Classification and Recording of Malocclusion
- Angles classification: Class II Division 1, Class II Division 2, Class III
- Based on the relationship of maxillary and mandibular first molars
- Describes 3 classes of malocclusion: Class I, Class II, Class III
- Massler and Frankels index records the number of displaced/rotated teeth
- Introduced in 1951 by Massler & Frankel
- Records prevalence of malocclusion
- Uses individual teeth as unit of occlusion
- Each maloccluded tooth is given a value of 1
- Score of 0 indicates perfect occlusion, score of more than 10 indicates need for orthodontic treatment
- Malalignment Index introduced in 1959 by Lawrence Vankirk and Elliott Pennell
- Uses a small plastic gauge-like tool for assessment
- Measures tooth rotation and displacement
- Mouth is divided into 6 segments for scoring measurement
- Score of 0 represents ideal alignment, score of 1 represents minor malalignment, score of 2 represents major malalignment
Assessment of Treatment Need and Priority
- Grade Index Scale for Assessment of Treatment Need (GISATIN)
- Created by Salonen L in 1966
- Grades the type and severity of malocclusion
- Treatment Priority Index (TPI)
- Created by R.M. Grainger in 1967
- Assesses the severity of common types of malocclusion
- Handicapping Malocclusion Assessment Record (HMAR)
- Created by Salzmann JA in 1968
- Establishes treatment needs for handicapping malocclusion
- Littles Irregularity Index (LII)
- Measures linear displacement of tooth contact points
- Model cast can be ranked on a scale of 0-10
- WHO/FDI - basic method for recording of malocclusion
- Developed by the Federation Dentaire Internationale (FDI)
- Uses prevalence of malocclusion to estimate treatment needs
- Subjective judgment of orthodontic treatment need: non necessary, doubtful, necessary
- Index of Orthodontic Treatment Need (IOTN)
- Developed and tested in 1989 by Brook and Shaw in England
- Determines treatment priority and eligibility for orthodontic treatment on the NHS in the UK
- Comprises dental health component (DHC) and aesthetic component (AC)
- Memorandum of Orthodontic Screen and Indication for Orthodontic Treatment
- Implemented in 1990 by Danish national board of health
- Describes health risks related to malocclusion and identifies treatment need
- Ideal Tooth Relationship Index (ITRI)
- Established in 1992 by Haeger
- Utilizes intra-arch and inter-arch relationships to generate index scores
- Need for Orthodontic Treatment Index (NOTI)
- First described and implemented in 1992 by Espeland LV et al
- Used by the Norwegian health insurance system for allocation of treatment subsidies
- Risk of Malocclusion Assessment (ROMA)
- Published in 1998 by Russo et al for use in exchange for the IOTN scale
Assessment of Orthodontic Treatment Outcome
- Assessment of treatment outcome is important in orthodontics
- The American Board of Orthodontics (ABO) cases have been used to evaluate treatment outcome
- Three-dimensional dental arch and palatal form changes can be assessed after extraction and nonextraction treatment
- The desire for orthodontic retreatment has been studied in different populations
- Public community orthodontics in Italy has been described as an experience
Comparison of Orthodontic Treatment Need Indexes
- Different orthodontic treatment need indexes have been compared
- The PAR Index and other indexes have been assessed for their validity and reliability
- The IOTN has been used in the UK to determine treatment need
- The Danish National Board of Health has provided guidelines for orthodontic screening and treatment indications
- The assessment of treatment outcome in ABO cases has been evaluated
Prevalence of Malocclusion
- Malocclusion is a common dental condition
- A study found that the prevalence of malocclusion in children aged 14 to 18 years was high
- Another study reported a prevalence of malocclusion in a specific population group
- The prevalence of malocclusion can be assessed and graded using different methods
- Variability exists in recording and grading the need for orthodontic treatment based on malocclusion
Orthodontic indices are one of the tools that are available for orthodontists to grade and assess malocclusion. Orthodontic indices can be useful for an epidemiologist to analyse prevalence and severity of malocclusion in any population.