Indics /certified fixed orthodontic courses by Indian dental academy

INDICES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Index
According 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.’

Requirements of ideal orthodontic index are –
(Jamison H.D. and Mc Millan R.S )
1.
2.
3.
4.
5.
6.
7.

Simple, reliable and reproducible.
Objective and yield quantitative data.
Differentiate b/w handicapping and non
handicapping malocclusions.
Measure degree of handicap.
Quick examination.
Amenable to modifications.
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
1987



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.





Treatment outcome 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

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 relnClass I

Class II

Class III

Incisor classi- Incisor reln
Class I

Class II

Class III

Skeletal classi-

Class I

Class II

Class III


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
1.
2.
3.
4.
5.
6.
7.
8.
9.

Cleft palate
Severe Traumatic deviations
Overjet in mm
Overbite in mm
Mandibular protrusion in mm
Open bite in mm
Ectopic eruption ,Anteriors only
Anterior crowding : Maxilla
Anterior crowding : Mandible

TOTAL


HLD score
Score 15
Score 15

x5
x4
x3

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.
2.
3.
4.
5.
6.
7.







Cleft palate
Traumatic deviations
Overjet
Overbite
Mandibular protrusion
Open bite
Labio Lingual spread
codes –
‘O’ = condition present
‘X’ = condition absent
‘M’= mixed dentition
‘A’= Clinical approval
‘D’=Clinical www.indiandentalacademy.com
disapproval

Occlusal index- Summers (1966)


Assess severity



9 weighted and defined measurements –
Molar relation
Over jet
Overbite
Posterior cross bite
Posterior open bite
Tooth displacement
Midline relation
Maxillary median diastema
Congenitally missing maxillary incisors.

1.
2.
3.
4.
5.
6.
7.
8.
9.


7 malocc syndromes
1.
2.
3.
4.
5.
6.
7.



OJ,OB
Distal molar relation,OJ,OB, post crossbite,
midline diastema, mid line deviation.
Congen missing max incisors.
Tooth displacement.
Post OB
Mesial molar reln,OJ,OB, post crossbite,
midline diastema, mid line deviation.
Mesial molar reln, mixed dentition analysis
(potential tooth disp), tooth disp
Diff scoring schemes and forms .


Treatment priority index- Grainger
(1967)
Public health significance





Malocclusion Severity Estimate (MSE) -Grainger
1960-61
MSE score- largest value
potential tooth displacement (mixed-dentition
space analysis), rating distoclusion,
mesioclusion equally.


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

11 weighted and defined measurements –
Upper ant OJ.
Lower ant OB.
OB
Ant openbite.
Congenital absence of incisors.
Distal molar relation
Mesial molar relation
Posterior cross bite (max. teeth buccal to normal).
Posterior cross bite (max. teeth lingual to normal).
Tooth displacement
Gross anomalies.

7 malocc syndromes defined 1.
2.
3.
4.
5.
6.
7.

Prognathism
Retrognathism
Overbite
Openbite
Maxillary expansion syndrome
Maxillary collapse syndrome
Congenitally missing incisors



1.
2.
3.
4.

TPI is based on a scale of
0 (near ideal occlusion)
1 - 3 ( mild malocclusion)
4 – 6 ( Moderate malocclusion)
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)

1.

Purpose – establish priority for treatment
according to severity shown by score.
Weighted measurements 3 parts –
Intra arch deviations
Missing teeth
Crowding
Rotation
Spacing

2.

Interarch deviations
Overjet
Overbite
Crossbite
Openbite
Mesiodistal deviations

3. Six handicapping dento-facial deformities

6.

Facial and oral clefts
Lower lip palatal to maxillary incisors.
Occlusal interferences
Functional jaw limitations
Facial asymmetry
Speech impairment.



add 8 points > 6.

1.
2.
3.
4.
5.


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


Phase one7 orthodontists – 50 casts
0 Perfect allignment
1-3 Min irregularity
4-6 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 components1.
2.
3.
4.
5.

Weighting
Upper & lower anterior segment - 1
Left and right buccal segments 1
Over jet
- 6
Overbite
- 2
Centerlines
- 4



summed final score..



change in total score- success of treatment.



1.
2.



Change expressed as:
22 point reduction – Greatly improved
< 30% reduction – worse/ no better
> 30% reduction – Improved.
Indicator of clinical performance.
Limitations of PAR
1.
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 Difficulty
De 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 components1.
2.



Dental Health component – derived from
occlusion and alignment.
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 teeth
2. Overjet
3. Crossbites
4. Displacements (Contact point)
5. Overbite


Esthetic
Index


Grades 8 – 10 =
definite need for
treatment.



5–7=
moderate/
borderline need



1 – 4 = No/
slight need


Limitations
1.
2.
3.

In aesthetic component ,Class III not
considered.
Facial profile not considered.
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


2.

Upper arch Crowding/ Spacing




3.
4.

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.

Crossbite
Incisor open bite/ overbite



5.

10 pictures

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

Buccal segment Antero posterior


Quality of buccal segment interdigitation is measured
(not Angles Classification)


1. Aesthetic component


Limitations
1.
2.
3.

Overjet not considered.
Lower anterior crowding not considered.
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
Vertical labial segment relationship – Open
bite> Reduced overbite > deep overbite.
Transverse relationship – Canine crossbites >
molar crossbites.

2.
3.




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


Group 4 – poor

limited ortho tmnt

without orthognathic
surgery,if growth fav


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


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Indics /certified fixed orthodontic courses by Indian dental academy

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