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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 15-18

Measuring orthognathic surgery satisfaction in orthodontic patients – A questionnaire survey


Department of Orthodontics, Asan Memorial Dental College and Hospital, Keerapakkam, Chengalpet, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance08-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. N Kannan
Department of Orthodontics, Asan Memorial Dental College and Hospital, Keerapakkam, Chengalpet, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_11_21

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  Abstract 


Introduction: In orthodontic-surgical treatment, the motivation of the patient for seeking treatment and her/his expectations of the results should be considered carefully in treatment planning. Therefore, the patient satisfaction will be improved. The objective of this study was to develop a reliable self-report measure of consumer satisfaction with orthodontic treatment, and to preliminarily assess its validity. The aim of this study was to assess patients who have undergone orthognathic surgery. Materials and Methods: A patient-centered questionnaire to assess the satisfaction of the patients undergoing orthognathic surgery was being prepared and given to fifty patients in Private Dental College, and the results are being discussed. This questionnaire is easily and quickly applicable and economic, however, it should be kept in mind that it is subjective. Results: Fifty participants who attended the out patient of Department of Orthodontics, Private Dental College, were included in the study. When questions were asked about their experience in the department, 98% felt the treatment was hygienic, 96% felt the treatment was expensive, and 86% felt they were well informed. Moreover, only 62% had discomfort during the treatment. When asked about treatment outcomes, 97% had a smile satisfaction and 95% said they would recommend to friends. Eighty-eight percent felt they had experienced pain. Finally, questions were asked about how it affects the quality of life of the patients. Conclusion: Orthognathic surgery causes a significant improvement in patients' quality of life. This improvement was seen in emotional, oral function, psychological, and social domains of quality of life. The maximum influence was in emotional and the least in functional aspect. Our study assessed the quality of life in a limited period postoperatively, and obviously, there is a need for longitudinal studies in this area of health-care services.

Keywords: Confidence, measurement, orthognathic surgery, satisfaction, smile


How to cite this article:
Banu S T, Kannan N. Measuring orthognathic surgery satisfaction in orthodontic patients – A questionnaire survey. Int J Soc Rehabil 2021;6:15-8

How to cite this URL:
Banu S T, Kannan N. Measuring orthognathic surgery satisfaction in orthodontic patients – A questionnaire survey. Int J Soc Rehabil [serial online] 2021 [cited 2022 Jan 16];6:15-8. Available from: https://www.ijsocialrehab.com/text.asp?2021/6/1/15/331472




  Introduction Top


Orthodontists, like other health-care professionals, rely on patient cooperation for successful treatment outcomes, and an important factor in this success is patient satisfaction with the delivery of care.[1] Patient satisfaction after orthodontic treatment is influenced by a number of factors. To illustrate, psychological traits of individual patients affect their satisfaction with orthodontic treatment outcomes. Factors such as gender, age, duration of treatment, compliance, and dentofacial improvement also seem to contribute to the level of satisfaction. Patient satisfaction is important for ensuring patient adherence in orthodontic treatment. In previous studies, different factors have been explored and different instruments have been used to assess satisfaction after orthodontic treatment. Not surprisingly, investigations of patient satisfaction after orthodontic treatment have shown a wide range of satisfaction levels. This makes comparisons between studies difficult. Almost a decade ago, in a study in The Netherlands, the patient satisfaction questionnaire was developed by Bos et al.

The factors such as doctor–patient relationship, situational aspects, dentofacial improvement, psychosocial improvement, and dental function, as well as a residual category, were explored. It was shown that the most important factor contributing to patient satisfaction was the patient satisfaction with the doctor–patient relationship. Gender was shown to be a significant predictor of the patient satisfaction with the doctor–patient relationship and the situational aspects of the treatment. However, dental attitudes of patients have changed over time. Over the past decade, the number of patients seeking orthodontic treatment has increased considerably with socioeconomic development and changing opinions on appearance.[2],[3],[4]

Orthodontic tooth movement is mainly a biological response toward mechanical force. Skeletal disfigurement of the face has a negative effect on many aspects of life. These include social interactions, opportunities, choice of profession, choice of partner, and personality characteristics. Subjects with malocclusion, particularly those in need of surgical corrections, have a lower health-related quality of life and are more anxious. It therefore seems reasonable to offer orthognathic surgery as an appropriate treatment to correct a disfigurement if it is subjectively perceived as a handicap, in part to improve the psychology of the patient. This leads to the consideration that patients' perception of the quality of orthognathic surgery is dependent upon several factors. These are not only esthetics and function but also psychological aspects. As a consequence, patients' preoperative expectations of orthognathic surgery and postoperative outcome could offer discrepancies if patients are not clearly informed of what is possible and what is not. However, without patient cooperation, few medical or dental therapies, including orthodontics, will achieve optimum results. It has been shown that a desire for orthodontic treatment, together with a sound understanding by the patient of the nature of the malocclusion, auger well for future compliance. Hence, compliance does not remain the sole responsibility of the patient.

Rather, orthodontists need to inform and instruct their patients to such a level as to ensure their full commitment. It is of concern that patients show a very low recall rate with regard to any risks associated with orthodontic treatment. Lack of communication between the orthodontist and the patient and insufficient information about orthodontics can lead to premature termination of the treatment. Orthodontists should therefore look at the way they educate patients, ensuring that full comprehension has been achieved. Measuring treatment satisfaction is a complex task. Patient satisfaction is higher when visible treatment outcome goals are met and when their expectancy with regard to psychosocial benefits is lower. The key to success is to discover the actions that will produce the most positive response from the patient. Orthodontists should strive to achieve the correct bite and an excellent smile, but they have not been truly successful if their patients have not also benefitted psychosocially. The fulfillment of patient expectations has become one of the main objectives of health-care systems.[5],[6]

Patients' expression of desires is important because health professionals often underestimate them for care. The clinician with an awareness of a patient's demands is better able to satisfy the patient's justified desires and to initiate frank discussion about those expectations that are unrealistic, leading to more productive clinical negotiations. Assessment of patients' expectations is central to understanding oral health needs, patient satisfaction with treatment, and ultimately, the perceived overall quality of health systems. Mismatch between patient desires and the service received is related to decreased satisfaction. Patient satisfaction is a multifaceted dimension; however, people may have a complex set of important and relevant beliefs. Interest in-patient satisfaction with various aspects of their health care has grown significantly for surgeons and orthodontists. The benefits of combined orthodontic plus surgical treatment is better than its potential risks and negative side effects regarding this therapy.[7],[8],[9]

Orthodontists and oral maxillofacial surgeons should use the informed consent and properly inform the patients expectations by limiting false impressions of a “new face” after such complex treatment. It has been observed that patients tend to expect their new profile to fit more closely to socially accepted patterns than what should really be expected. Another major factor to be considered is that the perceived care and attention the orthodontist, surgeon, and staff provided to the patient increased the patient's confidence in the orthodontic/surgical treatment outcomes. However, perception of care is a broad category that was sometimes only assessed as quality of care in the studies examined. The overall aim of orthodontic care should be good treatment results and satisfied patients but at a reasonable cost. To reach this goal, it is important that the quality of care is continuously and systematically evaluated and documented by means of professional clinical assessments and patient questionnaires or interviews. Patients with inappropriately high expectations may be dissatisfied with the optimal care and those with inappropriately low expectations may be satisfied with deficient care. From a policy perspective, understanding patients' concerns and requests is important for the measurement of health-care quality, the delivery of health services, and the costs of care. Correlations between satisfaction with dental and facial appearance and expectations of orthodontic treatment appear to be age but not gender related.[10],[11]

The aim of this study was to assess patients. Orthodontists should recognize and respond to these needs, for as caring professionals, they may be the patient's only source of positive reinforcement.

The main goals of orthodontic treatment are to correct esthetic impairment, improve oral function, and help patients restore their sociopsychological well-being. A number of factors may influence patient satisfaction, including physical comfort, emotional support, patients' expectations, and respect for patient preference. This research is being designed to measure the satisfaction of orthodontic patients undergoing orthodontic surgery.[12]


  Materials and Methods Top


A patient-centered questionnaire to assess the satisfaction of the patients undergoing orthognathic surgery was being prepared and given to fifty patients in Private Dental College, and the results are being discussed.

Inclusion criteria – This questionnaire was distributed only to patients who have undergone orthognathic surgery.

This questionnaire is easily and quickly applicable and economic, however, it should be kept in mind that it is subjective because replies can be affected by patients' moods at the time of questionnaire. The questionnaire is shown in [Table 1].
Table 1: Questionnaire

Click here to view



  Results Top


Fifty participants who attended the O.P of Department of Orthodontics, Saveetha Dental College, were included in the study. When questions were asked about their experience in the department, 98% felt the treatment was hygienic, 96% felt the treatment was expensive, and 86% felt they were well informed. Moreover, only 62% had discomfort during the treatment [Graph 1].



When asked about treatment outcomes, 97% had a smile satisfaction and 95% said they would recommend to friends. Eighty-eight percent felt they had experienced pain [Graph 2]. Finally, questions were asked about how it affects the quality of life of the patients, and the outcomes are listed in [Graph 3].




  Discussion Top


Patient satisfaction with orthodontic treatment has no definitive outcome in the literature. This can be explained by the different motivations and expectations of patients receiving orthodontic treatment. Most studies report functional, esthetic, and social reasons as the main motives to seek orthodontic treatment. Satisfaction level may be affected by the severity of the malocclusion at the beginning of the treatment or by the final result of the treatment. However, a recent study showed that patient satisfaction is not necessarily bound to the severity of malocclusion before treatment or the final result of the treatment. The current status of the dentition may be more relevant for patients than the benefits obtained just after orthodontic treatment. Dentofacial deformities drastically affect patients' health-related qualities of life. Especially, unesthetic appearances of soft-tissue and skeletal architecture in class 3 deformities may cause psychological problems.[13],[14]

Therefore, the most crucial step of preoperative planning in orthognathic surgery candidates is psychological assessment. Ideally, a psychiatrist or psychologist should undertake this assessment. If this cannot be provided, an orthodontist or surgeon should evaluate the patient carefully. Patients' self-perception of facial appearance can differ from physicians' perception. Therefore, patients' subjective complaints and expectations should be analyzed carefully.[15]

Physicians should decide whether they can meet these expectations.[16] Studies show that even if there are minor disparities in the results, patients are satisfied with the results of orthognathic surgeries. There are many factors that might cause postoperative dissatisfaction.[17] Most of them are secondary to miscommunication of patients and physicians rather than poor postoperative results or lack of surgical skills. Many measurement indexes are used for assessing the benefits of orthognathic surgery, and usually, questionnaires are preferred.[18] The questionnaire was assessed for the satisfaction of the patients. Fifty orthognathic patients completed the questionnaire. Moreover, 98% of them feel that the treatment is hygienic and sanitary.[19] Hence, it is understood that the treatment is a better one. However, 96% of them feel it is an expensive treatment.[20] Eighty-six percent of the doctors kept the patients well informed about this procedure and 62% of them feel discomfort and major percentage of them, that is, nearly 80%, feel that it is an expensive procedure. Ninety-four percent of the patients have reported that it improves their chewing ability, and expect few, everyone is happy about the smile and facial appearance.[21] Nearly 98% of patients are satisfied with speech quality and the tooth alignment and nearly 96% of people are satisfied with this procedure. Ninety-four percent of the patients would like to recommend it to their friends, relatives, and family. This study has several limitations. More patients with longer follow-up and a survey before the institution of orthodontics would be useful to better correlate the results with lasting benefits obtained through orthognathic surgery.


  Conclusion Top


Orthognathic surgery causes a significant improvement in patients' quality of life. This improvement was seen in emotional, oral function, psychological, and social domains of quality of life. The maximum influence was in emotional and the least in functional aspect. Our study assessed the quality of life in a limited period postoperatively, and obviously, there is a need for longitudinal studies in this area of health-care services. This report focuses on patient satisfaction with orthognathic treatment as an outcome measure of the quality of the treatment. Based on the results, it is very well clear that almost 94% of the patients are satisfied with this treatment, in spite of the discomfort. There are many studies which prove the quality and success rate of the orthognathic treatment. Although it is expensive, the effectiveness of the treatment overcomes it. This survey reveals the existing scenario of orthognathic practice and highlights the importance of it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Luzzi V, Guaragna M, Lerardo G, Saccucci M, Consoli G, Vestry AR, et al. Malocclusions and non-nutritive sucking habits: A preliminary study. Int J Adult Orthod Orthognath Surg 2011;17:75-81.  Back to cited text no. 11
    
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Zhou YH, Hägg U, Rabie AB. Concerns and motivations of skeletal Class III patients receiving orthodontic-surgical correction. Int J Adult Orthodon Orthognath Surg 2001;16:7-17.  Back to cited text no. 12
    
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Shell TL, Woods MG. Perception of facial esthetics: A comparison of similar Class II cases treated with attempted growth modification or later orthognathic surgery. Angle Orthod 2003;73:365-73.  Back to cited text no. 13
    
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Lazaridou-Terzoudi T, Kiyak HÁ, Moore R, Athanasiou AE, Melsen B. Long-term assessment of psychological outcomes of orthognathic surgery. J Oral Maxillofac Surg 2003;61:545-52.  Back to cited text no. 15
    
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Motegi E, Hatch JP, Rugh JD, Yamaguchi H. Health-related quality of life and psychosocial function 5 years after orthognathic surgery. Am J Orthod Dentofacial Orthop 2003;124:138-43.  Back to cited text no. 16
    
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Jędrzejewski M, Smektała T, Sporniak-Tutak K, Olszewski R. Preoperative, intraoperative, and postoperative complications in orthognathic surgery: A systematic review. Clin Oral Investig 2015;19:969-77.  Back to cited text no. 17
    
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Ruiz LP, Lara JC. Facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible. Int J Oral Maxillofac Surg 2011;40:884-6.  Back to cited text no. 18
    
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Chrcanovic BR, Custódio AL. Optic, oculomotor, abducens, and facial nerve palsies after combined maxillary and mandibular osteotomy: Case report. J Oral Maxillofac Surg 2011;69:e234-41.  Back to cited text no. 19
    
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Maple JR, Vig KW, Beck FM, Larsen PE, Shanker S. A comparison of providers' and consumers' perceptions of facial-profile attractiveness. Am J Orthod Dentofacial Orthop 2005;128:690-6.  Back to cited text no. 20
    
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