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Objective: To assess the correlations between objective measurements of 108 finished orthodontic cases and subjective assessments made by 69 orthodontic specialists, to explore the statistically significant measuring categories of cast and cephalogram and to validate the regression model., Methods: A stratified random sample of 108 cases was drawn from the large sample of 2 383 patients who finished orthodontic treatment between July 2006 and August 2008 in six orthodontic treatment centers around China. For each patient, the post-treatment information sources evaluated in this study included standardized plaster study casts and a lateral cephalometric X-ray image. These information sources were evaluated both singly and in combination by a panel of 69 orthodontic specialists. The average subjective grading scores of 69 orthodontists were regarded as the gold standard. Six examiners used the peer assessment rating (PAR) index and American board of orthodontics-objective grading system (ABO-OGS) to measure all the study casts respectively and three other examiners measured all the lateral cephalometric X-ray images by using customized software. The objective measuring data were correlated with the gold standard. The correlations between the objective measurement and the subjective evaluation were assessed, the statistically significant measuring categories of cast and cephalogram were explored and the regression model was validated., Results: The ABO-OGS scores of "occlusal relationship" correlated most strongly with the subjective scores of cast (r=0.655, P<0.01), and the secondarily correlated category with those were the PAR scores of "overjet" (r=0.525, P<0.01). The proclination of the lower incisors correlated most strongly with the subjective scores of cephalogram (r=0.446, P<0.01), and the secondarily correlated category with those was the protrusion of the lower lips (r=0.436, P<0.01). Nine components were predictive for the post-treatment model and lateral ephalometric film (Post-M+C) outcome: alignment (ABO-OGS), occlusal relationship (ABO-OGS), interproximal contact(ABO-OGS), L1/NB°, overjet (PAR), SNB°, occlusal contacts (ABO-OGS), U1/SN2° and centerline (PAR). These 9 components accounted for 72% of the variability in the average subjective grading scores., Conclusion: The objective regression model could replace the averaged opinion of Chinese orthodontic experts effectively, making objective assessment of orthodontic treatment outcome for Chinese patients.

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from -0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R(2)=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R(2)=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

Objective: To investigate the agreement of subjective evaluation of orthodontic treatment outcome and to analyze possible factors that may be related to it., Methods: As a randomized clinical trial, with Angle's classification as a stratification factor, our study contained 48 cases with integrity data, which were randomly extracted from 806 orthodontic treatment cases in Peking University School and Hospital of Stomatology during July 2004 and August 2008, and gathered post-treatment study casts, cephalometrics and photographs of the 48 cases as the research subjects. Similarly with Angle's classification as a stratification factor, the 48 cases were randomly divided into 4 groups. According to the monomial and combined subjects, 12 clinicians were asked to act as the raters to rank the 12 cases in each group., Results: Overall, there were 1 584 pairings between the raters in the examination of evaluation. The mean Spearman r was 0.565 3 ± 0.239 9. Grouping factor was related to the agreement of subjective evaluation (P<0.05). In the third trial item-Post-M+P, the correlations were the greatest among the judge-pairs (P<0.001). The other five items were at the same agreement level. The level of orthodontic treatment outcome was a factor that influenced the agreement level of subjective evaluation (P<0.05). The score stability of the patients, whose treatment duration was longer than 2.5 years, was significantly higher than that of the patients whose treatment duration was between 1.5 years and 2.5 years (P<0.05). The following factors, such as Angle's classification, age of patients and whether the teeth was extracted or not, were the insignificant factors (P>0.05)., Conclusion: The average correlations present a moderate agreement level. Grouping, experimental item, the length of treatment duration and the level of orthodontic treatment outcome are the factors that affect the agreement of subjective evaluation. Several factors including Angle's classification, age of patients and whether the teeth is extracted or not, do not affect the agreement of subjective evaluation.

Objective: To assess the consistency of the subjective evaluation of malocclusion severity by the Chinese orthodontic experts., Methods: Sixty-nine Chinese orthodontic experts subjectively evaluated the malocclusion severity for 120 cases which were selected randomly from 6 University orthodontic clinics by checking each case's pretreatment records including study cast, lateral head film, panoramic radiograph, facial photographs and patient chart. Each orthodontist was asked to independently rate the severity of every case into five grades: mild, mildly moderate, moderate, severely moderate and severe. Rating data was finally gathered to evaluate the intra-judge's reliability and the inter-judges' consistency., Results: Weighted Kappa test revealed that 8.33% orthodontists showed excellent intra-judge's reliability (Kappa ≥ 0.81), 78.33% orthodontists showed good intra-judge's reliability (Kappa ≥ 0.61) and 96.67% specialists displayed general intra-judge's reliability (Kappa ≥ 0.41). And intra-class correlation coefficient demonstrated a high level of inter-judges' consistency (r=0.989, P<0.01)., Conclusion: Good intra-judge's reliability and inter-judges' consistency can be demonstrated in the subjective evaluation of malocclusion severity by the Chinese orthodontic experts, which could the basis for establishing the objective grading system of malocclusion severity.

Introduction: In this study, we assessed agreement and disagreement among pairs of Chinese and US orthodontists in the ranking for "facial attractiveness" of end-of-treatment photographs of growing Chinese and white orthodontic patients., Methods: Two groups of orthodontist-judges participated: from the University of the Pacific, School of Dentistry, in California and from Peking University School and Hospital of Stomatology in China. Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 white patients and 48 Chinese patients. Pearson correlations were generated for a total of 1980 rankings by pairs of judges., Results: The resulting correlations ranged from +0.004 to +0.96 with a median of +0.54. Of these, 18.7% were lower than 0.4; 41.0% were lower than 0.5; 68.8% were lower than 0.6; 91.6% were lower than 0.7; and only 8.4% were greater than 0.7. As had been anticipated, correlations between judges were higher when they ranked patients of their own ethnicity than when they ranked patients of different ethnicity, but the differences were smaller than had been expected. The rankings of no pair of judges correlated negatively. This is to say that no pair of judges, whether of the same or different ethnicity, ranked the patients so that those 1 judge tended to find attractive were consistently found unattractive by the other., Conclusions: The distribution of levels of agreement between pairs of orthodontists did not differ substantially whether the pairs included 2 US orthodontists, 2 Chinese orthodontists, or 1 US and 1 Chinese orthodontist. As might be expected, the pairs of Chinese orthodontists agreed with each other slightly better on average when ranking Chinese patients, and the pairs of US orthodontists agreed with each other slightly better on average when ranking white American patients, but the overall differences were small. These findings appear consistent with the inference that, on average, judgments of "facial attractiveness" by orthodontists at the 2 venues are more similar than had been expected for patients of Chinese and white ethnicity.

Orthodontics in China has experienced two important stages. At its early stage from 1950's to 1970's orthodontics was a division of prosthodontic department in China. There were 3 top professors in this field, who got partly training at one time or another in USA and returned to China working in Beijing Medical College, the Fourth Military Medical University and Shanghai Second Medical College. Among them, Professor Mao of Beijing Medical College was regarded as the father of Chinese Orthodontics. Removable appliance was the main tool at that stage and Prof.Mao brought forward Mao's Classification of Malocclusion which is still used in China. The rapid developing stage began in the 1980's when China opened its door to the world. More and more orthodontists got further training abroad and brought back advanced techniques since then. Up to now, we have already had more than one thousand of orthodontic specialists and established its own organization--the Chinese Orthodontic Society (COS), which holds domestic orthodontic meetings and organize its members to attend international meetings. Right now, almost all advanced techniques in diagnosis and treatment are adopted in China, including 3D imaging, self-ligating bracket appliance, and implant anchorage. Chinese orthodontists have started to present or publish papers in international meetings and journals and more than that, started to develop new appliances, such as Driving-Force Straight Wire Appliance, which has shown advantages in treating skeletal Class III malocclusion.