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Indices

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Indices

  1. 1. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. 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 the 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 www.indiandentalacademy.com
  3. 3. Requirements of ideal orthodontic index are – (Jamison H.D. and Mc Millan R.S ) 1. Simple, reliable and reproducible. 2. Objective and yield quantitative data. 3. Differentiate b/w handicapping and non handicapping malocclusions. 4. Measure degree of handicap. 5. Quick examination. 6. Amenable to modifications. 7. Usable either on patient or on study model. www.indiandentalacademy.com
  4. 4.  Index should be equally sensitive throughout the scale  Index value should correspond closely with the clinical importance of the disease stage it present  Index value should be amendable to statistical analysis.  reproducible www.indiandentalacademy.com
  5. 5.  Requisite equipment and instrument should be practicable in actual field situation  Examination procedure should require a minimum of judgement  The index should be facile enough to permit the study of a large population without undue cost on time or energy  Index should be valid during time www.indiandentalacademy.com
  6. 6.  Occlusal Classification  Angle’s classification by Angle in 1899  Incisor classification by Ballard andWayman, 1964  Skeletal classification by Houston et al, 1993  Malocclusion  Occlusal index by Summers 1966  Handicapping Malocclusion Assessment Record (HMAR) by Salzmann, 1968  Index ofTreatment Need by Evans and Shaw 1987 www.indiandentalacademy.com
  7. 7.  Treatment assessment  Little’s irregularity index by Little 1975  Peer Assessment rating by Richmond et al, 1992  Cleft Outcome  GoslonYardstick 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 www.indiandentalacademy.com
  8. 8.  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 www.indiandentalacademy.com
  9. 9.  Treatment need (Treatment priority) indices.  Categorize malocclusion according to levels of treatment needs.  Eg 1. Index OfTreatment Need (IOTN) 2. Draker’s Handicapping Labio – Lingual Deviation index (HLD) 3. Grainger’sTreatment Priority Index.(TPI) 4. Salzmann’s Handicapping Malocclusion Index  Treatment outcome indices.  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) www.indiandentalacademy.com
  10. 10.  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. www.indiandentalacademy.com
  11. 11.  Proposed to select subjects with severe or handicapping malocclusions and dentofacial anomalies.  Applicable only to permanent dentition  First Orthodontic index to meet administrative needs of programme planners.  Made use of weighting factors developed by trial and error.  Had 9 components www.indiandentalacademy.com
  12. 12. Conditions observed HLD score 1. Cleft palate Score 15 2. SevereTraumatic deviations Score 15 3. Overjet in mm 4. Overbite in mm 5. Mandibular protrusion in mm x 5 6. Open bite in mm x 4 7. Ectopic eruption ,Anteriors only x 3 8. Anterior crowding : Maxilla 9. Anterior crowding : Mandible TOTAL www.indiandentalacademy.com
  13. 13.  Modification of earlier used HLD index  Main aim is to find presence or absence and degree of handicap caused by components of index.  Has 7 components.  All measurements are made with Boley gauge scaled in mm.  A score of 13 and over constitutes physical handicap www.indiandentalacademy.com
  14. 14. 1. Cleft palate 2. Traumatic deviations 3. Overjet 4. Overbite 5. Mandibular protrusion 6. Open bite 7. Labio Lingual spread Following codes are used –  ‘O’ = condition present  ‘X’ = condition absent  ‘M’= mixed dentition  ‘A’= Clinical approval  ‘D’=Clinical disapproval www.indiandentalacademy.com
  15. 15.  Used to assess severity of malocclusion in population  Nine weighted and defined measurements – 1. Molar relation 2. Over jet 3. Overbite 4. Posterior cross bite 5. Posterior open bite 6. Tooth displacement 7. Midline relation 8. Maxillary median diastema 9. Congenitally missing maxillary incisors. www.indiandentalacademy.com
  16. 16.  Seven malocclusion syndromes defined 1. Overjet and open bite 2. Distal molar relation, overjet, overbite, posterior crossbite, midline diastema and mid line deviation. 3. Congenitally missing maxillary incisors. 4. Tooth displacement. 5. Posterior open bite. 6. Mesial molar relation, overjet, overbite, posterior crossbite, midline diastema and mid line deviation. 7. Mesial molar relation, mixed dentition analysis (potential tooth displacement) and tooth displacement.  Different scoring schemes and forms for different stages of dental development: Deciduous, Mixed & Permanent dentition. www.indiandentalacademy.com
  17. 17.  The precursor of theTPI was the Malocclusion Severity Estimate (MSE) developed by Grainger at the Burlington Orthodontic Research Center in 1960-61  Unlike theTPI, the MSE score was that of the syndrome with the largest value, regardless of the scores of the other syndromes.  TheTPI also differed from the MSE by deleting potential tooth displacement (mixed-dentition space analysis) and by rating distoclusion and mesioclusion equally. www.indiandentalacademy.com
  18. 18.  11 weighted and defined measurements – 1. Upper anterior segment overjet. 2. Lower anterior segment overjet. 3. Overbite 4. Anterior openbite. 5. Congenital absence of incisors. 6. Distal molar relation 7. Mesial molar relation 8. Posterior cross bite (max. teeth buccal to normal). 9. Posterior cross bite (max. teeth lingual to normal). 10. Tooth displacement 11. Gross anomalies. www.indiandentalacademy.com
  19. 19. 1. Prognathism 2. Retrognathism 3. Overbite 4. Openbite 5. Maxillary expansion syndrome 6. Maxillary collapse syndrome 7. Congenitally missing incisors www.indiandentalacademy.com
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  21. 21.  TPI is based on a scale of 1. 0 (near ideal occlusion) 2. 1 - 3 ( mild malocclusion) 3. 4 – 6 ( Moderate malocclusion) 4. 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 www.indiandentalacademy.com
  22. 22.  The purpose of HMAR –To establish priority for treatment according to severity as shown by score.  Weighted measurements consists of 3 parts – 1. Intra arch deviations Missing teeth Crowding Rotation Spacing 2. Interarch deviations Overjet Overbite Crossbite Openbite Mesiodistal deviations www.indiandentalacademy.com
  23. 23. . Six handicapping dento-facial deformities 1. Facial and oral clefts 2. Lower lip palatal to maxillary incisors. 3. Occlusal interferences 4. Functional jaw limitations 5. Facial asymmetry 6. Speech impairment.  Score 8 points for each deviation. www.indiandentalacademy.com
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  26. 26.  Developed by 10 experienced British orthodontists.  Its developed mainly to assess effectiveness of Orthodontic treatment .  Assigns scores to different occlusal traits.  Study models used.  A scoring system was developed and a ruler designed to allow analysis of a set of study casts in 2 minutes. www.indiandentalacademy.com
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  28. 28.  5 components- Weighting 1. Upper & lower anterior segment - 1 2. Left and right buccal segments - 1 3. Over jet - 6 4. Overbite - 2 5. Centerlines - 4  Individual scores are summed to get a final score..  Index is applied to both the start and end of treatment study casts, and change in total score reflects the success of treatment. www.indiandentalacademy.com
  29. 29.  Change expressed as: 1. Reduction in weighted PAR score : 22 point reduction – Greatly improved 2. % reduction in weighted PAR score: < 30% reduction – worse/ no better > 30% reduction – Improved.  Indicator of clinical performance.  Limitations of PAR 1. Generic weightings of Over jet and overbite. 2. Sensitive to malocclusion with high over jet. 3. Overbite low weighting. 4. Zero weighting for displacements. 5. Facial profiles not considered Eg. Bimaxillary protrusion www.indiandentalacademy.com
  30. 30.  11 American Orthodontists examined a sample of 200 sets of study casts and rated them for malocclusion severity and perceived treatment difficulty.  The results of this study made it possible to derive a set of weightings for the PAR index that would represent groupings of malocclusion severity and treatment difficulty, according to perceptions of panel of Orthodontists. www.indiandentalacademy.com
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  32. 32.  Index has two components- 1. Dental Health component – derived from occlusion and alignment. 2. 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. www.indiandentalacademy.com
  33. 33.  A special ruler summarizes the information needed for dental health component.  Assessed in order : 1. Missing teeth 2. Overjet 3. Crossbites 4. Displacements (Contact point) 5. Overbite www.indiandentalacademy.com
  34. 34. According EVANS,MR,SHAW(1987,EU J ORTHOD)314-318 www.indiandentalacademy.com
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  36. 36. Grades 8 – 10 = definite need for treatment. 5 – 7 = moderate/ borderline need 1 – 4 = No/ slight need www.indiandentalacademy.com
  37. 37. 1. In aesthetic component ,Class III not considered. 2. Facial profile not considered. 3. Class I bimaxillary protrusion not considered. www.indiandentalacademy.com
  38. 38.  Based on expert opinions of 97 orthodontists from various countries.  For use on patients and Dental casts.  A single assessment method to record complexity, outcome and need. www.indiandentalacademy.com
  39. 39.  5 components taking about 1 min to measure. 1. Aesthetic component  10 pictures 2. Upper arch Crowding/ Spacing  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. 3. Crossbite 4. Incisor open bite/ overbite  Open bite measured at mid incisal edges  Deep bite is measured at deepest part of overbite. 5. Buccal segment Antero posterior  Quality of buccal segment interdigitation is measured (not Angles Classification) www.indiandentalacademy.com
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  43. 43. 1. Overjet not considered. 2. Lower anterior crowding not considered. 3. Midline shift not taken in account. www.indiandentalacademy.com
  44. 44.  This index is simple to use and faster than separate indexes for various facets of orthodontic treatment.  AJO(2007)onyeaso investigated relationship between ICON,DAI,PAR andABO objective grading system.  They found overall good assesment between the ICON and other indices. www.indiandentalacademy.com
  45. 45.  The purpose of this study was to develop a valid and reliable index that provides relatively objective judgments of dental-facial attractiveness.  The subjects in this study were eighth- and ninth- grade children. Few were seeking orthodontic treatment and few were not seeking treatment.  Photographs of the children were rated for dental- facial attractiveness by lay and dental judges. www.indiandentalacademy.com
  46. 46. Point 1 Point 2 Point 3 Point 4 Point 5 www.indiandentalacademy.com
  47. 47.  Children were also assessed for severity of malocclusion by means of theTreatment Priority Index  Children seeking treatment were perceived as significantly less attractive than children not seeking treatment.  The relationship between dental-facial attractiveness and overall severity of malocclusion is also established as proved by TPI scores. www.indiandentalacademy.com
  48. 48.  The GoslonYardstick is a clinical tool that allows categorization of the dental relationships in the late mixed and or early permanent dentition in to 5 discrete categories. www.indiandentalacademy.com
  49. 49.  Objective : 1. To categorize malocclusions in patients with UCLP to represent severity of malocclusion and the difficulty of correcting it. 2.To compare long term results of different approaches to the early treatment of children with UCLP. www.indiandentalacademy.com
  50. 50.  Development ofYardstick – Clinical features considered most important in characterizing malocclusion in children with UCLP are – 1. A- P arch relationship –Class III incisor relationship> class II div I 2. Vertical labial segment relationship – Open bite> Reduced overbite > deep overbite. 3. Transverse relationship – Canine crossbites > molar crossbites.  To test the application of these subjective criteria study models of 30 cases were taken.  These models were ranked by 4 orthodontists and separated in 5 groups , which then formed basis for yardstick. www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
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  56. 56.  Group 1 – excellent  Group 2 – good  Group 3 – fair  Group 4 – poor  Group 5 – very poor  Group 1 or 2 - simple orthodontic treatment/ no treatment  Group 3 – complex orthodontic treatment  Group 4 – limit of orthodontic treatment without orthognathic surgery  Group 5 – Orthognathic surgery www.indiandentalacademy.com
  57. 57.  American board of orthodontics(ABO)developed an index to represent the objective evalution of difficulty of a case presented for the phase III of ABO examination.  Index was called the descrepency index or DI  It evaluating dental models and cephalometric parametres. www.indiandentalacademy.com
  58. 58.  Clinical features of a patient’s condition include overjet,overbite,ant.open bite,lateral open bite,crowding,occlusion ,lingual posterior crossbite and buccal posterior crossbote.  Cephalometric parametres includeANB angle,IMPA angle and SN-GoGn angle. www.indiandentalacademy.com
  59. 59.  TheABO is considering several option for applying the descrepancy index to phase III clinical examination.  It can be applied on the condition like-  Missing or super numery teeth  Ectopic eruption  Transposition  Anomalies of tooth size and shape  CR-CO descrepancy, www.indiandentalacademy.com
  60. 60.  Skeletal asymmentry  Excessive curve of wilson. www.indiandentalacademy.com
  61. 61.  A quantitative method of evalution of the extent of abnormality from given standard requires grading the abnormality and assigning a score based on severity of problem,which is perceived by the degree of aesthetic/functional impairment produced.  Each index is designed with a definete purpose and should be valid in its application. www.indiandentalacademy.com
  62. 62. 1. Contemporary Orthodontics – Proffit 2. Longitudinal evaluation of theTreatment Priority Index (TPI) AJO-DO 1989 3. Goslon yardstick:A new system of assessing dental arch relationships in childeren with UCLP – Michael Mars, Dennis A. Plint : 1987 A cleft Palate journal 4. A dental-facial attractiveness scaleTedesco , Albino, Cunate AJO-DO 1983 5. The Development of PAR Index – S. Richmond 6. Relationship b/Wondex of ICON,DAI,PAR and ABO index,...onyeaso;ajo 2007 www.indiandentalacademy.com
  63. 63. Thank you www.indiandentalacademy.com
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  77. 77. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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