2002 JCO Study of Orthodontic Diagnosis and Treatment Procedures, Part 3: More Breakdowns of Selected Variables

The first article in this three-part series on the2002 JCO Study of Orthodontic Diagnosisand Treatment Procedures (JCO, October 2002)presented the methodology and basic results ofthe survey, as well as trends since the firstTreatment Study was conducted in 1986. In lastmonth's installment and this concluding article,we break down the routine usage of the mostimportant diagnostic and treatment methodsaccording to number of years in practice, geographicregion, and gross income level.



In general, the newer practices were morelikely to use titanium alloys than stainless steelfor initial archwires, with the opposite being trueof older practices (Table 35). More than three-quartersof each age group used stainless steelfinishing wires, but those who had been in practiceless than 16 years used TMA finishing wiresmore routinely than others did. Older practiceswere more routine users of chrome cobalt nickel(Elgiloy) archwires in both stages of treatment.

Stainless steel early archwires were usedmost routinely in the Mountain region, whereasnickel titanium and superelastic titanium earlyarchwires were most popular in the West NorthCentral region (Table 36). Multistranded andbraided stainless steel early archwires were usedmost routinely in the West South Central andMiddle Atlantic regions, and TMA early archwiresin the East and West North Central regions.West North Central practices also reported thehighest percentages of stainless steel and TMAfinishing archwires. Multistranded and braidedstainless steel finishing archwires were usedmost routinely in New England, and nickel titaniumfinishing archwires in the South andMiddle Atlantic regions.

Respondents with higher gross incomewere more likely than others to use titaniumalloys for both initial and finishing archwires(Table 37). Those with lower gross income weremore likely to use stainless steel.

Removable and Functional Appliances

Among the removable and functional appliancessurveyed, the newer practices were themore routine users of the Forsus appliance,Herbst with crowns, Hilgers Pendulum, Invisalign,Mandibular Corrector, Mandibular ProtrusionAppliance, and MARA (Table 38). Olderpractices were the more routine users of the activator,bionator, Class II Corrector, Fränkel,removable and fixed-removable Herbsts, andsagittal appliance.

Regionally, the most routine users of theactivator, removable Herbst, and Jones Jig werein the East South Central region; of the bionator,bonded and fixed-removable Herbsts, and twinblock in the West North Central region; of biteplates, the Class II Corrector, and the MandibularCorrector in the Middle Atlantic region; of theDistal Jet, Hilgers Pendulum, and MandibularProtrusion Appliance in the East North Centralregion; of the Forsus appliance and Herbst withcrowns in the West South Central region; of thebanded Herbst in the South Atlantic region; ofthe Invisalign and Jasper Jumper in the Mountainregion; of the MARA and sagittal appliances inNew England; and of Schwarz plates in thePacific region (Table 39).

Many of the removable and functionalappliances tended to be used more routinely inpractices with higher gross income, including theClass II Corrector, Distal Jet, Forsus, Herbst,Hilgers Pendulum, Invisalign, Jasper Jumper,Mandibular Corrector, Mandibular ProtrusionAppliance, and MARA (Table 40).


Respondents who had been in practicelonger were more likely to use Kloehn facebows,J-hook headgear, and chin cups, while newerpractices were more likely to use high-pull andreverse headgear, facial masks, and safety orbreakaway devices (Table 41).

Kloehn facebows were used most routinelyin the West South Central region (Table 42). EastSouth Central orthodontists were the most frequentusers of J-hook headgear and the least frequentusers of Kloehn facebows. Reverse headgear,chin cups, and safety or breakaway deviceswere most routinely used in the West NorthCentral region. Facial masks were most popularin the East North Central region.

Practices with the lowest gross incomewere the most likely to use Kloehn facebows(Table 43). Larger practices were more likely touse high-pull and reverse headgear, chin cups,and facial masks.

Finishing Procedures

There was no discernible pattern in the useof cosmetic procedures or stripping by number ofyears in practice (Table 44). Older practices weresomewhat more likely than others to routinelyprescribe fiberotomies, equilibration, and positioners."Invisible" types of retainers and fixedbonded retainers were clearly favored by theyounger practitioners, while fixed banded retainerswere used more routinely by older practitioners.

Cosmetic procedures and stripping weremost routinely performed by West South Centralarea respondents and least routinely performed inNew England (Table 45). Hawley and modifiedspring retainers were used most routinely in theSouth Atlantic region, spring retainers in the EastSouth Central region, clear slipover and fixedbanded retainers in the West North Centralregion, Essix and fixed bonded retainers in theWest South Central region, and Invisalign retainersin the East North Central region.

Routine use of every finishing procedureincreased almost linearly with gross income(Table 46). The higher-income practices werealso more likely to use clear slipover, Invisalign,and fixed bonded retainers, while lower-incomepractices were more likely to use Essix and fixedbanded retainers.


Orthodontic diagnosis and treatment methodshave not changed significantly over the 16-year-period covered by the JCO surveys. Nevertheless,several overall trends have emerged since1986:

  • Orthodontists are about five years older onaverage, and more than twice as many of themare women.
  • Fewer diagnostic records are being taken on aroutine basis.
  • Many more orthodontists are using digitalimaging and analysis.
  • Nickel titanium alloys have replaced stainlesssteel as the material of choice for initial archwires.
  • Light-cured adhesives have become muchmore popular than chemically cured composites.
  • Fixed functional devices are used more routinelythan removable appliances, and headgearuse is declining.
  • The percentage of patients treated with extractionsis dropping.
  • Cosmetic finishing procedures have becomecommonplace.
  • The next JCO Study of Orthodontic Diagnosisand Treatment Procedures may show a continuationof these trends, as well as the emergenceof new technologies that at present canonly be imagined.


    Dr. Keim is Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Gottlieb is Senior Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Nelson is Director and Research Consultant, Nelson Associates, Nederland, CO.


    Mr. Vogels is Managing Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.

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