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2. 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.’
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3. 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.
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4. 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
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5.
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
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6. 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
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7.
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)
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8. 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.
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9. Angles classi - Molar relnClass I
Class II
Class III
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12. Handicapping Labio – Lingual deviation
index(Draker-1960)
Handicapping malocc and dentofacial
anomalies.
permanent dentition
Administrative needs
Weighting factors by trial and error.
9 components
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13. 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
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HLD score
Score 15
Score 15
x5
x4
x3
14. Handicapping Labio – Lingual deviation
index by Draker (1960)
Modification
aim
7 components.
Boley gauge scaled in mm.
score 13 and over physical handicap
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22.
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
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23. 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
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32. 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.
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34.
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.
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35.
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
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36. 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
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38. 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.
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39.
A special ruler
Assessed in order :
1. Missing teeth
2. Overjet
3. Crossbites
4. Displacements (Contact point)
5. Overbite
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42. Esthetic
Index
Grades 8 – 10 =
definite need for
treatment.
5–7=
moderate/
borderline need
1 – 4 = No/
slight need
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43. Limitations
1.
2.
3.
In aesthetic component ,Class III not
considered.
Facial profile not considered.
Class I bimaxillary protrusion not
considered.
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44. 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.
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45. 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)
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50. 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.
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51.
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
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52. Group 1 – excellent
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