Index Of Complexity, Outcome And Need Scores Research Articles

Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study

BackgroundThe purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON).MethodsThis cross-sectional study included children diagnosed with ASD, aged 9–15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05.ResultsA total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001).ConclusionASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

The Impact of the COVID-19 Pandemic on Orthodontic Adult Patients' Characteristics and Decision on Orthodontic Appliance.

There is an overall paucity of data examining the specific details of orthodontic patients' patterns or orthodontic service disruptions possibly influenced by COVID-19 pandemic. Therefore, this study aimed to explore the impact of the COVID-19 pandemic on orthodontic clinic disruption regarding the change in adult patients' characteristics and decisions of orthodontic treatment devices. A retrospective sample of 311 patients receiving orthodontic treatment from 2018 to 2022 were collected and divided into two groups: before (n = 167) and during (n = 144) the COVID-19 pandemic. Demographics, dental indices, the index of complexity outcome and need (ICON), and the degree of treatment difficulty were analyzed. There were fewer students among patients during the COVID-19 pandemic than before (24.5% versus 35.9%, P = 0.036). Compared with patients before the pandemic, more patients selected ceramic brackets or Invisalign during the pandemic (P = 0.022). There were higher percentage of class I dental malocclusions among patients during than before the COVID-19 pandemic (P = 0.044). Moreover, the ICON score and the score of the degree of treatment difficulty were both significantly lower for patients during than before the COVID-19 pandemic (63.9±14.0 versus 58.3±15.3, P=0.001 and 7.4±2.6 versus 6.8±2.6, P=0.049, respectively). The COVID-19 pandemic influenced the characteristics and decisions of orthodontic patients. Those who still came to the orthodontic clinic despite the COVID-19 outbreak may have been those with less malocclusion severity and treatment difficulty. Besides, during the time of covid-19 pandemic, more patients chose ceramic bracket and Invisalign as their orthodontic treatment device rather than conventional or self-ligating metal brackets.

Evaluation of the relationship between anxiety levels and dental appearance.

The aim of this study was to evaluate the relationship between personal traits, dental anxiety level and dental appearance of the individuals. The study included 431 individuals who completed State Trait Anxiety Inventory-Trait Form (STAI-T) and Corah's Dental Anxiety Scale (CDAS) questionnaires during their first appointment at the orthodontic clinic. The Index of Complexity, Outcome and Need (ICON) index scoring was performed using intraoral frontal photographs by an orthodontist. According to the STAI-T scores, three anxiety groups were formed: mild, moderate, and severe. The Kruskal-Wallis H test was used for intergroup comparisons. Spearman's correlation analysis was performed to evaluate the relationship between STAI-T, CDAS, and ICON scores. It was found that 38.28% of the participants had mild, 34.1% had severe, and 27.62% had moderate anxiety levels. CDAS score was significantly lower in the mild anxiety group (p ≤ 0.0001) compared to the groups showing moderate and severe anxiety. There was no significant difference between the moderate and severe anxiety groups. ICON score was significantly higher in the severe anxiety group (p ≤ 0.0001) than the other groups. It was also significantly higher in the moderate anxiety group (p ≤ 0.0001) than in the mild anxiety group. There was a significant positive correlation between STAI-T and both CDAS and ICON scores. There was no significant correlation between CDAS and ICON scores. Dental appearance had a significant effect on the general anxiety of individuals. Improving the dental appearance with orthodontic treatments can have positive effects on reducing anxiety. The low level of dental anxiety in individuals with a high need for treatment will facilitate the work of the orthodontist in the procedures to be applied.

Mobile application evaluation of the orthodontic treatment success and the degree of change based on the index of complexity, outcome, and need (ICON)

Aim: To evaluate the success of orthodontic treatment and the degree of change using the mobile application-based Index of Complexity, Outcome and Need (ICON) score calculation and also inquired the difference of ICON score in time calculation in the results of orthodontic treatment estimated using the mobile application-based method compared with the manual method. Materials and Methods: The present analytic observational study with a cross-sectional approach with a total sampling was performed using 31 pairs of study models in patients treated at the Orthodontic Department of Nala Husada Dental and Oral Hospital, Hang Tuah University, Surabaya, in 2020. The components calculated consisted of the treatment need, complexity assessment, treatment outcome, and the degree of change. The study model was estimated objectively alternating from employing the mobile application to the manual calculation; thus, the results of the calculation time were balanced. The data were analyzed by the independent t-test and Mann–Whitney test (P < 0.05). Results: The results revealed that the independent t-test significance values were P = 0.780 for care needs, P = 0.880 for the assessment of complexity, P = 0.745; P > 0.05 for the treatment outcome, and P = 0.903 for the degree of change. There was a significant difference between manual and mobile application calculation to examine ICON (P = 0.001). Conclusions: The calculation of ICON in the mobile application showed faster performance than the manual method that can be used to evaluate the orthodontics treatment need, complexity assessment, orthodontic treatment outcome, and the degree of change.

Assessment of the relationship between oral health-related quality of life (OHRQoL) and dental malocclusion in a Portuguese sample

Introduction The assessment of the oral health-related quality of life (OHRQoL) and dental malocclusion are described in the literature and the results indicate a decrease in OHRQoL when clinically determined dental malocclusion severity increase [1,2]. However, there is still a lack of information for the Portuguese population for this issue. This exploratory study aimed to evaluate the relationship between patient perception of OHRQoL and the severity of dental malocclusion in a Portuguese sample. Materials and methods This work was approved by the Egas Moniz Ethics Committee. This cross-sectional observational study involved patients that sought orthodontic treatment between January and April 2019, at the Orthodontic Care Consultation of Egas Moniz Dental Clinic (Monte de Caparica – Almada, Portugal). Exclusion criteria were patients with severe diseases, craniofacial abnormalities, cognitive deficits, caries, periodontal diseases, and previous orthodontic treatment history. A total of 19 patients were enrolled in the study. OHRQoL was assessed by application of the Oral Health Impact Profile – Portuguese validated version (OHIP-14) [3] and dental malocclusion through the Index of Complexity, Outcome and Need (ICON) [4]. Based on the ICON score, patients were categorised as: in need of treatment (ICON > 43) or not (ICON ≤ 43). Resulting data were submitted to descriptive and inferential statistical analysis. Results The sample included 7 (37%) males and 12 (63%) females, with a mean age of 27.9 years. Overall OHIP-14 score ranged from 0 to 49 and ICON score from 13 to 75 (9 (47.4%) subjects with ICON > 43 and 10 (52.6%) with ICON ≤ 43). Total OHIP-14 score and all seven median domain scores were not found to be significantly different (p = .113 to p = .968), when comparing both groups. Discussion and conclusions OHRQoL was not found to be significantly different when considering the severity of dental malocclusion. Overall, results highlight a difference between patients’ self-perception of clinical condition impact in OHRQoL when compared to a clinical expertise judgement.

A comparison of self-esteem and social appearance anxiety levels of individuals with different types of malocclusions

Objective The aim was to compare Rosenberg self-esteem scale (RSES), sensitivity to criticism scale (STCS) and social appearance anxiety scale (SAAS) scores of individuals with different types of malocclusions, and investigate the correlation between these scores and the index of complexity, outcome and need (ICON) score. Materials and methods One hundred and twenty individuals, who did not have any previous orthodontic treatment, were included. Group 1 included 40 patients with Class I malocclusion (median age of 14 years), Group 2 included 40 patients with Class II malocclusion (median age of 14.25 years) and Group 3 included 40 patients with Class III malocclusion (median age of 15.15 years). ICON scores were 46, 53 and 56 for Groups 1, 2 and 3, respectively. RSES, STCS and SAAS questionnaires were performed to the patients. Student’s t-test, one-way analysis of variance (ANOVA), Mann–Whitney’s U and Kruskal–Wallis’s tests were used for the statistical analysis. Results Group 1 showed significantly higher level of RSES scores compared to Groups 2 and 3 (p<.05). STCS scores were found to be significantly higher in Group 2, compared to other groups (p<.05). Group 1 (32.53 ± 8.94) showed significantly lower level of SAAS scores compared to Group 2 (39.63 ± 9.28) and Group 3 (39.42 ± 10.54) (p<.05). A significant positive correlation was found between the ICON and SAAS scores (r = 0.247, p=.007). Conclusions Adolescents with Class II and III malocclusions reported higher levels of social appearance anxiety scores, and lower levels of self-esteem scores compared to Class I. Complexity of orthodontic treatment need showed a significant impact on social appearance anxiety.

Assessing Treatment Outcomes of a Graduate Orthodontic Program

Objectives: To assess treatment outcomes of a graduate orthodontic program during two different periods. Materials and Methods: Consecutive orthodontic patients’ files were selected from the archives of the Graduate Orthodontic Program, Aristotle University of Thessaloniki, Greece. Following the application of certain inclusion criteria, the final sample consisted of 109 patients. The sample was allocated into two groups depending on the time of treatment [Group A: 1998-2003, (n=60); Group B: 2004-2009 (n=49)]. The first period started a few years after the inception of the program and the second 10 years later. All pre- and post-treatment dental casts were blindly assessed by one investigator using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON). Statistical analysis included Student’s t-test, Mann-Whitney U test, Pearson Chi-Square test and Spearman correlation coefficient. The level of significance was set at p &lt; 0.05. Results: In Group A, the mean PAR index changed from 28.6 before treatment to 5.5 after treatment and the mean ICON index changed from 71.9 to 23.5. In Group B, the mean PAR index changed from 23.6 before treatment to 4 after treatment and the mean ICON index changed from 62.8 to 19.8. The mean PAR score reduction was 78.4% for the 1st group and 81.4% for the 2nd group, respectively. Ninety percent of the cases of Group A and 89.8% of the cases of Group B had a post-treatment ICON score &lt; 31. The severity of the initial malocclusion was found to be positively correlated with the treatment occlusal outcome. Out of the 109 cases, 68 were considered as substantially or greatly improved, 29 moderately improved, 8 showed minimal improvement and 4 cases were considered as not improved or worse. The mean PAR percentage improvement and the ICON score at the end of treatment were not correlated to the presence or absence of tooth extractions in the treatment plan. There was no correlation between the treatment outcome and the number of graduate residents involved in the therapy. The treatment outcomes were not correlated to the gender or age of patients. Conclusion: Patients treated by graduate orthodontic residents during 1998-2009 demonstrated significant improvement of their occlusion and the quality of the treatment remained constant throughout the years. The outcome of orthodontic treatment was not correlated to the gender and the age of patients, the number of postgraduate students performing the treatment, and the presence of tooth extractions in the treatment plan.

Correlation between the DAI and ICON Indices used for Assessment of Orthodontic Treatment need in Croatian Schoolchildren.

IntroductionThe aims were: evaluation of the correlation between the Dental Aesthetic Index (DAI) and Index of Complexity, Outcome and Need (ICON); the assessment of orthodontic treatment need for schoolchildren in a population with two indices, separately for schoolchildren with mixed and permanent dentition; the estimation of the population share that could not receive orthodontic treatment because of the presence of caries and/or gingivitis.MethodsA total of 2652 Zagreb school children (7 - 19 years old, 52.4% of them were females) completed a questionnaire regarding previous orthodontic treatment and the type of appliance used. Their oral cavity was also inspected. The DAI and ICON indices were used for the assessment of malocclusion prevalence.ResultsThe subjects with mixed dentition had a greater need for orthodontic treatment, when compared to subjects with permanent dentition, when using the DAI index (p<0.001). When using the ICON index, 11.7% of subjects with mixed dentition had very severe malocclusion, as opposed to 5.8% of subjects with permanent dentition. The DAI and ICON scores correlated positively linearly (r=0.521; p<0.001). A higher prevalence of both gingivitis and caries was recorded more often in boys; caries more often in the group with the mixed dentition, and gingivitis in the group with permanent dentition (p<0.05).ConclusionThe DAI and ICON indices have moderate agreement in assessment of malocclusion severity scores. One third of all schoolchildren with various degrees of both ICON and DAI indices have gingivitis, and half of them have caries.

Extraversion and openness to experience moderate the relationship between orthodontic treatment need and oral health-related quality of life in adolescents: A cross-sectional study.

To investigate the effects of personality traits to moderate the relationships between orthodontic treatment need and oral health-related quality of life (OHRQoL) in adolescents. A cross-sectional study was performed that included 230 subjects (125 girls and 105 boys) aged 11-14 years. Orthodontic treatment need was measured using the Index of Complexity, Outcome and Need (ICON). The Child Perceptions Questionnaire, the Basic Personality Traits Inventory (BPTI), and the Revised Life Orientation Test were used to assess the OHRQoL, basic personality dimensions, and dispositional optimism respectively. Potential moderation effects were evaluated with Spearman's correlations and multiple regression analyses. There were weak correlations between orthodontic treatment need and quality of life with social and emotional well-being dimensions ( r = 0.238, r = 0.296 and r = 0.209). A moderating effect of extraversion was observed in the relationship between orthodontic treatment need and OHRQoL, emotional well-being, and social well-being (SWB) (Δ R2 = 0.03, Δ R2 = 0.02, and Δ R2 = 0.04, respectively). Openness to experience affected relationships between orthodontic treatment need and OHRQoL, and emotional well-being (EWB) (Δ R2 = 0.03 and Δ R2 = 0.04, respectively). In children with higher extraversion, the increase in ICON scores resulted in less increase in CPQ total, EWB, and SWB scores. In children with higher openness to experience, the increase influenced CPQ total and EWB scores similarly. The relationship between orthodontic treatment need and quality of life is moderated by personality traits. Early adolescents with higher extraversion and openness to experience are less affected by increased orthodontic treatment need.

Self-reported temporomandibular disorder symptoms and severity of malocclusion in prospective orthognathic-surgical patients

Objective: The objective of this study is to analyze the association between self-reported symptoms of temporomandibular joint disorder (TMD) and the severity of malocclusion in prospective orthognathic-surgical patients.Material and methods: The subjects consisted of 50 consecutive patients (13 males and 37 females) referred to two university clinics for assessment of orthodontic-surgical treatment need. Data considering self-reported TMD symptoms were gathered using a semi-structured diary. At the first appointment, all patients rated the importance of treatment (on a scale of 1–10) and assessed self-perceived dental appearance using a VAS scale. The scale was anchored with photographs 1 and 10 from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Study models were assessed by an experienced orthodontic specialist using the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON). Association between the PAR and ICON scores and the number of reported symptoms was analyzed statistically.Results: Seventy-one percent of patients reported experiencing TMD symptoms. The most prevalent symptoms were pain in the head and/or neck region and fatigue in the TMJ region. The number of symptoms was highest in the morning. Ninety percent of males and 86% of females rated the importance of treatment as high; males experiencing TMD symptoms tended to rate surgery as more important compared with males with no symptoms (p = 0.056).Conclusions: In this sample, the results cannot unambiguously confirm an association between self-reported symptoms of TMD and objectively defined severity of malocclusion.

Validity assessment and determination of the cutoff value for the Index of Complexity, Outcome and Need among 12–13 year-olds in Southern Chinese

To validate the use of the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need among 12–13 year-olds in southern China, we determined the threshold value of ICON based on Chinese orthodontists' judgments. The samples consisted of 335 students in grade 7 from 16 randomly selected middle schools in Chengdu, China. Three associate professors provided ICON scores for each participant and the results were compared with the gold standard judgments from 25 experts on treatment needs. Based on the gold standard, 195 casts belonged to the treatment category, while the rest 140 belonged to the no-treatment category. With the international cutoff point of 43, the sensitivity and specificity of the ICON score were 0.29 and 0.98. The best compromise between sensitivity and specificity in Chengdu, compared with the gold standard, was found at a cutoff point of 29, and the sensitivity and specificity were 0.88 and 0.83. When used to evaluate the treatment need of 12–13 year-olds in southern China, the international ICON cutoff value did not correspond well with Chinese orthodontists' judgments; a lower cutoff value of 29 offered a greater sensitivity and specificity with respect to expert orthodontists' perception of treatment need.

Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets

To conduct a prospective and randomized study of the efficiency of orthodontic treatment with self-ligating edgewise brackets (SL; Time2 brand, American Orthodontics) and conventional edgewise twin brackets (CE; Gemini brand, 3M). One hundred consecutive patients were randomized to treatment with either SL or CE brackets. The participants were treated by one of three specialists in orthodontics and with continuous instructions alternately by five orthodontic assistants according to our normal treatment routine (ie, modified 0.022" MBT preadjusted edgewise technique). The treatments were evaluated in terms of overall treatment time, number of visits, and treatment outcome using the Index of Complexity, Outcome and Need (ICON). The number of emergency appointments, number of archwires, overjet, relative space, and extractions at treatment start were noted. After dropouts, the analyzed material consisted of 44 patients treated with SL (mean age 15.3 years, mean ICON 60.7, 70.4% female) and 46 patients treated with CE (mean age 15.0 years, mean ICON 56.5, 71.7% female). There were no statistically significant differences between the SL and CE groups in terms of mean treatment time in months (20.4 vs 18.2), mean number of visits (15.5 vs 14.1), mean ICON scores after treatment (13.2 vs 11.9), or mean ICON improvement grade (7.9 vs 9.1). Orthodontic treatment with SL brackets does not reduce treatment time or number of appointments and does not affect posttreatment ICON scores or ICON improvement grade compared with CE brackets.

The association between orthodontic treatment need and maxillary incisor trauma, a retrospective clinical study

Identifying risk factors for dental trauma in children is important. The main aim of this retrospective study was to investigate the association between maxillary incisor trauma (MIT) and variables such as gender, malocclusion complexity, and orthodontic treatment need (OTN). ICON (Index of Complexity, Outcome and Need) scores were calculated in 502 schoolchildren (253 girls and 249 boys, aged 11-14-years). Subjects were categorized into 5 ICON complexity groups (easy to very difficult) and into 2 groups according to OTN (ICON >43, ICON <44). Logistic regression was performed to test for any differences in risk of MIT among subjects in different ICON complexity groups and to estimate the predictive value of gender, OTN, and ICON scores for MIT. Nine percent experienced incisor trauma (93.4% maxilla, 6.6% mandible). Enamel fracture was the most common type (6.2%) of dental trauma. Boys had greater odds of MIT compared with girls (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.11-4.21). Subjects with OTN showed greater odds of MIT compared to those without (OR 2.37, 95% CI 1.21-4.64). Only subjects presenting with difficult complexity grade (64 < ICON < 77) showed significantly higher odds of experiencing MIT (OR 3.16, 95% CI 1.25-8.01) compared with the easy complexity group (ICON <29). The higher risk of experiencing MIT in malocclusions with difficult complexity warrants more vigilant screening of this group before and during dental or orthodontic treatment.

Effectiveness of interceptive orthodontic treatment in reducing malocclusions

In this retrospective cohort study of the effectiveness of interceptive orthodontic treatment, we compared patients receiving interceptive orthodontic treatment with untreated control subjects. Models were scored by using the index of complexity, outcome and need (ICON). Control models (n = 113) were archival and were selected based on malocclusion in the early mixed dentition and no orthodontic treatment during the subsequent 2 years. The patients (n = 133) were in the mixed dentition and consecutively treated in the University of Bergen orthodontic clinic. Initial ages were 9.4 years (+ or - 1.4) for the treated group and 9.3 years (+ or - 0.8) for the control group. The treatment took a mean of 27.2 months (+ or - 16.3) for the patients; the control group was observed for a mean of 24.4 months (+ or - 3.6). Subject Groups were matched for age, need, complexity, duration, and all ICON components except spacing (P <0.006) and crossbite (P <0.000). ICON scores decreased after treatment by 38.8% (P <0.0001) from 54.9 (+ or - 16.6) to 33.6 (+ or - 16.1). The controls were unchanged, with ICON scores of 54.0 (+ or - 14.8) and 54.2 (+ or - 16.9). Improvement grades were different (P <0.0001), with most controls categorized as "not improved or worse" (89.4%), whereas only 36.1% of the treated group were in that category. However, there were increases in the "minimal," "moderate," and "substantial" improvement categories for the treated subjects (22.6%, 21.1%, and 17.3%, respectively). The controls did not change in any ICON component and worsened in crowding (P <0.007), whereas the patients improved in esthetics, crowding, crossbite, and overbite (P <0.007). These results indicate that interceptive orthodontic treatment is effective for improving malocclusion but does not produce finished-quality results.

A preliminary evaluation of pre-treatment hypodontia patients using the Dental Aesthetic Index. How does it compare with other commonly used indices?

There is currently no specific occlusal index related to hypodontia and there is a paucity of published literature on this subject. The aim of this study was to determine the relationship, if any, between the Peer Assessment Rating (PAR) Index, the Index of Complexity, Outcome and Need (ICON), and the Dental Aesthetic Index (DAI) score and the severity of hypodontia. All new patients attending the Newcastle Dental Hospital hypodontia clinic between February 2002 and March 2003 were included in the study. Of the 60 patients, two were excluded as the models were unavailable and one because they were predominantly in the primary dentition, making scoring impractical. The patient casts were scored with respect to PAR, ICON, and DAI. The mean patient age at presentation was 12 years, with a standard deviation of 1.89 and a range of 9-16 years, and a female to male ratio of 1.1:1. A significant positive correlation, using Kendall tau b, was found between the number of missing teeth, excluding third molars, and the DAI score (tau = 0.215, P = 0.027). There was no significant positive correlation between PAR (tau = -0.186, P = 0.056) and ICON (tau = 0.017, P = 0.861) score and the number of missing teeth. The results of this investigation indicate that further research is required in order to assess if the DAI could be used to determine whether or not to refer hypodontia patients for specialist advice.

The relationship of medical and dental factors to perceived general and dental health

To determine the relative importance of dental and medical features in relation to perceived oral and general health in a sample of 31-year-old individuals. The present study used information collected from the longitudinal Cardiff Survey, which commenced in 1981. The initial sample consisted of 1018 11-year-old Caucasian schoolchildren. Three hundred and thirty-seven individuals attended the latest examination in 2001 (aged 31 years). For every individual who attended in 2001, the following information was collected: perceived general and oral health recorded on a five-point Likert scale; self-reported medical history; SF-36v(2) questionnaire; assessment of dental features; and the Index of Complexity, Outcome and Need (ICON). Ninety-four and 82% of individuals reported good-excellent general and oral health, respectively. Females reported a higher level of physical health than males as measured using the SF-36v( 2). Four medical conditions were associated with perceived poor general health: mental [odds ratios (OR); 95% confidence limits (95% CI): 4.5; 1.1-18.4], gastrointestinal (OR 3.4; 95% CI 1.2-9.5) and genitourinary disorders (OR 7; 95% CI 1.6-30.2), and conditions that did not readily fit into a defined category or system (OR 12.8; 95% CI 3.9-42.3). The highest prevalence of dental factors was gingivitis followed by gingival recession and plaque. Photographically assessed dental factors associated with self-reported poor/fair oral health were fillings (OR 0.45; 95% CI 0.2-0.9), root caries/abrasion (OR 0.37; 95% CI 0.1-0.9) and gingivitis (OR 0.31; 95% CI 0.1-0.9). There was a statistically significant association between oral and general health. Of those individuals reporting fair-poor oral health (18%), the proportion also reporting fair-poor general health was 63.6%. Unexpectedly, per-unit increase in ICON score was also significantly associated with fair-poor general health (OR 0.97) with clinically relevant increases of 7 ICON units producing an OR of 0.82. The relative importance of the various dental and medical conditions has been identified. Further studies are required to explore the importance of ICON in perceived medical health and importance of the various conditions on oral and general health over different age groups.

Orthodontic treatment complexity and need at the University College Hospital, Ibadan, Nigeria, according to the Index of Complexity, Outcome and Need (ICON): A pilot study

Although occlusal indices have been useful in research, audit, practice management, and quality assurance in clinical orthodontics, complexity of orthodontic cases had not been easy to assess for a long time in clinical practice. This pilot study aimed at assessing the orthodontic treatment need and complexity in a referral orthodontic centre in Nigeria. A retrospective analysis of 56 pre-treatment study models randomly selected from the orthodontic model collection of the University College Hospital, Ibadan, Nigeria was carried out without any bias for age or gender. The index of Complexity, Outcome and Need (ICON) was used as the outcome measure. Descriptive statistics were employed in the data analysis. Forty-seven (83.9%) of the sample needed treatment. Thirty-four (60.7%) cases were classified as difficult or very difficult. Only 1 (1.8%) and 13(23.2%) belonged to the easy and mild categories, respectively. The overall mean ICON score was 67.4±19.6SD (range 25–104). Considerable proportions of these referred orthodontic cases in Nigeria needed treatment and had treatment complexity comparable to the Caucasians.

The reliability and validity of the Index of Complexity, Outcome and Need for determining treatment need in Dutch orthodontic practice

The Index of Complexity, Outcome and Need (ICON), based on international opinion, has been proposed as a multipurpose occlusal index. The aim of this study was to validate the ICON for treatment need in the Netherlands by relating it to Dutch orthodontic opinion. Furthermore, the reliability of this index was explored, for both a calibrated orthodontist and non-calibrated orthodontists. A sample of 102 patients was chosen which represented the actual distribution of severity of malocclusion experienced by orthodontists in every day practice. The ICON was scored, based on complete patients records of those 102 patients, by an examiner calibrated in the use of this index. The results were compared with the opinion about treatment need of seven Dutch orthodontists - the 'gold standard'. Nine non-calibrated orthodontists also scored the ICON for 49 patients. The intra-examiner agreement of both the non-calibrated and the calibrated orthodontists was moderate to high [0.52-0.86 and 0.89, respectively, measured with the Intraclass Correlation Coefficient (ICC)]. The inter-examiner agreement of the ICON score of the nine orthodontists was moderate measured with the single estimate of the ICC (0.60), and high measured with the average estimate (0.93). Spearman's correlation coefficient between the ICON score (calibrated) and the gold standard was sufficient: 0.78. The sensitivity and specificity were 1 and 0.36, respectively. The best compromise between sensitivity and specificity was at a cut-off point of 52, instead of the international ICON cut-off point of 43. There was a significant difference in ICON score between the non-calibrated orthodontists and the calibrated orthodontist, mainly based on the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). It can be concluded that the ICON needs to be adjusted when used to determine treatment need in the Dutch orthodontic population.

Orthodontic treatment need in Latvia.

Measuring the prevalence of malocclusion and treatment need in a population is useful for the planning of orthodontic services. In addition, knowledge concerning the attitudes of patients to malocclusion is becoming increasingly important in orthodontics. Without a satisfactory estimate of the need and demand for treatment it is difficult to develop and organize a meaningful service. The aims of this investigation were to estimate the need for orthodontic treatment in 12-13-year-old school children in urban and rural schools in Latvia. Five hundred and four school children aged 12-13 years were examined using the Index of Complexity, Outcome and Need (ICON). The children were invited to complete a questionnaire about treatment need and their appearance. The survey was carried out in four urban and five rural school settings. There were no statistically significant differences in treatment need between rural and urban settings or between boys and girls. However, there was a difference in ICON scores between Riga and Daugavpils, with a greater need for treatment in Daugavpils. Individual responses to questionnaires illustrated a correlation between individuals who expressed dissatisfaction with the arrangement of their teeth and treatment need according to the ICON score. The overall prevalence of individuals needing orthodontic treatment in Latvia was 35.3 per cent, but this figure masked considerable variation between schools. For example, a greater need was found in Daugavpils than in Riga. This difference is not fully explained but could be due to genetics, the individuals in Daugavpils being mainly of Russian origin. The individuals' perception of the arrangement of teeth and the need for treatment correlated significantly with the ICON score.

ICON and the patient's perceptions of malocclusion

Aim To examine the relationship between the Index of Complexity, Outcome and Need (ICON) and the subjective opinions of patients attending for routine dental care. Materials and methods This study was undertaken at two general dental practices in Cardiff and Bedford. 50 patients aged between 11–14 years and 50 patients aged 30–40 years presenting for routine dental treatment were selected in each. The subjects were assessed objectively using the ICON guidelines by two examiners trained and calibrated in the use of this index. The scores were recorded directly from the patient. Subjective assessments were obtained from the patients by means of a questionnaire consisting of four simple questions addressing aesthetics, function, speech and treatment need using a five point Likert scale. Results The mean ICON scores for the different genders and age groups participating in this study were; 11–14 year old males 58.4 (SE 3.17); 11–14 year old females 51.8 (SE 3.51); 30–40 year old males 51.2 (SE 2.70); 30–40 year old females 45.3 (SE 2.56). There were statistically significant differences in ICON scores between the younger and older groups (P = 0.024) and females and males (P = 0.04). Adult patients were more likely to reject treatment than younger patients. Analysis of the professional scores in relation to subjective assessments, using the Spearman rank correlation coefficient, for 11–14 and 30–40 year olds, and for the male and female genders, revealed that the ICON has a significant correlation with patients' perceptions of aesthetics, function, speech and treatment need (r2 = 0.01 to 0.28). The only exceptions were patients' perceptions of speech in the 30-40 year old group, and function in the female gender, which did not show a statistically significant correlation to the professional assessments. Conclusion In this study, the ICON was found to correlate with patients' opinions of aesthetics, function, speech and treatment need. The strength of association, however, was low. It can be concluded that the ICON alone is not necessarily a suitable predictor for appearance, function, speech or treatment need for those individuals attending general dental practice for routine dental care. In combination with a simple question to assess the patient's desire for treatment, the shared decision for any particular individual to enter the treatment process can be determined.