Download Assessment of malocclusal traits using the index of complexity

Sagarkar et al
International Journal of Public Health Dentistry
RESEARCH ARTICLE
Assessment of malocclusal traits using the index of complexity, outcome and need (icon) index in
orthodontic patients reporting to a private practice
Anitha.R.Sagarkar, Roshan.M.Sagarkar, Appasaheb Naragond, R.Prashanth, V.N.Parameswaran
Abstract
Aims & Objectives: This study attempts to evaluate the usefulness of an index of complexity, outcome and treatment need
(ICON) in a group of orthodontic patients reported to a private practice. Materials & Methods: A total of 175 consecutively
treated patients identified from the Private or thodontic practice over a period of one year were selected and analysed as per
the ICON Index. Statistical analysis was done using SPSS Package-17 version. Results: Among males majority of them
showed substantial improvement; 59(86.7% ) in their treatment, followed by 7(10.2% ) greatly improved cases and 2(2.9% )
moderately improved cases. Amongst females majority of them were modera tely improved cases; 88(82.2% ), followed by
10(9.3%) substantially improved cases and 9(8.41% ) greatly improved cases. Conclusion: It was observed from this study
that, ICON index can be considered comprehensive enough for assessing the malocclusal traits amongst the patients.
Key Words: Adolescents; ICON (The Index of Complexity Outcome and Need); Pre and Post Treatment.
Introduction
In dentistry, the provision of or thodontic
treatment has been routinely justified on the grounds of
potentially improving dental aesthetics, dental health,
occlusal functioning, and psychosocial adjustment
(1). Numerous indices have been developed since the
1960s either to rank or score the severity of a
malocclusion relative to a preconceived orthodontic
ideal, or in ter ms of treatment need (1, 2). None of these
indices have been developed and validated for both the
deviation from nor mal occlusion and treatment need.
The limitations of these various indices have been
recognised for some time but, they are still being used to
evaluate the results of treatment. Since these known
orthodontic indices were not comprehensive enough, the
Index of Complexity, Outcome and Need was introduced
(1). The index takes into account five components: the
aesthetics, upper arch crowding/spacing, crossbite,
incisor open bite/overbite and buccal segment anterior
posterior relationship (3).
This study attempts to evaluate the usefulness of an
index of complexity, outcome and treatment need
(ICON) in assessing the malocclusal traits,
compreensively in a group of or thodontic patients
reporting to a private practice. The ICON attempts to
incorporate the patient’s and clinician’s perceptions of
orthodontic treatment into a single index.
Materials & Methods
Sample: A total of 175 consecutively treated
patients were identified from the Private or thodontic
practice over one year time per iod. Pre - (T 0) and post (T 1) treatment dental casts of 175 patients were
randomly selected from the patient archive of the private
practice.
Inclusion criter ia: Patients treated exclusively
by only practicing Or thodontists were included in this
1
study, with the pr ior consent from the patients. The study
sample met the following inclusion criteria:
(1) Permanent dentition,
(2) Apparently normal crown morphology (casts showing
gross abnormalities were excluded), and
(3) No features that would alter the natural mesio-distal
or bucco-lingual crown diameter, such as restorations,
caries, attrition, or fracture. The dental casts represented
a spectrum of malocclusion types and severity before
and after treatment.
Exclusion criteria: Those who had discontinued
the treatment due to various reasons were excluded
from the study. Patients w ith clefts and other craniofacial
deformities were excluded.
Tools:The measurements used were those
described in computing the ICON Index (1).
Statistical Analysis: The statistical analysis
was done using SPSS Package Version 17. The various
components of the ICON have different scales. Some
components result in ordinal data (e.g. upper arch
crowding/spacing crossbite), while other components are
recorded on a metric scale (AC, incisor overbite, and
sagittal relationship of the buccal segment, total score,
and weighted score). The data were analyzed using
descriptive and analytical methods for analysis.
Results:
There were totally 175 adolescents who
showed varied types of malocclusal traits, which was
assessed using ICON index. Table 1 shows
categorisation of the male, 68(38.2% ) and maximum
being females 107 (60.1%), who had reported for the
orthodontic intervention to the clinic.
Total Sample
Males
Females
175
68(38.2%)
107 (60.1%)
Table 1. Gender Wise Distribution of the Sample
The patients reporting to the clinic were
classified based on five point complexity scale,
International Journal of Public Health Dentistry 2011:2(2):1-3. © Publishing Division, Celesta Software Private Limited
Sagarkar et al
International Journal of Public Health Dentistry
N
Simple
Mild
Moderate
Difficult
Very difficult
Males
68
0 (0%)
50(73.5%)
5 (7.3%)
7(10.2%)
6(8.8%)
Females
107
0(0%)
70 (65.4%)
10(9.34%)
17(15.88%)
10(9.34%)
Table 2. Gender w ise distribution of the sample according to the fiv e point complexity scale
N
Not improv ed/Worse
Minimally improvedModerately improved
substantially improved
Greatly improved
Males
68
0 (0.0%)
0(0.0%)
2(2.94%)
59(86.76%)
7(10.2%)
Females
107
0(0.0%)
0(0.0%)
88(82.24%)
10(9.34%)
9(8.40%)
Table 3. Gender w ise distribution of the sample according to the fiv e point scale of assessing treatment outcome
presented in table 2, of which 50(73.5% ) of males and
70(65.4%) of females presented with mild for m of
complexity. This was followed by difficult form, with
17(15.88% ) of females and 7(10.2% ) of males. There
were in fact 10(9.34% ) of females and 6(8.8% ) of males
who reported with the very difficult type of complexity
scale, which was of very much significance in future to
assess the orthodontic treatment outcome.
Professionally defined or thodontic treatment
need according to the ICON value (with score >31) were
considered as the cut-off value for the treatment need.
Considerations for the treatment outcome were given as
follows: Among males majority of them showed
substantial improvement 59(86.76% ) in their treatment,
followed by 7(10.2% ) greatly improved cases and
2(2.94%) moderately improved cases. Amongst females
majority of them were moderately improved cases
88(82.24% ), followed by 10(9.34%) substantially
improved cases and 9(8.40% ) greatly improved cases
(table 3).
Discussion
The results of this study shed some light on
the pattern of malocclusion that is seen in Bagalkot
district which is dominant mainly of displacement, cross
bite, deep bite and increased overjet. However, larger
scale studies are required to evaluate the actual pattern
of malocclusion, via conducting survey studies on a
random sample. The age group targeted in the present
study were mainly adolescents, which were different
than most of the previous indices, which were conducted
on children and adolescents which moderately reflects
the subjective perception of dental aesthetics and
demand for orthodontic treatment (1, 2, 4).
Most studies on patterns of malocclusion and need
for orthodontic treatment have been described regarding
groups of children and orthodontic treatment need. The
need of professionally defined orthodontic treatment,
assessed according to IC ON (with score >43) in our
study was similar to the findings in other studies (2, 5, 6) .
The findings of these studies between countries cannot
be directly compared not only because of the difference
in the assessment methods, but also due to the
2
difference in the study design and the access to
orthodontic treatment in public care system. Taking into
account the literature and present data, there could be a
reason for the assumption that the severity of
malocclusion and complexity of or thodontic treatment
need can be optimally assessed using this index.
Actually, it is necessary to do a more detailed
investigation on the factor s influencing the development
of the severity of malocclusions and requiring an
interdisciplinary approach of treatment on adolescents in
future.
Limitations of using ICON index for the analysis of the
malocclusal triats:
1. It was observed through our study that, ICON index
doesn’t give any considerations for the
Cephalometric findings.
2. Discussions have been done only on crowding
while rotations are not taken into consideration.
3. Total space analysis has been not considered.
Conclusion
It was observed from this study that, ICON
index can be considered comprehensive enough for
assessing the malocclusal traits amongst the patients.
All groups presented mainly moderate severity of
malocclusion what corresponds with mild complex ity
grade of orthodontic treatment, while further detailed
surveys are required for a thorough analysis.
Affiliations of authors: 1. Dr. Anitha.R.Sagarkar, MDS,
Reader, Dept. of Public Health Dentistry, 2. Dr.
Roshan.M.Sagarkar,MDS, Reader, Dept. of Orthodontics, 3.
Dr. Appasaheb Naragond,MDS, Senior Lecturer, Dept. of
Orthodontics, PMNM Dental College and Hospital, Bagalkot, 4.
Dr. R. Prashanth,MDS, Assistant Professor, Dept. of
Orthodontics, Govt. Dental College and Research Institute,
Bellary, 5. Dr. V.N.Parameswaran,MDS, Assistant Professor,
Dept. Of Orthodontics, Mahatma G andhi Postgraduate Institute
of Dental Sciences, Pondicherry, India.
Conflict of Interest:
The author(s) declared no conflict of interests.
Source of Funding: Nil
International Journal of Public Health Dentistry 2011:2(2):1-3. © Publishing Division, Celesta Software Private Limited
Sagarkar et al
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International Journal of Public Health Dentistry
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Corresponding Author
Dr.Anitha R.Sagarkar,MDS,
Reader,
Dept. of Public Health Dentistry,
PMNM Dental College and Hospital,
Bagalkot, Karnataka, India.
Ph: +919448520027.
Email: [email protected]
International Journal of Public Health Dentistry 2011:2(2):1-3. © Publishing Division, Celesta Software Private Limited