A Comparison of Three Orthodontic Treatment Indices with Regard to Angle Classification

Objectives: To calculate the agreement between the Dental Aesthetic Index (DAI) and the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need and to determine correlations between the Peer Assessment Rating (PAR) and DAI and ICON scores according to Angle classification among patients referred for orthodontic evaluation.

Study Design: This study included 457 randomly selected patients between 9 to17 years of age. Patients were divided into four groups according to Angle classification [Class I (n=154), Class II division 1(Class II/1) (n=155), Class II division 2(Class II/2) (n=52) and Class III (n=96)]. Relationships between PAR scores and ICON and DAI scores were evaluated with the Spearman correlation test. Unweighted kappa statistics were used to analyse agreement between the ICON and DAI on the need for treatment, according to Angle classification. Results: Class I malocclusions scored significantly lower than other Angle classifications in all indices. Both the ICON and DAI showed significant positive correlations with the PAR in the general study population. For Class II/2 patients, no correlation was found between PAR and DAI scores. There was significant agreement between the ICON and DAI on treatment need among Class I, Class II/1 and Class II/2 patients however, no agreement was found for Class III malocclusions. Conclusions: The ICON, DAI and PAR produce similar results and can be used interchangeably for the general orthodontic patient population. However, based on Angle classification, prominent differences exist in scoring certain occlusal features.

Angle classification, DAI, ICON, Orthodontic indices, PAR

1. Borzabadi-Farahani A. An insight into four orthodontic treatment indices. Prog Orthod 12:132-42, 2011.

2. Borzabadi-Farahani A. A review of the evidence supporting the aesthetic orthodontic treatment need indices. Prog Orthod 13:304-13, 2012.

3. Cons NC, Mruthyunjaya YC, Pollard ST. Distribution of occlusal traits in a sample of 1,337 children aged 15-18 residing in upstate New York. Int Dent J 28:154-64, 1978.

4. Jenny J, Cons NC, Kohout FJ, Frazier PJ. Test of a method to determine socially acceptable occlusal conditions. Community Dent Oral Epidemiol 8:424-33,1980.

5. World Health Organization International Collaborative Study of Oral Health Outcomes (ICS II), document 2. Oral data collection instrument and evaluative criteria, WHO, Geneva. 1989.

6. Beglin FM, Firestone AR, Vig KW, Beck FM, Kuthy RA, Wade D. A comparison of the reliability and validity of 3 occlusal indexes of orthodontic treatment need. Am J Orthod Dentofacial Orthop 120:240-6, 2001.

7. Jenny J, Cons NC. Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment need and the Dental Aesthetic Index. Am J Orthod Dentofacial Orthop 110:410-6, 1996.

8. Danyluk K, Lavelle C, Hassard T. Potential application of the dental aesthetic index to prioritize the orthodontic service needs in a publicly funded dental program. Am J Orthod Dentofacial Orthop 116:279-86, 1999.

9. Richmond S, Shaw WC, O’Brien KD, Buchanan IB, Jones R, Stephens CD, et al. The development of the PAR index (peer assessment rating): reliability and validity. Eur J Orthod 14:125-39, 1992.

10. Holman JK, Hans MG, Nelson S, Powers MP. An assessment of extraction versus nonextraction orthodontic treatment using the peer assessment rating (PAR) index. Angle Orthod 68:527–34, 1998.

11. DeGuzman L, Bahiraei D, Vig KW, Vig PS, Weyant RJ, O’Brien K. The validation of the Peer Assessment Rating index for malocclusion severity and treatment difficulty. Am J Orthod Dentofacial Orthop 107:172-6, 1995.

12. Richmond S, Daniels CP, Fox NA, Wright J. The professional perception of orthodontic treatment complexity. Br Dent J 183:365-70, 1997.

13. Firestone AR, Beck FM, Beglin FM, Vig KW. Evaluation of the peer assessment rating (PAR) index as an index of orthodontic treatment need. Am J Orthod Dentofacial Orthop 122:463-469, 2002.

14. Soh J, Sandham A, Chan YH. Malocclusion severity in Asian men in relation to malocclusion type and orthodontic treatment need. Am J Orthod Dentofacial Orthop 128:648-52, 2005.

15. Daniels CP, Richmond S. The development of the index of complexity, outcome and need(ICON). J Orthod 27:149-62, 2000.

16. Richmond S, Ikonomou C, Williams B, Ramel S, Rolfe B, Kurol J. Orthodontic treatment standards in a public group practice in Sweden. Swed Dent J 25:137-44, 2001.

17. Firestone AR, Beck M, Beglin FM, Vig KWL. Validity of the index of complexity, outcome, and need. Angle Orthod 72:15-20, 2002.

18. Liepa A, Urtane I, Richmond S, Dunstan F. Orthodontic treatment need in Latvia. Eur J Orthod 25:279-84, 2000.

19. Borzabadi-Farahani A, Borzabadi-Farahani A. Agreement between the index of complexity, outcome, and need and the dental and aesthetic components of the index of orthodontic treatment need. Am J Orthod Dentofacial Orthop 140:233-8, 2011.

20. Silva RG, Kang DS. Prevalence of malocclusion among Latino adolescents. Am J Orthod Dentofacial Orthop 119:313-5, 2001.

21. Angle H. Classification of malocclusion. Dental Cosmos 41:248-64, 1899.

22. Baume LJ, Marechaux S. Uniform methods for the epidemiologic assessment of malocclusion. Am J Orthod 66:121-9, 1974.

23. McLain JB, Proffit WR. Oral health status in the United States: prevalence of malocclusion. J Dent Educ 49:386-96, 1985.

24. Koochek AR, Yeh MS, Rolfe B, Richmond S. The relationship between index of complexity, outcome and need, and patients’ perceptions of malocclusion: a study in general dental practice. Br Dent J 191:325-9, 2001.

25. Johnson M, Harkness M, Crowther P, Herbison P. A comparison of two methods of assessing orthodontic treatment need in the mixed dentition: DAI and IOTN. Aust Orthod J 16:82–7, 2000.

26. British Standard Institute. British Standard Incisor Classification. Glossary of Dental Terms BS 4492, BSI, London 1983.

27. Estioko LJ, Wright FA, Morgan MV. Orthodontic treatment need of secondary schoolchildren in Heidelberg, Victoria: an epidemiologic study using the Dental Aesthetic Index. Community Dent Health 11:147-51, 1994.

28. Onyeaso CO, Begole EA. Relationship between index of complexity, outcome and need, dental aesthetic index, peer assessment rating index, and American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop 131:248-52, 2007.

29. Manzanera D, Montiel-Company JM, Almerich-Silla JM, Gandia JL. Diagnostic agreement in the assessment of orthodontic treatment need using the dental aesthetic index and the index of orthodontic treatment need. Eur J Orthod 32:193-8, 2010.

30. Otuyemi OD, Noar JH. Variability in recording and grading the need for orthodontic treatment using the handicapping malocclusion assessment record, occlusal index and dental aesthetic index. Community Dent Oral Epidemiol 24:222-4, 1996.

31. Garbin JI, Perin PCP, Garbin CAS, Lolli LF. Malocclusion prevalence and comparison between the Angle classification and the Dental Aesthetic Index in scholars in the interior of São Paulo state –Brazil Dental Press J Orthod 15:94-102, 2010.