INDICIES IN

ORTHODONTICS

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B.D.S., Morth RCSEd., Scotland-Uk
Member of the Royal College of Surgeons of Edinburgh
John MCD. Medal RCSEd-Uk
P. Member European Board of Orthodontics
INTRO.
q Shall I treat this patient !!
q Have we improved your smile !!

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WHAT IS THE INDEX
CLINICAL OBSERVATION

NUMERICAL VALUE

INDEX
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WHAT IS IT USED FOR

1. Determine accesses to public health

2. Assessment of the treatment outcome

3. Research and quality assurance

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CRITIERIA FOR AN INDEX

a. Universally acceptable

b. Reliable

c. Reproducible
CRITIERIA
d. Valid

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CRITIERIA FOR AN INDEX

e. Simple

f. Cheap

g. Easy
CRITIERIA

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1. Index of Orthodontic Treatment Need (IOTN)

2. Index Of Complexity, Outcome And Need (ICON)

3. Peer Assessment Rating (PAR)

4. ABO Discrepancy Index (ABO DI)

5. Handicapping Malocclusion Assessment Record (HMAR)

6. Treatment difficulty index for impacted maxillary canine

7. Irregularities index (II)

8. Ginigval and plaque index

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1. IOTN (INDEX OF TREATMENT
NEED)

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Composed of two components:

a. The aesthetic component

b. The dental health component.

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o The occlusal traits were
defined and placed in
five grades.

o Only the highest

scoring trait need be
recorded.

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Oh the overjet is 8mm, the overbite is
complete and to the palate !!!

4a or 4f
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If two traits have the same
score, use the following order.

Missing
Overjet
Crossbite
Displacement
Overbite

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Now I know the esthetic component and the
dental health component what shall I do ?

Dental health component Treatment need

Grade 1 - 2 No need
Grade 3 Borderline
Grade 4 - 5 Definite

Aesthetic componenet Treatment need

Grade 1- 2- 3 No need
Grade 4 Mild
Grade 5 -6 -7 Borderline
Grade 8 -9-10 Definite

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Advantages

1. Valid

2. Easy and quick

3. Reproducible (Brook and Shaw in 1989)

4. Acceptable.
5. Used on patients or on casts

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The modified IOTN (Burden et al., 2001)

The idea behind it?

o Not an index to measure the complexity

o No benefit in recording the occlusal anomaly that

placed the child in treatment need category.

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The modified IOTN (Burden et al., 2001)

The index has been simplified to two categories

(Definite Need for Treatment) (No Definite Need for Treatment)

IOTN DHC ≥ 4 and/or IOTN AC ≥ 8 is in NEED OF TREATMENT.

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2. INDEX OF COMPLEXITY, OUTCOME
AND NEED (ICON) Charles Daniels and Stephen
Richmond 2000

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Consists of 6 occlusal & an aesthetic components.

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Multiple the score with the weight.

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A score > 44 indicates needs treatment.

Perception of treatment need in various

countries

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 The ICON formula to assess
orthodontic treatment outcome

Improvement grade= pre-treatment- (4 X post-treatment score)

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LET’S GIVE IT A TRY

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Improvement grade= pre-treatment- (4 X post-treatment score)

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Advantages :

a.Multifunctional index (treatment need/outcome)

b.Reliable and valid
c.High sensitivity
d.Incorporating an aesthetic score

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3. PEER ASSESSMENT RATING (PAR)
(Richmond et al. 1992)

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Series of meetings by 10 experienced orthodontists

Specific ruler

Measure occlusal traits

Assign a score
Factor
Sum all scores
Multiply each score

Compare pre/post scores

Degree of improvement
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Components (occlusal traits) of the PAR index:

1. Right and left buccal occlusion X 1

2. Overjet X 6
3. Overbite X 2
4. Centrelines X 4
5. Dental arches occlusal features X 1

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 1. Buccal occlusion X1

This is recorded for right/left sides

in occlusion in three dimensions.

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1. Buccal occlusion X1

Temporary developmental
stages is excluded.

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 2. Overjet X6

Most prominent incisor is recorded.

Overjets & crossbites are recorded.

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3. Overbite x2

The vertical overlap/openbite of the

anterior teeth is recorded.

If OB and AOB are present, then they

should be added.

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4. Centrelines X4

Record the centreline discrepancy

to the lower central incisor.

If a lower incisor was extracted

the measurement is not recorded.

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5. Occlusal features X1

Arch is divided into three recording segments to

record

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5. Occlusal features X1

Crowding

Impacted teeth are recorded when

space is = / <4 mm.

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LET’S GIVE IT A TRY

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1. Buccal occlusion X1

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2. Overjet X6

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3. Overbite x2

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4. Centrelines X4

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5. Occlusal features X1

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 Measure occlusal traits

Assign a score

Multiply each score

Sum all scores

Now compare the pre/post

treatment scores

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 Assessing the outcome of treatment

Three methods of assessing outcome using the PAR Index

1. Record the reduction in score.

2. Calculate the percentage change.

Peer Assessment Rating (PAR)

Start 46
Finish 2
Change 44
<30% worse/no improvement % Change 95%
30%-70% improved Greatly
improved
>70% great improvement
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 Assessing the outcome of treatment

Three methods of assessing outcome using the PAR Index

3. Use the graph

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Advantages

1. Excellent reliability (Richmond et al., 1992).

2. Easy and quick

3. Used for all types of malocclusion

4. Measuring the degree of improvement.

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Disadvantages

1. Not an index for treatment need

2. Over jet and over bite has high weight

3. Insensitive as it provides a single score for all
occlusal anomalies

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4. ABO DISCREPANCY INDEX

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The elements of the Index are :

1. Overjet & cross bite

2. Overbite & open bite
3. Crowding
4. Buccal occlusion
5. Cephalometry
6. Category designated "other"

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1 . OVERJET

OVERJET SCORE
0mm 1 point
0-3mm 0 point
3.1-5mm 2 points
5.1-7mm 3 points
7.1-9mm 4 points
>9mm 5 points
<0mm 1point/mm/tooth

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2. OVERBITE

OVERBITE SCORE
0< but <3mm 0 point
3.1-5mm 2 points
5.1-7mm 3 points
Impinging on the palatal tissue 5 points

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3. ANTERIOR OPEN BITE

ANTERIOR SCORE
OPENBITE
0mm 1 point
openbite 2 points/mm/tooth
(Canine-Canine)
Blocked out canine 0 point

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4. LATERAL OPEN BITE

LATERAL SCORE
OPENBITE
Lateral openbite 2 points/mm/tooth
(premolar-third molar)

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5. CROWDING

CROWDING SCORE
1-3mm 1 point
3.1-5mm 2 points
5.1-7mm 4 points
>7mm 7 points

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6. OCCLUSION

OCCLUSION SCORE/SIDE
Class I 0 point
Half unit 2 points
Full unit 4 points
More than full unit 4 points+ 1 point/mm

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 7. CEPHALOMETRICS

CEPHALOMETRIC SCORE

5.5º<ANB or ANB<-1.5º 4 points then 1 point/degree

SN/GoGn 27º-37º 0 points

SN/GoGn>37º 2 points/dgree

SN/GoGn<27º 1 point/degree

L1/GoGn >98º 1 point/degree

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8. OTHER: At the discretion of the examiner
ADDITIONAL FEATURES SCORE

Missing teeth except 3 rd molar

Supernumerary teeth

Impactions except 3 rd molar

Ectopic eruption 2 points/each

Tooth size/ shape anomalies

Midline deviation>3mm

Skeletal asymmetries

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 Advantages Disadvantages

§ Detailed § Complicated

§ Comprehensive § Time consuming

§ Suitability for examinations § Relies on cephalometry

§ Reproducibility

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8. Plaque / Gingival Index
(Stillness & Loe 1964)

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8. Plaque (Stillness & Loe 1964)

•Used to asses only the supra-gingival plaque

0 No plaque
1 Not visible to the eye
2 Visible to the eye
3 Heavy

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8. Plaque Index
(Quigley and Hein)

0 No plaque
1 Flecks of stain on the gingival margin
2 Definitive line of plaque
3 Gingival third
4 Gingival two thirds
5 More than gingival two thirds
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8. GINGIVAL INDEX
(Stillness & Loe 1963)

• Used to asses the gingival condition 6 2 4

• Record all four surfaces of the recommended teeth 4 2 6

0 Absence of inflammation
1 Mild inflammation (no bleeding on probing)
2 Moderate inflammation (redness and bleeding on probing)
3 Severe inflammation (marked redness, oedema and spontaneous
bleeding)
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 THANKS
Dr.amreldesouky@gmail.com
+2 0111 3000 850

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