Orthodontics for children and adolescents supplements KCE reports 77S Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d’expertise des soins de santé Belgian Health Care Knowledge Centre 2008 The Belgian Health Care Knowledge Centre Introduction : The Belgian Health Care Knowledge Centre (KCE) is an organization of public interest, created on the 24th of December 2002 under the supervision of the Minister of Public Health and Social Affairs. KCE is in charge of conducting studies that support the political decision making on health care and health insurance. Administrative Council Actual Members : Gillet Pierre (President), Cuypers Dirk (Deputy President), Avontroodt Yolande, De Cock Jo (Deputy President), De Meyere Frank, De Ridder Henri, Gillet Jean-Bernard, Godin Jean-Noël, Goyens Floris, Kesteloot Katrien, Maes Jef, Mertens Pascal, Mertens Raf, Moens Marc, Perl François, Smiets Pierre, Van Massenhove Frank, Vandermeeren Philippe, Verertbruggen Patrick, Vermeyen Karel. Substitute Members : Annemans Lieven, Boonen Carine, Collin Benoît, Cuypers Rita, Dercq Jean-Paul, Désir Daniel, Lemye Roland, Palsterman Paul, Ponce Annick, Pirlot Viviane, Praet Jean-Claude, Remacle Anne, Schoonjans Chris, Schrooten Renaat, Vanderstappen Anne. Government commissioner : Roger Yves Management Chief Executive Officer : Dirk Ramaekers Deputy Managing Director : Jean-Pierre Closon Information Federaal Kenniscentrum voor de gezondheidszorg - Centre fédéral d’expertise des soins de santé. Wetstraat 62 B-1040 Brussels Belgium Tel: +32 [0]2 287 33 88 Fax: +32 [0]2 287 33 85 Email : [email protected] Web : http://www.kce.fgov.be Orthodontics for children and adolescents - supplements KCE reports 77S CARELS C, DE RIDDER L, VAN LOOCK N, BOGAERTS K, EYSSEN M AND OBYN C Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d’expertise des soins de santé Belgian Health Care Knowledge Centre 2008 KCE reports 77S Title : Orthodontics for children and adolescents - supplements Authors : Carine Carels (Orthodontie, UZ Leuven, K.U.Leuven), Lutgart De Ridder (Orthodontist), Nathalie Van Loock (Projectmedewerker, UZ Leuven), Kris Bogaerts (Biostatistisch Centrum, K.U.Leuven), Marijke Eyssen (KCE), Caroline Obyn (KCE) External experts : Guy De Pauw (Orthodontie, UGent), Myriam Delatte (Orthodontie et Orthopédie Dentofaciale, Cliniques Universitaires Saint-Luc, UCL), Michel Limme (Orthodontie et Pedodontie, Centre Hospitalier Universitaire (CHU), Chantal Malevez (Département de Chirurgie Orale et Maxillofaciale, Hôpital Universitaire des Enfants Reine Fabiola, ULB), Jean-Philippe Mousset (Geneesheer-Inspecteur, RIZIV-D.G.E.C), Steven Simoens, Farmaceutische Wetenschappen, K.U.Leuven), Marc Tabak (Departement SOPA, VUB, UZ Brussel) Acknowledgements Bart Vande Vannet (Orthodontie, VUB; voor zijn belangrijke bijdrage aan hoofdstukken 3, 4 en 7), An Verdonck (Orthodontie, UZ, K.U.Leuven; for her important participation to chapters 2 and 8) Luc Trimpeneers (Orthodontie, UGent), Yasmine Antonis (Neus Keel Oorziekten, UZ Leuven) Murielle Lona (KCE), Natacha Van Moerkercke (Orthodontie, Ugent), Julie Bertrand (Orthodontie, K.U.Leuven), Elisa Vingerhoedt (Orthodontie, K.U.Leuven), Jeanine Vanwinkel (Tandheelkunde, UZ Leuven) External validators : Hervé Avalosse (Onderzoek en ontwikkeling, Christelijke Mutualiteit), Luc Dermaut (Prof. em. UGent), Kevin O’Brien (Department of Orthodontics, School of Dentistry, University of Manchester) Conflict of interest : Some authors work as orthodontists (Carine Carels, Lutgart De Ridder) and others work in orthodontic professional associations (Lutgart De Ridder). Disclaimer: The external experts collaborated on the scientific report that was subsequently submitted to the validators. The validation of the report results from a consensus or a voting process between the validators. Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE. Layout : Verhulst Ine Brussels, April 28th 2008 (2nd edition; 1st edition: April 7th 2008) Study nr 2007-20 Domain : Health Services Research (HSR) MeSH : Orthodontics ; Child ; Adolescent ; Developed Countries ; Health Services Research NLM classification : WU 400 Language :English Format : Adobe® PDF™ (A4) Legal depot : D/2008/10.273/22 How to refer to this document? Carels C, De Ridder L, Van Loock N, Bogaerts K, Eyssen M, Obyn C. Orthodontics for children and adolescents - supplements. Health Services Research (HSR). Bruxelles: Belgian Health Care Knowledge Centre (KCE); 2008. KCE Reports 77S (D/2008/10.273/22) KCE Reports 77 Orthodontics supplement 1 Appendices to orthodontics for children and adolescents (2007-20HSR/S) TABLE OF CONTENTS APPENDIX TO CHAPTER 1............................................................................................3 APPENDIX TO CHAPTER 2............................................................................................3 SOME PICO'S FOR THE CLINICAL RESEARCH PART...................................................................................3 LITERATURE SEARCHES..................................................................................................................................5 Search strategy OVID MEDLINE (R)..................................................................................................5 Search strategy Embase........................................................................................................................22 Search Strategy Tripdatabase..............................................................................................................29 CHARACTERISTICS OF INCLUDED STUDIES..............................................................................................29 ORTHODONTIC INDICES...........................................................................................................................75 IOTN index ( Index of Orthodontic Treatment Need)..............................................................75 2.PAR Index.............................................................................................................................................77 3. Index of Complexity, Outcome and Need (ICON).................................................................81 APPENDIX TO CHAPTER 3..........................................................................................85 FLOW-CHART SEARCHES OVID, COCHRANE AND EMBASE.................................................................85 1558 articles found by search strategy.............................................................................................85 91 possibly relevant articles...............................................................................................................85 FLOW-CHART SEARCHES CRD.................................................................................................................85 62 articles found by search strategy.................................................................................................85 11articles retrieved in full text...........................................................................................................85 9 articles quality appraised..................................................................................................................85 SOME PICO'S FOR THE ORGANIZATION AND FINANCING LITERATURE RESEARCH ON ORTHODONTICS.........................................................................................................................................86 DENSITY OF PRACTITIONERS.....................................................................................................................87 ORTHODONTIC FEES IN GERMANY..........................................................................................................89 PRIVATE INSURANCE POLICIES IN THE NETHERLANDS...........................................................................92 REPRESENTATIVES OF THE PROFESSIONAL ORTHODONTIC ORGANIZATIONS IN SEVEN EUROPEAN COUNTRIES CONTACTED FOR THE INTERNATIONAL QUESTIONNAIRE..............................................92 INTERNATIONAL QUESTIONNAIRE............................................................................................................94 Questionnaire 2 to professional orthodontic organization AAO (American Association of Orthodontists) of the USA...............................................................................................................103 RESPONSES TO INTERNATIONAL QUESTIONNAIRE...............................................................................111 Extra-tables related to the International Benchmarking Questionnaires and to former related studies......................................................................................................................................111 APPENDIX TO CHAPTER 4.........................................................................................117 DENSITY OF PRACTITIONERS...................................................................................................................117 APPENDIX TO CHAPTER 5........................................................................................121 FORM 60.....................................................................................................................................................121 DENTAL AND ORTHODONTIC NOMENCLATURE AND ITS APPLICATION IN GENERAL PRACTITIONERS (001) AND ORTHODONTISTS (007).........................................................................122 French version......................................................................................................................................124 EXCERPT FROM CIRCULAR LETTER OF RIZIV CONCERNING THE REIMBURSEMENT FEES FOR THE RIZIV ACTS ...............................................................................................................................................128 GUIDING TARIFFS......................................................................................................................................131 Guiding tariffs for orthodontic treatment initially negociated between the BBUSO (professional organization of the orthdontists) and the CM/MC sick fund in 1997...........131 2 Orthodontics Supplement KCE Reports 77 RIZIV/INAMI FEES....................................................................................................................................133 APPENDIX TO CHAPTER 6........................................................................................134 APPENDIX TO CHAPTER 7.........................................................................................149 QUESTIONNAIRE FOR PRACTITIONERS - DUTCH..................................................................................149 I. Algemene inlichtingen:....................................................................................................................149 II. Informatie naar patiëntencontacten en orthodontische behandelingen............................150 III. Informatie naar het invullen van deze enquête.......................................................................154 IV. Apparatuur in uw praktijk...........................................................................................................154 V. Overige kosten................................................................................................................................155 VI. Praktijkruimte.................................................................................................................................155 VII. Informatie betreffende personeel.............................................................................................156 VIII. Wij vinden uw mening of eventuele opmerkingen omtrent deze enquête belangrijk156 QUESTIONNAIRE FOR PRACTITIONERS - FRENCH................................................................................157 I. Informations générales:...................................................................................................................157 II. Informations relatives aux patients et aux traitements orthodontiques...........................158 III. Informations relatives à cette enquête.....................................................................................162 IV. Appareillage.....................................................................................................................................162 V. Autres coûts....................................................................................................................................163 VI. Locaux professionnels..................................................................................................................163 VII. Information concernant le personnel......................................................................................164 VIII. Nous apprécierions votre opinion et vos éventuelles remarques concernant cette enquête...................................................................................................................................................164 QUESTIONNAIRE RESULTS.........................................................................................................................165 FURTHER IMA-AIM STATISTICS ON DURATION OF TREATMENT..........................................................184 SOME EXTRA CM/MC DATA...................................................................................................................186 APPENDIX TO CHAPTER 8........................................................................................188 TABLE OF THE DIFFERENT IOTN GRADES.............................................................................................188 DATA FROM CLEFT LIP AND PALATE TEAM OF LEUVEN........................................................................189 ORTHODONTIC CONSUMPTION BY 3 TO 18 YEAR OLDS IN BELGIUM (CM/MC DATA)...............191 REFERENCES..............................................................................................................198 KCE Reports 77 Orthodontics supplement 3 APPENDIX TO CHAPTER 1 No appendix to chapter 1 APPENDIX TO CHAPTER 2 SOME PICO'S FOR THE CLINICAL RESEARCH PART PICO I.1: Can the orthodontic treatment need of my child be determined objectively? Patient: orthodontic deviation, orthodontic malocclusion, malocclusion Intervention: assessment of treatment need or no treatment Comparison: low/no orthodontic treatment need versus high treatment need Outcome: yes or no indication of orthodontic treatment, determining the degree of orthodontic treatment need PICO I.2: Can the complexity of the malocclusion of my child be determined? Patient: is my malocclusion complex? Intervention: either short orthodontic treatment with with removable or other simple appliance or long duration of treatment with anchorage problems and fixed appliances Comparison: low versus high complexity of malocclusions Outcome: ICON can determine the treatment need and complexity of malocclusions PICO I.3: Does the complexity of treatment index reveal the way an orthodontic treatment will be performed? Patient: which type of treatment? (fixed, functional, orthopedic, removable plates, other...) Intervention: decide on which type of treatment Comparison: results with different types of treatment Outcome: quality of treatment outcome PICO I.4 At what age should my child be treated orthodontically? Is there an ideal age for orthodontic treatment? Patient: should my malocclusion be treated early (7-8 yrs) or late (13-15yrs)? Intervention: orthodontic treatment now yes or no? Comparison: early versus late orthodontic treatment Outcome: timing of orthodontic treatment? PICO I.5. Can orthodontic treatment have adverse effects for the teeth? Patient: what are the risks for my teeth due to orthodontic treatment? Intervention: orthodontic treatment yes or no? Comparison: root length, periodontal health, occlusion, DMF in treated vs non treated individuals Outcome: advantages and disadvantages on the long term for dental health PICO I.6. Are there contraindications for the orthodontic treatment of my child? (fe medication like biphosphonates, blood clothing problems, periodontal problems, root resorption, ...) Patient: ongoing medical treatment with different types of medications, or : contra- indications? 4 Orthodontics Supplement KCE Reports 77 Intervention: either treatment now or not, or postpone Comparison: orthodontic treatment in patients with and without combined problems Outcome: adapt the timing of orthodontic treatment PICO I.7. Will the orthodontic treatment result in my child be stable? Patient: stability expectation with different types of malocclusions Intervention: application of fixed retainer or removable retainer Comparison: groups with different types of retainers Outcome: in which cases to use a fixed vs a removable retainer? PICO I.8. Is retention necessary after orthodontic treatment? Patient: should I wear a retainer after my active orthodontic treatment or not? Intervention: apply retention or not Comparison: patients treated with and without any retention Outcome: wear a retainer or not? PICO I.9. Which retention procedure (type of retainer, duration of retention, ...) should be used after orthodontic treatment? Patient: hesitating which type of retainer is necessary and for how long time? Intervention: place a fixed vs removable retainer? Comparison: fixed vs removable retainers Outcome: evidence for one or another type of retainer PICO I.10. Is "early" orthodontic treatment of Cl II div 1 and Cl III malocclusion preferable to "late" orthodontic treatment? Patient: (dis)advantages of early vs late orthodontic treatment? Intervention: early of late orthodontic treatment Comparison: of all aspects in late vs early treatment group (final occlusion, duration of treatment, ...) Outcome: PICO I.11. Is speech therapy necessary for the correction of the orthodontic deviation in my child? PICO I.12. Will the orthodontic deviation in my child be corrected spontaneously after speech therapy in my child? PICO I.13. Can orthodontic deviations be prevented/avoided with speech therapy? PICO I.14: Can the skeletal malocclusion of my child of 13yrs of age be corrected without maxillofacial surgery? PICO I.15: My child lost a central incisor during a trauma: can tooth transplantation be an aid during orthodontic treatment? PICO I.16: My child fractured a central incisor during a trauma: can this tooth still be moved orthodontically? PICO I.17: There is a tooth that remains impacted in my child (11 yrs of age): will it erupt spontaneously? PICO I.18: My child has an open bite: should this be treated orthodontically? PICO I. 19: My child is 9yrs and shows a lateral cross bite and a forced bite: should this be treated? When and how? PICO I.20: My child has a deep frontal overbite: should this be treated? When and how? KCE Reports 77 Orthodontics supplement 5 PICO I.21: Could I have prevented the malocclusion of my child? PICO I.22: Will correction of my malocclusion contribute to the Quality of Life of my child? PICO I.23. What will happen if my child is not treated orthodontically? Patient: with orthodontic deviation is referred by dentist for orthodontic diagnosis and treatment, but patient and mother are hesitating Intervention: either treatment or not Comparison: treated groups vs non treated groups Outcome: advantages of orthodontic treatment for the dentition on the long term PICO I.24. Should wisdom teeth be removed by the end of orthodontic treatment? Patient: hesitates whether his wisdom teeth should be removed after orthodontic treatment Intervention: either removal of 4 wisdom teeth or not Comparison: treated groups with vs without extraction of wisdom teeth Outcome: (dis)advantages for the results of the orthodontic treatment long term Search Strategy LITERATURE SEARCHES Search strategy OVID MEDLINE (R) Search 1 Orthodontics and Needs assessment ( 02102007) Database: Ovid MEDLINE(R) <1950 to September Week 3 2007> Search strategy Results 1 orthodontic$.mp. or exp Orthodontics, Corrective/ or exp Orthodontics, Preventive/ or exp 113 Orthodontics/ or exp Orthodontics, Interceptive/ (36432) 2 Needs assessment$.mp. or exp Needs Assessment/ (15222) 3 1 and 2 (115) 4 exp Needs Assessment/ or needs assessments$.mp. (13964) 5 1 and 2 and 4 (113) 6 from 5 keep 1-113 (113) 7 from 6 keep 1-113 (113) Search 2 Orthodontics and Health Services Needs and Demands ( 02102007) Database: Ovid MEDLINE(R) <1950 to September Week 3 2007> Search strategy Results 1 orthodontic$.mp. or exp Orthodontics, Corrective/ or exp Orthodontics, Preventive/ or exp 105 Orthodontics/ or exp Orthodontics, Interceptive/ (36313) 2 Needs assessment$.mp. or exp Needs Assessment/ (15123) 3 1 and 2 (114) 4 exp Needs Assessment/ or needs assessments$.mp. (13868) 5 1 and 2 and 4 (112) 6 from 5 keep 1-112 (112) 7 exp "Health Services Needs and Demand"/ (30456) 8 (Health Services Needs and Demand).mp. [mp=title, original title, abstract, name of substance word, subject heading word] (27132) 9 (Health Services Needs and Demand$).mp. [mp=title, original title, abstract, name of substance word, subject heading word] (27133) 10 (Health Services Need$ and Demand$).mp. [mp=title, original title, abstract, name of substance word, subject heading word] (27137) 6 Orthodontics Supplement KCE Reports 77 11 (Health Service$ Need$ and Demand$).mp. [mp=title, original title, abstract, name of substance word, subject heading word] (27140) 12 7 or 8 or 9 or 10 or 11 (30464) 13 1 and 12 (354) 14 exp Epidemiologic Studies/ (992532) 15 epidemiologic$ stud$.mp. (41258) 16 randomized controlled trial$.mp. or exp Randomized Controlled Trials/ (294484) 17 randomised controlled trial$.mp. (8284) 18 controlled clinical trial$.mp. or exp "Controlled Clinical Trial [Publication Type]"/ (88800) 19 review.mp. or exp "Review [Publication Type]"/ (1532417) 20 review$.mp. (1675876) 21 systematic review.mp. or exp Meta-Analysis/ (17560) 22 systematic review$.mp. (12079) 23 guideline$.mp. or exp "Guideline [Publication Type]"/ (143526) 24 meta analysis.mp. or exp Meta-Analysis/ (27399) 25 systematic review.mp. (10164) 26 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 (2899991) 27 13 and 26 (105) 28 from 27 keep 1-105 (105) Search 3 Orthodontics and Health services accessibility (02102007) Database: Ovid MEDLINE(R) <1950 to September Week 3 2007> Search strategy Results 1 orthodontic$.mp. or exp Orthodontics, Corrective/ or exp Orthodontics, Preventive/ or exp 101 Orthodontics/ or exp Orthodontics, Interceptive/ (36313) 30 Health services accessibility.mp. or exp Health Services Accessibility/ (55341) 31 health service$ accessibility.mp. (28961) 32 30 or 31 (55344) 33 1 and 32 (101) 34 from 33 keep 1-101 (101) Search 4 Orthodontics an treatment need ( 02102007) Database: Ovid MEDLINE(R) <1950 to September Week 3 2007> Search strategy Results 1 orthodontic$.mp. or exp Orthodontics, Corrective/ or exp Orthodontics, Preventive/ or exp 136 Orthodontics/ or exp Orthodontics, Interceptive/ (36313) 14 exp Epidemiologic Studies/ (992532) 15 epidemiologic$ stud$.mp. (41258) 16 randomized controlled trial$.mp. or exp Randomized Controlled Trials/ (294484) 17 randomised controlled trial$.mp. (8284) 18 controlled clinical trial$.mp. or exp "Controlled Clinical Trial [Publication Type]"/ (88800) 19 review.mp. or exp "Review [Publication Type]"/ (1532417) 20 review$.mp. (1675876) 21 systematic review.mp. or exp Meta-Analysis/ (17560) 22 systematic review$.mp. (12079) 23 guideline$.mp. or exp "Guideline [Publication Type]"/ (143526) 24 meta analysis.mp. or exp Meta-Analysis/ (27399) 25 systematic review.mp. (10164) 26 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 (2899991) 35 Treatment need$.mp. (2519) 36 Treatment need.mp. (834) 37 Treatment$ need$.mp. (2678) 38 Treatment needs.mp. (1590) 39 35 or 36 or 37 or 38 (2678) 40 1 and 39 (323) 41 26 and 40 (136) 42 from 41 keep 1-136 (136)