Orthodontic Index Research Articles

The factors that influence the oral health-related quality of life in 12-year-old children: baseline study of a longitudinal research

BackgroundOral health-related quality of life (OHRQoL) could be affected not only by oral health but also by demographic and ecosocial factors. This research aimed to analyze the sociodemographic and clinical factors that may influence the OHRQoL of 12-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 Questionnaires (CPQ11–14-ISF:8 and CPQ11–14-RSF:8) including four domains, namely oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB), were used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression.ResultsTotally 589 eligible subjects (305 females, 284 males) were recruited. Males tended to rank higher in OS domain but lower in EWB domain (adjusted OR = 1.89 and 0.67). Mother’s education was linked more closely with children’s CPQ scores. Higher education levels were associated with better quality of life (adjusted OR = 0.45 and 0.37). Household income showed no effect on CPQ scores. Unhealthy periodontal conditions had a negative effect on EWB and total CPQ (adjusted OR = 1.61 and 1.63). High caries experience only had a negative effect on SWB (adjusted OR = 1.60). Malocclusion affected FL, EWB, SWB and total CPQ: all malocclusion severities affected SWB; only severe malocclusions affected FL, EWB and total CPQ.ConclusionMales were more tolerant of oral symptoms than females were. Higher levels of mother’s education led to better OHRQoL of their children. Unhealthy periodontal conditions affected emotional well-being, while high caries experience affected social well-being. All malocclusion severities had an effect on social well-being; severe malocclusion further caused functional limitations, worse emotional well-being, and hence worse OHRQoL.

Orthodontic treatment need of 9-, 12-, and 15-year-old children according to the index of orthodontic treatment need and dental aesthetic index.

Occlusal indices have been used for many years in orthodontics, but only a few have gained prominence. The IOTN (Index of Orthodontic Treatment Need) is the most familiar and the most widely used, ...

Orthodontic Treatment Need in 11-13 Years Old Shoolchildren in Republika Srpska

SUMMARY Introduction Need for orthodontic treatment is determined by the severity of specific malocclusion. Orthodontic indices are used to objectively present treatment needs. The most commonly used is the Index of Orthodontic Treatment Need (IOTN). The aim of this study was to determine the need for orthodontic therapy in 11 to 13 years old schoolchildren in Republika Srpska. Material and Methods 1377 patients, 11 to 13 years old, were included in this study. The examinations were performed in elementary schools, using daylight, flat mirror and two-dimensional orthodontic caliper. Patients were ranked into 5 grades according to the Dental Health Component (DHC) and graded on a scale 1 to 10 for the Aesthetic Component (AC) of the IOTN index. Results According to the Dental Health Component (DHC), 79.23% of patients needed orthodontic treatment. Little and borderline orthodontic need was present in 27.74% and 24.83% children, respectively, while severe need was present in 19.98% and 6.68% respectively. 20.77% of subjects did not need orthodontic treatment. In regards to the Aesthetic Component (AC) (face appearance related to orthodontic need) little or no treatment was needed in 91.42% of subjects while 6.42% were borderline and 2.16% of subjects had severe relation between orthodontic need and facial appearance. Conclusion Due to the wide presence of orthodontic irregularities in schoolchildren 11-13 years old in Republika Srpska, it is important to introduce orthodontic indices in clinical practice in order to determine orthodontic treatment needs.

Dental Aesthetic Index among Nepalese Orthodontic Patients

Introduction: Orthodontic indices are used for the assessment of malocclusion, its severity level, and treatment need. Dental Aesthetic Index (DAI) is a simple, valid and reliable index commonly used for epidemiological survey and initial screening of the orthodontic patients.Objective: To evaluate the frequency and severity of malocclusion and orthodontic treatment need among Nepalese patients using DAI and to compare the treatment need between gender groups.Materials & Method: 150 pairs of maxillary and mandibular pre-treatment orthodontic study models of 59 male and 91 female patients with permanent dentition were randomly selected from the Department of Orthodontics, Kantipur Dental College. Ten occlusal traits of DAI were assessed on each pair of study models using graduated periodontal probe and metallic scale by a single examiner. Cumulative DAI scores were calculated according to standard DAI method to differentiate the severity of malocclusion and orthodontic treatment need.Result: About 60% of the sample presented severe or very severe (handicapping) malocclusions indicating highly desirable or mandatory treatment need. 21.3% had definite malocclusion that required elective treatment need, 19.3% had normal occlusion with no or slight treatment need. There was no statistically different mean DAI scores between male and female samples (p=0.116)Conclusion: Most of the samples were in great need of orthodontic treatment with very severe malocclusions. Male samples had greater percentage of ‘very severe’ malocclusion than female. Malocclusion was characterized with high frequency of anterior incisal irregularity, maxillary overjet, midline diastema. DAI can be used as a screening tool rather than the decision making tool.

A Review of Orthodontic Indices

Orthodontic indices are essential component in assessing severity, complexity and treatment outcome of malocclusion. Moreover, they are useful in evaluating treatment need, funding for treatment cost and public health aspects of orthodontic treatment. The present article reviews orthodontic indices used for clinical and epidemiologic purposes. The article attempts to classify the indices in qualitative and quantitative methods

Normative and perceived orthodontic treatment need of senior year dental students

Objective: The purpose of this study was to determine perceived and normative orthodontic treatment need of senior year dental students using the Index of Orthodontic Treatment Need (IOTN) and Dental Aesthetic Index (DAI). Materials and Methods: Ninety-nine senior year students of the Faculty of Dentistry, Obafemi Awolowo University Ile-Ife, Nigeria, participated. Normative assessment of occlusal characteristics was car¬ried out using IOTN and DAI while the Aesthetic Component (AC) scale of IOTN was used by the students to assess perceived need. Results: With the AC scale of IOTN, 6.1% of the students expressed “borderline need” and 2% “great need” for treatment, while normative need was 41.4% for “borderline need” and 11.1% for “great need”. The Dental Health Component found 37.4% and 24.2% in these categories, respectively. The DAI gave 26.3%, 13.1% and 15.1% in the elective treatment, highly desirable treatment and mandatory treatment categories respectively. No gender-dependent differences were found. Moderate correlation was observed between perceived and normative need (r=0.643), which was significant (p<0.001). Conclusions: Over half of the dental students had orthodontic treatment need with both indices. Normative and perceived treatment need differed significantly. The perception of treatment need is not only influenced by knowledge and severity of malocclusion, as psychosocial factors acting on individuals may be involved.

A comparison of two orthodontic aesthetic indices

Abstract Objectives: A cross-sectional study was conducted to determine the level of agreement between the Dental Aesthetic Index (DAI) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Methods: DAI and AC scores were recorded in 728 subjects (340 females and 388 males, aged 11-20 years). The percentage of subjects needing treatment and the different treatment categories for the DAI and AC were gender compared. Spearman’s rank correlation coefficient (rho) was used to explore the relationship between the DAI and AC scores. Observer determined and Kappa statistics were used to analyse the diagnostic level of agreement between the DAI and AC, sorted into ‘yes’ or ‘no’ categories of orthodontic treatment need. Results: According to the DAI and AC, 21.8 and 10.9% of subjects were in need of treatment, respectively. Significant positive correlations existed between the DAI and AC scores (rho = 0.795). The DAI had a lower treatment need threshold compared with the AC. The Kappa statistics and percentage agreement between the DAI and AC was 0.55 (95% CI: 0.46-0.63) and 87.6%, respectively. Conclusion: The DAI and AC showed strong association. However, only a moderate level of diagnostic agreement was identified (12.4% difference in observed percentage agreement) which highlights the need for a unified and universal orthodontic index for consideration when interpreting, comparing, or quantifying treatment needs.

An Overview of Orthodontic Indices

ABSTRACT Analysis of prevalence of various types of malocclusion is an important aspect of today's evidence-based dentistry. Orthodontic indices are a tool in the hands of an epidemiologist to analyze the prevalence and severity of various kinds of malocclusion. The aim of this article is to look into the various qualitative and quantitative methods of grading and assessing malocclusion and their evolution over the years along with their advantages and limitations have also been analyzed. The article also compares the commonly used indices—DAI and IOTN. How to cite this article Agarwal A, Mathur R. An Overview of Orthodontic Indices. World J Dent 2012;3(1):77-86.

Orthodontic treatment need in a representative adult cohort

There is currently no representative information for central Germany on the prevalence of dental malalignments and jaw discrepancies in permanent dentition. The aim of this study was to describe the extent of tooth and jaw malformations in a representative adult population according to conventional orthodontic indices. Three dimensionally (3D)-oriented study casts were measured from a representative sample of adults from the Halle and Leipzig urban areas consisting of 102men and 143women aged between 18 and 39years, yielding a total of 245volunteers. The index values we determined were the Index of Orthodontic Treatment Need (IOTN), the German Orthodontic Indication Groups (OIG) and the Occlusal Index (OI). The descriptive evaluation of the data and group comparisons (U test, chi(2) test) were performed with SPSS® 13.0. More than half of the adults we examined were assessed as needing treatment according to the IOTN (61.6%), the German OIG (59.6%) and the OI (58.4%; intermediate severity = 5.92). We observed no significant differences in age or gender. This is the first time that the prevalence of orthodontic findings has been documented for the central German area in a cohort representative of the population. Our results reveal a great need for therapy. As the classifications describe different patient groups, the individual need for treatment is inadequately documented.

Treatment results evaluation using the Index of Orthodontic Treatment Need

Background: The use of orthodontic indices were increasingly popular in the last few years. Index of Orthodontic Treatment Need (IOTN) usually was used to assess the needs and demand of orthodontic treatment, eventhough, indices can be used for more than one purpose. Purpose: To determine whether the Index of Orthodontic Treatment Need (IOTN) could be able to evaluate the treatment results as well. Method: Data was obtained by evaluating each of 202 study models from 17 Orthodontic Postgraduate students. The ‘before’ and ‘after’ treatment models were assessed, using the Index of Orthodontic Treatment Need. Result: Using the Wilcoxon Signed-Rank test, the assessment of Dental Health Component (DHC) and Aesthetic Component (AC), before and after orthodontic treatment showed significantly differences from each others (p : 0,000 < α : 0.05). The Null hypothesis were rejected. The grade of DHC and AC were decreasing to a better score. Conclusion: The Index of Orthodontic Treatment Need (IOTN) could be used to assess the orthodontic treatment outcomes, to evaluate before and after orthodontic treatment of the patients. The results of the treatment showed good improvements of dentofacial appearance of the patients which means the successful achievement of the clinical works programs.

Occlusal indexes as judged by subjective opinions

An orthodontic index is validated by comparing its scores with a gold standard, commonly the consensus opinion of a group of experienced orthodontists. The purpose of this investigation was to evaluate contemporary occlusal indexes against the subjective opinions of people with varying levels of dental knowledge. Randomly selected orthodontic study models (n = 25) with full permanent dentitions were scored according to the peer assessment rating (PAR) index, the index of complexity, outcome, and need (ICON), and the occlusal index (OI). The models were also scored according to the subjective opinion of orthodontists (n = 10), general dentists (n = 10), and social workers (n = 10) by using a Q-sort assessment. High correlation coefficients were found between the panelists and the occlusal indexes. The average correlation was about 0.8. Regardless of background and clinical experience, people with various levels of dental knowledge have similar opinions when quantifying relationships of teeth and dental arches.

Is the Child Perceptions Questionnaire for 11–14 year olds sensitive to clinical and self‐perceived variations in orthodontic status?

To assess the association between scores on the Child Perceptions Questionnaire for 11-14 year olds (CPQ11-14) and clinical and self-perceived measures of malocclusion. Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the CPQ11-14 and a short questionnaire concerning their feelings about the condition of their teeth. Study models were taken and rated according to the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index by two sets of three examiners. Intra and inter-rater reliabilities for the two sets of examiners ranged from 0.80 to 0.99. CPQ11-14 scores were calculated for the full 35-item version and for 16 and 8-item short forms by summing the item response codes. The association between these scores, the DAI and PAR ratings and self-perceived measures of malocclusion were examined using appropriate parametric and nonparametric tests. Complete data were collected for 141 children, 63 boys and 78 girls. The mean age was 12.5 (SD = 1.0). DAI scores ranged from 17.0 to 58.0 with a mean of 35.0 (SD = 8.0). The distribution of subjects across the four severity categories was minor/none - 6.6%, definite - 35.2%, severe - 15.6% and handicapping 42.6%. PAR scores ranged from 8.0 to 66.0 with a mean of 31.4 (SD = 11.1). Eight percent had scores of 50 or above indicating marked deviation from an ideal occlusion. Both the long and the short forms of the CPQ11-14 identified substantial variability in the impacts of malocclusion. Correlations between CPQ11-14 scores and the orthodontic indices ranged from 0.26 to 0.31 (P < 0.01). There was a clear gradient in CPQ11-14 scores across four categories of the PAR based on quartiles. The gradient across the DAI categories was less clear. There were significant associations between all CPQ11-14 scores and the children's self-ratings of oral health, ratings of the extent to which the condition of the teeth affected life overall and expressions of happiness with the appearance and arrangement of the teeth. The results provide some evidence of the validity of the CPQ11-14 when used with children needing orthodontic treatment. However, because clinical samples are biased the study needs to be repeated in different treatment settings in order to confirm the utility of the measure.

Calibration of dental nurses in orthodontic occlusal indices

A useful tool in clinical audit is orthodontic occlusal indices as they allow an objective method of assessing malocclusion. Dental nurses might wish to be invoved further in audit as part of their career progression. In this article, Gurpreet Kaur and Lynn Campbell give a dentist's and dental nurse's perspective on the calibration of dental nurses in orthodontic occlusal indices.

Le besoin de traitement orthodontique Justification et méthodes d'évaluation (première partie)

Most adolescents in developing countries undergo orthodontic treatment. Three main reasons are routinely cited to justify the provision of orthodontic treatment i.e. the improvement of facial and/or dental aesthetic, the preservation of the health and functioning of the dentition. Orthodontic indices have been devised to minimise the subjectivity related to the classic orthodontic diagnosis. These indices can be classified under five headings: nosological, epidemiological, treatment need, outcome and complexity.

An update on the analysis of agreement for orthodontic indices

The training of clinicians in the correct use of commonly used orthodontic indices involves calibration. The level of agreement between the trainee and a standard is assessed both as a measure of reproducibility and the success of training programmes. For the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON), the recommended level of acceptable inter-rater agreement is no more than +/-12 and +/-18, respectively. Many commonly used methods of analysing this type of agreement are inappropriate. The method used in this investigation allows the calculation of limits of agreement, which easily demonstrate any major departures in agreement between trainee scores and standard scores. The basic method assumes that the differences between trainee and standard scores are normally distributed and that there is no relationship between these differences and the magnitude of the index. An extension to this approach is required when the assumptions of the basic method are not upheld. This extension provides a regression-based approach to calculating limits of agreement. The results of this study demonstrate that the assumptions of the basic approach need to be checked for each comparison of trainee versus standard. In addition, regression-based methods are a more accurate means of calculating limits of agreement when these assumptions are not upheld. They also provide more information about bias and the range of disagreement between raters.

A cephalometric analysis of patients with recessive dystrophic epidermolysis bullosa.

Patients diagnosed with Recessive Dystrophic Epidermolysis Bullosa (RDEB) suffer from severe growth inhibition due to reduced food intake as a result of severe oropharyngeal and esophageal blistering. This investigation examined the patterns of facial growth in a group of 42 children with RDEB for whom lateral skull radiographs were available. The differences between RDEB patients and patients with normal cephalometric values were also assessed. Lateral skull radiographs were digitized and a number of orthodontic indices were compared to the published normal values. The RDEB patients examined demonstrated smaller maxillae than normal (length 41.3 +/- 2.9 mm compared to 47.4 +/- 2.5 mm) and smaller mandibles than normal (length 82.3 +/- 6.1 mm compared to 93.1 +/- 4.2 mm). This impaired growth may result from reduced food intake or severe orofacial scarring associated with RDEB. This contributes significantly to dento-alveolar disproportion and dental crowding and puts patients at increased risk of dental caries.

歯周病治療における矯正治療

Orthodontics methods,from aligning dentition to orthodontic traction has been widely used in the treatment of periodontal disease.However,the parameters used to evaluate the effects of orthodontic treatment on periodontal disease are not consistent.This article presents a review on this aspect,summarizing the respective periodontal and orthodontic indices.

The development of the index of complexity, outcome and need (ICON).

This paper is based on the winning submission for the 1998 Chapman prize awarded by the British Orthodontic Society for an essay on a subject promoting the interests of orthodontics. The aim of the investigation is to develop a single index for assessing treatment inputs and outcomes. An international panel of 97 orthodontists gave subjective judgements on the need for treatment, treatment complexity, treatment improvement, and acceptability on a diverse sample of 240 initial and 98 treated study models. The occlusal traits in the study models were scored according to a defined numerical protocol. Five highly predictive occlusal traits were identified (IOTN Aesthetic Component, crossbite, upper arch crowding/ spacing, buccal segment antero-posterior relationships, and anterior vertical relationship) and then used to 'predict' the panelist's decisions using regression analysis. Cut-off values were determined for the dichotomous judgements by plotting specificity sensitivity and overall accuracy. Twenty percentile ranges were used to determine 5 grades of complexity and improvement. The index prediction of decisions for treatment need, had specificity 84.4 per cent, sensitivity 85.2 per cent, and overall accuracy 85 per cent. When used to predict treatment outcomes, the new index had specificity 64.8 per cent, sensitivity 70.1 per cent, and overall accuracy 68.1 per cent. The index could explain 75.6 per cent of the variance in the mean casewise complexity score and 63.5 per cent of the mean casewise improvement score. A new orthodontic index is proposed to assess treatment need, complexity, and outcome. It is based on international orthodontic opinion.

A comparison of DAI scores and characteristics of occlusal traits in three ethnic groups of Asian origin

The Dental Aesthetic Index (DAI) is an orthodontic index based on socially defined aesthetic standards. The primary aim of this study was to compare the prevalence of malocclusion using the DAI among three ethnic groups of Asian origin; Japanese, Chinese in Taiwan and Native Americans with white Americans. A secondary goal was to consider the possibility that genetic factors might be the cause of the characteristics of malocclusion in the ethnic groups of Asian origin. Malocclusion was evaluated in 1029 Japanese and 176 Chinese in Taiwan students utilising the DAI, and the findings were compared with those of Native Americans and white Americans. The DAI values of Japanese and Native Americans were significantly higher than those of Chinese in Taiwan and white Americans. The mean DAI values showed no common tendency among the three ethnic groups. The characteristics of malocclusion in each ethnic group were also evaluated by analysis of each of the 10 DAI component scores. The results revealed common characteristics of malocclusion in the three ethnic groups of Asian origin using white Americans as the standard. The findings in the present study suggest the possibility that genetic factors might have an influence on the characteristics of malocclusion.

Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment Need and the Dental Aesthetic Index

This article compares and contrasts two orthodontic indices, the Index of Orthodontic Treatment Need (IOTN), and the Dental Aesthetic Index (DAI). Both contain esthetic and clinical criteria. Both accept the premise that a significant benefit of orthodontic treatment is improved esthetics and, by inference, social and psychological well-being. Both have as their goal the identification of children most in need of orthodontic treatment subsidized by public funds. The first part of this article describes the IOTN, its development, reliability, and validity. The second section describes the DAI, its development, reliability, and validity. The third part of the article compares and contrasts the indices. There are a number of differences between the IOTN and the DAI. In the IOTN, the esthetic component is a separate instrument from the dental health component. The unique aspect of the DAI is its linking of people's perceptions of esthetics with anatomic trait measurements by regression analysis to produce a single score obviating the need, as in the IOTN, for two separate scores that cannot be combined. Both components of the IOTN have only three grades, “no need,” “borderline need,” and “definite need.” The IOTN cannot rank order cases with greater or lesser need for treatment within grades. In contrast, DAI scores can be rank ordered on a continuous scale and can differentiate cases within severity levels. With the IOTN, about a third of British schoolchildren would be found eligible for treatment in public programs. Providing publicly funded orthodontic care to as many as a third of the schoolchildren would not be feasible in the United States. (Am J Orthod Dentofac Orthop 1996;110:410-6.)