There are few scientific data available to support any specific length of graduate orthodontic education in terms of clinical education. The results derived from ongoing outcomes assessments of clinical treatment should provide a much better basis for curriculum planning, licensing, and certifications than relying on editorials, opinions, and anecdotal evidence. Ideally, such assessments should be broad based, include a variety of educational philosophies and treatment modalities, and evaluate all finished patients regardless of outcome.

As of 2005, only 1 program of any length, a 24-month program, had reported long-term scientific data based on the treatment results of consecutively finished patients. The goal of this study was to contribute to the rather small body of scientific data regarding clinical outcomes of postgraduate orthodontic education, by using the objective scoring methods of the American Board of Orthodontics (ABO).

Outcomes assessments allow private practitioners, university residents, and faculties to evaluate their results and raise the level of treatment outcomes. In 1998, the ABO introduced the objective grading system (OGS) for evaluation of completed treatment based on dental casts and panoramic radiographs. The discrepancy index (DI), was introduced by the ABO as a method to evaluate pretreatment complexity in 2004. The DI takes into account the initial dental casts, cephalometric values, and other pretreatment orthodontic records.

A 4-year collaborative project by the ABO and 15 graduate programs concluded that orthodontic residents can treat selected patients to an ABO standard within the time frame of graduate orthodontic programs ( Table I ). The project also showed that ABO resident examinees, on average, scored higher (poorer finish), on the OGS than traditional ABO examinees, but the scores were nevertheless of sufficient quality to satisfy ABO standards. In a pilot study of the DI, orthodontic resident cases selected with faculty guidance for inclusion were compared with those submitted by ABO candidates ( Table I ). It was concluded that the DI scores were “remarkably similar.”

The first published comprehensive study of a postgraduate orthodontic residency program was completed at Indiana University School of Dentistry (IUSD) and included the records of 521 consecutively finished patients; it reported average OGA scores of 32.4, 33.1, and 37.8 for 1998, 1999, and 2000, respectively ( Table I ). The report noted that longer treatment times were associated with poorer results (higher OGA scores), since problem patients were often transferred in the clinic.

IUSD initiated a number of curriculum changes to improve the outcomes and treatment efficiencies, having established a 3-year baseline in the 1998-2000 study. After implementation of these changes, IUSD reported the results for 437 consecutively finished patients: average OGA scores of 28.66, 24.97, and 22.42 for 2001, 2002, and 2003, respectively ( Table I ). Knierim et al stated, “We concluded that treatment outcomes improved as a result of the quality assessment process instituted after the baseline study.”

IUSD did not report pretreatment assessment scores (DI) on the patients from 1998 through 2003 but recently reported on case complexity by using the DI for 2004 through 2006. The mean DI scores were 15.13, 14.99, and 15.58, respectively ( Table I ).