Orthodontic Treatment Complexity Research Articles

Initial development of an 'Orthodontic Care Index' involving treatment need,-complexity and-priority.

The aim of this study was to develop an evidence-based scoring system for prioritizing limited orthodontic resources based on orthodontic treatment need (OTN), orthodontic treatment complexity (OTC), and orthodontic treatment priority (OTP), which is not merely a scoring system for malocclusion but also a comprehensive classification of orthodontic issues incorporating patient- and treatment-related factors, called Orthodontic Care Index (OCI). The development of the OCI involved eight phases, starting with a systematic literature review to identify all possible parameters involved in determining OTN, OTC, and OTP. An eight-member orthodontic specialist panel then evaluated and scored the significance of each parameter, resulting in a parameter-score list. Subsequently, a retrospective convenience sample of 61 patients was scored with the parameter-score list, and using the same convenience sample a gold standard was established through the expert opinion of a third orthodontic panel. Linear regression analysis was used to estimate weights of importance and construct a formula to calculate index scores. Lastly, the expert opinion was compared to the index scores, to determine the index performance. The preliminary index separately calculates OTN, OTC, and OTP for a patient as the weighted sum of his/her domain scores. The sensitivity of the index for predicting OTN, OTC, and OTP was high (98.1%, 82.9%, and 92.7% respectively), while the variability of each was relatively low (52.1%, 31.2%, and 52.6% respectively). The OCI shows promise as a guideline for prioritizing orthodontic care. It will be further refined and validated to enhance its performance and usefulness.

Knowledge Enhancement about Preventive Orthodontic Treatment for Malocclusion and Stunting in Elementary School Children after Community Empowerment

Background: Nutritional insufficiency and stunting during infant growth and development also causes a delay in the ossification centers and may lead to poor skeletal and dental forms resulted in malocclusion. Early interceptive orthodontics can eliminate or reduce the severity of a developing malocclusion, the complexity of orthodontic treatment, the overall treatment time, and the cost. Proper oral and dental health knowledge and a favorable attitude toward oral and dental health are critical in preventing numerous dental issues such as malocclusion. Purpose: the aim of this community empowerment is to enhance the knowledge of preventive orthodontic treatment for malocclusion and stunting in elementary school children. Methods: The data was collected at Miftahul Ulum Melirang's Madrasah Ibtidaiyah, or elementary school, in Melirang Village, Bungah District, Gresik, East Java. For the community empowerment program assessment, participants were requested to fill out a Google form for the pre- and post-test to identify the enhancement of knowledge about or preventative orthodontic treatment for malocclusion and stunting in primary school children. Results: The majority of the community empowerment participants understood the presentation on oral and dental health empowerment. The post-test percentage was greater (91.5%) than the pre-test rate (53.75%). Conclusion: The dental and oral health empowerment program about preventive orthodontics, malocclusion, and stunting was effectively completed, enhancing the knowledge level of elementary school children.

Direct-to-consumer orthodontics: Exploring laypeople’s perception of orthodontic treatment complexity

BackgroundThe authors aimed to explore the treatment preferences of laypeople regarding direct-to-consumer (DTC) orthodontics and to identify whether case complexity, as perceived by laypeople, is one of the factors influencing interest in DTC orthodontics. MethodsAn online cross-sectional survey was conducted. Data analysis was performed using logistic regression models. ResultsA total of 1,362 surveys were completed. A significant inverse association was identified between the complexity of an orthodontic case, as measured using the American Board of Orthodontics’ discrepancy index (DI) score, and the likelihood of choosing DTC treatment over an orthodontist. Participants were 3.53 times as likely to choose DTC treatment for a mild case (DI score, 0-10) compared with a complex case (DI score, > 20), although the likelihood of choosing DTC treatment for a moderate case (DI score, 11-20) was only 1.79 times higher than for a complex case. ConclusionsWhen laypeople were asked to consider each case as if it were their own dentition, there was a significant inverse association between the complexity of an orthodontic case, as measured using the DI score, and the likelihood of choosing DTC treatment over an orthodontist. Laypeople were seemingly more likely to choose DTC orthodontics for dentitions that did not appear crowded and were well aligned within the arches. Laypeople seemed to have an understanding that there are some limitations to DTC orthodontics. Practical ImplicationsOrthodontists should better understand the factors influencing consumers’ decisions to select DTC orthodontics and dental organizations should focus their educational campaigns on these factors.

Peer Assessment Rating (PAR) scoring of cleft patients treated within a regional cleft centre in the United Kingdom.

To assess static occlusal outcomes for patients with cleft lip and/or palate (CLP) and cleft palate (CP) managed within a UK Regional Cleft Service and to compare with previously published Peer Assessment Rating (PAR) scores from a non-cleft population of patients treated within a UK consultant-led hospital service. Retrospective multicentre study. Eight orthodontic hospital units within the Spires Cleft Service, UK. Patients born with CLP or CP between 1985 and 1995 treated within the service. Patients were assigned to groups by cleft type and whether they were treated by orthodontics only or a combination of orthodontics and orthognathic surgery. PAR was recorded before and after treatment from study models. Data were collected for 171 patients included in the study. Median pre-treatment PAR was 42 and post-treatment 11. Median percentage change in PAR for all patients was 73%, although 12% of cleft patients had a PAR improvement that was worse or no different. Median change in PAR score was 71% for those treated with orthodontics only and 83% for those who had an osteotomy. Median PAR improvement for those treated with orthodontics only was 73% in the cleft lip group, 77% in the CP group, 66% in the unilateral CLP group and 53% in the bilateral CLP group. Median pre- and post-treatment PAR for the cleft group was higher and PAR reduction lower than those published for non-cleft patients. These data demonstrate high severity of malocclusion, complexity of orthodontic treatment and difficulty in achieving an ideal static occlusion for cleft patients. If PAR is to be used to assess orthodontic outcomes in cleft patients the findings of this study should be considered. A higher proportion of cases are likely to be classed as 'worse or no different', and a lower percentage change will be expected.

Impact of early extraction of the deciduous canine on relief of severe crowding.

To explore whether there were any differences in orthodontic treatment need, treatment complexity, treatment time, or the number of visits between a group of children receiving early intervention (extraction of upper and lower deciduous canines) and an age- and condition-matched control group without intervention. Patient records and study casts in the late mixed or early permanent dentitions of 46 subjects (20 from the extraction group and 26 from the control group) of an earlier prospective longitudinal study were retrieved. Orthodontic treatment need and complexity were assessed by the index of complexity, outcome, and need (ICON). Statistical calculations were performed by t-test for parametric outcome variables (treatment time, number of visits, and orthodontic treatment need) and Fisher exact test for the categorical variable (tooth extractions). There were no statistically significant differences between the groups in ICON scores of orthodontic treatment need (extraction group, mean score 59.8; control group, mean score 52.8), number of visits (mean of about 15 visits for both groups), or treatment time (extraction group, mean 21.5 months; control group, mean 20.3 months). The extraction of permanent teeth was more prevalent in the deciduous canine extraction group (59%) as compared with the control group (28%); however, this was not statistically significant (P = .07) but showed a tendency toward worsening the crowding and the future need of orthodontic extractions. Early removal of deciduous primary canines will reduce neither the need for later orthodontic treatment nor its complexity, nor will it shorten the treatment time.

English

BACKGROUND To provide efficient and well-planned orthodontic treatment orthodontists must be able to assess the type of malocclusion and the complexity involved in its treatment. Hence, the purpose of this study was to validate index of orthodontic treatment complexity (IOTC) as a reliable index to assess the treatment complexity in treating different malocclusion groups. METHODS A retrospective study with sample of 120 pairs of orthodontic study model consisting of treated and untreated cases, were collected and equally divided into class I, class II including both division 1 and division 2 and class III malocclusions based on Angles system of classification of malocclusion. Study casts were scored according to criteria given by the index of orthodontic treatment complexity and the degree of complexity is established for each of the malocclusion groups and the occlusal traits. RESULTS The Spearman correlation coefficients test shows that occlusal traits like overjet, centreline discrepancy, molar correction, overbite, crowding, posterior cross bite, alone significantly correlated with degree of complexity. Multiple regression analysis and one way ANOVA tests were performed for the three types of malocclusion and the test showed that in individual classes of malocclusion, the predictor variable (occlusal traits) significantly predicts the degree of complexity in class I and class II malocclusion cases, but not in class III. CONCLUSIONS Overjet, centreline discrepancy, molar correction, overbite, crowding, posterior cross bite correlated with degree of complexity. IOTC forecasts the degree of complexity in class I and class II malocclusion cases, but not in class III. KEY WORDS IOTC, Malocclusion, Occlusal Traits

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 Complexity among 13-15 Year-Old Schoolchildren in Kerman, Iran

Statement of the Problem: Effective and informed planning for orthodontic services in any population requires assessment of the orthodontic treatment need and complexity. Purpose:The present cross-sectional study was conducted to assess these parameters using index of complexity, outcome, and need (ICON) in an Iranian schoolchildren population. Materials and Method: In total, 600 randomly selected individuals (300 girls, 300 boys; aged 13-15 years) participated in this study. The treatment need (ICON score>43) and the grades of complexity were compared between two genders and in different age groups. Descriptive statistics and Chi-square test were applied for data analysis considering p< 0.05. Results: Out of 45% of the population found in need for orthodontic treatment, there was no significant difference between the two genders, but the 15-year-old individuals needed treatment significantly more than the individuals with 13 and 14 years of age. The mean ICON score was 44.3±20.28, which showed no significant difference between the two genders. The majority of the cases (34%) were categorized in the easy compartment in terms of complexity and 18% had difficult or very difficult grades of complexity. The genders and age groups exhibited no significant difference in terms of the complexity grade. Conclusion:Although half of the studied cases needed treatment, nearly one-fifth had difficult or very difficult complexity grade, which indicates the need for specialist care.

LABOR AND FINANCIAL COSTS IN TREATMENT OF DENTOALVEOLAR ANOMALIES IN THE PERIOD OF THE MIXED OCCLUSION

The aim of the present study is to analyze the complexity and cost of modern methods of orthodontic treatment of children during the period of replacement bite. The study of the duration and frequency of visits to the doctor the orthodontist with the use of technology 2x4, removable plates with artificial teeth, ring spacer, plate from the front Nakonechny pad and plate valve for the language of the Twin-block appliance, mask dilara combined with the expanding apparatus, plate screw, machine screw hyrax expansion. Based on the complexity of the calculated salary orthodontist doctor, medical and other personnel. The cost of consumables at the clinical and dental stages was determined by taking into account the purchase prices and the cost of a specific manipulation by weighing or measuring. Calculated the expenditure on maintenance of workplaces of the doctor and dental technician in the calculations of the required funding early orthodontic treatment used more information about the structure and prevalence of orthodontic pathology in children in the period of the mixed occlusion. It was found that the complexity of modern orthodontic treatment during the period of replacement bite varies from 5.55 hours (spacer with a ring in case of premature loss of a temporary tooth) to 10.73 hours in the treatment of distal bite with the twin-block device. The cost of orthodontic treatment during the period of replacement bite ranges from 12.6 thousand rubles (spacer with a ring in case of premature loss of a temporary tooth) to 33.4 thousand rubles in the treatment of mesial bite using a dilyar mask in combination with an expanding apparatus. Taking into account the prevalence of dentoalveolar anomalies in children during the period of replacement bite, the necessary financial costs for orthodontic treatment per one examined child and per child with a dentoalveolar anomaly reach 30 and 40 thousand rubles, respectively.

Applicability of the aesthetic component of the index of complexity, outcome and need of orthodontic treatment (ICON), by three non-calibrated panels of evaluators

Introduction: The occlusal indices, particularly those that measure the need for orthodontic treatment, have arisen to assess and prioritize the malocclusion’s need for treatment. Its use minimizes the subjectivity related to diagnosis, evaluation of the result and complexity of the orthodontic treatment [1]. The index of complexity, outcome and need of orthodontic treatment (ICON) is the only index that measures all three variables with only one protocol [2]. However, it has some limitations, namely the excessive weight and subjectivity assigned to the aesthetic component [2]. Therefore, this pilot study aims to evaluate the applicability of ICON’s aesthetic component by non-calibrated panels of evaluators. Materials and methods: This study was submitted to the Egas Moniz Ethics Committee (Protocol 468). Twelve frontal intraoral photographs of patients with four anterior aesthetics displays were evaluated. Three versions of an online inquiry were created (with random different orders of the photographs) so that the evaluators could classify the aesthetic attractiveness of each case from 1 to 10, being 1 the most attractive and 10 the least. This evaluation was made using ICON’s aesthetic component scale as reference. The evaluators were divided in three non-calibrated groups, in order to verify if the professional training level was a differentiating factor in the dental aesthetic assessment: orthodontic specialists (n=28), non-specialists working in orthodontics at Clínica Dentária Universitária Egas Moniz (n=21) and final year dentistry students from Instituto Universitário Egas Moniz (n=52). Data analysis was performed using IBM SPSS Statistics version 24.0 for Windows (Armonk, NY: IBM Corp.). The statistical analysis comprised descriptive measures and inferential median comparisons, by using non-parametric tests. The level of significance was set at 5%, in all comparative statistical inference analyses. Results: Figure 1 shows the median of the answers by the three groups, with higher median values (in the range 3–9) obtained for the orthodontic specialists (A) group, followed by the non-specialists working in orthodontics (B) (range 2–8) and dentistry students (C) (range 2–7). Nonetheless, the observed differences between professionals (A + B) and students (C) were not found to be statistically significant, except for photograph nº 5 (p = 0.012, Mann-Whitney test). However, when comparing groups A and B, the evaluation of all photographs, except for nº 3, was significantly different (p < 0.05, Mann-Whitney test). Figure 1. Median, as a function of intraoral photograph, for the answers of the three groups: orthodontic specialists (blue), nonspecialists working in orthodontics (red) and students (green). Discussion and conclusions: Based on these results it is possible to conclude that the professional training level influences the aesthetic evaluation using ICON’s scale, when comparing orthodontic specialists with non-specialists.

Changes in orthodontic occlusal indices after semi-rapid maxillary expansion

ObjectivesTo quantify malocclusion complexity changes after semi-rapid maxillary expansion. Materials and methodThe study sample consisted of pre- and postexpansion dental models and frontal intraoral photographs of 195 consecutive patients treated for maxillary expansion using a removable plate and a semi-rapid screw activation protocol. Differences between the pre- and posttreatment scores of the weighted Peer Assessment Rating Index (PAR), dental health component (DHC), aesthetic component (AC) of Index of Orthodontic Treatment Need (IOTN), and Discrepancy Index (DI) were analyzed. ResultsThe intraclass correlation coefficient test to assess the intraobserver error in PAR index and DI was performed and the value was found to be more than 0.80. The kappa score of 0.923 and 0.926 was observed in DHC and AC indices of IOTN, respectively, suggesting a good intraobserver agreement of scores. The pre- and postexpansion mean values in all the indices showed a significant reduction (P < 0.001). The IOTN-DHC, PAR, IOTN-AC, and DI scores showed improvements in 87.2%, 81.6%, 80.5%, and 72.8% of the subjects, respectively. The percentage change in the scores was maximum for IOTN-DHC (−27.8%) followed by PAR (−23.3%). IOTN-AC and DI showed approximately 20% improvement each. More than 25% improvement in scores was seen in 47% to 82% of the subjects. ConclusionThe study suggests that there is a significant decrease in orthodontic treatment need and treatment complexity after semi-rapid maxillary expansion treatment.

The cost of orthodontic treatment in children during the mixed bite period

In order to analyze the complexity and cost of methods of modern orthodontic treatment for children in the mixed bite period as well as to determine the necessary costs for eliminating dentoalveolar anomalies in primary school children taking into account the prevalence of anomalies we studied the duration and frequency of orthodontist visits during treatment using the 2x4 technique, a removable plate with artificial teeth, a ring with a spacer, a plate with a front bite pad, a plate with a shutter for the tongue, and Twin-block appliance, Dilar mask in combination with an expansion apparatus, plates with a screw, appliance with a hyrax expansion screw. Based on the complexity the salary of the orthodontist and other personnel, the costs of maintaining the doctor’s workplace and the dental technician are calculated. The cost of consumables at the clinical and dental stages was determined considering the purchase prices and the cost of a specific manipulation by weighing or measuring. When calculating the necessary funding for early orthodontic treatment modern data on the prevalence and structure of orthodontic pathology in children during the mixed bite period were used. It was found that the complexity of modern orthodontic treatment during the mixed bite period varies from 5.55 hours (spacer with a ring for premature loss of a temporary tooth) to 10.73 hours in the treatment of a distal bite with a twin-block device. The cost of orthodontic treatment in mixed bite varies from 12.6 thousand rubles (a spacer with a ring for premature loss of a temporary tooth) to 33.4 thousand rubles for the treatment of a mesial bite using a Dilar mask in combination with an expanding device. Given the prevalence of dentoalveolar anomalies in children during mixed bite period, the necessary financial costs for orthodontic treatment per child examined should be at least 30 thousand rubles, and at least 40 thousand rubles for a child with a dentoalveolar anomaly.

Influence of impacted maxillary canine orthodontic traction complexity on root resorption of incisors: A retrospective longitudinal study.

The orthodontic traction of impacted canines is a procedure of variable complexity. The objective of this study was to determine the influence of this complexity on the root resorption (RR) of adjacent incisors, using cone-beam computed tomography. This longitudinal retrospective study included 45 patients (19 female, 11 male; ages, 18.16±7.3years) with maxillary impacted canines, classified into 2 groups according to the level of orthodontic traction complexity: low complexity group (n=20) and high complexity group (n=25). The amounts of RR of 45 maxillary central and 45 lateral incisors were evaluated before and after treatment. Complexity was defined considering impaction sector, eruption inclination angle, and canine position (palatal, buccal, or bicortical). Three orthodontists measured RR in each maxillary incisor. Independent t tests or Mann-Whitney U tests were used to compare resorption between groups depending on the normality of the data. A multiple linear regression was calculated to evaluate the influence of all variables on RR (α=0.05). RR of maxillary incisors in the sagittal, coronal, and axial sections showed no significant differences between groups (P>0.05). Independently of the groups, RR ranged approximately from 1 to 1.5mm and from 3 to 4mm2. RR was less than 2mm2 in the axial sections. Multiple linear regression indicated no significant influence of orthodontic treatment complexity on RR. Male patients had more RR, specifically in the maxillary central incisors than female patients (P<0.05). The complexity of orthodontic traction of impacted maxillary canines is not a risk factor for greater RR of maxillary incisors close to the impaction area.

Occlusal traits, orthodontic treatment need and treatment complexity among untreated 17–21-year-olds in Estonia

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17–21-year-old Estonians.Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17–21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants’ opinions regarding their teeth were determined with a questionnaire.Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5 mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5 mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants’ main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants’ desire for orthodontic treatment.

Skeletal Class III malocclusion in conjunction with early childhood caries increases orthodontic treatment complexity: A case report.

Introduction: Many objective indexes of orthodontic treatment complexity and need have been compiled over the years, most of which have been based on the morphological characteristics of malocclusion. Objective: The aim of this paper is to report a clinical strategy for treating multiple early childhood caries in conjunction with skeletal Class III malocclusion. Case report: A 5-year-old female patient sought dental treatment complaining of dental caries, pain, and malocclusion. The treatment plan involved three steps: pain alleviation, carious control and restauration, and, an orthodontic-orthopedic approach. Treatment also involved a behavioral change in eating habits of the family unit preceding the treatment of malocclusion. Results: The complex clinical cases can yield satisfactory outcomes when pediatric dentistry and orthodontic disciplines are integrated. Conclusion: Orthodontic treatment complexity in children should also be determined by remaining craniofacial growth and both patient and parent’s adhesion and compliance.

Occlusal traits and orthodontic treatment need in 7‐ to 10‐year‐olds in Estonia

The aim of this study was to evaluate the distribution of occlusal traits and orthodontic treatment need and complexity in Estonian 7‐ to 10‐year‐old children. This data provides solid information for planning of orthodontic care. Data of 392 Estonian children (198 girls and 194 boys, mean age 9.0 years, range 7.1–10.4 years) was analysed in this cross‐sectional study. Assessed traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Orthodontic treatment need and complexity were assessed using the Index of Complexity, Outcome, and Need. Parents' opinion regarding their child's teeth was determined using a questionnaire. The most prevalent occlusal traits were canine class I sagittal relationship (73.7%), midline diastema (73.0%), molar class I sagittal relationship (57.4%), and overbite ≥3.5 mm (51.8%). According to the Index of Complexity, Outcome, and Need, 64.3% of Estonian elementary school children were in need of orthodontic treatment. Treatment complexity was simple in 12.5%, mild in 38.8%, moderate in 22.7%, difficult in 14.0%, and very difficult in 12.0% of the children. Approximately 66.4% of the parents felt that their child needed orthodontic treatment. This study confirms earlier findings indicating that the most frequent sagittal relationship is class I in the first molars and class I in the canines. However, the sagittal relationship was asymmetric in more than half of the children. Correlation between objectively defined treatment need and parents' desire for treatment was high in Estonia.

Judging orthodontic treatment complexity.

Objective: The aim of the present study was to investigate possible relations between anticipated overall treatment complexity (AOTC) of an orthodontic case and malocclusion characteristics. Methods: Two groups of orthodontists (groups A and B) were asked to define perceived treatment complexity (PTC) of orthodontic cases based on 16 characteristics of malocclusion by means of a questionnaire. Each question was answered on a six-point ordinal scale, with one "not applicable" option (score 0). Group A was also asked to give the AOTC of the specific case on a five-point ordinal scale. The index of orthodontic treatment need (IOTN) score of the specific cases as well as the malocclusion characteristics were assessed by one author. Results: There is a significant relationship between IOTN and AOTC (p< 0.0001), 22% of variability is explained by differences in IOTN. Adding objective characteristics of malocclusion to explain AOTC does not significantly increase the explained variability (p = 0.086). In judging interobserver agreement, a weighted Kappa of 0.60 for group A and 0.56 for group B was found. The weighted Kappa for agreement in AOTC equals 0.06. Conclusion: The relation between IOTN and AOTC was found to be significant. Moderate agreement on PTC among observers and a low level agreement regarding AOTC were found in the present study.

Relationship between Two Indices in the Assessment of Orthodontic Treatment Complexity and Need

Objective: To determine the relationship between the Index of Complexity, Outcome and Need (ICON) and Dental Aesthetic Index (DAI) in the assessment of orthodontic treatment complexity and need. Method s : A cross - sectional study was carried out. Pre - treatment dental casts of 150 consecutive patients from Lagos, Nigeria were assessed using the ICON and the DAI criteria. One investigator assessed all the models. In addition to descriptive statistics, the rel ationship between the ICON and DAI was examined by using non - parametric correlations (Spearman Rank Order and Pearson’s Product Moment Correlation Coefficient. Original Research Article

Utilização do ICON para aferição da necessidade e eficácia dos tratamentos ortodônticos

Objectives(1) To assess the orthodontic treatment effect need in patients that were submitted to orthodontic treatment at the department of Orthodontics of the Faculty of Medicine, University of Coimbra; (2) To evaluate the treatment effectiveness. MethodsThe ICON was applied to 200 subjects and two calibrated observers evaluated the pre‐treatment and post‐treatment models. The results were analyzed using the IBM‐SPSS v20 statistical platform. The need, complexity and outcome of the orthodontic treatment were described by means of descriptive statistics. The relationship between the complexity and the outcome of the orthodontic treatment was analyzed using a chi‐square test. The statistical significance level adopted was 0.05. ResultsThe orthodontic treatment need meant 70% of the sample (ICON value>43). In the majority of the sample (62%), the complexity ranged between “moderate” to “very difficult”. Regarding the outcome of the orthodontic treatment, none of the patients remained the same or got worse. Most of the sample (55.5%) reached the level of “great improvement”. The component of upper arch crowding/spacing demonstrated the best results, followed by the aesthetic component, crossbite, anterior vertical relationship and lastly, the component of buccal segment antero‐posterior relationship. Comparison between complexity and outcome of orthodontic treatment showed that the higher the complexity, the better the outcome achieved by orthodontic treatment. ConclusionsIn our study, 70% of the sample needed orthodontic treatment. All of the subjects reported an improvement of their condition.

Space Maintainers in Dentistry: Past to Present

Early orthodontic interventions are often initiated in the developing dentition to promote favourable developmental changes. Interceptive orthodontic can eliminate or reduce the severity of a developing malocclusion, the complexity of orthodontic treatment, overall treatment time and cost. The safest way to prevent future malocclusions from tooth loss is to place a space maintainer that is effective and durable. An appropriate use of space maintainer is advocated to hold the space until the eruption of permanent teeth. This case report describes the various changing trends in use of space maintainers: conventional band and loop, prefabricated band with custom made loop and glass fibre reinforced composite resins as space maintainers.