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Occlusal Indices: Dr. Rajshekhar Banerjee Dept. of Orthodontics and Dentofacial Orthopaedics, Absmids
Occlusal Indices: Dr. Rajshekhar Banerjee Dept. of Orthodontics and Dentofacial Orthopaedics, Absmids
INDICES
Dr. Rajshekhar Banerjee
Dept. of Orthodontics and
Dentofacial Orthopaedics,
20-4-2018
ABSMIDS
Contents
1. Introduction
2. Ideal requisites
3. Types of Indices
4. Index of Orthodontic Treatment Need (IOTN)
5. Peer Assessment Rating Index (PAR)
6. Handicapping Malocclusion Assessment Rating
7. Dental Aesthetic Index
8. Orthodontic Treatment Priority Index
9. Occlusal Index
10. Handicapping Labio-Lingual Deviation Index
11. ABO Objective Grading System
12. Index of Complexity Outcome & Need (ICON)
13. Treatment Difficulty Index
14. Conclusion
15. References
Introduction
Definition
2. Validity
3. Reliability
4. Quantifiability
5. Sensitivity
6. Acceptability
■ A) Diagnostic classification :
Eg - Angle’s classification being used to
describe incisor and buccal segment
relationships.
These classifications serve their purpose
reasonably well, allowing ease of
communication between orthodontists.
Types of Indices
■ B) Epidemiologic indices :
Records every trait in a malocclusion to
allow estimation of the prevalence of
malocclusion in a given population.
Eg. - Summer’s occlusal index, Little’s
Irregularity index.
Types of Indices
■ Grade I
■ Grade II No need for
treatment
■ Grade III Borderline
■ Grade IV Definitive need
■ Grade V
Modification of IOTN
■ In the aesthetic component (AC) the 10 point
scale was reduced to a 3 point scale.
■ It has 2 components:
○ Clinical component
○ Esthetic component
Dental Aesthetic Index (DAI)
Overjet:
Measured perpendicular to coronal plane.
Tooth displacement :
Sum of the number of teeth noticeably
rotated or displaced from ideal alignment,
plus 2 times the number of teeth rotated
more than 45º or displaced more than 2mm.
Orthodontic Treatment Priority Index (TPI)
Buccal/lingual crossbites:
Number of maxillary teeth in the buccal
segments (according to their position).
Measurement is positive for buccal crossbite,
negative when lingual crossbite is observed.
Orthodontic Treatment Priority Index (TPI)
0 - 1 : No treatment need,
2 – 3 : Minimal need,
4 – 6 : Moderate need,
>6 : definite need.
The Occlusal Index
The Occlusal Index
■ Non mixed
• 1.5 – 2mm deviation or 35º to 45º of
rotation . Scored as 1 or single weight.
• B) >2mm deviation or >45º of rotation.
Scored as 2 or double weight.
7. Tooth Displacement
■ Mixed dentition :
1. Tooth displacement not associated with space
deficiency: Deviation 1.5mm or more or rotated
35º or more. These teeth are weighted (1 or 2) ,
as in displacement scoring procedure for non
mixed dentition.
2. Tooth displacement associated with space
deficiency: Assess space deficiency by
measuring mesio-distal widths of permanent
teeth & subtract the length of arch perimeter.
7. Tooth Displacement
■ 3 planes –
Sagittal plane,
F–H plane ,
Orbital plane
are the basis for
the HLD index
measurements.
Handicapping Labio-lingual Deviation Index
4. Overbite :
Measurement is
rounded off to the
nearest mm &
recorded.
Components
0 = Condition absent
X = Condition present
M = Mixed dentition (to be indicated if
present)
A = Clinical approval
D = Clinical disapproval
ABO Objective
Grading System
(OGS)
Objective Grading System (OGS)
1. Alignment
2. Marginal ridges
3. Buccolingual inclination
4. Occlusal relationships
5. Occlusal contacts
6. Overjet
7. Interproximal contacts
8. Root angulation
1. Alignment
■ MODEL ANALYSIS
1. Alignment
• If all teeth are in alignment or within 0.50 mm of
proper alignment, no points are subtracted from
the candidate’s score.
GUIDE FOR GRADING CLINICAL CASE
REPORTS
2. Marginal Ridge
• The marginal ridge will be considered as the
most occlusal point that is within 1 mm of the
contact at the occlusal surface of adjacent teeth.
• If adjacent marginal ridges deviate from 0.50 to 1
mm , then 1 point shall be subtracted for that
interproximal contact.
• If the marginal ridge discrepancy is greater than
1 mm , then 2 points shall be subtracted for that
interproximal contact
GUIDE FOR GRADING CLINICAL CASE
REPORTS
3. Buccolingual Inclination
• Assessed by using a flat surface that is extended
between the occlusal surfaces of the right and left
posterior teeth.
4. Occlusal Contacts
• If the cusps are in contact with the opposing arch,
no points are deducted. If a cusp is out of contact
with the opposing arch and the distance is 1 mm
or less , then 1 point is subtracted for that tooth.
• If the cusp is out of contact and the distance is
greater than 1 mm , then 2 points are subtracted
for that tooth. No more than 2 points are
subtracted for each tooth.
GUIDE FOR GRADING CLINICAL CASE
REPORTS
5. Occlusal Relationship
• If the maxillary buccal cusps deviate between 1
and 2 mm from the positions, then 1 point shall
be subtracted for that tooth.
• If the buccal cusps of the maxillary premolars or
molars deviate by more than 2 mm from ideal
position , then 2 points shall be subtracted for
each tooth that deviates.
• No more than 2 points shall be subtracted for
each tooth.
GUIDE FOR GRADING CLINICAL CASE
REPORTS
6. Overjet
• If the mandibular buccal cusps deviate 1 mm or
less from the center of the opposing tooth , 1
point is subtracted for that tooth.
• If the position of the mandibular buccal cusps
deviates more than 1 mm from the center of the
opposing tooth , two points are subtracted for
that tooth.
• No more than 2 points are subtracted for any
tooth.
GUIDE FOR GRADING CLINICAL CASE
REPORTS
7. Interproximal Contacts
• If no interproximal spaces exist, then no points
are subtracted.
• If up to 1 mm of interproximal space exists
between two adjacent teeth , then 1 point is
subtracted.
• If more than 1 mm of space is present between
two teeth , then 2 points are subtracted
GUIDE FOR GRADING CLINICAL CASE
REPORTS
■ RADIOGRAPHIC ANALYSIS
Root Angulation
• The roots of the maxillary and mandibular teeth
should be parallel to one another and oriented
perpendicular to the occlusal plane .
• If this situation exists or if a deviation of the apex
is 1 mm or less, then no points are subtracted.
GUIDE FOR GRADING CLINICAL CASE
REPORTS
1. Dental Aesthetics
○ The dental aesthetic component of the IOTN (Shaw
et al.,1991a) is used.
○ The dentition is compared to the illustrated scale
and a global attractiveness match is obtained
without attempting to closely match the
malocclusion to a particular picture on the scale.
The scale works best in the permanent dentition.
○ The scale is graded from 1 for the most attractive to
10 the least attractive dental arrangement. Once this
score is obtained it is multiplied by the weighting of
7.
COMPONENTS
2. Crossbite
i. Present if a transverse relation of cusp to cusp
or worse exists in the buccal segment. This
includes buccal and lingual crossbites
consisting of one or more teeth, with or without
mandibular displacement.
ii. If crossbite is present, a raw score of 1 is given
which is multiplied by the weighting of 5.
iii. A score of 0 is given if crossbite is not present.
COMPONENTS
1. Rotation.
2. Angulation to midline.
3. Age of patient.
4. Coincidence of arch midlines.
5. Alignment and spacing of the upper labial
segment.
6. Vertical height.
7. Bucco-palatal position.
8. Condition of primary canine.
9. Missing teeth.
10. Horizontal position.
To simplify calculation of a treatment difficulty
score, regression coefficients were rounded to the
nearest half to produce the regression equation:
Difficulty score
= Constant –8 + Horizontal position 2.0 + Age
1.5 + Vertical height 1.5 + Bucco-palatal
position 1.5 + Rotation 1.0 + Midline 1.0 +
Angulation 1.0 + Alignment 0.5
Comparing and contrasting two orthodontic indices, the Index
of Orthodontic Treatment Need and the Dental Aesthetic Index