Evaluation of the aesthetic component of the Index of Orthodontic Treatment Need by Swedish orthodontists

Does facial appearance of dentofacial deformity influence the need for orthognathic surgery: The Malaysian perception

Aim: This study evaluates perception toward facial appearance in dentofacial deformity and the need for orthognathic surgery among the public with and without dental backgrounds. Materials and Methods: A questionnaire consisting of 12 facial photographs of cases with dentofacial deformity or malocclusion in varying severity was used. A hundred individuals were selected to answer the questionnaire. The perception of facial appearance (FAS), treatment need score (TNS), and knowledge regarding dentofacial deformity were used for the evaluation. Results: Significant differences were found between dental and non-dental when the respondents' knowledge in all the questionnaire items ([Formula: see text].05) was assessed. However, no significant difference was found in the mean of FAS and TNS in all the presented cases (normal, borderline, severe). Pearson correlation between perceived FAS and TNS was statistically negative for severe and normal cases, whereby a decrease in FAS for severe cases showed an increase in TNS, and an increase in FAS for normal cases showed a decrease in TNS. Conclusion: Respondents with dental background had sound knowledge of dentofacial deformity. A poorly attractive respondent with dentofacial deformity showed a greater need for orthognathic surgery.

Perception of orthodontic treatment need among Swedish children, adolescents and young adults

OBJECTIVE

Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

MATERIALS AND METHODS

A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

RESULTS

The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19.

CONCLUSIONS

The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

Assessment of objective and subjective measures as indicators for facial esthetics

Background:

The study mentioned was aimed to examine the contribution of the objective measures representing anterior-posterior (AP) and vertical characteristics, dental esthetics, or their combination that are used in daily orthodontic practice in the assessment of the facial esthetics.

Materials and Methods:

A panel of 64 laypersons evaluated the facial esthetics of 32 boys and 32 girls, stratified over four different angle classes, on a visual analog scale. The relationship between the objective parameters and facial esthetics was evaluated by the backward multiple regression analysis.

Results:

Dental esthetics, expressed by the esthetic component of the index of orthodontic treatment need (AC/IOTN), appeared to be the most vital indicator for facial esthetics. The horizontal sum, a variable for AP characteristics of the patient, could be a better variable when compared with the overjet.

Conclusion:

Addition of this newly defined parameter to the AC/IOTN improved the prognostic value from 25% to 35%.

Orthodontic treatment: need and demand in north karnataka school children

OBJECTIVES

To assess the normative need, demand and knowledge of/for/on orthodontic treatment in Karnataka school children who were aged 12-16 years.

METHOD

A simple random selection of a sample of 1000 students who were aged 12-16 years was made. Informed consents were obtained from each subject. The dental health component (DHC) and aesthetic component (AC) of the index of orthodontic treatment need (IOTN) and the index of complexity, outcome and need (ICON) were assessed by using the index. The knowledge and demand on/for orthodontic treatment were assessed by using a questionnaire.

RESULTS

The survey population showed 49.3%, 44.4%, and 7.1% of samples needed definite orthodontic treatment need on basis of DHC, ICON, AC respectively. In terms of treatment need, boys were more likely to seek orthodontic treatment need than girls. There was fair agreement between operator and students. A high percentage of students clearly expressed a 'definite need' of orthodontic treatment. Only 40% of children had some knowledge on orthodontic treatment.

CONCLUSION

The present study showed that the awareness, need and demand for orthodontic treatment were less among school children. So, we need to enlighten the students regarding aesthetics among children.

Perceptions of dental aesthetics of Class III and anterior open bite malocclusions: a comparison between 10- to 11-year-old schoolchildren and orthodontists

OBJECTIVE

To compare perceptions of dental aesthetics of Class III and anterior open bite (AOB) malocclusions between 10- to 11-year-old Birmingham schoolchildren and orthodontists.

MATERIALS AND METHODS

Thirty-one orthodontists practicing in Birmingham (UK) and 383 school children aged 10-11 years from a random and representative sample of seven primary schools in South Birmingham participated in the study. Participants were asked to assess five anterior photographs of the dentition representing varying degrees of aesthetic impairment of Class III and AOB malocclusions. Perceptions of dental aesthetics were determined using the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN).

RESULTS

Perceptions of dental aesthetics were similar among males and females (P > .05). Both groups allocated the highest median AC score to the photo representing severe Class III malocclusion and the lowest to the photo representing mild Class III and AOB malocclusion. Differences in perceived dental aesthetics were significant for photos representing severe Class III and moderate AOB malocclusions, with orthodontists perceiving greater aesthetic impairment for severe Class III and schoolchildren for moderate AOB, respectively (P < .05).

CONCLUSIONS

Schoolchildren and orthodontists perceived Class III malocclusions to have greater aesthetic impairment compared to AOB malocclusions. Surprisingly, none of the median AC scores allocated to the five photos were in the "Definite need" for treatment category. The IOTN may not be sensitive to these types of malocclusions. This finding merits further investigation.

Factors associated with orthodontic treatment seeking by 12-15-year-old children at a state university-funded clinic

OBJECTIVES

To investigate the interrelationships between factors involved in orthodontic treatment seeking by children aged 12-15 years.

SETTING

State funded orthodontic clinic at the Faculty of Dentistry of the Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil, and a nearby public school.

SUBJECTS AND METHODS

One hundred and ninety-four adolescents aged 12-15 years took part in the study; 92 had sought orthodontic treatment at UERJ (orthodontic group) and 102 were from a nearby public school and had never undergone or sought orthodontic treatment (comparison group). Each participant underwent a comprehensive oral examination, and both parent and child were questioned about who had initiated the orthodontic referral.

OUTCOMES

Normative need assessed with IOTN DHC; clinician and self-perceived aesthetic perception assessed with IOTN AC, previous caries experience was determined using the decayed, missing and filled teeth index (DMFT) and WHO diagnostic criteria. The 'Brazil Economic Classification Criteria' was used to classify the socioeconomic status. Intra-examiner repeatability and inter-examiner agreement were assessed with kappa statistics. Univariate and multiple logistic regression analyses were used to investigate the association between orthodontic treatment seeking (dependent variable) and the independent variables (i.e. aesthetic impairment, malocclusion severity, socioeconomic status, gender, age and DMFT).

RESULTS

Univariate analyses showed that self-perceived aesthetics (P<0.001), examiner-assessed aesthetics (P = 0.01) and treatment need (P<0.001), socioeconomic status (P<0.001) were significantly associated with orthodontic treatment seeking, but gender (P = 0.22) and DMFT (P = 0.41) were not. Multiple logistic regression analyses showed that poor self-perceived aesthetics (OR = 16.7; 95% CI: 4.17-61.9), more severe malocclusion (OR = 3.4; 95% CI 1.64-7.14) and better socioeconomic position (OR = 39.1; 95% CI: 5.47-280.54) significantly influenced the decision to seek orthodontic treatment.

CONCLUSIONS

Concern about dental appearance and the desire for treatment, together with normative orthodontic need, should be carefully assessed by dentists before referring patients to specialized orthodontic care in publicly-funded clinics. In a publicly-funded oral health care system, self-perceived orthodontic treatment need is the key to establishing treatment priority.

Intra- and inter-examiner reliability of intraoral malocclusion assessment

Malocclusion assessment methods are based on measurements of study casts, which requires that impressions be taken. In addition to being costly and time consuming, this process can be unpleasant for children. Therefore, the aim of this study was to evaluate intra- and inter-examiner reliability of intraoral score measurements to determine malocclusion severity in the permanent dentition. The research was a part of a longitudinal study from which a cohort of 92 children (39 boys, 53 girls), with a mean age of 14.8 years (standard deviation = 0.18), were randomly selected and classified into severity grades based on total malocclusion score. Subsequently, 12 children were randomly selected for a reliability study to assess intra-examiner reliability of malocclusion trait measurements. Nine subjects gave informed consent to participate in the study. Quantitative registrations of space and occlusal anomalies were performed intraorally by five examiners, on two occasions with a 1-month interval between the two measurements. Intra- and inter-examiner reliability was determined using intraclass correlation coefficients (ICCs). Overall classification into severity grades, based on total malocclusion score, showed almost perfect intra-examiner reliability for all examiners (ICC = 0.97-0.99); inter-examiner ICC was almost perfect (0.97). Near perfect intra-examiner reliability was determined for eight occlusal trait measurements (ICC = 0.89-1.0); substantial reliability for midline deviation (ICC = 0.68), overbite (ICC = 0.78), but large variability for space condition assessment (ICC = 0.42-0.52). Inter-examiner reliability was almost perfect for the eight traits (ICC = 0.81-1.0); substantial reliability for midline deviation (ICC = 0.65), and axial tooth inclination (ICC = 0.75), but large variability for space condition assessment (ICC = 0.13-0.26). Intra- and inter-examiner malocclusion assessment, recorded and measured intraorally to determine malocclusion severity scores in 14-year old children, is reliable. It is therefore proposed as the method of choice to be used not only in epidemiological studies and screening but also in clinical orthodontic assessment.

Evaluation of 3 occlusal indexes: Eismann index, Eismann-Farčnik index, and index of orthodontic treatment need

INTRODUCTION

The aim of this study was to compare the validity, reliability, and time needed to use the Eismann index, the Eismann-Farcnik (EF) index, and the index of orthodontic treatment need (IOTN).

METHODS

One hundred pretreatment study casts of adolescent patients in the permanent dentition period (mean age, 15.4 years; SD, 0.4 year; 53 girls, 47 boys) were used. Three examiners trained and calibrated in the use of the Eismann and EF indexes and the IOTN scored the casts using the 3 indexes. A panel of 10 orthodontists individually rated the same casts for degree of malocclusion severity. The mean rating of the panel on the severity of malocclusion was used as the gold standard for evaluating the validity of the 3 indexes. Furthermore, the agreement of the 3 indexes in assessing the severity of malocclusion was evaluated. Ten randomly selected casts were reevaluated for the reliability study. Each evaluation was timed and rounded off to the nearest half minute.

RESULTS

The intraclass correlation coefficient indicated excellent agreement of the EF index with the ratings of the orthodontists (0.819), good agreement for the Eismann index (0.742), and moderate agreement for the IOTN (0.597). Receiver operating characteristic curves were plotted for the 3 indexes. The diagnostic accuracy, as determined by the area under the curve, was found to be the best for the EF index, followed by the Eismann index and the IOTN. Intraexaminer and interexaminer reliability was high (>0.75) for all 3 indexes. The most time-consuming methods were the EF (27.10 minutes) and the Eismann (26.86 minutes) indexes; the IOTN (1.97 minutes) was the least time-consuming method.

CONCLUSIONS

All 3 indexes are valid and reliable methods for assessing malocclusion severity. The EF index is the most time-consuming method, but it had the best agreement with clinical orthodontic diagnosis.