Date of Award

9-26-2025

Department

Department of Orthodontics

First Advisor

Heeyeon Suh

First Committee Member

James Chen

Second Committee Member

Heesoo Oh

Abstract

Objectives: This study aimed to evaluate clinician agreement on treatment decisions and perceptions of success for adult Class III malocclusions treated with clear aligners and to identify cephalometric predictors of treatment success. Materials and Methods: Twelve adult Class III patients treated exclusively with clear aligners were selected from a private practice. Twenty-four orthodontists evaluated pre- and post-treatment records through a structured survey. Part 1 assessed treatment objectives and surgical versus non-surgical preferences; Part 2 evaluated treatment outcomes before and after disclosure of the non-surgical constraint. Cohen's kappa assessed inter-rater agreement, and mixed-effects logistic regression identified predictors of success. Results: Agreement on surgery versus non-surgery decisions was fair (κ=0.23, P < .0001). Agreement on treatment success was also fair before (κ=0.32, P < .0001) and after (κ=0.24, P < .0001) disclosure of the non-surgical constraint. The Overall mean success rate was 79.7%. Clinician background influenced treatment preferences, with non-academic clinicians more likely to recommend surgery. Initial lower incisor inclination (IMPA) was the only significant predictor of treatment success (P=0.002), with less retroclined lower incisors associated with higher success ratings. Conclusions: Clinician agreement on treatment planning and perceived success in non-surgical Class III aligner therapy was limited, even after treatment constraints were disclosed. Initial lower incisor inclination may serve as a predictor of nonsurgical treatment success. Despite variability in individual assessments, the overall success rate of 79.7% suggests that non-surgical clear aligner therapy can produce satisfactory outcomes in carefully selected adult Class III patients.

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