Tyler Crowe

Date of Graduation


Document Type


Degree Type



School of Dentistry



Committee Chair

Peter Ngan

Committee Co-Chair

Chris A Martin

Committee Member

Daniel W McNeil

Committee Member

Susan K Morgan


Background and Objectives: It is well known that a multitude of factors have an influence in the field of orthodontics from both the provider and the patient perspective. Patient compliance and oral hygiene both play a pivotal role in keeping an orthodontic treatment plan on track to become a successful treatment outcome. One question that is not completely understood, however, is how does each of these factors specifically affect the treatment outcome? Furthermore, patients come from different backgrounds and socioeconomic situations. Access to care and appointment keeping behavior are thought to vary between private pay, insurance subsidy, and Medicaid/CHIP patients. Therefore, it is imperative to look at these factors and identify to what extent, if any, they affect the overall success of the treatment outcome.;Experimental Design and Methods: A sample of 91 patients aged 8-20 from the private practice of Dr. Daniel Foley was used for this study. IRB-approval was obtained. Pre- and post-treatment photographs were taken according to the record specifications set by the American Board of Orthodontists (ABO). Pre-treatment records were scored using the ABO Discrepancy Index form. A retrospective chart analysis was completed to obtain payment type, distance traveled, oral hygiene, broken appointments, and treatment length. Post-treatment scans were taken using an iTero Element intraoral scanner and subsequent models were printed by an orthodontic lab. Post-treatment models were graded using the ABO Model Grading System to determine the success of the treatment outcome. The data was examined using a combination of one-way ANOVA, Chi-square, Wilcoxon Rank Sum, Kruskal Wallis, and logistic regression tests.;Results: There is no significant difference between any payment type and treatment outcome, however, private pay patients showed a significantly higher average oral hygiene scores than Medicaid/CHIP patients (p<0.05). Private pay patients traveled a significantly longer distance to obtain orthodontic treatment than Medicaid/CHIP patients (p<0.05). The actual length of active orthodontic treatment for Medicaid/CHIP was significantly longer than either private pay or insurance patients (p<0.05). Conversely, no significant difference was found in the appointment keeping behavior between payment types.;Conclusions: There is no difference in the ability of private pay, insurance, or Medicaid/CHIP patients to attain a successful treatment outcome, nor is there a difference in their appointment keeping behavior. On average, private pay patients have significantly better oral hygiene and travel a significantly longer distance for orthodontic treatment than Medicaid/CHIP patients. Medicaid/CHIP patients are in active orthodontic treatment significantly longer than private pay and insurance patients. More research needs to be conducted to determine the specific impact of oral hygiene on the ability to obtain a successful treatment outcome. Also, it would be beneficial to replicate this study on a larger sample size to eliminate any limitations due to a small number of subjects.