Relationship between index of complexity, outcome and need, dental aesthetic index, peer assessment rating index, and American Board of Orthodontics objective grading system

Evaluating Dental Monitoring effectiveness compared with conventional monitoring of clear aligner therapy using the Peer Assessment Rating index

INTRODUCTION

This study aimed to evaluate the effectiveness of Dental Monitoring (DM) (Dental Monitoring SAS, Paris, France) compared with conventional monitoring (CM) during active orthodontic treatment.

METHODS

The Peer Assessment Rating (PAR) index was used to evaluate the pretreatment and posttreatment records of 51 patients, with 26 in the CM group and 25 in the DM group. The change in weighted PAR was analyzed to assess the effectiveness of treatment.

RESULTS

The chi-square test revealed that the CM group had a higher percentage of patients in the great improvement category compared with the DM group. However, this difference was not statistically significant (P = 0.192). A repeated measures general linear model demonstrated significant improvement over time (P <0.001), with no statistically significant group differences noted between CM and DM (P = 0.181) and no statistically significant time-by-group interaction (P = 0.299).

CONCLUSIONS

Both CM and DM showed significant improvements in weighted PAR scores, but no statistically significant difference is present between the 2 groups.

Malocclusion complexity as an associated factor for temporomandibular disorders. A case-control study

OBJECTIVE

To evaluate the association between temporomandibular disorders (TMD) and malocclusion complexity using the Index of Complexity Outcome and Need (ICON) levels.

METHODS

A prospective, cross-sectional, case and control study was done. Cases and controls were matched in a one-to-one relationship (179 subjects each). The Research Diagnostic Criteria was used to evaluate the presence of TMD, and the ICON was used to quantify malocclusion complexity. A binary logistic regression (p < 0.05) was used to identify associations between variables.

RESULTS

TMD presence was associated with gender and malocclusion complexity (p < 0.05). The largest proportion of controls were in the lowest three levels of ICON complexity, while most cases were in the three highest levels (p < 0.001). Higher malocclusion complexity indicated a greater TMD risk.

CONCLUSION

The results indicate that TMD is associated with malocclusion complexity. As malocclusion complexity increases, so do the odds of presenting with TMD.

Malocclusion Complexity in Patients with Disc Displacement Disorders: A Case-Control Study

This study aimed to determine the possible association between disc displacement (DD) disorders and malocclusion complexity. This cross-sectional study was carried out using a case-control design. The Research Diagnosis Criteria for Temporomandibular Disorders were used to identify cases and controls. The Index of Complexity, Outcome, and Need (ICON) was used to quantify malocclusion complexity as easy, mild, moderate, difficult, or very difficult. A total of 310 subjects were included: 130 cases and 180 controls. A binary logistic regression (p < 0.05) was used to identify associations. The odds ratio (OR) was also calculated. DD was associated with sex, age, and malocclusion complexity (p < 0.05). The malocclusion complexity comparison showed that 89.3% of the controls fell within the easy-moderate levels of the ICON, whereas 85.4% of the cases were in the moderate-very difficult levels (p ≤ 0.001). Difficult and very difficult malocclusions had high ORs (9.801 and 9.689, respectively) compared to the easy cases. In conclusion, patients with malocclusion complexity levels classified as difficult or very difficult have greater odds of presenting DD.

Subjective and objective analysis of orthodontic expert consensus on the assessment of orthodontic treatment outcomes

OBJECTIVE

The objective of the study was to explore and validate the consensus of orthodontic experts on the assessment of orthodontic treatment outcomes based on subjective and objective analysis.

MATERIALS AND METHODS

The research consisted of two parts: the exploration and verification of expert consensus. First, a sample of 108 cases randomly selected from six dental schools in China were evaluated by 69 orthodontic experts and measured by researchers based on post-treatment study casts and lateral cephalograms, respectively. Then, through statistical analysis, the objective indicators significantly correlated with experts' subjective evaluations were selected, their weights were determined, and the critical values of satisfactory, acceptable and unacceptable grades were screened. Subsequently, another sample of 72 cases were evaluated by another 36 orthodontic experts, and the subjective evaluation results were compared with the objective measurement results.

RESULTS

There were six model indicators and seven cephalometric indicators being significantly correlated with the experts' subjective evaluations, including occlusal contact, overjet, midline, interproximal contact, alignment, occlusal relationship, L1/NB, ANB, SN/OP, U1/SN, LL-EP, Cm-Sn-UL and Ns-Prn-Pos, with a cumulative R² of 0.704. In the verification part, the correlation coefficient between the 36 experts' subjective scores and objective regression scores was 0.716 (P < .001); the correlation coefficient between the 36 experts' subjective grades and objective grades was 0.757 (P < .001).

CONCLUSIONS

Orthodontic experts had good consistency in the subjective evaluation of the combined records of post-treatment study casts and lateral cephalograms. The objective indicators selected from subjective and objective analysis had good reliability and validity and could further improve the existing occlusal indices.

Malocclusion Complexity in Patients with Myofascial Pain with or without Mouth-Opening Limitation: A Case-Control Study

Background

This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity.

Methods

A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (n = 76, group A) and subjects with mouth-opening limitation (group B, n = 20). Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables.

Results

Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain.

Conclusions

Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain.

American Board of Orthodontics (ABO) Discrepancy Index and peer assessment rating (PAR) index with models versus photographs

BACKGROUND

The objectives of this study were to determine whether rating systems, such as the Peer Assessment Rating (PAR) and the American Board of Orthodontics Objective Grading System (ABO-OGS) can be applied to intraoral photographs.

METHODS

Models and photographs of 50 cases were graded by 4 raters, and a 20% repeat of randomized cases was completed 2 weeks later. Intraclass correlation coefficients (ICCs) were used to assess inter- and intra-rater agreements, as well as the level of agreement between the ratings on models and photographs.

RESULTS

The intra- and inter-rater agreements were considered good to excellent. The paired mean difference (model minus photo) for the PAR index and the ABO Discrepancy Index as a total was 2.405 and 1.156, respectively. Overjet was the subdomain that produced the highest differences between photos and models. The ABO- Discrepancy Index method on photographs was more reliable than the PAR index when grading pre-treatment and more-severe malocclusions.

CONCLUSIONS

Both methods can be used, but the choice depends on the purpose of the evaluation, and on consideration of the weaknesses and strengths of each relating to its use on photographs.

Consistency and Reliability Analyses of a Comprehensive Index for the Evaluation of Teeth Alignment Performance

(1) Introduction: The purpose of this work was to describe a method and propose a novel accuracy index to assess orthodontic alignment performance. (2) Methods: Fifteen patients who underwent orthodontic treatment using directly printed clear aligners were recruited. The study sample included 12 maxillary and 10 mandibular arches, whose pre-treatment, predicted and post-treatment digital models were superimposed on the untreated posterior teeth by means of a best-fit surface-based registration, which was also used to transfer three anatomical landmarks, digitally labeled on the crown of each anterior moving tooth, from the pre-treatment to the predicted and post-treatment models. The Teeth Alignment Performance (TAP) index, quantifying how close the final landmarks were to their expected final position, was proposed as an accuracy index of both individual tooth and group of teeth movement, and its inter-examiner repeatability was tested. (3) Results: No systematic inter-rater discrepancy associated with TAP was observed (p > 0.05), not even when a slight systematic inter-rater difference in landmark labelling was detected (for the upper central incisors, p < 0.001). In addition, all Intra-class Correlation Coefficient (ICC) values showed excellent inter-rater agreement (>0.95), and the small Random Error of Measurement (REM), ranging from 1% for the arch TAP to 3% for the lower canine TAP, indicated that this accuracy index is highly repeatable. (4) Conclusions: The TAP index was proven to be comprehensive, consistent and reliable in assessing the performance of teeth alignment according to a digital plan. The proposed method is also suitable to be implemented in the clinical digital workflow.

Comparison of treatment outcomes as assessed by 3 indexes in subjects with Class I malocclusion treated by 3 different methods: A cross-sectional study

INTRODUCTION

Various treatment modalities exist to improve and correct Class I malocclusion. This study was conducted to evaluate the outcomes of nonextraction (NE), premolar extraction (PME), and mandibular incisor extraction (MIE) treatment modalities in subjects presenting with Class I malocclusion.

METHODS

A cross-sectional study was conducted at a tertiary care hospital using pretreatment and posttreatment dental casts along with intraoral photographs of 90 orthodontic subjects. These subjects were divided equally into NE, PME, and MIE groups and scored using the Index of Orthodontic Treatment Need, Index of Complexity, Outcome, and Need (ICON), and peer assessment rating (PAR) indexes. Nonparametric tests were run to compare pretreatment and posttreatment scores and to evaluate the percentage and categorical changes for the treatment modalities. Pairwise comparisons were performed using the Mann-Whitney U test.

RESULTS

Statistically significant differences (P ≤0.001) were seen between the pretreatment and posttreatment scores for all modalities. Statistically significant improvements were seen between the 3 treatment modalities for the PAR (P = 0.010) and ICON (P = 0.003) indexes. Significant categorical improvements were found for the Aesthetic Component (AC) (P = 0.012) among the 3 groups. Pairwise comparison revealed significant differences between the NE and MIE groups (ICON, P = 0.001; AC, P = 0.018) and PME and MIE groups (PAR, P = 0.002; ICON, P = 0.007; AC, P = 0.007).

CONCLUSIONS

Posttreatment scores of all indexes were reduced, with significant differences found among the treatment modalities for all except the Dental Health Component index. The pairwise comparison revealed suboptimal occlusal results with the MIE group. Good occlusal and esthetic treatment outcomes were achieved with the PME and NE groups.

Effects of self-ligating brackets and other factors influencing orthodontic treatment outcomes: A prospective cohort study

Objective

The purpose of this study was to evaluate the effects of self-ligating brackets (SBs) and other factors that influence orthodontic treatment outcomes.

Methods

This two-armed cohort study included consecutively treated patients in a private practice. The patients were asked to choose between SBs and conventional brackets (CBs); if any patient did not have a preference, he or she was randomly allocated to the CB or SB group. All patients were treated using an identical archwire sequence. Evaluated parameters were as follows: treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, extraction, use of orthodontic mini-implants (OMI), OMI failure, American Board of Orthodontics (ABO) Discrepancy Index (DI), arch length discrepancy, and ABO Cast-Radiograph Evaluation (CRE) score. Stepwise regression analysis was performed to generate the equation for prediction of the CRE.

Results

The final sample comprised 134 patients with an average age of 22.73 years. The average DI, CRE, and treatment duration were 21.81, 14.25, and 28.63 months, respectively. Analysis of covariance showed a significant difference in CRE between the CB and SB groups after adjusting for the effects of confounding variables. Stepwise regression analysis using four variables, namely extraction, SB use, poor elastic wear, and additional appliance use, could explain only 25.2% of the variance in the CRE.

Conclusions

Although the CRE was significantly better for CBs than for SBs, the clinical significance of this result seems to be limited. Extraction, SB use, poor elastic wear, and additional appliance use may have significant effects on treatment outcomes.

The effect of orthodontist change on treatment duration and outcomes

INTRODUCTION

This retrospective study aimed to evaluate whether there are differences in the duration of treatment and the quality of treatment results between patients whose entire treatment process is carried out by a single operator and those patients who are transferred to a second operator.

METHODS

One hundred twenty-three patients whose fixed orthodontic treatments were completed and included in the study, and their posttreatment plaster models and panoramic radiographs were used. Fifty-nine of the subjects were transfer patients, and their treatment was administered by 2 residents (transfer group). For the remaining 64 patients, all the treatment was carried out by a single resident (control group). Each group was further divided into 2 groups according to the treatment modality, resulting in 4 groups (nonextraction transfer group [n = 27], extraction transfer group [n = 32], nonextraction control group [n = 32], and extraction control group [n = 32]). The quality of the treatment outcomes was evaluated and compared using the American Board of Orthodontics cast-radiograph evaluation (CRE).

RESULTS

The total mean CRE scores in the nonextraction transfer and nonextraction control groups were 35.74 and 29.88, respectively. The means of treatment duration in the nonextraction transfer and nonextraction control groups were 32.7 months and 17.25 months, respectively. The total mean CRE scores in the extraction transfer and extraction control groups were 39.53 and 31.41, respectively. The means of treatment duration in the extraction transfer and extraction control groups were 34.38 and 22.94 months, respectively. Differences between all the compared pairings were statistically significant.

CONCLUSIONS

The transferred patients had longer treatment times and poorer treatment quality than the control group patients.

Index of Complexity, Outcome, and Need (ICON) in Dubai school-aged adolescents

Objectives:

The purpose of the study was to epidemiologically assess the prevalence of malocclusion and orthodontic treatment need in school-aged adolescents in Dubai using the Index of Complexity, Outcome, and Need (ICON). Null hypothesis tested was no significant differences in ICON scores among Dubai students as a function of gender or geographic/ethnic background.

Materials and Methods:

The sample was 17,763 adolescents with nearly equal by gender; India and the United Arab Emirates were represented about the same. Scores for malocclusion from Peer Assessment Rating (PAR) index evaluations combined with the esthetic component of the Index of Orthodontic Treatment Need (IOTN) comprised the ICON score.

Results:

Male ICON scores were significantly greater than female scores. Three scores contributing to ICON were significantly higher in males, i.e., buccal anterior-posterior occlusion, incisor overbite, and esthetic component. ICON scores for South Asia were significantly higher than the Middle East, i.e., 59.9 versus 52.4, P = 0.000. ICON scores were no different for the UAE males and females but otherwise significantly different (>) as follows: Indian males > Indian females > UAE males = UAE females.

Conclusions:

Dubai school-aged adolescents treatment need is the same for the UAE males and females, but there is a significantly greater orthodontic treatment need for males and females from India.

Salivary protein biomarkers associated with orthodontic tooth movement: A systematic review

OBJECTIVE

Saliva can provide a non-invasive approach to indicate changes in the oral and systemic conditions. Salivary proteomics allows the discovery of new protein biomarkers associated with certain conditions. The effectiveness and physiological effects of orthodontic tooth movement in theory can be measured using salivary protein biomarkers.

SETTING AND SAMPLE POPULATION

This study applied a systematic review to analyse current literature to define and summarize salivary biomarkers associated with orthodontic tooth movement identified by mass spectrometry proteomics and other protein detection techniques.

MATERIALS AND METHODS

Peer-reviewed articles published through the 15th of November 2018 via the PubMed, EMBASE, Web of Science and Dentistry & Oral Sciences databases were reviewed. Only studies analysing protein biomarkers in saliva samples collected from human subjects associated with orthodontic treatments were included.

RESULTS

Out of 482 articles, 7 studies were selected. Sample size ranged from 3 to 72 subjects. Minor variations of unstimulated whole saliva sample collection protocol were noted. Mass spectrometry proteomics and ELISA represented the majority of biomarker discovery and targeting, respectively. Twenty biomarkers were identified or chosen as target biomarkers.

CONCLUSION

Salivary proteins may be used to indicate effectiveness of orthodontic treatment and orthognathic treatment as well as adverse treatment consequence, such as root resorption.

Peer Assessment Rating (PAR) Index as an Alternative for Orthodontic Treatment Need Decision in Relation to Angle Classification

OBJECTIVE

This study aimed to determine cut-off points for the Peer Assessment Rating (PAR) index in relation with Angle classification to use as an alternative index for the treatment need assessment.

METHODS

This study included 607 orthodontic patients aged between 9 and 18 years. Angle classification, PAR, and dental aesthetic index (DAI) scores were determined. The DAI was used as the gold standard to evaluate the subjects for treatment need. The receiver operating characteristics (ROC) analysis was used to evaluate the PAR index in relation to treatment need assessed by DAI.

RESULTS

The mean PAR scores for Class I, II, and III malocclusions and total sample were 17.54, 14.27, 18.7, and 20.04, respectively. The areas under the ROC of PAR scores in relation to the DAI assessment were found as 68.3% for the total sample, 66.6% Class I, 59.2% Class II, and 71.3% Class III malocclusions. For the total sample, the optimum cut-off PAR score was 14 in relation to DAI assessment. The cut-off scores for Class I, II, and III malocclusions were 13, 11, and 16, respectively, but considering psychosocial aspects, the recommended score is 14 for Class III.

CONCLUSION

The PAR index can be considered to have an acceptable level of validity for the assessment of orthodontic treatment need regarding Angle classification.

Treatment outcome differences between pass and fail scores and correlation between cephalometric changes and cast-radiograph evaluation of the American Board of Orthodontics

OBJECTIVE:

Using the cast-radiograph evaluation (CRE) score of the American Board of Orthodontics (ABO), the purpose of this study was 1) to find the post-treatment discrepancies that contributed to low-quality outcomes and 2) to identify if there might be any correlation between cephalometric changes and post-treatment discrepancies.

MATERIALS AND METHODS:

About 200 records submitted for the Thai Board of Orthodontics examination were analyzed. Overall, 23 parameters of the CRE scores and 12 cephalometric changes were collected. Based on the total CRE score, the cases were classified into three categories: pass (score <20), undetermined (score 20–30), and fail (score >30). Kruskall–Wallis was used to analyze the differences of mean CRE scores among these three categories. In addition, the cases were further classified into fixed appliance, two-phase and orthognathic surgery groups. Correlation tests were carried out to determine if there might be any association between cephalometric changes and CRE parameters.

RESULTS:

Significant differences of mean CRE scores were found for all CRE components except interproximal contacts. Significant correlation coefficients with the total CRE scores were found for all parameters except interproximal contacts. Significant moderate association was found between lower incisor changes and CRE scores in the two-phase and orthognathic surgery group.

CONCLUSIONS:

In order to improve treatment outcome quality, the top four parameters that orthodontists should pay attention to are occlusal contacts, occlusal relationship, marginal ridges, and alignment and rotations. Cephalometric changes were not suitable as weighting factors for total CRE scores.

Correlation between the DAI and ICON Indices used for Assessment of Orthodontic Treatment need in Croatian Schoolchildren

INTRODUCTION

The aims were: evaluation of the correlation between the Dental Aesthetic Index (DAI) and Index of Complexity, Outcome and Need (ICON); the assessment of orthodontic treatment need for schoolchildren in a population with two indices, separately for schoolchildren with mixed and permanent dentition; the estimation of the population share that could not receive orthodontic treatment because of the presence of caries and/or gingivitis.

METHODS

A total of 2652 Zagreb school children (7 - 19 years old, 52.4% of them were females) completed a questionnaire regarding previous orthodontic treatment and the type of appliance used. Their oral cavity was also inspected. The DAI and ICON indices were used for the assessment of malocclusion prevalence.

RESULTS

The subjects with mixed dentition had a greater need for orthodontic treatment, when compared to subjects with permanent dentition, when using the DAI index (p<0.001). When using the ICON index, 11.7% of subjects with mixed dentition had very severe malocclusion, as opposed to 5.8% of subjects with permanent dentition. The DAI and ICON scores correlated positively linearly (r=0.521; p<0.001). A higher prevalence of both gingivitis and caries was recorded more often in boys; caries more often in the group with the mixed dentition, and gingivitis in the group with permanent dentition (p<0.05).

CONCLUSION

The DAI and ICON indices have moderate agreement in assessment of malocclusion severity scores. One third of all schoolchildren with various degrees of both ICON and DAI indices have gingivitis, and half of them have caries.

An Overview of the Peer Assessment Rating (PAR) Index for Primary Dental Care Practitioners

The Peer Assessment Rating (PAR) index is a valid and reliable measure of orthodontic treatment outcome and is the most widely accepted such index. Assessing outcomes with the PAR index requires the examination of pre-treatment and post-treatment orthodontic study models. Beginning with the pre-treatment models, a score is given to each feature that deviates from an ideal occlusion (all anatomical contact points adjacent, good interdigitation between posterior teeth and non-excessive overjet/overbite), the scores are then added together to give a total that represents the severity of the malocclusion. The process is then repeated with the post-treatment models. The difference between the pre-treatment and the post-treatment scores reflects the improvement that has taken place during treatment. A score of zero represents an ideal occlusion and in general the higher the score, the more extensive the malocclusion. It is currently a condition of the NHS orthodontic contract for providers to monitor a proportion of their cases using the PAR index. This paper aims to provide primary dental care practitioners with an overview of the PAR index and should provide a useful guide for those wishing to seek calibration in the use of the index.

The Improvement and Completion of Outcome index: A new assessment system for quality of orthodontic treatment

Objective

Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system―the Improvement and Completion of Outcome (ICO) index―to evaluate the outcome of orthodontic treatment.

Methods

Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or −1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful.

Results

Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values.

Conclusions

Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.

Outcomes of different Class II treatments : Comparisons using the American Board of Orthodontics Model Grading System

OBJECTIVE

The aim of this study was to evaluate the clinical outcomes of three different Class II treatment modalities followed by fixed orthodontic therapy, using the American Board of Orthodontics Model Grading System (ABO-MGS).

MATERIALS AND METHODS

As a retrospective study, files of patients treated at postgraduate orthodontic  clinics in different cities in Turkey was randomly selected. From 1684 posttreatment records, 669 patients were divided into three groups: 269 patients treated with extraction of two upper premolars, 198 patients treated with cervical headgear, and 202 patients treated with functional appliances. All the cases were evaluated by one researcher using ABO-MGS. The χ (2), Z test, and multivariate analysis of variance were used for statistical evaluation (p < 0.05).

RESULTS

No significant differences were found among the groups in buccolingual inclination, overjet, occlusal relationship, and root angulation. However, there were significant differences in alignment, marginal ridge height, occlusal contact, interproximal contact measurements, and overall MGS average scores. The mean treatment time between the extraction and functional appliance groups was significantly different (p = 0.017).

CONCLUSION

According to total ABO-MGS scores, headgear treatment had better results than functional appliances. The headgear group had better tooth alignment than the extraction group. Headgear treatment resulted in better occlusal contacts than the functional appliances and had lower average scores for interproximal contact measurements. Functional appliances had the worst average scores for marginal ridge height. Finally, the functional appliance group had the longest treatment times.

Computerized occlusal analysis: correlation with occlusal indexes to assess the outcome of orthodontic treatment or the severity of malocculusion

Objective

The aims of our study were to verify the validity of the T-Scan III system (Tekscan) as an objective occlusal evaluation tool, and to assess the differences between two occlusal indexes-the peer assessment rating (PAR) index and the American Board of Orthodontics objective grading system (OGS)-by comparing the scores derived from the T-Scan III system with the two occlusal indexes and analyzing the correlations between them.

Methods

The final study sample included 48 adult volunteers (39 men and 9 women, mean age 24.14 ± 3.16 years), after excluding 29 volunteers whose occlusion could not be evaluated by the T-Scan III system due to severe skeletal or occlusal problems. PAR index and OGS scores were assessed using dental study models, and measurements of centric occlusion, protrusive movement, and lateral excursion movement were obtained via the T-Scan III system. The results were analyzed to determine correlations.

Results

Occlusal analysis by the T-Scan III system was clinically reliable (p < 0.05), and the PAR index and OGS scores were significantly correlated with several measurements obtained with the T-Scan III system (p < 0.05).

Conclusions

The T-Scan III system is a quantitative and reliable method for occlusal evaluation, and represents a potential substitute for occlusal indexes. Compared to the PAR index, the OGS scores of more variables were significantly correlated with the T-Scan measurements.

Comparison of orthodontic treatment outcomes in nonextraction, 2 maxillary premolar extraction, and 4 premolar extraction protocols with the American Board of Orthodontics objective grading system

INTRODUCTION

The aim of this study was to compare the orthodontic clinical outcomes of 2 maxillary premolar extraction, 4 premolar extraction, and nonextraction treatment protocols.

METHODS

The sample for this retrospective study was selected randomly from the archives of postgraduate orthodontic clinics in various cities in Turkey. Posttreatment records including dental casts and panoramic radiographs of 1098 patients were divided into 3 groups: group 1 comprised 269 patients treated with 2 maxillary first premolar extraction, group 2 comprised 267 patients treated with 4 premolar extraction, and group 3 comprised 562 patients treated with a nonextraction protocol. Only 1 researcher evaluated all subjects using the American Board of Orthodontics objective grading system.

RESULTS

There were no statistically significant differences among the 2 maxillary premolar extraction, 4 premolar extraction, and nonextraction treatment groups for alignment, marginal ridge height, buccolingual inclination, overjet, and interproximal contact measurements. Statistically significant differences were found in occlusal contacts, occlusal relationships, and root angulation measurements between the 4 premolar extraction and the nonextraction groups.

CONCLUSIONS

The nonextraction patients had more teeth in occlusion than did the 4 premolar extraction patients. The nonextraction patients finished with more satisfactory sagittal dental relationships. The 4 premolar extraction group had the least satisfactory sagittal dental relationships. The nonextraction patients finished with better root angulations.

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman r_s values, ranging from –0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R²=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R²=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r_{(SC+LX)vs.(SC+LX+PH)}=0.96, r_{(SC+PH)vs.(SC+LX+PH)}=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

Validity assessment and determination of the cutoff value for the Index of Complexity, Outcome and Need among 12-13 year-olds in Southern Chinese

To validate the use of the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need among 12–13 year-olds in southern China, we determined the threshold value of ICON based on Chinese orthodontists' judgments. The samples consisted of 335 students in grade 7 from 16 randomly selected middle schools in Chengdu, China. Three associate professors provided ICON scores for each participant and the results were compared with the gold standard judgments from 25 experts on treatment needs. Based on the gold standard, 195 casts belonged to the treatment category, while the rest 140 belonged to the no-treatment category. With the international cutoff point of 43, the sensitivity and specificity of the ICON score were 0.29 and 0.98. The best compromise between sensitivity and specificity in Chengdu, compared with the gold standard, was found at a cutoff point of 29, and the sensitivity and specificity were 0.88 and 0.83. When used to evaluate the treatment need of 12–13 year-olds in southern China, the international ICON cutoff value did not correspond well with Chinese orthodontists' judgments; a lower cutoff value of 29 offered a greater sensitivity and specificity with respect to expert orthodontists' perception of treatment need.

Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: a prospective randomized clinical trial

OBJECTIVE

To conduct a prospective and randomized study of the efficiency of orthodontic treatment with self-ligating edgewise brackets (SL; Time2 brand, American Orthodontics) and conventional edgewise twin brackets (CE; Gemini brand, 3M).

MATERIALS AND METHODS

One hundred consecutive patients were randomized to treatment with either SL or CE brackets. The participants were treated by one of three specialists in orthodontics and with continuous instructions alternately by five orthodontic assistants according to our normal treatment routine (ie, modified 0.022" MBT preadjusted edgewise technique). The treatments were evaluated in terms of overall treatment time, number of visits, and treatment outcome using the Index of Complexity, Outcome and Need (ICON). The number of emergency appointments, number of archwires, overjet, relative space, and extractions at treatment start were noted.

RESULTS

After dropouts, the analyzed material consisted of 44 patients treated with SL (mean age 15.3 years, mean ICON 60.7, 70.4% female) and 46 patients treated with CE (mean age 15.0 years, mean ICON 56.5, 71.7% female). There were no statistically significant differences between the SL and CE groups in terms of mean treatment time in months (20.4 vs 18.2), mean number of visits (15.5 vs 14.1), mean ICON scores after treatment (13.2 vs 11.9), or mean ICON improvement grade (7.9 vs 9.1).

CONCLUSION

Orthodontic treatment with SL brackets does not reduce treatment time or number of appointments and does not affect posttreatment ICON scores or ICON improvement grade compared with CE brackets.

Orthodontic Treatment Need and Complexity among Nigerian Adolescents in Rivers State, Nigeria

Introduction. The assessment of orthodontic treatment need and complexity are necessary for informed planning of orthodontic services. The aim of this cross-sectional study was to assess these parameters using the Index of Complexity, Outcome, and Need (ICON) in a Nigerian adolescent population in a region where orthodontic services are just being established. Methods. Six hundred and twelve randomly selected Nigerian adolescents aged 12 to 18 years were examined using the ICON in their school compounds. Descriptive statistics were employed in the data analysis. Results. Out of a total of 38.1% of the population found to need orthodontic treatment, there were more males and older adolescents. The overall mean ICON score for the population was 39.7 ± 25.3 SD with males having statistically higher mean ICON score. The grades of complexity of the population were 21.6% for very difficult and difficult, 7.5% moderate, and 70.9% mild/easy. Conclusions. Although just over a third of the adolescents were found to have a need for treatment, about a quarter of them were found to have difficult and very difficult complexity grades indicating a need for specialist care. The authors recommend the training of more specialist orthodontists in this region.

Clinical outcomes for patients finished with the SureSmile™ method compared with conventional fixed orthodontic therapy

OBJECTIVE

Utilize American Board of Orthodontics (ABO) cast/radiographic evaluation (CRE) to compare a series of 63 consecutive patients, finished with manual wire bending (conventional) treatment, vs a subsequent series of 69 consecutive patients, finished by the same orthodontist using the SureSmile™ (SS) method.

MATERIALS AND METHODS

Records of 132 nonextraction patients were scored by a calibrated examiner blinded to treatment mode. Age and discrepancy index (DI) between groups were compared by t-tests. A chi-square test was used to compare for differences in sex and whether the patient was treated using braces only (no orthopedic correction). Analysis of covariance tested for differences in CRE outcomes and treatment times, with sex and DI included as covariates. A logarithmic transformation of CRE outcomes and treatment times was used because their distributions were skewed. Significance was defined as P < .05.

RESULTS

Compared with conventional finishing, SS patients had significantly lower DI scores, less treatment time (∼7 months), and better CRE scores for first-order alignment-rotation and interproximal space closure; however, second-order root angulation (RA) was inferior.

CONCLUSION

SS patients were treated in less time to better CRE scores for first-order rotation (AR) and interproximal space closure (IC) but on the average, malocclusions were less complex and second order root alignment was inferior, compared with patients finished with manual wire bending.

Evaluation of agreement and correlation of three occlusal indices in an assessment of orthodontic treatment need

Background/Aim. Occlusal indices are quantitative diagnostic indicators of malocclusion severity, orthodontic treatment need, complexity and outcome. The aim of this study was to determine correlations and agreement among three occlusal indices: the Index of Orthodontic Treatment Need (IOTN), the Peer Assessment Rating Index (PAR) and the Index of Complexity, Outcome and Need (ICON) in evaluating orthodontic treatment need. Methods. A total eighty study models of patients referred to the Department of Orthodontics, School of Dentistry, Belgrade, were assessed in this retrospective study. Malocclusions of various types and severity in the permanent dentition were included. Results. The Aesthetic and the Dental Health Component of IOTN determined orthodontic treatment need in 25% and 51% of the patients, respectively. PAR determined orthodontic treatment need in 59% and ICON in 53% of patients. The Aesthetic Component of IOTN and ICON had the highest correlation (Spearman's correlation coefficient 0.95, p < 0.01). Correlations between indices were 0.44 to 0.61 with statistical significance (p < 0.01). The agreement between indices, calculated using Kappa statistics, was 0.22 to 0.63. Conclusion. The most critical in malocclusion assessment was PAR. The Aesthetic Component of IOTN and ICON correlated highly (p < 0.01). Correlations between other pairs of indices were moderate (p < 0.01). The Aesthetic Component of IOTN and ICON had substantial agreement, whereas agreement between other indices was fair or moderate. ICON could replace PAR and IOTN. Application of occlusal indices enables objective evaluation of orthodontic treatment need and easier determination of the treatment priorities.

Dental aesthetics assessed against orthodontic treatment complexity and need in Nigerian patients with sickle-cell anemia

This study investigates the relationship between dental aesthetics and orthodontic treatment complexity and need in a group of patients with sickle-cell anemia (SCA) in Nigeria. The study sample consisted of 176 individuals - 77 (43.8%) male and 99 (56.3%) female subjects with SCA (aged 10 to 35 years) who were coming for routine medical care to two outpatient clinics. Dental aesthetics were assessed using the Standardized Continuum of Aesthetic Need component of the Index of Orthodontic Treatment Need. Treatment complexity and need were assessed according to the Index of Complexity, Outcome and Need and Dental Aesthetic Index. Both parametric and nonparametric statistics were employed in the data analysis. Significant positive relationships were found between dental aesthetics and orthodontic treatment complexity as well as treatment need according to both indices (p= .000). The correlations of the scores for dental aesthetics and the objectively derived treatment complexity and need were significant (p= .01). About 50% of the subjects had poor dental aesthetics and this correlated with their high orthodontic treatment complexity and need.

A 20-year cohort study of health gain from orthodontic treatment: Psychological outcome

INTRODUCTION

Despite the widespread expectation that orthodontic treatment improves psychological well-being and self-esteem, there is little objective evidence to support this. The aim of this study was to compare the dental and psychosocial status of people who received, or did not receive, orthodontic treatment as teenagers.

METHODS

A prospective longitudinal cohort design was adopted. A multidisciplinary research team evaluated 1018 participants, aged 11 to 12 years, in 1981. Extensive assessments of dental health and psychosocial well-being were conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pretreatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up, 337 subjects (30-31 years old) were reexamined in 2001. One-way ANOVA was used to explore differences between the 4 groups (need/no need; treatment/no treatment).

RESULTS

The percentage changes in index of complexity, outcome and need scores for the 4 groups were need/no treatment (12.7%), no need/no treatment (-17.1%), need/treatment (31%), and no need/treatment (-11.4%). Participants with a prior need for orthodontic treatment as children who obtained treatment had better tooth alignment and satisfaction. However, when self-esteem at baseline was controlled for, orthodontic treatment had little positive impact on psychological health and quality of life in adulthood.

CONCLUSIONS

Lack of orthodontic treatment when there was need did not lead to psychological difficulties in later life.