indics / orthodontic courses by Indian dental academy

INDICES INDIAN DENTAL ACADEMY

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IndexAccording to Russell, an index is defined as

‘A numerical value describing the relative status of the population on a graduated scale with definite upper and lower limits which is designed to permit and facilitate comparison with other population classified with the same criteria and method.’

In the orthodontic context index is described as –

‘A rating or categorizing system that assigns a numeric score or alpha numeric label to a person’s occlusion.’ www.indiandentalacademy.com

Requirements of ideal orthodontic index are –(Jamison H.D. and Mc Millan R.S )

1. Simple, reliable and reproducible.2. Objective and yield quantitative data.3. Differentiate b/w handicapping and non

handicapping malocclusions.4. Measure degree of handicap.5. Quick examination.6. Amenable to modifications.7. Usable either on patient or on study

model.


Types of Indices ( according to WHO)

Occlusal Classification Angle’s classification by Angle in 1899 Incisor classification by Ballard and

Wayman, 1964

Skeletal classification by Houston et al, 1993

Malocclusion Occlusal index by Summers 1966 Handicapping Malocclusion Assessment

Record (HMAR) by Salzmann, 1968 Index of Treatment Need by Evans and Shaw

1987www.indiandentalacademy.com

Treatment assessment Little’s irregularity index by Little 1975 Peer Assessment rating by Richmond et al,

1987

Cleft Outcome Goslon Yardstick by Mars et al, 1987 5Year olds’ Index by Atack et al ,1997

Periodontal Plaque Index by Stilness & Loe , 1964 Gingival Index. by Loe & Stilness, 1963


Types of Indices ( according to Richmond et al)

Diagnostic Classification Angle’s classification Incisor classification

Epidemiologic indices Study prevalence of malocclusion in

population. Eg 1.Summer’s occlusal index. 2. Registration of malocclusion

described by Bjork, Krebs and Solow


Treatment need ( Treatment priority) indices. Categorize malocclusion according to levels of treatment

needs. Eg 1. Index Of Treatment Need (IOTN) 2. Draker’s Handicapping Labio – Lingual Deviation

index (HLD) 3. Grainger’s Treatment Priority Index.(TPI) 4. Salzmann’s Handicapping Malocclusion Index

Treatment outcome indices. Assesssment of changes resulting from treatment Eg 1. Peer Assessment Rating index 2. Summer’s index

Treatment complexity index Index of Complexity Outcome and Need (ICON)


Various indices of Occlusion

Master and Frankel (1951) Count the number of teeth displaced

or rotated Qualitative assessment

Malalignment Index byVankrik and Pennel (1959) Tooth displacement and rotations

were measured.


Angles classi - Molar reln-

Class I

Class II

Class III


Incisor classi- Incisor reln

Class I

Class II

Class III


Skeletal classi-

Class I Class II

Class IIIwww.indiandentalacademy.com

Handicapping Labio – Lingual deviation index(Draker-1960) Handicapping malocc and dentofacial

anomalies.

permanent dentition

Administrative needs

Weighting factors by trial and error.

9 components


Conditions observed HLD score1. Cleft palate Score 152. Severe Traumatic deviations Score 153. Overjet in mm4. Overbite in mm5. Mandibular protrusion in mm x 5 6. Open bite in mm x 47. Ectopic eruption ,Anteriors only x 38. Anterior crowding : Maxilla9. Anterior crowding : Mandible

TOTAL


Handicapping Labio – Lingual deviation index by Draker (1960)

Modification

aim

7 components.

Boley gauge scaled in mm.

score 13 and over physical handicap


7 conditions of HLD index are - 1. Cleft palate2. Traumatic deviations3. Overjet4. Overbite5. Mandibular protrusion6. Open bite7. Labio Lingual spread

codes – ‘O’ = condition present ‘X’ = condition absent ‘M’= mixed dentition ‘A’= Clinical approval ‘D’=Clinical disapproval


Occlusal index- Summers (1966)

Assess severity

9 weighted and defined measurements – 1. Molar relation2. Over jet3. Overbite4. Posterior cross bite5. Posterior open bite6. Tooth displacement7. Midline relation8. Maxillary median diastema9. Congenitally missing maxillary incisors.


7 malocc syndromes 1. OJ,OB2. Distal molar relation,OJ,OB, post crossbite,

midline diastema, mid line deviation.3. Congen missing max incisors.4. Tooth displacement. 5. Post OB6. Mesial molar reln,OJ,OB, post crossbite,

midline diastema, mid line deviation.7. Mesial molar reln, mixed dentition analysis

(potential tooth disp), tooth disp

Diff scoring schemes and forms .


Treatment priority index- Grainger (1967)

Malocclusion Severity Estimate (MSE) -Grainger 1960-61

MSE score- largest value

potential tooth displacement (mixed-dentition space analysis), rating distoclusion, mesioclusion equally.

Public health significance


11 weighted and defined measurements –1. Upper ant OJ.2. Lower ant OB.3. OB4. Ant openbite.5. Congenital absence of incisors.6. Distal molar relation7. Mesial molar relation8. Posterior cross bite (max. teeth buccal to normal).9. Posterior cross bite (max. teeth lingual to normal).10. Tooth displacement11. Gross anomalies.


7 malocc syndromes defined -

1. Prognathism2. Retrognathism3. Overbite4. Openbite5. Maxillary expansion syndrome6. Maxillary collapse syndrome7. Congenitally missing incisors



TPI is based on a scale of1. 0 (near ideal occlusion)2. 1 - 3 ( mild malocclusion) 3. 4 – 6 ( Moderate malocclusion)4. Over 6 ( severe malocclusion)

TPI scores only occlusal characteristics, excluding skeletal and facial components.

TPI is used in national studies of orthodontic needs for children. Eg. USPHS study in USA of childeren aged b/w 6-11 yrs in year 1967


Handicapping malocclusion assessment records by Salzmann (1968) Purpose – establish priority for treatment

according to severity shown by score. Weighted measurements 3 parts –1. Intra arch deviations

Missing teeth Crowding Rotation Spacing

2. Interarch deviations Overjet Overbite Crossbite Openbite Mesiodistal deviations


3. Six handicapping dento-facial deformities

1. Facial and oral clefts2. Lower lip palatal to maxillary incisors.3. Occlusal interferences4. Functional jaw limitations5. Facial asymmetry6. Speech impairment.

add 8 points > 6.


Instruction for Scoring



Irregularity index - Robert Little(1975)

Measuring linear displacement


Sum of 5 disp- degree of ant irregularity

Dial calipers used

Measuremets from casts


7 orthodontists – 50 casts

Phase one-

0 Perfect allignment

1-3 Min irregularity4-6 Moderate irregularity

7-9 Severe irregularity

10 Very severe irregularity


Phase 2-

•5 orthodontists – 25 casts

•2 separate occasions

•10 severity estimates for each cast


Scattergram-


Peer Assessment Rating Index (PAR)by Richmond et al., 1987

10 British orthodontists. Effectiveness Orth tmnt. Assigns scores to different occlusal traits. Study models used. A scoring system and a ruler.



5 components- Weighting1. Upper & lower anterior segment - 12. Left and right buccal segments - 13. Over jet - 64. Overbite - 25. Centerlines - 4

summed final score..

change in total score- success of treatment.


Change expressed as:1. 22 point reduction – Greatly improved2. < 30% reduction – worse/ no better > 30% reduction – Improved. Indicator of clinical performance.

Limitations of PAR1. Generic weightings of OJ and OB.2. Sensitive to malocclusion with high OJ.3. OB low weighting..4. Facial profiles not considered Eg.

Bimaxillary protrusion


TheValidation of PAR for Malocclusion severity and Treatment DifficultyDe Guzman,bahiraei, Vig, Weyant and O’Brien – AJO-DO 1995

11 American Orthodontists -200 casts

Results PAR index weightings -malocc severity and treatment difficulty



Index of Treatment Need (IOTN) by Shaw Index has two components-

1. Dental Health component – derived from occlusion and alignment.

2. Aesthetic component – Derived from comparison of dental appearance to standard photographs.

Aesthetic component is calculated by direct examination, but dental health component can be studied by dental casts.


A special ruler

Assessed in order :1. Missing teeth2. Overjet3. Crossbites4. Displacements (Contact point)5. Overbite




Esthetic Index

Grades 8 – 10 = definite need for treatment.

5 – 7 = moderate/ borderline need

1 – 4 = No/ slight need


Limitations1. In aesthetic component ,Class III not

considered.2. Facial profile not considered.3. Class I bimaxillary protrusion not

considered.


Index of Complexity Outcome and Need (ICON)

97 orthodontists various countries.

patients and Dental casts.

A single assessment method to record complexity, outcome and need.

5 components -1 min to measure.


1. Aesthetic component 10 pictures

2. Upper arch Crowding/ Spacing Score according to amount of crowding or spacing Impacted teeth in either arch immediately scored 5 Spacing in one part can cancel out crowding

elsewhere.3. Crossbite4. Incisor open bite/ overbite

Open bite measured at mid incisal edges Deep bite is measured at deepest part of overbite.

5. Buccal segment Antero posterior Quality of buccal segment interdigitation is measured

(not Angles Classification)


1. Aesthetic component




Limitations1. Overjet not considered.2. Lower anterior crowding not considered.3. Midline shift not taken in account.


Goslon yardstick :A new system of assessing dental arch relationships in children with UCLP – Michael Mars, Dennis A. Plint : 1987 A cleft Palate journal

The Goslon Yardstick- clinical tool, 5 discrete categories.

Objective : 1. categorize malocclusions in UCLP –

severity,difficulty

2. compare results of different approaches to the early treatment of children with UCLP.


Development of Yardstick – Imp clinical feat

1. A- P arch relationship –Class III incisor relationship> class II div I

2. Vertical labial segment relationship – Open bite> Reduced overbite > deep overbite.

3. Transverse relationship – Canine crossbites > molar crossbites.

30 cases taken. ranked by 4 orthodontists, separated in 5

groups


Group 1 – excellent


Group 2 – good


Group 1 or 2 - simple orthodontic treatment/ no treatment


Group 3 – fair

complex ortho tnmt,good result antisipated


limited ortho tmnt without orthognathic surgery,if growth fav

Group 4 – poor


Group 5 – very poor

Orthognathic surgery


5yr old’s Index(Atack)-

Subjects & mothod-

-Born UCLF

-Repair of ULCP-No orth tmnt

-No bone grafting

-Casts


Intra-examiner


Inter-examiner


Reln of Golson ranking


Group 1-Excelent


Group 2- Good


Group 3-Fair


Group 4- Poor


Group 5- Very poor


Plaque index-Stilness& loe


Gingival index – Loe & Stilness


Thank you

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indics / orthodontic courses by Indian dental academy