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Indexes in orthodontics


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indexes of Orthodontics treatment

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Indexes in orthodontics

  1. 1. Shahzad Hussain Final year BDS Roll no 52
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.
  13. 13.  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
  14. 14.  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.
  15. 15.  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.
  16. 16. Contemporary Orthodontics