This is an HTML version of an attachment to the Official Information request 'Orthognathic Surgical Criteria for Adults Class III Malocclusion'.
Severity and Outcome Assessment for Surgical-Orthodontic cases 
 
 
 
Patient name      ………………………………. 
 
Surgeon’s initials      …………………… 
 
Hospital number ……………………………… 
 
Orthodontist’s initials    ……………….. 
 
Type of Case:  Tick Box(es) 
 
Class I    
Class II     
Class III     
Anterior Open Bite     
Asymmetry   
 
 
Section A: Assessment of Severity: Pre-Treatment Cephalometric Analysis    
 
Date of Ceph 
 
 
Measurement 
Acceptable Range 
Within Range? (Yes or No) 
ANB 
-1° to 7° 
 
SNB 
72° to 84° 
 
LFH% 
51% to 59% 
 
Overjet 
1.3mm to 5.3mm 
 
Overbite 
0.8mm to 6.8mm 
 
UI / Mx 
97° to 121° 
 
Holdaway 
7° to 14° 
 
Severity Score  = Total number of Yes Grades (Possible Range 0-7, 
 
lower scores represent more severe pre-treatment) 
 
Comparison with the National Outcomes Audit findings 
 
The Mean Severity Score in the National Audit was 3.8 with a standard deviation of 1.3. Therefore 68% of cases fell within the 
range of 2.5 to 5.1 in the National Audit. 
 
3% of cases had the most severe scores of 1 or less; 16% had a score of 2 or less; 41% had a score of 3 or less; 69% of cases had 
a score of 4 or less; and 92% had a score of 5 or less. 
 
(e.g. A pre-treatment severity score of 2 would put that case among the most severe 16% of the national audit cases) 
 
 
Section B: Assessment of Outcome: Post Treatment Cephalometric Analysis    
 
Date of Ceph  
 
(pre- or post-debond) 
 
Measurement 
Acceptable Range 
Within Range? (Yes or No) 
ANB 
-1° to 7° 
 
SNB 
72° to 84° 
 
LFH% 
51% to 59% 
 
Overjet 
1.3mm to 5.3mm 
 
Overbite 
0.8mm to 6.8mm 
 
UI / Mx 
97° to 121° 
 
Holdaway 
7° to 14° 
 
Outcome Score: = Total number of Yes Grades (Possible Range 0-
 
7, higher scores represent better outcome): 
 
Comparison with the National Outcomes Audit findings
 
The Mean Outcome Score in the National Audit was 5.4 with a standard deviation of 1.3. Therefore 68% of cases fell within the 
range of 4.1 to 6.7 in the National Audit. 
 
20% of cases had the best score of 7 (best outcome); 52% had a score of 6 or above; 80% had a score of 5 or above; and 91% of 
cases had a score of 4 or above. 
 
(e.g. A post-treatment outcome score of 7 would put that case among the most best 20% of outcomes from the national audit) 
 
 
 
Feb 04 


Explanatory Notes on Using the Surgical Orthodontics Assessment Sheet 
 
 
 
1. 
The assessment is based on the National Outcomes Audit for Surgical Orthodontic Treatment that was presented at the 
Consultant Orthodontic Group Symposium in 2002. 
 
2. 
Measurements can be carried using the COGSOFT OPAL software or similar software. The Holdaway angle cannot be 
measured using the current version of OPAL software (although this is planned for future versions) and must be 
therefore be measured manually. This can be easily carried out using a plot from the OPAL software and it is not 
necessary to measure it on the film itself. The Holdway angle is measured as the angle STNasion (Soft Tissue Nasion) – 
STPog (Soft Tissue Pogonion) – LabrSup (Labrale Superius). These points can be printed on an OPAL plot by selecting 
the Show Points option. The angle needs to be measured manually using a protractor. 
 
 
 
3. 
The acceptable ranges are based on the Eastman Normal values plus/minus 2 standard deviations with the exception of 
the Holdaway measurement for which the acceptable range is as suggested by its originator 
 
4. 
The outcome and severity analyses are most useful if used on groups of cases (i.e. calculating mean severity and 
outcome scores in order to audit one’s own cases). In the National Outcomes Audit, each orthodontist was asked to 
submit 6 cases. Nevertheless the proforma can also be used for single cases to identify which individual parameters fall 
outside the normal ranges. 
 
 
5. 
It is recognised that the assessment only includes 7 parameters. These were carefully chosen so as to provide a 
representation of the main skeletal, dento-skeletal, dental and soft tissue measurements.  
Feb 04 

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