Index Of Complexity, Outcome And Need 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.

Comparison of orthodontic treatment need and malocclusion prevalence according to KIG, ICON, and mIOTN in German 8- to 9-year-old children of the Sixth German Oral Health Study (DMS6).

The aim of the present study was to compare the malocclusion indices KIG (Kieferorthopädische Indikationsgruppen, Orthodontic Indication Groups), ICON (Index of Complexity, Outcome and Need), and mIOTN (modified Index of Orthodontic Treatment Need) regarding differences in malocclusion prevalence and their assessment of orthodontic treatment need in German 8‑ to 9‑year-old children of the Sixth German Oral Health Study (Deutsche Mundgesundheitsstudie, DMS6). The necessary data for the calculation of the KIG, mIOTN, and ICON were collected by adentist as part of aclinical orthodontic examination during the field phase of the DMS6 and by asubsequent digital orthodontic model-analytical evaluation of intraoral scans of the dental arches and the occlusal situation in habitual occlusion. Prevalence, severity, and treatment need of tooth and jaw misalignments differed in part considerably depending on the index used for assessment. On the other hand, there were several outcomes which yielded quite similar results for the different indices used, such as orthodontic treatment need, which ranged from 40.4% (KIG) over 41.6% (ICON) to 44.2% (mIOTN). Interestingly, orthodontic treatment need for the individual subject could differ considerably, when assessed using different indices. In general, the results show that the mIOTN is much more conservative in assessing malocclusion prevalences often being smaller than those derived by KIG or ICON. In contrast, KIG and ICON often yield similar prevalences with certain distinct differences due to discrepancies in the respective definitions and also clearly differentiate between treatment possibility and arbitrarily determined treatment need.

Orthodontic retreatment need and related self-perceived factors among contemporary college freshmen in China.

Given that an increasing number of patients who received orthodontic treatment during their childhood or adolescence are seeking retreatment in contemporary China, it is of great necessity to comprehensively understand their motivations. A valid and reliable self-designed questionnaire, based on the Index of complexity, outcome and need (ICON), was distributed online to college freshmen who received orthodontic treatment during their childhood or adolescence. After collecting their basic information and orthodontic retreatment needs data from the survey, the participants' general self-perception of front facial appearance, lateral facial appearance and tooth alignment, as well as their self-perceived dental alignment, occlusal status, oral function and psychological status, were assessed. Correlation analysis, Chi-square test, Kruskal-Wallis test and logistic regression were performed. Reliability was evaluated for 20 paired questionnaires, and all questions were found to be reliable (intraclass correlation coefficient, >0.70). Among the 1609 participants with a history of orthodontic treatment, 45.56% were males and 54.44% were females. Their mean age was 18.48 ± 0.91 years. Our results showed that self-perceived front facial appearance, lateral facial profile, tooth alignment, occlusal status, oral function and psychological status were significantly correlated with orthodontic retreatment needs. Both appearance and psychological status affected their self-perceived dental alignment and occlusal status. In conclusion, patients who received orthodontic treatment during their childhood or adolescence in contemporary China seek orthodontic retreatment because they desire better aesthetics of their front facial appearance and tooth alignment, especially the anterior region of the tooth, the lower part of the face and a decent pronunciation. Additionally, psychological concerns should be viewed as an urge, while intraoral factors should be viewed as the foundation during future clinical practice regarding orthodontic retreatment in this age group.

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.

Minimally important differences in oral health-related quality of life after fixed orthodontic treatment: a prospective cohort study.

The minimally important difference (MID, the smallest difference that patients perceive as beneficial) has been proposed to assess whether study results are clinically meaningful, reducing the shortcoming of P-values-based approaches in the assessment of clinical outcomes. The post-treatment changes and the MID in Oral Health-Related Quality of Life (OHRQoL) among adults undergoing fixed orthodontic treatment were investigated. Ninety-two patients (29.1 ± 6.3 years old, 18 males and 74 females) were prospectively included. Oral Health Impact Profile (OHIP-14) and United Kingdom Oral Health-related Quality of Life (OHQoL-UK) were used to assess OHRQoL at baseline and post-treatment (50.8 ± 15.7 months). Global Transition Rating (GTR) was used to assess oral health/well-being, Peer Assessment Review (PAR), and Index of Complexity, Outcome and Need (ICON) were used to assess occlusion. Wilcoxon signed-rank test was used to assess changes in OHRQoL and occlusion, Kruskal-Wallis one-way ANOVA and Mann-Whitney U-test were used to assess associations between OHRQoL and oral health/well-being or occlusion. MID for OHIP-14 and OHQoL-UK was estimated via anchor-based (PAR, ICON, GTR) and distribution-based approach (effect size, standardized response mean, standard error of measurement). The median OHIP-14 and OHQoL-UK post-treatment scores were significantly changed, indicating improved OHRQoL. Based on the agreement between different methods, the MID of OHIP-14 and OHQoL-UK were at least 15 and 6 scale points, corresponding to a large effect size (1.5-1.7). Orthodontic treatment had a positive long-term impact on OHRQoL. MID for the OHIP-14 and OHQoL-UK provide guidance to interpreting the impact of orthodontic treatment on the OHRQoL of patients.

Characteristics and Dental Indices of Orthodontic Patients Using Aligners or Brackets.

Background. Clear aligners have become a treatment alternative to metal brackets in recent years due to the advantages of aesthetics, comfort, and oral health improvement. Nevertheless, few studies have analyzed the clinical characteristics and dental indices of orthodontic patients using aligners or brackets. Methods. A total of 170 patients received orthodontic treatment at Chang Gung Memorial Hospital in 2021. Patients were stratified by types of treatment (Invisalign® clear aligner (n = 60) or metal bracket (n = 110). Results: Patients were aged 26.1 ± 7.2 years, and most were female (75.0%). The Invisalign® group was older than the bracket group (p = 0.003). The skeletal relationships were mainly Class I (49.4%), followed by Class II (30.0%) and Class III (20.6%). The molar relationships were primarily Class I (38.8%), followed by Class II (37.1%) and Class III (24.1%). The decayed, missing, and filled tooth (DMFT) index was 9.9 ± 6.0, including 2.1 ± 2.9 for decayed teeth, 0.5 ± 1.1 for missing teeth, and 7.3 ± 4.3 for filled teeth. There were no significant differences in the DMFT index or skeletal and molar relationships between the groups (p > 0.05). The index of complexity outcome and need (ICON) was 56.8 ± 13.5, and the score was lower in the Invisalign® group than in the bracket group (p = 0.002). Among the variables included in the ICON assessment, only the aesthetic variable was lower in the Invisalign® group than in the bracket group (p < 0.001). The Frankfort-mandibular plane angle was 27.9 ± 5.1 degrees. Finally, the E-line of the lower lip was lower in the Invisalign® group than in the bracket group (1.5 ± 2.4 versus 2.8 ± 3.1, p = 0.005). Conclusions. Older patients showed a greater intention to choose Invisalign® treatment for improving the appearance of their teeth than younger patients, who chose metal bracket treatment. The demand for Invisalign® aligner treatment for aesthetic reasons was substantial. A soft tissue profile with more protrusive lower lips and a greater need for orthodontic treatment was found in the bracket group.

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.

Impact of Malocclusion, Tooth Loss and Oral Hygiene Habits on Quality of Life in Orthodontic Patients: A Cross-Sectional Study.

We aimed to assess the impact of malocclusion on oral health-related quality of life (OHRQoL) in a sample composed of adolescents, younger adults and adults seeking orthodontic treatment. Participants were consecutively enrolled from January 2019 to March 2020. The oral health impact profile (OHIP-14) was used to measure the OHRQoL. The index of complexity, outcome and need (ICON) was used to assess malocclusion. Sociodemographic, medical, and clinical questionnaires were recorded. Statistical analyses were performed according as a function of sex and age range (15–30 or >30 years old). Linear and logistic regression models were applied to assess the association between OHIP-14 total score, malocclusion, and other relevant confounding variables. In a final sample of 93 participants (60 females and 33 males, aged 15 to 60 years), men reported significantly better OHRQoL (p = 0.005). Participants aged 30 years or older reported significantly worse OHRQoL (p = 0.042). OHIP-14 was significantly correlated with age (ρ = 0.259, p < 0.05) and the number of missing teeth (ρ = 0.369, p < 0.001). Multivariable regression showed OHIP-14 being associated with the number of missing teeth (B = 1.48, SE = 0.57, p < 0.05) and the presence of missing teeth (B = 1.38, SE = 0.65, p < 0.05). Malocclusion showed no association with OHRQoL. Age and the number of missing teeth may be key factors on self-perceived OHRQoL in adult patients seeking orthodontic treatment.

Environmental Cadmium Exposure and Dental Indices in Orthodontic Patients.

Background. Previous studies have shown that environmental cadmium exposure could disrupt salivary gland function and is associated with dental caries and reduced bone density. Therefore, this cross-sectional study attempted to determine whether tooth decay with tooth loss following cadmium exposure is associated with some dental or skeletal traits such as malocclusions, sagittal skeletal pattern, and tooth decay. Methods. Between August 2019 and June 2020, 60 orthodontic patients with no history of previous orthodontics, functional appliances, or surgical treatment were examined. The patients were stratified into two groups according to their urine cadmium concentrations: high (>1.06 µg/g creatinine, n = 28) or low (<1.06 µg/g creatinine, n = 32). Results. The patients were 25.07 ± 4.33 years old, and most were female (female/male: 51/9 or 85%). The skeletal relationship was mainly Class I (48.3%), followed by Class II (35.0%) and Class III (16.7%). Class I molar relationships were found in 46.7% of these patients, Class II molar relationships were found in 15%, and Class III molar relationships were found in 38.3%. The mean decayed, missing, and filled surface (DMFS) score was 8.05 ± 5.54, including 2.03 ± 3.11 for the decayed index, 0.58 ± 1.17 for the missing index, and 5.52 ± 3.92 for the filled index. The mean index of complexity outcome and need (ICON) score was 53.35 ± 9.01. The facial patterns of these patients were within the average low margin (26.65 ± 5.53 for Frankfort–mandibular plane angle (FMA)). There were no significant differences in the above-mentioned dental indices between patients with high urine cadmium concentrations and those with low urine cadmium concentrations. Patients were further stratified into low (<27, n = 34), average (27–34, n = 23), and high (>34, n = 3) FMA groups. There were no statistically significant differences in the urine cadmium concentration among the three groups. Nevertheless, a marginally significant p-value of 0.05 for urine cadmium concentration was noted between patients with low FMA and patients with high FMA. Conclusion. This analysis found no association between environmental cadmium exposure and dental indices in our orthodontic patients.

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.

Cancer survivors present significantly lower long-term stability of orthodontic treatment: a prospective case-control study.

SummaryBackground/ObjectivesThe aim of the study was to compare the stability of orthodontic treatment in cancer survivors who had been treated with cytotoxic drugs with a generally healthy control group.Materials/MethodsThe study included 52 cancer survivors treated orthodontically and 52 healthy control subjects matched for age, gender, and malocclusion. The weighted Peer Assessment Rating (w-PAR) index, the Index of Complexity, Outcome and Need (ICON) were assessed before treatment, after the treatment, and at the 3-year follow-up. Patients Satisfaction Score was assessed after the treatment and at the 3-year follow-up. A repeated analysis of variance test was used to check the statistical significance between the scores.ResultsIdeal occlusion was achieved in all patients. The mean w-PAR and ICON values were significantly reduced in both groups after the end of the orthodontic treatment with no significant differences between the groups regarding the obtained results. However, after the 3-year follow-up, only the cancer survivors’ group presented statistically significant (P < 0.001) increase of the w-PAR and ICON values comparing to the values obtained at the end of the treatment. There was no significant change in Patients’ Satisfaction Score within 3 years after treatment.LimitationsThe limited size of the study sample as well as different types of oncological diagnoses could have had an impact on the final results of the study.Conclusions/ImplicationsPrevious cytotoxic drug treatment significantly decreases the stability of orthodontic treatment among the cancer survivors, particularly within first 12 months after the end of the treatment.

Malocclusion complexity as an associated factor for temporomandibular disorders. A case-control study

ABSTRACT Objective To evaluate the association between temporomandibular disorders (TMD) and malocclusion complexity using the Index of Complexity Outcome and Need (ICON) levels. Methods A prospective, cross-sectional, case and control study was done. Cases and controls were matched in a one-to-one relationship (179 subjects each). The Research Diagnostic Criteria was used to evaluate the presence of TMD, and the ICON was used to quantify malocclusion complexity. A binary logistic regression (p < 0.05) was used to identify associations between variables. Results TMD presence was associated with gender and malocclusion complexity (p < 0.05). The largest proportion of controls were in the lowest three levels of ICON complexity, while most cases were in the three highest levels (p < 0.001). Higher malocclusion complexity indicated a greater TMD risk. Conclusion The results indicate that TMD is associated with malocclusion complexity. As malocclusion complexity increases, so do the odds of presenting with TMD.

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.

Formulating a New Orthodontic Index: An Indian Board of Orthodontics Initiative

A proposal to formulate an orthodontic index specific for the Indian Board of Orthodontics (IBO) to determine the acceptability and degree of difficulty of a cases submitted for the phase III examination was discussed at the College of Diplomates meet (CDIBO). To ascertain the degree of difficulty of a case is very subjective; therefore, the need to quantify the complexity of a case in a standard format is required. To develop a Discrepancy Index for the IBO, 20 Dental and Cephalometric components of a malocclusion and 20 intraoral frontal photographs would have to be evaluated and a weightage score for each component would be assigned. Components such as upper and lower anterior proclination, commonly seen in our Asian population which have been omitted in the commonly used indices such as PAR (Peer Assessment Review) IOTN (Index of Orthodontic Treatment Need) and the ICON (Index of Complexity,Outcome and Need) have been included. The proposed IBO Index would add uniformity and standardization in assessing the degree of difficulty and also the degree of improvement of a case, which would be a beneficial tool for a fair evaluation.

Factors influencing orthodontic treatment outcome in South East Wales and implications for service commissioning.

To determine factors that may influence the outcome of orthodontic treatment undertaken in General Dental Services/Personal Dental Services in South East Wales. A retrospective study of a requested 20 consecutively treated cases (for the year 2014-2015) provided by 26 performers in South East Wales. Performer and patient information was obtained by use of a questionnaire and FP17OW forms, respectively. A calibrated investigator recorded the Index of Orthodontic Treatment Need (IOTN), Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) on start- and end-study models for each case. Descriptive and regression analyses were undertaken to identify any predictive factors of a good treatment outcome. Two respondents completed < 20 cases, so all of their cases were assessed. A total of 495 cases were assessed. The overall achieved mean end-PAR score of 5 is collectively a good occlusal outcome. Predictive factors of a good quality of occlusal outcome (end-PAR score being ⩽ 5) were: dual arch treatment; use of functional with fixed appliances; treatment undertaken in non-corporate practices; and treatment undertaken by registered specialists (P < 0.001). Predictive factors for occlusal improvement (change in PAR score) were: IOTN aesthetic component (AC); IOTN dental health component (DHC) (1-3 or 4-5); and number of arches treated and malocclusion type (P < 0.001). Dual arch fixed appliances undertaken by orthodontic specialists in non-corporate environments produced the highest quality orthodontic outcomes. Those who have the highest need for treatment according to IOTN DHC and AC benefit most in terms of improvement achieved in PAR score.

Impact of Orthodontic Treatment Complexity on Oral Health-Related Quality of Life in Turkish Patients: A Prospective Clinical Study.

The study aimed to evaluate the relationship between orthodontic treatment complexity and oral health-related quality of life (OHRQoL) and to assess the impact of malocclusion and orthodontic treatment on OHRQoL in orthodontic patients with regard to gender and age. This prospective clinical study included 102 patients aged 13-35 years who were referred to the orthodontic department. The impact of orthodontic treatment complexity was assessed using the Index of Complexity, Outcome and Need (ICON). The Turkish version of the Oral Health Impact Profile (OHIP-14) was used to examine the subjects for OHRQoL before and after treatment. The before and after treatment data (T1 and T2, respectively) were tested using a paired t-test, and one-way analysis of variance (ANOVA) with the Bonferroni test was used to assess the differences in OHIP-14 across groups, as defined by the ICON. The cross-sectional comparisons between genders and age groups before and after treatment were tested using the Student's t-test. The level of significance was set to a p value of 0.05. Patients with moderate treatment complexity reported a significantly negative impact on the psychological disability domain compared to the difficult treatment complexity. OHRQoL improved after treatment. Females showed statistically significant and highest scores on the physical pain domain compared to males. Adults showed a statistically significant negative impact on the psychological domains before treatment as well as a statistically significant positive impact on the psychological disability domain after treatment compared to adolescents (p<0.05). Orthodontic treatment improves OHRQoL, and orthodontic treatment complexity does not seem to have an impact on OHRQoL.

Orthodontic Treatment Need and the Psychosocial Impact of Malocclusion in 12-Year-Old Hong Kong Children.

Objectives To determine the prevalence of orthodontic treatment need in 12-year-old children in Hong Kong and its relationship with the psychosocial impact of malocclusion and to assess their associations with sociodemographic factors. Materials and Methods A random sample of 687 12-year-old children was recruited from 45 secondary schools in Hong Kong. Orthodontic treatment need was assessed on study models by five indices: the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC), the Aesthetic Component of the IOTN (IOTN-AC), the Dental Aesthetic Index (DAI), the Index of Complexity Outcome and Need (ICON), and the Peer Assessment Rating (PAR). The psychosocial impact of malocclusion on participants and sociodemographic factors were obtained from a questionnaire. Logistic regression was used to examine the correlations between treatment need and the psychosocial impact of malocclusion as well as their associations with sociodemographic factors. Results The final number of participants was 667 (339 boys and 328 girls, participation rate 667/687 = 97.1%). The prevalence of orthodontic treatment need varied depending on the indices used (10.9–47.8%), but significant correlations were found among the five indices (p < 0.01). The uptake of treatment among the cohort was 2.3%. Boys had higher IOTN-DHC (p < 0.05), DAI (p < 0.05), and PAR (p = 0.05) scores than girls. IOTN-AC was significantly associated with the psychosocial impact of malocclusion (p < 0.05). Parents' level of education and household income were not significantly associated with either treatment need or the psychosocial impact of malocclusion (p > 0.05). Conclusion The need for orthodontic treatment in 12-year-old children in Hong Kong remained high, and the uptake of treatment was low. Boys had a higher normative treatment need than girls. Among the five indices, IOTN-AC appears to be the best indicator of the psychosocial impact of malocclusion.

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.