Semester

Spring

Date of Graduation

2025

Document Type

Thesis

Degree Type

MS

College

School of Dentistry

Department

Orthodontics

Committee Chair

Khaled Alsharif

Committee Co-Chair

Peter Ngan

Committee Member

Guoqiang Guan

Committee Member

Will Andrews

Abstract

ABSTRACT

Inter/Intra Reliability of Diagnosis using the Andrews Six Elements Treatment Philosophy

Jenna M. Schneider, D.D.S., Khaled Alsharif, B.D.S, M.S., Peter Ngan, D.M.D., Guoqiang Guan, D.D.S., Ph.D., Will A. Andrews, D.D.S.

Background and Objectives: In order to diagnose and treatment plan orthodontic cases, orthodontists employ many different treatment philosophies and disciplines, and practice with their own understanding and adaptation of such philosophies. Andrews-trained orthodontics incorporate the defined six elements: the dental arch and its supporting tissues/structures, anteroposterior jaw relations and positions, buccal-lingual jaw relations and positions, jaw heights, chin prominence, and the occlusion [ideal characteristics described in the Six Keys to Normal Occlusion].1 While treatment philosophies, like the Andrews Six Elements, help to guide those taught its methodologies, the reliability of implementing the Andrews Six Elements diagnosis and treatment planning has not yet been studied. This project is intended to be a pilot study in the evaluation of space analysis via the Andrews Six Elements methodology.

Experimental Design and Methods: One bilateral Class I moderate crowding orthodontic patient case was selected and distributed for completion of space analysis using the Andrews Six Elements Diagnostic Sheet at two different time points to 12 participants of various levels of experience. Participants include Dr. Will Andrews, WVU Orthodontics faculty, recent WVU Orthodontics alumni, and current residents trained using the Andrews Six Elements philosophy.

Results: Intra-class reliability at the two separate time points (T1 and T2) was measured with moderate to excellent values (ICC of 0.651-0.951) for all measured variables. Statistically significant differences between the average measurement of all participants and Dr. Andrews’ measurements of CD Max, SI Max, BL (jaw), ICD Max, CD Md, AP Md, SI Md, BL L Md, and BL R Md measurements were noted. There was no significant difference noted between the average measurement of all participants and Dr. Andrews’ measurements for AP Max, BL L Max, BL R Max, Internal Max, Internal Md, and ICD Md measurements.

Conclusions: The Andrews Six Elements Diagnostic Worksheet is a helpful tool for orthodontic space analysis. Drawn maxillary core lines have more variation than drawn mandibular core lines. Intra-class reliability ranged from moderate to excellent reliability, with most measurements having good or excellent reliability. Despite all statistically significant findings, the average ICD for all participants and for Dr. Andrews, the gold standard, resulted in values that correspond with extraction treatment plans for both maxillary and mandibular arches.

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