protrusion (14%), need for profile correction (8%), Class II severity (5%), and achievement of a stable result (5%). When all the reasons for extraction in each clinician's decision were considered as a group, crowding was cited in 73% of decisions, incisor protrusion in 35%, need for profile correction in 27%, Class II severity in 15% and posttreatment stability in 9%. Tooth size anomalies, midline deviations, reduced growth potential, severity of overjet, maintenance of existing profile, desire to close the bite, periodontal problems, and anticipation of poor cooperation accounted collectively for 12% of the first reasons and were mentioned in 54% of the decisions, implying that these considerations play a consequential, if secondary, role in the decision-making process. All other reasons taken together were mentioned in fewer than 20% of cases. In this sample at least, clinicians focused heavily on appearance-related factors that are qualitatively determinable by physical examination of the surface structures of the face and teeth. They appear to have made primary use of indicators available on study casts and facial photographs and relatively little use of information that is available only on cephalograms or that involves the application of specialized orthodontic theories.