Orthodontic Index Research Articles

Pont’s Index, is it Reliable and Applicable for Iraqis?

To facilitate the correct diagnosis and treatment planning, a range of diagnostic orthodontic indices have been developed. Pont’s index, as one of them, was documented to estimate the ideal maxillary dental arch widths from the sum of crown widths of maxillary incisors. This retrospective study aimed to evaluate the applicability of Pont’s index to Iraqi individuals. Fifty stone dental models for 25 females and 25 males were retrieved from the archives of the Department of Orthodontics in Baghdad College of Dentistry. The dental arch widths at the level of 1st premolar and molar areas in addition to the mesiodistal crown widths of all teeth were measured using an electronic vernier. The estimated arch widths were compared to the actual ones using paired sample t-test. The results showed highly significant differences between the actual and estimated maxillary inter-premolar and intermolar widths with over-estimated values in both genders. New formulas were developed to make Pont's index more reliable, and the newly estimated widths were non-significantly different from the actual one. The original Pont’s index is an unreliable and inapplicable method for arch width prediction. A specific modification of Pont’s index is developed and can be applied for more reliable results.

IBO Orthodontic Index Part III

A new orthodontic index was proposed by the College of Diplomates to assess the degree of difficulty of cases submitted for the IBO Phase III clinical examinations. This article is the continuation of Parts I and II of the article, which gave a brief insight into the need and the methodology undertaken to formulate this index. A weightage score grading the degree of difficulty was formulated based on the Dental, Cephalometric, and Miscellaneous components. An Aesthetic component was also developed. Further statistical evaluation was done to formulate a cut-off score required for cases submitted for the Phase III examination. This index would help to categorize the malocclusion in a structured manner.

Hubungan tingkat kebutuhan perawatan ortodonti menggunakan index of orthodontic treatment need (iotn) dengan dental aesthetic index (dai)

Background: Malocclusion occurs due to a change in dimensions from primary teeth to permanent teeth. The most common malocclusion in children aged 9-11 years is caused by the eruption of the canines and second premolars, requiring orthodontic treatment. To be able to determine the level of need for orthodontic treatment, an orthodontic index is needed, one of which is the Index Of Orthodontic Treatment Need (IOTN) and the Dental Aesthetic Index (DAI). The orthodontic clinic at RSGM-P FKG Trisakti University is a clinic that performs interceptive orthodontic treatment in the mixed dentition period. The aim of this study was to determine the correlation between the level of need for orthodontic treatment using the Index Of Orthodontic Treatment Need (IOTN) and the Dental Aesthetic Index (DAI) on patients aged 9-11 years at the orthodontic clinic of the RSGM-P FKG Trisakti University. Methods: The research method used was an analytic observational study with a cross-sectional study design. Results: The results of the research based on the results of the Spearman's rho correlation test, obtained a significance value of 0.905 (sig <0.05), the strength of the relationship of 0.023 means that the correlation is very weak between variables. Conclusion: So that it can be concluded that there is no significant relationship between the need for orthodontic treatment based on IOTN and DAI in patients aged 9-11 years at RSGM-P FKG Trisakti University.

Common orthodontic indices and classification

An orthodontic index is a rating or categorizing system that assigns a numeric score or alphanumeric label to a person's occlusion. Indexing of malocclusions and their correction is important in epidemiology, diagnosis, communication between clinicians as well as with their patients, and assessing treatment outcome. Many useful indices have been put forward, but no one method appears to be equally suitable for the use of epidemiologists, public health programme planners and clinicians. This article describes the common clinical orthodontic indices and classifications used in the UK. CPD/Clinical Relevance: Readers can gain an insight into the advantages and disadvantages of the commonly used orthodontic indices and classifications in the UK.

Formulating a New Orthodontic Index: An Indian Board of Orthodontics Initiative—Part 2

A new orthodontic index was proposed by the College of Diplomates to assess the degree of difficulty of cases submitted for the Indian Board of Orthodontics Phase III clinical examinations. This article is the continuation of the part 1 article which gave a brief insight into the need and the methodology undertaken to formulate this index. A weightage score grading the degree of severity of a case was obtained for dental, cephalometric, and miscellaneous components based on the results of a survey taken from the Diplomates of the Indian Board of Orthodontics. An aesthetic component was also developed using photographs and the relative aesthetic score for every photograph was graded. This index would help to categorize the malocclusion based on the severity, in a single, linear, and transparent manner.

Tingkat Kebutuhan dan Perubahan Hasil Perawatan Ortodonti Berdasarkan Indeks ICON (Kajian pada Pasien Klinik Ortodonti RSGM-P FKG USAKTI)

Background: Malocclusion is a common oral health problem. Orthodontic treatment is needed to treat malocclusion so that the teeth can achieve a good occlusion. The need for orthodontic treatment and the outcome can be measured using an orthodontic index. One of the orthodontic indexes that can measure the need for orthodontic treatment and the outcome is ICON index. Purpose: To find out the level of need and changes in the outcome of orthodontic treatment in the RSGM-P FKG USAKTI’s orthodontic clinic based on the ICON index. Method: This research is a descriptive observational study with a cross-sectional design. Examination and measurement of the study model of patients aged 8 – 12 years old who came to the orthodontic clinic of RSGM-P FKG USAKTI in January 2018 – December 2019 was carried out based on the ICON component. a score was given based on the condition of the teeth in the study model. Result: the assessment of 48 patients showed that 36 patients (75%) were categorized as needing orthodontic treatment and 12 patients (25%) were categorized as not needing orthodontic treatment. Treatment result were assessed with improvement level. It was found that no subject was categorized as greatly improved, 5 patients (10,42%) were categorized as substantially improved, 15 patients (31,25%) were categorized as moderately improved, 15 patients (31,25%) were categorized as minimally improved, and 13 patients (27,08%) were categorized as not improved/worst. Conclusion: The research results illustrate that most of the patients treated at the orthodontic clinic RSGM-P FKG USAKTI require orthodontic treatment and the improvement level are mostly categorized as moderately improved and minimally improved.

Interceptive orthodontic treatment need index for children in mixed dentition (study on 8-11 years old children at SDK Santo Yoseph 1 Denpasar)

Objective: Mixed dentition is a stage where teeth of both deciduous and permanent dentition are seen from 6-12 years of age and most malocclusions make their appearance during this stage. Interceptive orthodontic treatment aims to recognize and elimina-te dental irregularities in the developing dentofacial complex to prevents malocclusion from worsening in the future. Intercepti-ve Orthodontic Treatment Need Index (I-OTNI) is an interceptive orthodontic treatment filtering instrument on children in mixed dentition. The aim of this study is to know the age of highest interceptive orthodontic treatment need on 8-11 years old child-ren in mixed dentition at SDK Santo Yoseph 1 Denpasar. Methods: Descriptive study with cross sectional approach, with sam-ples that match the inclusion criteria, conducted by intraoral examination for identification and fill in I-OCN form for classi-fication based on orthodontic treatment need. Result: 56.81% samples of 8 years old children, 46.34% samples of 9 years old children, 30.43% samples of 10 years old children, and 32.55% samples of 11 years old children need interceptive orthodontic treatment. Conclusion: Children at 8 years of age is the highest need of interceptive orthodontic treatment followed by 9 years of age. The 8 and 9-years-old children need more interceptive orthodontic treatment than 10 and 11-years old children that mea-sured using I-OTNI at SDK Santo Yoseph 1 Denpasar.

Management of Class II Division 1 Subdivision malocclusion using unilateral bicuspid extractions and fixed functional appliance: A Two Year Follow-Up

Introduction: Management of Class II Subdivision cases pose a clinical dilemma and require a careful diagnosis to ascertain the source of asymmetry. Various treatment modalities involving: different protocols of tooth extractions; molar distalization; fixed functional appliances or orthognathic surgery have been proposed for the same.
 Objective: This article reports a unique approach for management of a severe skeletal Class II with Angle’s Class II Division 1 subdivision malocclusion using unilateral bicuspid extractions in mandibular and maxillary arches and a fixed functional appliance.
 Results: A 13 year 1 month old male in CVMI transition stage was successfully treated. Extraction of #44 was done to alleviate crowding in the mandibular anterior region and #15 was extracted to protract #16 to achieve a Class II molar relationship. A pre-functional Class II molar and canine relationship with co-incident midlines was achieved. The functional phase consisted of a fixed functional appliance (Forsus FRD) for mandibular advancement to correct the severe skeletal Class II. Class I molar and canine relationships were achieved with reduction of facial convexity and overjet. Result remained stable 24 months after treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pre and post treatment.
 Conclusions: Management of Class II subdivision malocclusion requires careful planning. This paper presents a unique approach utilizing unilateral extractions and fixed functional appliance to address severe skeletal Class II discrepancy and the subdivision dilemma.

Orthodontic indices

Orthodontic indices

An Orthodontic Index assessment and its relationship with total treatment time in surgery first orthognathic approach: an observational study

The aim of this study was to highlight the connection between orthodontic difficulty before surgical treatment and in the transient malocclusion as evaluated by the mean of the of Complexity, Outcome, and Need (ICON) Score and total treatment time in surgery-first approach (SFA). For each patient, the ICON Score was evaluated preoperatively and on the 3rd postoperative day in order to assess the orthodontic difficulty of presurgical occlusion and the transient malocclusion. Our group of patients at the preoperative stage showed score values between hard and very hard with only one patient scored as "easy" and nine "medium" patients. All scores lowered after surgical treatment. This confirms that the surgery first approach can change a malocclusion from not orthodontically treatable to an orthodontically treatable one. In our study, this was objectified by improvements in the ICON Score. In the conventional three-phase approach of orthognathic surgery the total treatment time found in literature is around 18-36 months. In our study, even the most difficult cases do not have a duration of more than 15 months This demonstrates that the surgery-first approach can reduce the total treatment time even in more severe cases.

Addendum

Addendum

Management of Bilaterally Impacted Labial and Palatal Maxillary Canines With One-Year Follow-Up: A Case Report

Introduction:Management of impacted maxillary canines is considered to be complex and challenging task by orthodontists due to the varied biomechanical considerations involved.Objective:This article describes an effective and efficient treatment modality for de-impaction of bilaterally impacted labial and palatal canines.Case Report:A female patient aged 13 years and 5 months presented with the following complaints: absence of tooth numbers 13 and 23, crowding in the upper and lower anterior dental units, and over-retained tooth numbers 53 and 63 with a non-consonant smile arc.Results:Arch development was done to create space for tooth numbers 13 and 23, as well as to relieve crowding. The impacted canines were surgically exposed, and guided traction was employed to place them in their ideal position. A class I canine and premolar relation was established. The smile aesthetics were also improved. The result remained stable 12 months after the end of treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pretreatment and posttreatment.Conclusion:Modifications in continuous arch mechanics can be reliably used in the management of impacted canines and arch development.

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.

A cohort study of factors that influence oral health-related quality of life from age 12 to 18 in Hong Kong

BackgroundThere is a lack of cohort studies on the influence factors of oral health-related quality of life (OHRQoL). This study aimed to follow subjects from age 12 to 18 to analyse the sociodemographic and clinical factors that may influence OHRQoL.MethodsThis cohort study selected a representative sample from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perceptions Questionnaires (CPQ11–14) with 8 items (CPQ11–14-ISF: 8) and 37 items were used to assess OHRQoL at age 12 and age 15, respectively; Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL at age 18. Wilcoxon signed ranks test and Friedman’s test were used to analyse the age-related change of OHRQoL and malocclusion from age 12 to 18. Generalized estimating equations were used to analyse the influence factors of OHRQoL and to calculate adjusted risk ratio (RR).ResultsSubjects recruited in this study were 589 (305 females, 284 males), 364 (186 females, 178 males) and 300 (165 females, 135 males) at age 12, 15 and 18, respectively. Among them, 331 subjects (172 females, 159 males) were followed from age 12 to 15, and 118 subjects (106 females, 82 males) were followed from age 12 to 18. Subjects had less severe malocclusion at age 12 than at ages 15 and 18 (p = 0.000, measured by Dental Aesthetic Index). Age, periodontal status, and malocclusion had an effect on OHRQoL. When compared with OHRQoL at age 12, worse OHRQoL was observed at age 15 (adjusted RR = 1.06, 95%CI = 1.01–1.12, p = 0.032), but not at age 18 (adjusted RR = 1.01, 95%CI = 0.95–1.08, p = 0.759). Unhealthy periodontal conditions had a negative effect on OHRQoL (adjusted RR = 1.14, 95%CI = 1.04–1.25, p = 0.007). Only severe malocclusions had a negative effect on OHRQoL; a more severe malocclusion was associated with a higher effect on OHRQoL (adjusted RR = 1.09, 95%CI = 1.01–1.18, p = 0.032 for severe malocclusion, and adjusted RR = 1.17, 95%CI = 1.07–1.28, p = 0.001 for very severe malocclusion measured by Dental Aesthetic Index).ConclusionAge, periodontal status, and malocclusion had an influence on OHRQoL from age 12 to 18. When clinicians attempt to improve subjects’ OHRQoL, it is necessary to consider these factors.

Status quo of plaque removal in adolescent patients undergoing fixed orthodontics in a ClassIII stomatology hospital in Shanghai

Objective To explore the status quo of plaque removal in adolescent patients undergoing fixed orthodontics in a ClassⅢ stomatology hospital in Shanghai, and to provide a reference for formulating precise oral health education measures and improving patients' health self-management ability. Methods Totally 220 patients undergoing fixed orthodontics in a ClassⅢ stomatology hospital in Shanghai between September and November 2018 were selected by convenient sampling. The plaque disclosing agent was used to stain the plaque. A 5-degree method was used to collect and record the patients' orthodontic plaque index which was calculated according to the plaque area on the dental face. Statistical analysis was employed to analyze the differences in the plaque index between different locations, quadrants, tooth positions, teeth in different shapes and different areas on the dental or lip face in patients with different characteristics. Results The orthodontic plaque index of the 220 patients undergoing fixed orthodontics was (1.58±0.66) , ranging 0.31-3.33. There were statistically significant difference in the plaque index between different locations, quadrants, tooth positions, teeth in differents shapes and different areas on the dental or lip face (F=99.432, 6.552, 3.862, 25.887; P<0.05) . There were statistically significant differences in the plaque index between patients with different gender, age or time of orthodontics (F/t=5.681, 3.159, 2.947; P<0.05) . Compared with the teeth in the other 3 shapes, grinded teeth showed the highest plaque index. The plaque removal effect of mandibular teeth was better than that of maxillary teeth. The plaque removal of lateral incisors and areas under the arch wire on both right and left orthodontic brackets as well as the mesial and distal areas of the gingiva was not satisfactory. Conclusions The plaque removal in adolescent patients undergoing fixed orthodontics is not satisfactory. Targeted health education should be provided based on the collected orthodontic plaque index. Key words: Stomatology; Orthodontics; Dental plaque; Adolescent; Oral health; Orthodontic plaque index

Comparison of shear bond strength of orthodontic bracket bonding to teeth using light-curing units between halogen and LED: An in vitro study

Background: Light-cured bonding systems have been widely accepted among orthodontists. Various light curing units are available now. Recently, the light emitting diode (LED) has been introduced alongside halogen light curing units. There is lack of information on the advantages and disadvantages of different light curing systems. The aim of this in vitro study was to compare the shear bond strength of orthodontic brackets and adhesive remnant index (ARI) of an adhesive cured with two different orthodontic light sources i.e. LED and halogen.&#x0D; Methods: Forty four (22 in each group) extracted human premolars without any defects were etched with 37% phosphoric acid and cleansed with water spray and air dried. The sealant (Ortho Solo) was applied on the tooth surface and the brackets were bonded using adhesive (Enlight). Adhesives were cured with Halogen (Litex) and LED (D-LUX) for 40 seconds. Then the specimens were debonded later using a universal testing machine, with crosshead speed of 0.2 mm/min until the brackets were detached. Adhesive remnant index (ARI) scores were assessed under stereomicroscope at ×10 magnification.&#x0D; Results: The shear bond strength in Halogen group was 19.73 ± 3.44 MPa and in the LED group 20.81±3.02 MPa which is little higher than halogen group. The proportion of being adhesive remaining index for ARI Score 1 in Halogen group was 5 (22.7%) and in LED group 7 (31.8%). While ARI Score 2 in the Halogen group was 13 (59.1%) compared to LED group 8 (36.4%). However, ARI Score 3 in Halogen group was 4 (18.2%) and in LED group 7 (31.8%). The overall model showing no significant difference.&#x0D; Conclusion: Within limitations, this in vitro study showed the shear bond strength of orthodontic adhesives cured with a LED was statistically equivalent to those cured with a halogen light curing unit. There were significant differences in the ARI scores of the light-curing units tested. LED light-curing units can be suggested for the polymerization of orthodontic bonding adhesives because it showed a balanced effect on ARI index.&#x0D; Bangladesh Med Res Counc Bull 2019; 45: 17-22

The factors that influence oral health-related quality of life in young adults

BackgroundYoung adulthood is a time when subjects transform their role from a dependent child to an independent social identity. This cross-sectional study aimed to analyze the sociodemographic and clinical factors that may influence the OHRQoL of 18-year-old young adults.MethodsA representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. The oral health impact profile (OHIP-14) was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression.ResultsA total of 300 eligible subjects (165 females, 135 males) were recruited. Females had more severe caries than males; however, gender was not a significant factor of OHRQoL. Household income affected OHRQoL more than parents’ education did: household income had effects on physical pain, psychological discomfort, psychological disability, and the total OHIP; while parents’ education had some effects on functional limitation, physical pain and psychological discomfort. As for clinical factors, unhealthy periodontal conditions were more prevalent than caries (94.67% vs. 59.00%); however, both of them showed no effect on OHRQoL. Malocclusion had a negative effect on OHRQoL; the most affected subscales were psychological discomfort and psychological disability.ConclusionIn this study, family ecosocial factors and malocclusion had an effect on OHRQoL. Among the family ecosocial factors, it was household income that had the most effect on OHRQoL. Malocclusion mainly affected the subscales of psychological discomfort and psychological disability. Gender, periodontal status and caries had no effect on young adults’ OHRQoL.

Association Between the Severity of Malocclusion, Assessed by Occlusal Indices, and Oral Health Related Quality of Life: A Systematic Review and Meta-Analysis.

To assess whether different levels of malocclusion have different effects on the oral health-related quality of life (OHRQoL) and which domains of OHRQoL could be affected. Nine electronic databases were searched. To make studies comparable, studies using the Child Perceptions Questionnaire (CPQ) to measure OHRQoL, and the Dental Aesthetic Index, Index of Orthodontic Treatment Need, and Index of Complexity, Outcome and Need to measure malocclusion were selected for systematic review. Meta-analysis was performed to calculate the weighted mean scores of CPQ. The two independent samples t-test was used to detect whether different severity groups of malocclusion have different CPQ scores. A total of 22 studies were included in this review and 6 were included in the meta-analysis. Most studies used a cross-sectional design and convenience sampling. Meta-analysis showed that the weighted mean scores of CPQ increased with malocclusion severity. The t-test showed nearly all levels of malocclusion affected the domains of functional limitation and social well-being; only very severe malocclusion affected the domains of oral symptoms, emotional well-being and the overall OHRQoL (p < 0.05). When OHRQoL was assessed by CPQ11-14 and malocclusion was assessed by orthodontic indices, children with malocclusion could have oral functional limitations and worse social lives; children with very severe malocclusion could further develop oral symptoms and had worse emotional experiences. Future longitudinal population-based studies would be helpful to confirm these results.

The factors that influence oral health-related quality of life in 15-year-old children

BackgroundSeveral hypotheses on factors that influence oral health-related quality of life (OHRQoL) have been proposed but a consensus has not been reached. This cross-sectional study aimed to analyse the sociodemographic and clinical factors that may influence the OHRQoL of 15-year-old children.MethodsA representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perception Questionnaire (CPQ11–14, 37 items) including four domains, namely oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB), was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression.ResultsA total of 364 eligible subjects (186 girls, 178 boys) were recruited. The prevalence of caries was higher in girls than in boys (P = 0.013). Compared with girls, boys tended to have a better experience in the domains of EWB, SWB and the total CPQ (adjusted OR = 0.46, 0.59 and 0.61, respectively). Unhealthy periodontal conditions were more prevalent than caries (92.6% vs. 52.7%); moreover, periodontal conditions with CPI scores of 2 had a negative effect on the domain of SWB and the total CPQ (adjusted OR = 1.76 and 1.71, respectively). Only the most severe malocclusion showed an effect on the domain of FL and the total CPQ (adjusted OR = 1.55 and 2.10, respectively). Little effect of family ecosocial factors and caries was found on CPQ scores.ConclusionIn this study, gender, periodontal status, and malocclusion showed an effect on OHRQoL after adjusting for potential confounders. Boys had less caries and better OHRQoL than girls did. Unhealthy periodontal conditions led to worse social welfares and OHRQoL. The most severe level of malocclusion caused oral functional limitations, hence worse OHRQoL.

The 5-year-olds' index, the GOSLON Yardstick index, and the modified Huddart/Bodenham index among children with complete unilateral cleft lip and palate: A methodological study

Background: The function of many orthodontic indices is to assess occlusion in patients born with a cleft. The aim of this study was to assess the intra- and interexaminer reliability for the 5-year-olds' (5YO) index, the GOSLON Yardstick index, and the modified Huddart/Bodenham (MHB) index in dental casts of children with complete unilateral cleft lip and palate (UCLP); a further aim is to compare the indices to each other. Methods: Forty dental casts from 5-year-old nonsyndromic patients with complete UCLP who had undergone primary surgery at Skane University Hospital in Malmo, Sweden, were examined by two examiners: one orthodontic specialist and one general dentist. Results: Intraexaminer reliability for 5YO and MHB had a substantial (κ: 0.61–0.80) to almost perfect agreement ( κ: 0.81–1.00) and GOSLON Yardstick moderate (κ: 0.41–0.60) to almost perfect agreement. Grouped teeth or single-tooth MHB had an almost perfect agreement for both examiners. Interexaminer reliability for 5YO had a moderate agreement, whereas GOSLON Yardstick and MHB had a fair agreement (κ: 0.21–0.40). Grouped teeth or single-tooth MHB had an almost perfect agreement. Conclusions: The 5YO index illustrates the occlusion and has a high degree of reliability for an experienced orthodontist. The GOSLON Yardstick also illustrates the occlusion, but reliability between assessments is lower. MHB index can be used with a high degree of reliability when categorized as grouped or single tooth, but the judgment of total occlusion is more uncertain.