Orthodontic dentistry

seminar
 Alaa Abu Shamala Huda Taysier Alamassi

Sulaiman Nayef Abu

Ahmad Hassan Al Haj Ahmad
Sharia
Meet
Our
Team
 Reference:

Davies, C. (2020). Textbook for

Orthodontic Therapists (1st ed.). John
Wiley & Sons.
Contents:
01 Index of Orthodontic Treatment Need (IOTN)

Dental Health Component

Aesthetic Component

02 Peer Assessment Rating (PAR)

Components of PAR

Assessment of Improvement in PAR

Who Uses PAR?

 Index of Orthodontic Treatment Need (IOTN). (Brook
and Shaw, 1989)

The IOTN is the Index of Orthodontic Treatment Need and has two components:

• Dental Health Component (DHC).

• Aesthetic Component (AC).

o It assesses the worst feature of the malocclusion and the need for treatment.

o Can be used in clinical assessment, at chairside, and on study models.

 Dental Health Component

• This component looks at the worst feature of the malocclusion that has an impact on
dental health.

• It operates by the following the acronym that helps to identify the worst occlusal
feature, MOCDO:

M – Missing
O – Overjet/reverse overjet
C – Crossbites
D – Displacement in contact points
O – Overbite/openbites
Missing -
Hypodontia
Missing
Overjet
Reverse
overjet
Crossbites
Displacement in contact points
Overbite
Openbites
• Once the worst feature has been identified, it is then initialized with a letter, as follows:

a – Overjet
i – Impeded or impacted teeth
m & b – Reverse overjet
p – Cleft lip and palate
s – Submerged deciduous teeth
h – Hypodontia
l – Lingual crossbite
t – Tipped teeth
x – Supernumerary
g – Good occlusion
c – Crossbites
d – Displacement of contact points
e – Openbites/anterior openbites (AOB)
f – Overbites/deepbites
 DHC Component, Using The MOCDO Acronym
IOTN Dental Health
Component 5 4 3 2 1

5h=More than one missing 4h =Only one missing tooth in any

Missing teeth
tooth in any quadrant. quadrant.
5s=Submerged deciduous
teeth.
5i=Impeded or impacted
teeth

5a = OJ>9 mm 4a = OJ 6.1-9 mm. 3a = OJ 3.6-6 mm + 2a = OJ 3.6-6 mm + competent

Overjet
5m ₌ ROJ >3.5 mm + 4b = ROJ > 3.5 mm with no incompetent lips lips
masticatory and speech masticatory and speech difficulties. 3b = ROJ 1.1-3.5 mm 2b = ROJ 0.1-1 mm
difficulties 4m = Reverse overjet greater than 1
mm but less than 3.5 mm with
recorded masticatory or speech
difficulties.

4c =Anterior & posterior x-bites + 3c =Anterior and posterior x- 2c = x-bite with up to 1 mm

Crossbite
>2 mm discrepancy between RCP bite + 1.1 – 2 mm discrepancy between ICP and
and ICP. discrepancy between RCP RCP.
4l = posterior lingual x-bite. and ICP

4d = contact point displacement >4 3d = contact point 2d = contact point displacement

Displacement of contact
mm. displacement 2.1- 4 mm 1.1 – 2 mm
point 4t = Tipped teeth, partially erupted.
4x =Supernumerary
Teeth.

4e = lateral or anterior open bite >4
Overbite (including open
mm.
bite) 4f = increased + complete OB +
Gingival or palatal trauma
3e = lateral or anterior open 2e =anterior or posterior open
bite 2.1- 4 mm bite 1.1 – 2 mm
3f = increased + complete 2f = increased OB ≥
OB with no gingival trauma 3.5 mm and no gingival contact
• After initialization there are five grades within the DHC into which the patient
can be classified.

• The grading all depends on if their worst feature meets the requirements of that
grade:

Grade 5 – Very great need

Grade 4 – Great need
Grade 3 – Borderline need (AC component used)
Grade 2 – Little need
Grade 1 – No need

• Regardless of MOCDO, the highest grade is always chosen.

• For instance, if there is one occlusal anomaly in grade 5 and the rest in grade 4,
it would be grade 5.
 Grade 5 (Very great need)

5i  Impeded or impacted teeth

5h More than one missing tooth in any quadrant

5a Overjet >9 mm

 Reverse overjet >3.5 mm with

5m
masticatory/speech difficulties

Defects of cleft lip and palate and other

5p
craniofacial anomalies.

5s Submerged deciduous teeth

 Grade 4 (Great need)

4h Only one missing tooth in any quadrant

4b Reverse overjet >3.5 mm with no masticatory/speech difficulties

4m Reverse overjet >1 mm but <3.5 mm with masticatory/speech difficulties

Anterior and posterior crossbites with >2 mm displacement between retruded

4c contact position (RCP) and intercuspal position (ICP)

Posterior lingual crossbite with no functional occlusal contact in one or both

4l buccal segments.

4d Contact point displacement >4 mm

4e Extreme lateral openbites or AOB >4 mm

4f  Increased and complete overbite with trauma

4t   Tipped teeth, partially erupted

4a Overjet >6 mm or = 9 mm

4x  Supernumerary present
 Grade 3 (Borderline need)

Increased overjet greater than 3.5 mm but less than or

3a
equal to 6 mm with incompetent lips.
Reverse overjet greater than 1 mm but less than or equal
3b
to 3.5 mm.

Anterior and posterior crossbites with greater than 1 mm

3c but less than or equal to 2 mm discrepancy between
retruded contact position and intercuspal position.

Contact point displacements greater than 2 mm but less

3d
than or equal to 4 mm.
Lateral or anterior open bite greater than 2 mm but less
3e
than or equal to 4 mm.
Deep overbite &complete on gingival or palatal tissues but
3f
no trauma.
 Grade 2 (Little need)

Increased overjet greater than 3.5 mm but less

2a
than or equal to 6 mm with competent lips.
Reverse overjet greater than 0 mm but less than or
2b
equal to 1 mm.
Anterior and posterior crossbites ≤1 mm between
2c
RCP and ICP
Contact point displacements greater than 1 mm
2d
but less than or equal to 2 mm.
Anterior or posterior open bite greater than 1 mm
2e
but less than or equal to 2 mm.
Increased overbite ≥3.5 mm with no gingival
2f
contact
Pre‐ or post‐normal occlusion with no other
2g
anomalies – good occlusion
 Grade 1 (No need)

• Extremely minor malocclusions, including contact point displacements less

than 1 mm.

RCP and ICP

RCP and ICP look at how the teeth meet on occluding:

• Retruded contact position (also known as centric relation): the position at which
the teeth meet first before deviating into complete intercuspation.

• Intercuspal position (also known as centric occlusion): complete intercuspation

of the opposing teeth.

• The molars meet cusp to cusp on closing (RCP), then deviate into complete
intercuspation (ICP).

Centric Relation:
https://www.youtube.com/watch?v=rBv1W5m1h2I
Dental Health Component
Dental Health Component
 Aesthetic component

• Connected with grade 3.

• Concerned with the appearance of malocclusion to the patient.
• 10 colors photographs of different levels of attractiveness of
malocclusion is used .
• The clinician should pick photographs before, during and after
the treatment.
• Photograph 1–5 do not qualify
for treatment.

• Photograph 6–10 do qualify for

treatment.

• The disadvantage of the

photographs is that they are all
the same, just presenting more
crowding.

• There are no examples of AOB,

class III malocclusion, POB,
and so on.
 Peer Assessment Rating (PAR)

• Index used to measure the success of treatment, so it used pre and

post treatment.

Benefits of PAR:
o Measure the degree of success of treatment.
o Improve the Quality of treatment.
o As a cumulative score.
 Components of (PAR)

o Upper and lower anterior segments.

o Right and left buccal segments.

o Overjet and reversed overjet.

o Overbite ang open bite.

o Centerline.
o PAR in each component are scored added up and given an unweighted total. .
o The unweighted total in each section is then multiplied by the relevant
weighting factor to give an overall weighted total for each section.
 Components and Weightings of (PAR) :

Component 1:
Upper and lower anterior segments(×1 )

Component 2:
Right and left buccal segments(×1)
Component 3:
Overjet (×6)
Component 4:
Overbite(×2)
Component 5:
Centerline(×4)

o All the PAR components are given an unweighted total then multiplied by the relevant
weighting factor to give an overall weighted total.

o Total for component X Weighting factor = Weighted total

 :Upper and Lower Anterior Segments (ULS , LLS)

Scores Displacement

0 0mm – 1mm
o Recording Zone = canine(mesial
contact point).
1 1.1mm – 2mm
o They score between 1 and 5.
2 2.1mm – 4mm
o The scores are added up and
multiplied by their weighting
3 4.1mm – 8mm factor ×1.

4 more than 8mm

5 impacted teeth
 : Right and Left Buccal Segments or Occlusion (RBO\LBO)

o Recording Zone = canine for last molar (either 1st ,2nd or 3rd ).
o A-P , VERTICAL , TRANSVERCE scores are summed for each buccal segment.

Scores A-P

0 good interdigitation

1 less than 1\2 unit from full

2 1\2 unit ( cusp _ cusp)

Scores VERTICAL

0 NO open bite

1 lateral open bite less than 2mm on at least two teeth

Scores TRASVERCE

0 NO cross bite

1 cross bite tendency

2 single tooth in cross bite

3 more than 1 tooth in cross bite

4 more than 1 tooth in scissors bite

o Each plane is scored and added up separately and multiplied by
the weighting factor of ×1.

o The weighted totals for all components need to be added together

to give the total PAR score for both pre‐ and post‐study models.
 

NOTE :
 Greatly improve < 22 points
 Improved < 30%
 Worse \ No different > 30%
 Overjet and Reversed Overjet
o Looks at anterior segment in occlusion.
o Measures positive and negative overjet:

Positive overjet:
• Measured from the most prominent incisor.
• PAR ruler held parallel to the occlusal plane using the overjet
section.
• See which box the most prominent incisor sits in, if it sits on a
line take the lower score.
• Scored as 0, 1, 2, 3, or 4.
Negative overjet:
• Looks for any anterior crossbites.
• Negative overjet scored as:
0 = No crossbite
1 = 1 or>1 tooth edge to edge
2 = 1 tooth in crossbite
3 = 2 teeth in crossbite
4 = >2 teeth in crossbite
• Each occlusal feature is scored and added up separately
and multiplied by the weighting factor of ×6.
 Overbite and Openbite
Looks at the anterior segment in occlusion
Overbite :
o Recorded vertically on the greatest coverage of the lower incisors.
o Scores are made up in thirds.
o Lower incisor visually divided up into horizontal thirds.
o Score assessed by how many thirds the upper incisors cover.
o Scores calculated as:
• 0=<1/3 coverage
• 1=>1/3 & 2/3 coverage
• 2=>2/3 coverage
• 3= full tooth coverage
Openbite :
o Recorded between incisal edges.
o Openbite section used on PAR ruler.
o Lines placed vertically between upper and lower incisor edges.
o Line of best fit given a score:
• 0 = No anterior openbite (AOB)
• 1 = ≤1mm
• 2 = 1.1–2mm
• 3 = 2.1–4mm
• 4 = >4.1mm
Each occlusal feature is scored and added up separately and then
multiplied by the weighting factor of ×2.
 Centerline

o Looks at the relation of the upper centerline in relation to the lower centerline.
o Looks at the anterior segment in occlusion.
o Scores made up into quarters.
o Lower incisor divided into vertical quarters.
o Upper centerline then worked out by how many quarters it is off relative to the
lower incisor.
o Scores calculated as:
• 0=<1/4
• 1=1/4 – ½
• 2=>1/2
o Scores added up and multiplied by the weighting factor of ×4.
 Assessment of Improvement in PAR
Since PAR is used to measure the success of treatment, calculations are
carried out on each patient’s initial and final study models to work out
the overall percentage of improvement. The calculations for this are as
follows:

• Record the starting PAR

• Record the finishing PAR
• Work out the reduction in PAR:
Starting PAR - Finishing PAR
 Assessment of Improvement in PAR
• % Reduction:
(Reduction / starting PAR) *100 = Percentage reduction
70% is a good standard.
• Less than 5 PAR points for final study model = excellent occlusion.
• More than 10 PAR points for final study model = unacceptable occlusion.

Remember:
o Scores are cumulative, unlike in the IOTN.
o 10 or fewer PAR points = greatly improved.
• If you lose the pre‐study model for a particular patient, a finishing PAR
score of 10 or less signifies a great improvement.
 Who Uses PAR?

• Any member of the orthodontic team can PAR score, especially

team members who have undergone special training in how to
achieve the ratings.

• PAR is used on pre‐ and post‐treatment study models for all

patients who have undergone orthodontic treatment on the NHS.

• Primary Care Trusts use this method to assess treatment outcomes

each year on a sample of more than 30 cases.

• Orthodontists are allowed to have 5% of cases graded as no

improvement, but if more than 5% of all their cases are deemed to
be graded as no improvement, then this is a very poor result.
Thank you