Background: Assessment of orthodontic treatment need is a complicated issue. As integral part of oral health care programs, Orthodontic treatment needs to be based on information of treatment needs. The evaluation of malocclusion is the essential component in establishing the diagnosis and treatment need of the orthodontic patient.Taking decision of whether or not one should undergo orthodontic treatment, both the desire of the patient (and/ or parents) and the opinion of the orthodontist must be taken into account. One of the major problems in studying malocclusion is the availability of a suitable objective method for recording the occurrence and severity of orthodontic problem. Thus, orthodontic indices are used in clinical and epidemiological studies of malocclusion. The aim of this study is to determine the necessity and complexity of orthodontic anomalies by applying Index of Complexity, Outcome and Need (ICON) in Saudi population.Methods: A descriptive cross-sectional study was conducted on dental casts of 150 patients (mean age 15.66±1.07) adolescents randomly selected from the northern border region of Saudi Arabia (KSA). Index of Complexity Outcome and Need (ICON) was applied to find out the orthodontic treatment need and initial stage complexity grades. The data was performed using the statistical software package IBM SPSS Statistics 24.0. Results: 80% of the patients needed some sort of orthodontic therapy. More than 65% of the cases were classified as being difficult and very difficult to treat. Conclusion: It was concluded that a high number of cases were in need of the orthodontic therapy and majority of the patients undergoing orthodontic treatment were in difficult grades.