Assessing orthodontic treatment need in virtual consultations: A comparative analysis of photographic evaluations and clinical grading

Objectives The increased use of virtual orthodontic consultations through photographic assessments prompts a need for rigorous evaluation to determine the accuracy and reliability compared to actual orthodontic treatment requirements. This study aimed to establish the consistency of orthodontic treatment need assessments from photographs, comparing evaluations between dental professionals and laypeople and the index of orthodontic treatment need dental health component (IOTN DHC) grading of study models within the same patient cohort. Material and Methods A retrospective analysis was conducted using intraoral photographs and digital study models selected from 50 orthodontic patients from a national dental center’s records archive, representing specific occlusal traits. Twenty-four assessors were categorized into orthodontists, general dentists, non-orthodontic specialists, orthodontic residents, and laypeople. Intergroup evaluations of treatment needs based on photographs were compared with the IOTN DHC grade of digital study models, employing Kappa statistics and percentage agreement for analysis. Results Agreement between photographic assessments and IOTN DHC grades varied from fair to substantial. Orthodontists, orthodontic residents, and general dentists exhibited higher agreement (k = 0.339–0.655) for photographic assessments in comparison to non-orthodontic specialists and laypeople (k = 0.075–0.468) against the IOTN DHC grade. Across all groups, agreement was substantial for photographs depicting crowding (k = 0.493–0.602) and low for spacing (k = −0.039–0.237). Spacing was perceived to require higher treatment intervention than indicated by IOTN DHC across all groups. Orthodontists and general dentists perceived reverse overjet, posterior crossbite, and lateral open bite photographs to necessitate higher treatment intervention compared to laypeople. Conclusion Photographic assessments of orthodontic treatment needs showed varying agreement with IOTN DHC grades, with dental professionals demonstrating higher consistency. Agreement was highest for crowding but lower for spacing, reverse overjet, posterior crossbite, and lateral open bite. These findings emphasize the need for improved patient-clinician communication and technological advancements to enhance virtual orthodontic assessments.