Index of Complexity, Outcome and Need (ICON) - Orthodontic Index

1. Nasir Al-Hamlan BDS, MPH, MSc, FDS RCSEd, FDS RCSEd, MOrth RCSEd, FICD
Consultant and Assistant Professor, Orthodontics
King Saud bin Abdulaziz University for Health Sciences
Riyadh, Saudi Arabia
@nhalhamlan
@saudibraces
nasiralhamlan
@nasiralhamlan
Index of Complexity, Outcome and Need (ICON)
(Daniels and Richmond, 2000)

2. 2000

3. ICON
- Assesses need and outcome,
- Contains 5 components, all need to be scored:
. AC of IOTN–multiplied by 7
. Buccal segment antero-posterior-multiplied by 3
. Upper arch crowding and spacing–multiplied by 5
. Anterior vertical relationships–multiplied by 4
. Crossbite–multiplied by 5
Treatment need 43
Treatment outcome 31

4. Advantages:
. Simple and quick,
. Similar to IOTN and PAR indices,
. Fewer traits to measure compared to IOTN and PAR,
.Valid for need, complexity, outcome and international use.
Limitations:
. Assumed patient cooperation,
. Heavily depend on aesthetic component,
. May require radiographical confirmation.

5. • COMPLEXITY OF ICON
Complexity grade Score range
Easy < 29
Mild 29-50
Moderate 51-63
Difficult 64-77
Very difficult > 77
• TREATMENT IMPROVEMENT
Improvement grade Score range
Greatly improved > -1
Substantially improved -25-1
Moderately improved -53 to-26
Minimally improved -85 to-54
Not improved or worse < -85

6. PROTOCOL FOR OCCLUSAL TRAIT SCORING
Occlusal Trait Score
Aesthetics: 1-10 as judged using IOTN AC

7. Upper arch crowding:
score the highest trait either spacing or crowding
Crowding Score
Less than 2 mm-score 0
2.1 to 5 mm-score 1
5.1 to 9 mm-score 2
9.1 to 13 mm-score 3
13.1 to 17 mm-score 4
17 mm or impacted teeth-score 5
Upper spacing Score
Up to 2 mm-score 0
2.1 to 5 mm-score 1
5.1 to 9 mm-score 2
> 9 mm-score 3

8. Crossbite Score
Transverse relationship No crossbite-score 0
of cusp or worse Crossbite score 1
Openbite
Score only the highest Complete bite-score 0
trait either openbite Less than 1 mm-score 1
or overbite 1.1 to 2 mm-score 2
2.1 to 4 mm-score 3
> 4 mm-score 4
Overbite
Lower incisor Up to 1/3 tooth
coverage 1/3 to 2/3 coverage
2/3 up to full covered
Fully covered

9. Buccal segment anteroposterior
- Left and right added together
▪ Cusp to embrasure relationship only. Class I,II or III-Score 0
▪ Any cusp relation up to but not including cusp to cusp to cusp-Score 1
▪ Cusp to cusp-Score 2

10. APPENDIX OF ICON

11. General Assumptions of the Index
. Assume that cooperation was obtained from patient,
. May need to use radiograph to confirm the presence of teeth,
. Except for aesthetic assessment, primary teeth not scoring, unless they
are to be retained in the permanent dentition.

12. Dental aesthetics
. Using AC OF IOTN,
. Scale the dentition according to the global attractiveness match not to
match the malocclusion itself,
. Once the score is obtained, then it is multiplied by the weighting of 7.

13. Anterior Vertical Relationships
. This includes both openbite and overbite,
. If both are present, then score the highest. The selected score is
multiplied by the weighting 4.

14. Crossbites
. This includes buccal and lingual crossbites;
I. In the anterior segment, a tooth in crossbite is defined as the upper
incisor or canine in edge to edge or lingual occlusion.
II. When a crossbite is present in the anterior or posterior segment or
both, the raw score of is given which is multiplied by the weighting
of 5.
III. When there is no crossbite the score will be 0.

15. Upper Arch Crowding/Spacing
. Included only the discrepancy in the upper arch or the presence of
impacted teeth in both arches,
. Score immediately for the maximum crowding if there is impacted tooth
in either the upper or lower, or for unerupted tooth,
. Unerupted tooth is defined as impacted under the followings conditions:
(i) Ectopically placed or impacted against an adjacent tooth (exclude
3rd molar)
(ii) Less than 4mm of space is available.

16. Upper Arch Crowding/Spacing
. Retained primary teeth in case of congenital absent of permanent teeth
and erupted supernumerary teeth should be scored as space unless
there are to be retained to obviate the need for the prosthesis,
. Once the crowding, spacing measured, then it is reduced to the ordinal
scale (0-5),
. Once the raw score has been obtained it is multiplied by the weighting 5.

17. Buccal Segment Antero-posterior Relationship
. The scoring zone includes the canine, premolar and molar teeth,
. The antero-posterior cuspal relationship is scored each side, and then
both scores for the two sides are added and multiplied by the
weighting 3.

18. CASE

19. PRETREATMENT
AC: score = 5 Weighting 5 x 7
= 35
Overbite: score = 1
Weighting 1 x 4 = 4

20. PRETREATMENT
ULS: impaction = 5
Weighting 5 x 5 = 25

21. PRETREATMENT
Crossbite: score = 1
Weighting 1 x 5 = 5
RBS: score = 1 and LBS: score 1
Total = 2
Weighting 2 x 3 = 6
Total Pretreatment Score = 75
Treatment Need = 75 > 43 (YES)
Complexity = 75 (DIFFICULT)

22. POSTTREATMENT
AC: score = 1
Weighting 1 x 7 = 7
Overbite: score = 0
Weighting 0 x 4 = 0

23. POSTTREATMENT
ULS: score = 0
Weighting 0 x 5 = 0

24. PRETREATMENT
Crossbite: score = 0
Weighting 0 x 5 = 0
RBS: score = 0 and LBS: score 1
Total = 1
Weighting 1 x 3 = 6
Total Posttreatment Score = 10
Improvement = 75 – 4 x 10 = 35 > – 1 (Greatly Improved)

25. •Thank YOU