Orthodontic indecis for orthodontists by Almuzian

UNIVERSITY OF GLASGOW
Orthodontic Indices
Personal notes
Mohammed Al Muzian
5/2/2013
An Orthodontic index or a malocclusion index can be defined as a means of objectively
assessing occlusal status.

Mohammed Almuzian, University of Glasgow 1
List of contents
Definition
Uses of orthodontic indices
1. Epidemiological
2. Clinical Assessment
3. Uniformity in inter-disciplinary communication and description of a malocclusion
General requirement of an index
Types of indices
1. Classification indices
2. Diagnostic indices
3. Treatment assessment (need, complexity and outcome)
4. Cleft outcomes
5. Oral health indices
Angle’s classification
• Some modification has been added like:
• Advantage
• Drawbacks
Incisor classification
• Some modification has been added like:
Skeletal classification
Index of Orthodontic Treatment Need
1. The aesthetic component
Treatment priority and need according to AC
2. The dental health component

• Treatment priority and need according to DHC
• Advantages
• Disadvantages:
• Reproducibility of the IOTN:
1. Dental Health Component
2. Aesthetic Component:
 Missing teeth (5.i, 5.h or 4.h)
 Impeded eruption (5.i)
 Hypodontia (5.h or 4.h)
 Overjet (2.a, 3.a, 4.a, 5.a, 2b, 3b, 4b, 4m,5m)
 Crossbite (2.c, 3.c, 4.c)
 Displacement of contact points (2.d, 3.d, 4.d)
 Overbite and Open bite (2.e/f, 3.e/f, 4.e/f)
 Buccal occlusion (2.g)
 Submerging teeth (5.S)
 Tipped teeth (4.t)
 Supernumerary teeth (4.x)
Peer Assessment Rating (PAR)
Reliability
 Buccal and anterior segments
 Buccal occlusion
 Overjets
 Overbite
 Centrelines
Advantages
Disadvantages
Outcome assessment

Index Of Complexity, Outcome And Need (ICON)
ABO Discrepancy Index (ABO DI)
Disadvantages of ABO DI
Advantages of ABO DI
Handicapping Malocclusion Assessment Record (HMAR)
Irregularity index
Crowding index
The validity of maxillary expansion indices, O'Reilly, 1995
A treatment difﬁculty index for unerupted maxillary canines
Plaque index
Gingival index
Handicapping Labio-Lingual Deviation (HLD)
Swedish Index (Need For Treatment Index)
Treatment Priority Index (TPI)

Orthodontic Indices
Definition
An Orthodontic index or a malocclusion index can be defined as a means
of objectively assessing occlusal status.
Uses of orthodontic indices
1. Epidemiological
A. determine the prevalence and incidence of occlusal anomalies
B. economic health care resource planning (financially and in terms of
manpower)
C. for academic research
2. Clinical Assessment
A. Classification of malocclusion (Angle classification, incisor classification
by BSI, 1983)
B. Diagnostic (Occlusal index)
C. Treatment Need or priority (e.g. IOTN).
D. Treatment Complexity /difficulty (NB: ICON tries to address
Complexity, Outcome & Need).
E. Treatment Outcome /success (PAR).
3. Uniformity in inter-disciplinary communication and description of a
malocclusion
Generalrequirement of an index
1. Reliable
2. Reproducible: closeness of successive evaluation.

3. Valid: the index should measure what it was intended to measure.
4. Universally acceptable to profession and public
5. Require minimal adjustment.
6. Simple to administer.
7. Cheap.
Types of indices
1. Classificationindices
a) Skeletal classification
b) Soft tissue classification
c) Occlusal classification:
 Angle’s Classification
 Incisor Classification
 Canine Classification
2. Diagnostic indices
a) Occlusal index
b) Handicapping Malocclusion Assessment Record (HMAR)
3. Treatment assessment(need, complexity and outcome)
a) IOTN
b) Irregularity Index
c) Peer Assessment Rating (PAR)
d) ICON
4. Cleft outcomes
a) GOSLON Yardstick
b) 5 year Old’s Index
c) Bergalnd index for SABG

d) Kindealan index for SABG
5. Oral health indices
a) Plaque Index
b) CPITN
c) Gingival Index
Angle’s classification
a) This classification is used in orthodontics to assess the anterior posterior
relationship with regards to the lower first permanent molar as a key.
b) Three classes were described by Angle (1899):
 Class I (neutrocclusion): when the mesiobuccal cusp of the upper first
permanent molar occlude with the buccal groove of the lower first
permanent molar.
 Class II (distocclusion/ Post-Normal): when the mesiobuccal cusp of the
upper permanent first molar at least one cusp width mesial to Class I (Full
unit class II).
 Class III (mesiocclusion/ Pre-normal): when the mesiobuccal cusp of the
upper permanent first molar at least one cusp width distal to Class I (Full
unit Class III).
Some modification has been added like:
 Class II subdivision: when there is a Cl1 on one side and Cl2 on
the other side
 Class III subdivision: when there is a Cl1 on one side and Cl3
on the other side
 1/2, 1/3, 1/4 unit Class II and Class III are also used now.

Advantage
 Simple
 Widely accepted
 Reliable and reproducible
Drawbacks
 Cannot used in primary dentition
 Not distinguish between dental and skeletal problems
 Only consider problem in AP direction
 Consider the 6s as fixed point which are not in reality and can be affected
by environmental factors.
 Cannot used when 6s extracted
Incisor classification
By British standard institutes (1983)
 It is based on the relationship between the lower incisor edges and the
upper central incisors’ cingulum plateau.
 According to the definition of these classes as follows:
A. Class I: the lower incisor edges occlude with or lie immediately below the
cingulum plateau of the upper incisors.
B. Class II: the lower incisor edges occlude or lie posterior to the cingulum
plateau of the upper incisors. Two divisions of this class were described:
 Division 1: the upper incisors are proclined with an increased overjet.
 Division 2: all the upper incisors or just the centrals are retroclined. The
laterals may be proclined. The overjet is decreased but may be increased.
C. Class III: the lower incisor edges occlude or lie anterior to the cingulum
plateau of the upper incisors. Overjet is usually reduced or reversed.

Some modification has been added like:
 Class II subdivision: one incisor in CLII and other side CLI
 Class II indefinite when one incisor retroclined and the other is
proclined (Gravely)
 Class II intermediate when the incisor retroclined or upright and
the OJ 5-7 mm (Stephen and William, 1993).
Skeletalclassification
1. Skeletal classification is obtained from lateral cephalometric radiograph
to support the clinical findings.
2. Three skeletal classes were described using cephalometric points and
angular measurements:
 Class I: lower dental base is related to the upper dental base (ANB= 2-
4˚).
 Class II: lower dental base is retruded relative to the upper dental base
(ANB> 4˚)
 Class III: lower dental base is protruded relative to the upper dental base
(ANB <2˚).
 Wits appraisal and Balllard conversion can be used in a similar way to
ANB.
Index of Orthodontic Treatment Need
 This was developed by Brooke and Shaw in 1989.
 Specific ruler had been developed to make the procedure easy.
 IOTN in general is composed of two components:

1. The aesthetic component
a) This was developed by Evans and Shaw (1987). It was originally called
the SCAN (Standardised Continuum of Aesthetic Need). A lay panel was
used.
b) It is a ranking system (1-10) using coloured photographs which can be
said to assess dental attractiveness.
c) Number 1 is the most attractive while number 10 is the least attractive.
Rating is allocated to the clinician and sometime to the patient for overall
attractiveness compared with the photo and not specific morphological
similarity to the photo.
d) The NHS does recognise that some children need and benefit from
orthodontic treatment on the basis of poor aesthetics. The Aesthetic
Component of the IOTN is a scale of 10 colour photographs showing
different levels of dental attractiveness. The grading is made by the
orthodontist matching the patient to these photographs. The photographs
were arranged in order by a panel of lay persons.
e) Within the NHS if a patient in Dental Health category 3 has an Aesthetic
Component rating of 6 or more NHS treatment is permissible.
f) Monochromic photographs are used for dental cast assessments.
g) It has been reported that monochromic photographs have advantage
that raters are not influenced by oral hygiene, gingival condition, or
poor colour matching in anterior restorations . the black and white is
used to rate the SM. (Woolass and Shaw, 1987).
Treatment priority and need according to AC
1. Grades 1 - 3 No/slight need for treatment
2. Grades 4 mild
3. Grades 5 6 7 borderline need for treatment

4. Grades 8 9 10 Definite need for orthodontic treatment
2. The dental health component
a) This was developed based on the index used by the Swedish Dental
Board. It consists of 14 qualifiers and 5 grades, grade 1 representing little
or no need for treatment and grade 5 representing great need of treatment.
Ruler is used for measurement.
b) It assesses few points in order as follows (MOCDO): Missing teeth,
Overjets, Crossbites, Displacements, and Overbites.
c) Only the highest scoring trait need be recorded, as this determine the
grading for the patient.
Treatment priority and need according to DHC
1. Grades 1 & 2 No need for orthodontic treatment
2. Grade 3 Borderline need for treatment
3. Grades 4 & 5 Definite need for treatment
Advantages
1. Valid
2. Reproducible
3. Acceptable to clinician

4. Easy and quick to apply
5. Can be used directly on patients or on dental casts
6. Yield quantitative data which can be analyzed.
Disadvantages:
1. Crowding represented a problem in recording when the patient is in the
mixed dentition.
2. The AC has no side view rating or class III malocclusion.
3. Objective index
4. No representation of aesthetic or skeletal relationship
5. No assessment of crowding which relies on displacement only
NB:
 Complexity can be defined as "intricate or complicated".
 Difficulty is defined as "needing much effort and skill"
 Severity is how far a malocclusion deviates from normal.
Reproducibility of the IOTN:
1. Dental Health Component
 In the study of Brook and Shaw in 1989 they have shown that the
reproducibility of this component is very good.
 They also found that the common trait causing disagreement in
descending order of frequency were; crowding, increased overjet,
crossbites, and overbites.

2. Aesthetic Component:
 High level of agreement found between patients, parents and
orthodontists when grading a patient (Evans and Shaw, 1987).
 This was supported with the results that suggested that the
correlation coefficients of this component were reasonably high
(Brook and Shaw, 1989).

In order to memorize them use this acronym
1) Grade 1=D
2) Grade 2= ABCDEFG
3) Grade 3= ABCDEF
4) Grade 4= ABCDEF+LHM+TX
5) Grade= SIMPHA
Missing teeth (5.i, 5.h or 4.h)
Missing teeth relates to: impacted, impeded eruption, hypodontia.
Impeded eruption (5.i)
 If a tooth is out of the line of the arch and erupted it would be considered
(ectopic)
 The tooth is considered impeded or impacted if the spaceremaining for
an erupted tooth is less than or equal to 4mm and the angulation is not
favorable (horizontal directed not vertical)
 In the mixed dentition, the distance from the mesial contact point of the
first permanent molar to distal contactpoint of the lateral incisor is less
than 18 mm or 17 mm in the upper and lower dental arches respectively,
then the canine is considered impacted.
Hypodontia (5.h or 4.h)
 Where there is extensive hypodontia (more than one tooth missing in
each quadrant) requiring either space closure or pre-restorative
orthodontics the grade would be 5h.
 When there is only one tooth missing per quadrant the scorewould be 4h
 Hypodontia is counted if the spacewill be address orthodontically (open
or close not to accept)

Overjet (2.a, 3.a, 4.a, 5.a, 2b, 3b, 4b, 4m,5m)
The overjet
 It is measured using the ruler held parallel to the occlusal plane and radial
to the line of the arch
 The overjet is recorded to the labial aspect of the incisal edge of the most
prominent incisor (lateral or central incisors). If the incisor falls on the
ruler line the lower grade is allocated.
A reverse overjet
 It is recorded when ALL four incisors are in lingual occlusion.
 If the reverse overjet is greater than 1 mm it is important to investigate
whether the individual has masticatory or speech (M&S) difficulties.
 There are several methods of investigation but a simple approachis to ask
the individual to count from 60-70 noting any difficulty in pronunciation.
In addition, any signs and symptoms of mandibular dysfunction should be
checked.
Crossbite (2.c, 3.c, 4.c)
 An anterior crossbite is when 1, 2 or 3 incisors (BUT) not all of them
are in lingual occlusion.
 A posteriorcrossbite is recorded when the posterior tooth or teeth are
cusp to cusp or in full crossbitein a buccal or lingual perspective.

 The grade recorded depends on the severity of discrepancy between
retruded contactposition (RCP) and intercuspal position (IP).
 The greater the discrepancy between RCP an IP, the higher the grade
 Scissorbite always has a grade of 4L
Displacementof contactpoints (2.d, 3.d, 4.d)
The contactpoint displacement is measured between anatomical contact
points where teeth deviate from the line of the arch. Only the worst
displacement is recorded
 Vertical displacements from the occlusal plane are not recorded.
 Spacing is not generally recorded in the Dental Health Component. But if
spacing is associated with a tooth or teeth deviating from the line of the
arch, the contact point displacement is recorded.
 Displacements between deciduous and permanent teeth are not recorded.
 Contact point displacements due to rotated teeth (generally lower 2nd
premolars) are not recorded.
 However, if the rotation results in a discrepancy between retruded contact
position (RCP)and intercuspal position (IP) as a direct result of occlusal
interference then a crossbite is recorded according to the severity of the
discrepancy between IP and RCP.

Overbite and Open bite (2.e/f, 3.e/f, 4.e/f)
 Overbite and open bite relates to any of the lateral or central incisors.
 The largest vertical discrepancy is recorded.
 It is also important to note if there is any gingival or palatal trauma as a
result of the deep overbite
Other like acronym GTSXas below
Buccalocclusion(2.g)
The buccalocclusion is assessed irrespective whether the teeth
interdigitate in Angle's Class I, II or III.
Submerging teeth (5.S)
Submerging teeth are not generally recorded unless only two cusps
remain visible and/or the adjacent teeth are severely tipped towards each
other and closely approximated.

Tipped teeth (4.t)
When a tooth has erupted and is tipped against an adjacent tooth,
resulting in food packing it may require orthodontic treatment to upright
and level to eliminate the problem
Supernumerary teeth (4.x)
It is graded ONLY if a supernumerary tooth requires extraction followed
by orthodontic alignment and/or spaceclosure
PEER ASSESSMENTRATING (PAR)
 This index was developed by Richmond et al. (1992). It was formulated
over a series of six meetings in 1987 with a group of 10 experienced
orthodontists.
 This index was developed to record the malocclusion at any stage of
treatment.
 The concept is to assign a score to various occlusal traits which make
up a malocclusion.
 The individual scores are summed to obtain an overall total, representing
the degree a case deviates from normal alignment and occlusion.
 Study models used with a specifically designed ruler for this index. The
ruler has all the information summarized which makes measurement
quick and easy to perform.
 The score zero indicates good alignment and higher scores (rarely beyond
50) indicates increased levels of irregularity.
 The difference between the pretreatment and posttreatment scores
represent the degree of improvement as a result of orthodontic
intervention and active treatment.

 There are 11 components of the PAR index:
1. Upper anterior segment
2. Lower anterior segment
3. Upper right segment
4. Upper left segment
5. Lower right segment
6. Lower left segment
7. Right buccal occlusion
8. Left buccal occlusion
9. Overjet
10.Overbite
11.Centrelines
 Each dental arch is divided into three recording segments left and right
buccal segments and the anterior segments.
Reliability
It has been reported that the PAR index has an excellent reliability within
intra and inter-examiner agreement (Richmond et al., 1992).
Buccaland anterior segments
o Buccal segments start from the mesial anatomical contact point of the
first permanent molar to the distal anatomical contact point of the canine.
o Anterior segments starts from the mesial anatomical contact point of the
canine on one side to the mesial anatomical contact point of the canine on
the opposite side.
o The occlusal features recorded are crowding, spacing, and impacted teeth.
o Displacements are recorded at the shortest distance between contact
points of adjacent teeth parallel to the occlusal plane with the exception
of the displacements that are present between the first, second and third

molars. This is because of the fact that the contact points are very broad
and are extremely variable within the normal range.
o In case of potential crowding in the mixed dentition, average mesio-distal
widths are used to calculate the space deficiency. Impacted teeth are
recorded when the space available for the tooth is equal or less than 4
mm.
o Displaced contact points due to poor restoration are not recorded and the
same for contact points between deciduous teeth.
o Orthodontic extraction spaces are not recorded
o Spacing in the anterior segment resulting from extraction, agenesis or
avulsion of incisors or cuspids is recorded as follows:
- If closing spacethe spaceis recorded
- If opening spaceand restore it, the spaceis not recorded unless it is less
than or equal to 4 mm
PAR Score Amount of teeth
displacement
0 0 mm – 1mm
1 1.1 mm – 2mm
2 2.1 mm – 4mm
3 4.1 mm- 8mm
4 Greater than 8mm
5 Impacted teeth
Mixed dentition crowding assessment using average mesio-
distal width
Upper
Canine 8mm Total 22mm
Impaction < = 18mm1st 7mm

Premolar
2nd
Premolar
7mm
Lower
Canine 7mm Total 21mm
Impaction < = 17mm1st
Premolar
7mm
2nd
Premolar
7mm
Buccalocclusion
oThis is recorded for both right and left sides in occlusion in three
dimensions. A-P, vertical and transverse.
oThe recorded zone is from the canine and to the last molar whether this
was the first, second or third molar.
oTemporary developmental stages and submerging deciduous teeth are
excluded.
PAR
Score
Buccal Occlusion discrepancy
Vertical
0 No discrepancy in intercuspation
1 Lateral open bite on at least 2 teeth greater
than 2 mm
Antero-posterio
0 Good interdigitation (Cl I, Cl II or Cl III)

1 Less than ½ unit discrepancy
2 ½ a unit discrepancy (cusp to cusp) or more
Transverse
0 No crossbites
1 Crossbite tendency
2 Single tooth in crossbite
3 More than 1 tooth in crossbite
4 More than 1 tooth in scissor bite
Overjets
o The recording zone starts from the distal anatomical contact point of the
lateral incisor on one side to the distal anatomical contact point of the
lateral incisor on the other side.
o The most prominent aspect of any one incisor is recorded with a ruler
held parallel to the occlusal plane.
o Overjets and crossbites are recorded here. The sum of the two scores is
the total score for this component. If there is a positive overjet and
incisors or canines in crossbite the scores should be added together
Overjet component
measurements
Overjet
0 0-3 mm
1 3.1- 5mm
2 5.1- 7mm
3 7.1- 9mm
4 Greater than 9mm

Anterior crossbites
0 No discrepancy
1 One or more teeth edge to
edge
2 One single tooth in
crossbite
3 Two teeth in crossbite
4 More than two teeth in
crossbite
Overbite
oThe vertical overlap or open bite of the anterior teeth is recorded.
oThe tooth with the greatest overlap is recorded.
oIf OB and AOB are present, then they should be added.
Overbite component measurements
Open bite
0 No open bite
1 Openbite less than and equal to 1mm
2 Openbite 1.1 mm – 2 mm
3 Openbite 2.1 mm- 3 mm
4 Open bite greater than or equal 4mm
Overbite
0 Less than or equal to 1/3 coverage of the lower incisor
1 Greater than 1/3, but less than 2/3 coverage of the
lower incisor

2 Greater than 2/3 coverage of the lower incisor
3 Greater than or equal to full tooth coverage.
Centrelines
o Records the centreline discrepancy in relation to the lower central incisor.
o If a lower incisor has been extracted the measurement is not recorded.
PAR Score Centrelines discrepancyassessment
0 Coincident and up to ¼ lower incisor
width
1 ¼ to ½ lower incisor width
2 Greater than ½ lower incisor width
Advantages
1) Reliable.
2) Easy and quick considering the PAR ruler is used.
3) May be used for all types of malocclusion, treatment modalities, and
extraction / non-extraction cases.
4) The score provides an estimate of how far a case deviates from the
normal
5) Good tool in measuring the perceived degree of improvement and
therefore the success of treatment. Thus, it is an indicator for clinical
performance
NB: OJ multiplied by 6, OB by 2 and ML by 4, Zero weighing for
displacements
Disadvantages
1. It is not an index of treatment need.

2. It provides a single summary score for all the occlusal
anomalies. Thus, it is insensitive and can misjudge
individual patient need. Therefore, it is better to weigh each
malocclusion individually.
3. The reliability of the upper left and right segments was
found to be low and this was referred to the fact that the
upper teeth varies in size. The larger teeth cause a broader
contact points which makes inaccurate recording of the
scores (Richmond et al. 1992).
4. Hamdan and Rock (1999) suggested the limitation of PAR
index to be:
 Overjet high weighing
 Overbite low weighing
Outcome assessment
There are basically three methods of assessing outcome using the PAR
Index.
o The first is to record the reduction in PAR score. 22 point reduction
indicates great improvement.
o The second method is to calculate the percentage change. A percentage
improvement of greater than 70% can be considered as a good standard of
orthodontic treatment. While, 30-70% reduction represents an
improvement. Less than 30% reduction is either considered as becoming
worse or no improvement.
o The final method of assessmentis to use the graph (nomogram)

INDEX OF COMPLEXITY, OUTCOME AND NEED (ICON)
 This is the first index based on an international orthodontic opinion.
 This index comprised of an assessment of:
Score 0 1 2 3 4 5
1) Aesthetic 1-10 as judged
using IOTN
AC
2) Upper arch
crowding
Only the
highest trait
either spacing
or crowding
Less than
2mm
2.1-
5mm
5.1-
9mm
9.1-
13mm
13.1-
17m
m
More
than
17mm
or
impacte
d teeth
3) Upper spacing Up to
2mm
2.1-
5mm
5.1-
9mm
More
than
9mm
4) Crossbite Transverse
relationship of
cusp to cusp or
worse
No
crossbites
Cross
bite
present
5) Incisor open bite Only the
highest trait
either openbite
or overbite
Complete
bite
Less
than
1mm
1.1-
2mm
2.1-
4mm
More
than
4mm
6) Incisor overbite Lower incisor
coverage
Up to 1/3
tooth
1/3- 2/3
coverag
e
2/3 up
to full
covered
Fully
covere
d

7) Buccal segment
anterioposterior
Left and right
added together
Cusp to
embrasure
relationshi
p only, Cl
I, II, III
Any
cusp
relation
up to
but not
includin
g cusp
to cusp
Cusp to
cusp
relation
ship
ABO DiscrepancyIndex (ABO DI)
The elements which make up the ABO Discrepancy Index are
measurements of:

1. Overjet and anterior cross bite
2. overbite and anterior open bite and lateral open bite,
3. crowding,
4. buccalocclusion,
5. lingual posterior crossbite and buccal posterior crossbite,
6. ANB angle and SN-Go-Gnand lower incisor to GoGnangle.
7. An additional category designated "other" is available so that other
conditions which may affect or add to complexity of treatment may be
scored.
OVERJET:Overjet is scored as the distance between the incisal edge of
the most forward positioned maxillary incisor and the most forward
positioned mandibular incisor. For overjets of 0 mm. (edge to edge), 1
point is scored;for overjets of 0 to 3 mm., no points are scored;for 3.1 - 5
mm., 2 points are scored;for 5.1 - 7 mm., 3 points are scored;for 7.1 - 9
mm., 4 points are scored and if over 9 mm., 5 points are scored. If there is
a negative overjet (anterior crossbite), the scoreis recorded as 1 point per
mm. per anterior tooth in crossbite.
OVERBITE:For overbites of up to 3 mm. no points are scored. If the
overbite is between 3.1 to 5 mm. 2 points are scored;if between 5.1 to 7
mm. 3 points are scored. If the lower incisors are impinging on the palatal
tissue (100% overbite), then 5 points are scored.
ANTERIOR OPEN BITE:If the maxillary and mandibular incisors are
in an edge to edge relationship (overbite = 0), then 1 point is scored. For
each millimeter of open bite, 2 points are scored for each maxillary tooth
involved from canine to canine. No points are scored for the maxillary
canines if they are blocked out of the arch to the labial.

LATERAL OPEN BITE:For each maxillary tooth (from the first
premolar to third molar) in an open bite relationship with the lower arch,
2 points are scored per mm. of open bite for each tooth.
CROWDING:When scoring crowding, the most crowded dental arch is
considered. From 1 to 3 mm. one point is scored;from 3.1 - 5 mm. 2
points are scored;from 5.1 - 7 mm. 4 points are scored. If the crowding is
greater than 7 mm. 7 points are scored.
OCCLUSION:When scoring occlusion, the Angle classification is used.
If the mesiobuccal cusp of the maxillary first molar occludes with the
buccalgroove of the mandibular first molar or anywhere between the
buccalgroove and the mesiobuccal cusp (cusp to cusp or end on), no
points are scored. If the occlusal relationship is end on (cusp to cusp)
class II or III, then 2 points are scored per side. If the relationship is a full
class II or III, then 4 points are scored per side. If the relationship is
greater or beyond class II or III, then 1 additional point is scored per mm.
for each side.
LINGUAL POSTERIOR CROSSBITE:For each maxillary posterior
tooth in lingual crossbite(from the first premolar to the third molar), 1
point is scored.
BUCCAL POSTERIOR CROSSBITE:For each maxillary posterior
tooth (from the first premolar to the third molar) in complete buccal
crossbite, 2 points are scored.
CEPHALOMETRICS:If the ANB angle is greater than 5.5 degrees or
less than -1.5 degrees, 4 points are scored. Foreach additional degree
above or below these values, an additional point is scored.

If the SN-Go-Gnangle is between 27 and 37 degrees, zero points are
scored.
If the SN-Go-Gnangle is greater than 37 degrees, then 2 points are scored
for each additional degree above 37.
If the SN-Go-Gnangle is less than 27 degrees, then 1 point is scored for
each additional degree below 27.
If the lower incisor to GoGn angle is greater than 98 degrees, then 1 point
is scored for each additional degree above 98.
OTHER:At the discretion of the examiner an additional 2 points may be
awarded for each of the following conditions:
 Missing teeth (except for third molars)
 Supernumerary teeth
 Impactions (except for third molars)
 Ectopic eruption
 Anomalies of tooth size and shape
 Dental midline discrepancies greater than 3 mm.
 Skeletal asymmetries (involving dental compensation for case
completion)
Disadvantagesof ABO DI
 Complicated
 Time consuming
 Relies on cephs, expensive, time consuming, irradiation, reproducibility
 Reproducibility
Advantages of ABO DI
o Detailed/comprehensive

o Measures case complexity-link this to who should treat the case, and case
suitability for examinations, remember that difficulty is elusive and
subjective.

HANDICAPPING MALOCCLUSION ASSESSMENT RECORD
(HMAR)
 The purpose of the HMAR form is to provide a means for establishing
priority for treatment dentofacial deformity constitute a hazard to the
maintenance of oral health and interfere with the well-being of the child
by adversely affecting dentofacial aesthetics, mandibular function or
speech (Salzmann, 1968).
 The HMAR is used to:
 Inter and intra-arch relationships are looked at.
1. Intra-arch deviations include:
 Missing teeth
 Crowding
 Rotations
 Spacing
2. Inter-arch relationships include:
 Overjet
 Crossbite
 Overbite
 Openbite
 Molar and canine relationships
IRREGULARITY INDEX
 Developed by Little (1975).
 It assess the irregularity of the lower labial segment by measuring the
linear displacement of the contact points in mm (from the mesial contact
point of the canine on one side to the mesial contact point of the canine
on the other hand side)

 The sum of these 5 displacments representing the relative degree of
anterior irregularity.
Crowding index
In occlusal view, the CI was determined by measuring the available
horizontal space parallel to the occlusal plane, between the least displaced
interproximal contact points. The actual width of the corresponding tooth
was then deducted from the available spaceto give a resultant amount of
crowding (positive measure) or spacing (negative measure) for each tooth
The validity of maxillary expansion indices, O'Reilly, 1995
1) In 1909, Pont (overestimate)described a method which assumed a
constant relationship between the sum of the maxillary incisor widths
(SI=Sum of Incisors) and the width of the dental arch in an ideal
uncrowded dentition. The formula was then transposed to allow arch
width prediction: Required inter-premolar width = SI/ 0.80 Required
inter-molar width = SI/0.6
2) McNamara (overestimate)proposed asimple rule of thumb indicating an
ideal average Intermolar width in males of 37 mm and in females of 36
mm

3) Schwarz's analysis (accurate)was calculated with the appropriate
formula as described by Schwarz. In narrow faces, the first inter-premolar
width is SI + 6 mm while the intermolar width is SI + 12 mm; in the
average face the widths are SI + 7 mm and SI + 14 mm; in broad faces
they are SI + 8 mm and SI + 16 mm respectively.
A treatment difﬁculty index for unerupted maxillary canines, Pitt,
Hamdan and Rock, 2006
The prognosis for alignment of an impacted maxillary canine is affected
by several factors (McSherry, 1996):
1. Horizontal position
2. Age of patient.
3. Vertical height.
4. Bucco-palatal position.
5. Angulation to midline.
6. Rotation.
7. Coincidence of arch midlines.
8. Alignment and spacing of the upper labial segment.
9. Condition of primary canine.
10. Missing teeth.
Result of this study, Difficulty scorein order: (ACRONYM HAV
BARMA CM)
Plaque index
 Records levels of supragingival plaque present
 Subjective scoring:
o 0= no plaque at gingival margin
o 1= initial deposite of plaque at gingival margin (not visible to the eye)

o 2= plaque at the gingival margin (visible to the eye)
o 3= heavy plaque accumulation on tooth
Gingival index
o 0= healthy
o 1= mild inflammation, slight change in colour.
o 2= moderate inflammation, redness, moderate glazing, bleeding on
pressure.
o 3= severe inflammation, redness, hyperplasia, tendency for spontaneous
bleeding.
 Recommends scoring of 6 teeth which are: 6 2 | 4
4 | 2 6
 Four values per tooth recorded;buccal, lingual, mesial and distal.
Further reading if you like the indecis!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
• HANDICAPPING LABIO-LINGUAL DEVIATION (HLD)
• SWEDISH INDEX (NEED FOR TREATMENT INDEX)
• TREATMENT PRIORITY INDEX (TPI)

Orthodontic indecis for orthodontists by Almuzian

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