Orthodontic Indices

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
ORTHODONTIC INDICES

LEARING OUTCOME
• Definition
• Justification for orthodontic treatment
• Objective of indices
• Types of indices
• IOTN, PAR, ICON
• Direction for research

DEFINITIONS
• Malocclusion: is defined as a handicapping dentofacial anomaly
which causes disfigurement or functional defect (WHO, 1962). This
requires treatment if the defect is/or is likely to be an obstacle to the
patients physical/emotional well being.

DEFINITIONS
Salzmann (1968) defined a handicapping malocclusion, as one which
adversely affects aesthetics, function, or speech.

DEFINITIONS
• Orthodontics:
The branch of dentistry that specializes in the diagnosis, prevention and
treatment of dental and facial irregularities.(American Association of Orthodontists)

DEFINITIONS
Desire , Demand, Need

DEFINITIONS
• Need:
Need is intended to be objective, but has significant psycho-
social aspects not easily quantifiable.
• Desire:
While need is intended to be objective, desire is affected by self
perception of need, social class, age, attitudes of peers and
gender (Barmes, 1973)
• Demand:
• Demand partly determined by socio-economic and political
consideration i.e. the health care system, benefits, funding,
and manpower (Grewe, 1973).

DEFINITIONS
Index: An index is defined as a structured scale or
ranking used to allocate a feature or set of features
to a particular grade or class.
•An orthodontic index/malocclusion index is a
means of objectively assessing occlusal status

ASSESSMENT OF MALOCCLUSION
• Psychosocial

• Medical Parameters

• Extra-Oral Examination

• Intra-Oral Examination

• Radiographs

• Study Model

JUSTIFICATIONS FOR ORTHODONTIC TREATMENT

JUSTIFICATION FOR ORTHODONTIC TREATMENT
• Aesthetics;
• Dental health;
• Occlusal functioning;
• Psycho-social enhancement (Daniels & Richmond, 2000).

METHODS USED FOR QUALITY AND NEED FOR
ORTHODONTIC TREATMENT

METHODS USED FOR QUALITY AND NEED FOR ORTHODONTIC TREATMENT
• The occlusal aims include the creation of the six key as presented by
Andrews (1972), but very few treatments achieve the six keys (Kattner
and Schneider, 1993),
• The evidence supporting that orthodontic treatment enhances dental
and oral health somewhat weak,
• Potential of damage from orthodontic treatment,
• Treating cases with mild malocclusion may become worse from
orthodontic treatment (Richmond et al., 1994).

METHODS USED FOR QUALITY AND NEED FOR ORTHODONTIC TREATMENT
• Therefore, there should be guide to protect the patients from
risk of damage, and preserve the national resources for
patients who are really in need for orthodontic treatment in
term of INDICES

METHODS USED FOR QUALITY AND NEED FOR ORTHODONTIC TREATMENT:
OBJECTIVE OF ORTHODONTIC INDICES
1. Epidemiology
2. Individual case assessment
• Diagnosis classification
• Indices of treatment need
• Indices of treatment outcome
• Indices of treatment difficulty

USES OF INDICES IN ORTHODONTICS
• Guide, and not dictating,
• Objective and qualitative,
• Survey population,
• Decide treatment need i.e. allows best use of resources.
• Evaluate the provided orthodontic treatment.

REQUIREMENTS OF INDICES
• Give an objective evaluation of the malocclusion,
• To survey a population,
• Estimate the treatment needs,
• To evaluate the standard type of orthodontic treatment provided and
assess differences,
• Reliable,
• Valid,
• Acceptable to profession and public,
• Simple,
• Quick,
• Not expensive.

TYPES OF INDICES IN ORTHODONTICS

TYPES OF INDICES IN ORTHODONTICS:
I. Diagnostic Classifications
1. Angle’s classification
2. Incisor classification
3. Skeletal classification

II. Epidemiological Data Collection (Bjork et.al. 1964).
Record every trait in a malocclusion and allow estimation of
the prevalence of malocclusion, or its traits.

III. Indices of Treatment Need
1. Handicapping Labiolingual Deviation (HLD Index) (Draker, 1960),
2. Treatment Priority Index (TPI) (Grainger, 1967)
3. Swedish Index of Treatment Need (National Swedish Board of
Health, 1967)
4. Handicapping Malocclusion Assessment Record (HMAR Index)
(Salzmann, 1968)
5. Occlusal Index (OI) (Summers, 1971)
6. Index of Treatment Need (IOTN) (Brook and Shaw, 1989)

Handicapping Labiolingual Deviation (HLD Index) (Draker, 1960)
▪ Depends on Sagittal, Frankfurt and Orbital Planes,
▪ Separate the very worst malocclusion,
▪ Used in developing IOTN,
▪ But it is less reproducibility.

Treatment Priority Index (TPI) (Grainger, 1967)
• Score: MR, OJ, OB/Openbite, crowding/rotation, missing
teeth, and X-bite. i.e. 6 Features,
• A score from 0-10:
0 = normal
1-3 = minor malocclusion – no treatment required
4-6 = definite deviation – treatment elective
7-9 = handicapping malocclusion – treatment desirable
10 = severe handicapping malocclusion – treatment necessary
• TPI is very precise and sensitive, therefore, is not very reproducible.

Swedish Index of Treatment Need (National Swedish Board of Health, 1967)
• Consider objective need and subjective demand i.e. patient’s
concerns and motivation,
• Grade 1 = little need → Grade 4 = great need.

Handicapping Malocclusion Assessment Record (HMAR Index) (Salzmann,
1968)
▪ Simple,
▪ Performed at chairside or using study models,
▪ Weighting factors used,
▪ Highly reproducible.

Occlusal Index (OI) (Summers, 1971)
• 9 Features measured (as TPI + dental age, centerlines
and posterior openbite)
• More reliable of ranking severity than HMAR,
• Can be used to assess success of treatment,

Index of Orthodontic Treatment Need (IOTN) (Brook and
Shaw, 1989)

- Developed to rank malocclusion in terms of various occlusal
traits to:
- Dental health
- Aesthetic impairment,
- Fulfill general requirement of indices
- The components of IOTN
1- Dental Health Component (DHC)
2- Aesthetic Component (AC)
III. Indices of Treatment Need, IOTN

Advantages of IOTN
- Involved both patient and clinician
- Quick and simple
- Can be used directly on patients or SM
- Reliable
- IOTN has been validated by a panel of 74 dentists (Shaw et al., 1991)
- Operators scores improves overtime (Cooper et al., 2000)

It records only the worse occlusal feature:
- Hierarchical scale:
1- Missing teeth (including developmental absence, ectopic and impacted
teeth)
2- OJ (including reverse OJ)
3- Crossbites
4- Displacement of contact points
5- Overbites (including openbites)
“MOCDO”
Dental Health Component (DHC)

DHC has 5 categories (with multiple sub divisions) :
Grade 1-2 = No need for treatment
Grade 3 = Moderate/borderline need for treatment
Grade 4-5 = Need treatment

GRADE 1 (No Need)
1. Extremely mild malocclusions including contact point
displacements < 1 mm

GRADE 2 (Little Need)
2.a Increased OJ > 3.5 mm ≤ 6 mm with competent lips
2.b Reverse OJ > 0 mm ≤1 mm
2.c Anterior/posterior crossbite ≤ 1 mm discrepancy RCP-ICP
2.d Contact point displacements > 1 mm ≤ 2 mm
2.e Anterior/posterior openbite > 1 mm ≤ 2 mm
2.f Increased OB ≥ 3.5 mm without gingival contact
2.g Pre-normal/post-normal occlusions with no other anomalies,
(includes up to ½ unit discrepancy)

GRADE 3 (Moderate Need)
3.a Increased OJ > 3.5 mm but ≤ 6 mm with incompetent lips
3.b Reverse OJ > 1 mm but ≤ 3.5 mm
3.c Anterior/posterior crossbites > 1 mm ≤ 2mm discrepancy between RCP- ICP
3.d Contact point displacements > 2 mm ≤ 4 mm
3.e Lateral /anterior open bites > 2 mm ≤ 4 mm
3.f Deep OB complete to gingival or palatal tissues but non traumatic

GRADE 4 (Great Need)
4.h Less extensive hypodontia requiring prerestorative ortho/or ortho
space closure to obviate need for prosthesis
4.a Increased OJ > 6 mm ≤ 9 mm
4.b Reverse OJ > 3.5 mm but no masticatory/speech problems
4.m Reverse OJ > 1 mm < 3.5 mm with masticatory/speech problems
4.c Anterior/posterior crossbites > 2 mm discrepancy between RCP – ICP

GRADE 4 (Great Need)
4.l Posterior lingual crossbites with no functional occlusal contact in one
or both buccal segments
4.d Severe contact point displacements > 4 mm
4.e Extreme lateral or anterior openbites > 4 mm
4.f Increased/complete OB with gingival/palatal trauma
4.t Partially erupted teeth, tipped/impacted against adjacent teeth
4.x Supernumerary teeth

GRADE 5 (Very Great Need)
5.i Impeded eruption of teeth (except for third molars) due to crowding,
displacement, supernumerary teeth, retained deciduous teeth and pathology.
5.h Extensive hypodontia with restorative implications (more than 1 tooth
missing in any quadrant) requiring prerestorative orthodontics
5.a Increased OJ > 9 mm
5.m Reverse OJ > 3.5 mm with reported masticatory/speech problems
5.p Cleft lip/palate and other craniofacial anomalies
5.s Submerged deciduous teeth (2 cusps visible or severe tipping adjacent teeth)

Ruler

• 1- attractive ! 10- least attractive,
• Grading:
Grades 1 – 3 = No/slight need for treatment
Grades 5 – 7 = Moderate/borderline need for treatment
Grades 8 – 10 = Need for treatment
• High levels of agreement found between patients, parents
and orthodontists (Evans and Shaw, 1987),
• No account taken of dentition within facial appearance or
direct psychological indexing.
Aesthetic Component (AC)

Aesthetic Component (AC)

APPENDIX
Index of Orthodontic Treatment Need (IOTN) (Brook and Shaw, 1989)

APPENDIX OF IOTN DHC
BUCCAL OCCLUSION
- Full unit I, II or III relationship are not recording.
CROSSBITE
. Anterior 1-3 incisors are in lingual occlusion
. Posterior cusp-cusp or in full crossbite
CROWDING
- If space between two teeth next to an unerupted tooth is ≤4 mm,
then this tooth is regarded as being impacted.

CONTACT POINT DISPLACEMENT
- Measured between anatomical contact points when teeth deviate from
the line of the arch
- NOTE displacements between deciduous and permanent teeth are NOT
recorded
IMPEDED ERUPTION
- Tooth unerupted due to close contact of adjacent teeth then DHC = 5.i
- Tooth not fully erupted to the occlusal plane but has tipped against its
adjacent tooth DHC = 4.t

OVERJET
- Most prominent incisor.
- Reverse OJ recorded when FOUR incisors are in lingual occlusion
ROTATION OF TEETH
- NOTE displacements between contact points of rotated teeth are NOT
recorded if they are in the line of the arch
SPACING
- NOT recording, Unless spacing associated with teeth deviating from
the line

SUBMERGING DECIDUOUS TEETH
- NOT recorded unless only two cusps visible and/or the adjacent
teeth are severely tipped towards each other.
PATH OF CLOSURE
- Discrepancies between ICP and RCP are recorded as with crossbites.
OPENBITES
- Measure GREATEST HEIGHT

- Patient can be asked to assess; “Here is a set of
t e n p h o t o g r a p h s s h o w i n g d e n t a l
attractiveness. Number 1 is the most and 10
the least attractive arrangement of teeth.
Where would you put your teeth on this scale?”
APPENDIX OF IOTN AC

IV. Indices of Treatment Outcome
1. Little’s Irregularity Index (Little, 1975)
2. Peer Assessment Rating (PAR) (Richmond et al.,1992)

Little’s Irregularity Index (Little, 1975)
• Assesses irregularity of LLS.
• Measures contact points displacement in mm, mesial to lower canines.
• Summed displacement of adjacent anatomical contact points of
mandibular teeth.

Indices of Treatment Outcome
Peer Assessment Rating (PAR) (Richmond et.al., 1992)

Peer Assessment Rating (PAR) (Richmond et.al., 1992)
• Over 6 meetings with 10 experienced orthodontists to formulate
PAR index by using over 200 SM (pre-/post-treatment),
• Zero = good alignment and higher scores (rarely above 50)
indicate increasing degrees of irregularity,
• Grade treatment results for self teaching device, however; it can be
insensitive and misjudge individual patient needs, therefore it is
not an index of treatment need.

COMPONENTS AND WEIGHTINGS
COMPONENTS WEIGHTINGS
Upper/lower anterior segment x 1
Left/right buccal occlusion x 1
Overjet x 6
Overbite x 2
Centerline x 4
• Greatly improve: > 22 points
• Improved: > 30%
• Worse/no different: < 30%

Ruler

Indices of Treatment Outcome, PAR
Advantages
• Accumulative scores,
• Gives grading treatment results,
• Reliable (Richmond et al., 1992),
• 2 minutes stated as time required for scoring.

Limitation (Hamdan and Rock, 1999)
• Sensitive with increased OJ
• OB low weighting
• Zero weighting for displacement

DESCRIPTION OF PAR

• Anterior segments
- ULS/LLS
- Recording zone = canine (mesial contact points)
- Recorded features: Crowding, Spacing, Impaction
- Contact point displacement:
SCORE DISPLACEMENT
0 0 mm – 1 mm
1 1.1 mm – 2 mm
2 2.1 mm – 4 mm
3 4.1 mm – 8 mm
4 > 8 mm
5 Impacted teeth

• Anterior segments
- Impactions of canines and incisors are recorded
- Impacted = space between two adjacent teeth is ≤ 4 mm
- Ectopic incisors and canines are recorded in the anterior segment
- Contact point displacement scores and impacted/ectopic teeth
scores are summed ! overall score for anterior segment

• Buccal occlusion
- Record left and right and in all three planes
- Recording zone = canine "! LAST molar (either 1st, 2nd or 3rd)
- All features recorded with teeth in occlusion
- A-P, VERTICAL and TRANSVERSE scores are summed for each buccal segment

Score A-P
0 good interdigitation
1 < ½ unit from full
2 ½ unit (cusp-cusp)

Score VERTICAL
0 no open bite
1 lateral open bite > 2 mm on at least two teeth

Score TRANSVERSE
0 no crossbite
1 crossbite tendency
2 single tooth in crossbite
3 > 1 tooth in crossbite
4 > 1 tooth in scissors bite
• Do NOT sum x-bites and x-bite tendency

• Overjet
- Record OJ and anterior crossbites,
- Recording zone most prominent incisal edge,
- Some patients have OJ and anterior x-bite..record both and summate score:
Score OJ Score Anterior crossbite
0 0-3 mm 0 No crossbite
1 3.1 – 5 mm 1 One or more teeth edge-edge
2 5.1 – 7 mm 2 One single tooth in x-bite
3 7.1 – 9 mm 3 Two teeth in x-bite
4 > 9 mm 4 > Two teeth in x-bite
NOTE: Canine crossbites recorded in OJ assessment

• Overbite
- Record worst vertical overlap OR openbite of ANY of the four incisors (DO
NOT summate)
OPEN BITE OVERBITE
Score Score
0 No open bite 0 ≤ 1/3rd Lower Incisor
1 ≤ 1 mm 1 > 1/3rd < 2/3rd Lower Incisor
2 1.1 mm – 2 mm 2 > 2/3rd Lower Incisor
3 2.1 mm – 3 mm 3 ≥ full tooth coverage
4 ≥ 4 mm

• Centerline
- Difference between upper and lower midlines recorded in RELATION TO
LOWER DENTAL MIDLINE and NOT face.
Score Centerline
0 Coincident and up to ¼ lower incisor width
1 ¼ - ½ lower incisor width
2 > ½ lower incisor width

Indices of Treatment Outcome, PAR- case analysis
• PRETREATMENT
ULS: (3-2) 1, (2-1) 0, (1-1) 0, (1-2) 1, (2-3) 2
Total = 4
Weighting 4 x 1 = 4
LLS: (3-2) 1, (2-1) 0, (1-1) 0, (1-2) 0, (2-3) 0
Total = 1
Weighting 1 x 1 = 1

• PRETREATMENT
• RBO: A-P = 0, Vertical = 0, Transverse = 0
Total = 0
Weighting 0 x 1 = 0
• LBO: A-P = 1, Vertical = 0, Transverse = 0
Total = 0
Weighting 1 x 1 = 1

• PRETREATMENT
• OJ: 10mm = 3, Crossbite = 0
Total = 3
Weighting 3 x 6 = 18

• PRETREATMENT
Either overbite or openbite
Overbite > 2/3rd of Lower Incisor =2
Total = 2
Weighting 2 x 2 = 4
CL: 1/2 Lower Incisor width = 1
Total = 1
Weighting 1 x 4 = 4
Total Pretreatment Score = 32 points

• POSTTREATMENT
ULS: (3-2) 0, (2-1) 0, (1-1) 0, (1-2) 0, (2-3) 0
Total = 0
Weighting 0 x 1 = 0
LLS: (3-2) 0, (2-1) 0, (1-1) 0, (1-2) 0, (2-3) 0
Total = 0
Weighting 0 x 1 = 0

• POSTTREATMENT
RBO: A-P = 1, Vertical = 0, Transverse = 0
Total = 1
Weighting 1 x 1 = 1
LBO: A-P = 0, Vertical = 0, Transverse = 0
Total = 0
Weighting 0 x 1 = 0

• POSTTREATMENT
OJ: 2mm = 0, Crossbite = 0
Total = 0
Weighting 0 x 6 = 0
Either overbite or openbite = 0
Total = 0
Weighting 0 x 2 = 0
CL: Coincident = 0
Total = 0
Weighting 0 x 4 = 0
Total Posttreatment Score = 1 point

Measurement the Treatment Outcome
Points:
Pretreatment score (32) – Posttreatment score (1) = 31
> 22 (Greatly Improved)
Percentage:
Pretreatment score reduced was from 32 to 1 in posttreatment;
therefore, the reduction was 31 points.
32-------------------31
100-----------------96.88
96.88 > 30% (Improved)

Indices of Treatment Difficulty/Complexity
• Determine who is best to treat a particular case (e.g.
GDP, Specialist or Consultant),
• To be used vary the payment for treatment depending on
difficulty/complexity,
1. Index of Complexity, Outcome and Need (ICON)
(Daniels and Richmond, 2000)

Indices of Treatment Difficulty/Complexity
1. Index of Complexity, Outcome and Need (ICON)
(Daniels and Richmond, 2000)

Indices of Treatment Outcome, ICON
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

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.

• 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

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

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

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

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

APPENDIX OF ICON

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.

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.

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.

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.

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.

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.

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.

Indices of Treatment Outcome, ICON case analysis
PRETREATMENT
AC: score = 5 Weighting 5 x 7
= 35
Overbite: score = 1
Weighting 1 x 4 = 4

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

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)

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

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

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)

CONCLUSIONS
- Safeguards for patients
e.g. . Mild crowding treated by extractions may lead to residual spacing, tipped teeth
and disturbed buccal occlusion,
. IOTN 1,2; unlikely to obtain dental health benefit.
- Patient may accept advice against treatment, if based on clinical
convention, rather than a personal view,
- IOTN/PAR for resource allocation/health….etc,
- Monitoring and promoting higher standard of care,
- AC and IOTN give a guide to professional in terms of patient’s
acceptance and ranking the dental attractiveness,
- Yet there is no such index or method that can serve for controlling the
quality and need of orthodontic treatment in ideal approach.

DIRECTIONS FOR RESEARCH
- PAR
- IOTN
- ICON
- PARIOTNICON
- MEASURING THE QUALITY
- COMPARISON BETWEEN POSTGRADUATE AND
SPECIALIST

Orthodontic Indices

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