indexes of Orthodontics treatment

1. Shahzad Hussain
Final year BDS
Roll no 52

2. Index has been defined as a numerical value
describing the relative status of a population
on a graded scale with defined upper and
lower limits, which is defined to facilitate and
permit comparison with other populations
classified under the same criteria and method.
In the ORTHODONTIC context an index is
used to describe a rating system that assingns
a numeric score to a person’s occlusion.

3.  In this era of evidence based Dentistry,
Quantitative measurements are necessary, so as to
quantiate the treatment and compare the results
with some standard care.
 Comparing the quality of Orthodontic treatment is
more difficult.
 For this reason several valid and reliable Indices
have been developed to
1. Asses the treatment need
2. Compare the treatment Outocome
 Indices have been used for the purpose of
Epidemiology , research and for categorizing
patients according to treatment need.

4.  Five distinct Type of Indices have been defined,
each for a distinct purpose.
1. Diagnostic Indices
2. Epidemiologic Indices
3. Treatment need indices
4. Treatment outcome Indices
5. Treatment Complexity Indices

5.  Proposed by BROOK and SHAW in 1989.
 Asses orthodontic treatment need from
anatomic and aesthetic point of view.
 It consists of Two independent components
1. Dental Health component
2. Aesthetic Component

6.  This is categorized in 5 grades ranging from 1
(no treatment need ) to 5 (great need).
 Based on evaluation of 5 occlusal traits
1. Missing teeth
2. Overjet
3. Crossbite
4. Contact point diplacment
5. Overbite

7.  Grade 1 (no treatment need)
 Extremely minor malocclusion including contact point displacement.
 Grade 2 (Mild/little need)
2.a) Increased overjet greater than 3.5mm but less than or equal to 6 mm
with competent lips
2.b) reverse overjet greater than 0 mm but less than or equal to 1 mm
2.c) anterior or posterior crossbite with less than or equal to 1 mm
discrepency
2.d) anterior or posterior open bite of 1 mm but less than or equal to 2 mm.
2.e) increased overbite greater than or equal to 3.5 mm but with no gingival
contact.
2.f) contact point diplacment equal to 1 mm but less than or equal to 2 mm.
2.g) pre normal or post normal occlusion with no other abnormalities.

8.  Grade 3(moderate/borderline need)
3.a) Same as grade 2 with incompetent lips
3.b) reverse overjet greater than 1 mm but less than or equal to 3.5
mm
3.c) anterior or posterior crossbite with greater than 1mm discrepancy
but less than 2 mm
3.d) contact point displacement greater than 2 mm but less than or
equal to 4 mm.
3.e) lateral or anterior open bite greater than 2 mm but less than or
equal to 4 mm
3.f) Deep overbite on gingival and palatal tissues but no trauma

9.  Grade 4(severe/need treatment)
4.a) Less extensive hypodontia (less than or equal to one tooth per
quadrant)
4.b) increased over jet greater than 6 mm but less than or equal to 9 mm
4.c) reverse over jet greater than 3.5 mm with no speech or masticatory
difficulty.
4.d) anterior or posterior crossbite with greater than 2 mm discrepancy.
4.e) posterior lingual crossbite with no functional occlusal contact in one
or both buccal segments.
4.f) severe contact point displacement greater than 4 mm.
4.g) extreme openbite greater than 4mm
4.h) partially erupted, impacted tipped teeth.
4.i) increased overbite with palatal trauma.
4.j) presence of supernumerary teeth.

10.  Grade 5(extreme/need treatment)
5.a) Impacted eruption of teeth(except third molars) due to crowding,
displacement, the presence of supernumerary, retained deciduous
and pathological causes
5.b) extensive hypodontia
5.c) increased overjet greater than 9 mm
5.d) reverse overjet greater than 3.5 mm with reported masticatory
and speech problems
5.e) submerged deciduous teeth

11.  10 front viewing photographs illustrating
varying degree of Occlusion (serves as a scale)
attractive and unattractive occlusion or casts
viewed from front.
 The rating is based on matching the dental
appearance of the patient with one of the
photographs by an orthodontist or non
professional
 No profile views are included

12.  Photographs are arranged from number 1(most
attractive) to number 10(most non attractive)
 The patient score is based on matching his/her
photograph with that of reference
photographs.
 Rating is allocated for overall dental
attractiveness rather than specific morphologic
similarities to the photographs.

15.  Modifications were introduced in 1993
 The Dental health component and aesthetic
component were modified to improve the
reliability of these components.
 In the dental health component DHC, the 5
grades were reduced to 3
 Grade 1,2….. No treatment need
 Grade 3……. Borderline
 Grade 4,5….. Treatment need

16.  In the Aesthetic component AC the 10 point
scale was reduced to 3 point scale
1. Photographs 1-4…. No treatment need
2. Photograph 5-7….. Borderline need
3. Photograph 8-10…. Definite need
 These modifications were accepted and are
used in British standards for Orthodontic
treatment.

17.  The use of indices in orthodontics allows more
uniform interpretation and application for
criteria for treatment need and changes.
 Still there is a need of a development of index
which can be universally accepted in terms of
reliability and validity.
 There is a need to improve diagnostic criteria
and develop a common approach for assessing
treatment need.

18. Contemporary
Orthodontics