Judging orthodontic treatment complexity

Abstract

Objective: The aim of the present study was to investigate possible relations between anticipated overall treatment complexity (AOTC) of an orthodontic case and malocclusion characteristics. Methods: Two groups of orthodontists (groups A and B) were asked to define perceived treatment complexity (PTC) of orthodontic cases based on 16 characteristics of malocclusion by means of a questionnaire. Each question was answered on a six-point ordinal scale, with one "not applicable" option (score 0). Group A was also asked to give the AOTC of the specific case on a five-point ordinal scale. The index of orthodontic treatment need (IOTN) score of the specific cases as well as the malocclusion characteristics were assessed by one author. Results: There is a significant relationship between IOTN and AOTC (p< 0.0001), 22% of variability is explained by differences in IOTN. Adding objective characteristics of malocclusion to explain AOTC does not significantly increase the explained variability (p = 0.086). In judging interobserver agreement, a weighted Kappa of 0.60 for group A and 0.56 for group B was found. The weighted Kappa for agreement in AOTC equals 0.06. Conclusion: The relation between IOTN and AOTC was found to be significant. Moderate agreement on PTC among observers and a low level agreement regarding AOTC were found in the present study.

Relationship between the Dental Aesthetic Index and Discrepancy Index

“…Even though the terms severity and complexity are related, they are not synonymous. In reference to malocclusion, they have different meanings; case complexity can be defined as the measure of effort, difficulty and skill needed to treat malocclusion, while severity is a measure of how much a malocclusion deviates from the ideal (Clijmans et al, 2016). Other authors have highlighted that the difficulty in dealing with cases is a subjective concept and that the differences in overall treatment approach, appliance design and academic training are other important variables in the perceived case complexity (Cangialosi et al, 2004).…”

“…Although the terms ‘complexity’ and ‘severity’ have been associated with malocclusions, there are differences between them. While the severity of malocclusion is a measure of how much a malocclusion of the ideal deviates and is related with the need for orthodontic treatment (Shivakumar et al, 2010), the complexity of malocclusion has been associated with a measure of effort and skill to treat (Clijmans et al, 2016). Orthodontic indices play an important role in the classification of malocclusions, orthodontic treatment needs, level of complexity and prediction of treatment duration.…”

The IOTN in latest studies – a literature review

“…The ICON's weakest aspect appears to be its strong association with the AC at 7 points (8). Therefore, the final score depends mainly on the assessment of the aesthetics of the occlusion, which, as we know, can be very subjective (44).…”

“…Najsłabszym aspektem wskaźnika ICON wydaje się silne powiązanie ze składową AC na poziomie 7 punktów (8). Z tego względu końcowy wynik w ogromnej mierze zależy od oceny estetyki zgryzu, która jak wiadomo, bywa bardzo subiektywna (44).…”