Grading your own treatment results can be a painful procedure, but if it is done in a consistent and organized way, it can be one of the most constructive steps you can take to better orthodontic treatment. First you have to decide that you really want to know what your treatment results are and how well you achieved your treatment objectives. Then you have to set down in as much detail as you wish, what your treatment objectives are. You establish the yardstick against which to measure your treatment results. For some, it may be more simple than for others. Some yardsticks may be divided into inches and some may be divided into millimeters. Some orthodontists may select a more qualitative list such as is suggested in the article on this subject in this issue. Some may select a more quantitative approach with a detailed cephalometric analysis with which to measure treatment results. Some may find a way to insert characteristics such as esthetics, gingival health, oral health, decalcification. Hopefully, some may want to add occlusion and slide. Treatment time might be a good ingredient. My suggestion would be to start with the suggested list and get the feel of grading. Then the list can be individualized.
The whole point of grading is to create an individualized tool that will serve you; that will evaluate your treatment results in more than a perfunctory way; that will evaluate all treatment results, the not-so-successful as well as the successful, the easy as well as the hard; that will systematically make you perform this step as routinely as any other; that the grading will be performed with the intention of learning how your treatment is doing with regard to a fundamental set of orthodontic corrective movements. Grading is comparable to a standard checklist of production quality in a factory. We do not have the advantage of being able to throw out those products that do not measure up, but we do have the possibility of re-treating certain of the characteristics that may be found wanting; and we certainly can have a guide to doing a better job on the next production.
While models are far from the whole or even the true story in orthodontics, the suggested basic list lends itself to model analysis. This means, of course, that you must have models on which to make the grading analysis. It could conceivably be done in the mouth, but models are easier to examine and permit grading to be done at any convenient time. If one were to have cephalometric factors, of course one would need cephs and ceph tracings on which to make that analysis. If factors such as occlusion and slide were included, an oral examination would need to be made for them .
To make the grading meaningful, you have to establish standard rules for yourself concerning when the records will be taken that will be compared to the original records and be sure to take them on each case--good, bad or indifferent--at the appointed time. Obvious possible times would be upon removal of active appliances or at the completion of active treatment (and these two do not coincide for everyone), at the end of retention, or some period of time after retention. Some might want to grade themselves at all of these points, because they tell you different things.
As a start, however, let us accept the suggested list of treatment objectives or a similar list modified in any way you wish, and set as a first goal to find out whether we fulfilled our treatment objectives. Since most of us take impressions for retaining appliances, make a second pour of those impressions for grading models. Grade them all.
Many orthodontists have cases that are overtreated or undertreated and will improve following active appliance removal. For them, I would suggest a standard deadline of let us say, three months after active appliance removal for taking grading model impressions--again good, bad or indifferent.
It should be implicit in the grading procedure that you follow the rules. The object may be to get high marks, and your marks are likely to improve, but unless you are honest with yourself in your grading and unless you resist the temptation to skip grading an obviously imperfect result and also resist the temptation to postpone the grading until the case improves some more, you will be missing the point of grading. You are grading how well you performed with your appliance and technique--how well you moved teeth. And, when you reevaluate after grading, you are considering what it was that may have cut down on your grade and whether that could have been improved and will be improved on the next case. You may decide that it was lack of patient cooperation that caused a low grade. Consider then whether patient cooperation could be improved, especially if there are a considerable number of cases in that category.
Now proceed to the article referred to previously (see "Grading Your Orthodontic Treatment Results" by the editor in this issue) and good luck with your grading.
