Success in orthodontically treating malocclusion is somewhat dependent upon the severity of the initial malocclusion. The American Board of Orthodontics developed the Discrepancy Index (DI) as a measure of pre-treatment malocclusion severity and the Objective Grading System (OGS) to assess orthodontic treatment outcomes. Objectives: To compare non-extraction orthodontic treatment and retention outcomes with and without selective alveolar decortication plus grafting (AOOtm) for pre-treatment malocclusion with DI scores greater than 10. Methods: Pre-treatment patient records were screened for DI scores greater than 10 and grouped for treatment with (n=26) and without (n=28) AOOtm. Study casts and panoramic x-rays for non-extraction, straight-wire therapy were scored at post treatment (T1) and retention (T2) using the OGS for 8 criteria plus total OGS score. Results: For the AOOtm group, total post treatment (T1) OGS score (21.7) was significantly lower (p<.001) than the group without surgery (30.6), as were buccal-lingual inclinations (4.6 v 6.6, p=.04), marginal ridge relationships (2.7 v 5.9, p<.001) and interproximal contacts (.3 v 1.1, p=.03). At retention (T2), the AOOtm group had significantly lower scores for alignment (1.3 v 3.8, p<.001) and marginal ridge relationships (1.4 v 4.9, p<.001) as well for effect sizes.. Conclusions: Orthodontics combined with selective alveolar decortication plus grafting (AOOtm) to resolve malocclusions with pre-treatment Discrepancy Index scores greater than 10 produced better orthodontic and retention outcomes in non-extraction, straight wire therapy cases.

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