Initial development of an 'Orthodontic Care Index' involving treatment need,-complexity and-priority.

BACKGROUND/OBJECTIVES: The aim of this study was to develop an evidence-based scoring system for prioritizing limited orthodontic resources based on orthodontic treatment need (OTN), orthodontic treatment complexity (OTC), and orthodontic treatment priority (OTP), which is not merely a scoring system for malocclusion but also a comprehensive classification of orthodontic issues incorporating patient- and treatment-related factors, called Orthodontic Care Index (OCI). MATERIALS AND METHODS: The development of the OCI involved eight phases, starting with a systematic literature review to identify all possible parameters involved in determining OTN, OTC, and OTP. An eight-member orthodontic specialist panel then evaluated and scored the significance of each parameter, resulting in a parameter-score list. Subsequently, a retrospective convenience sample of 61 patients was scored with the parameter-score list, and using the same convenience sample a gold standard was established through the expert opinion of a third orthodontic panel. Linear regression analysis was used to estimate weights of importance and construct a formula to calculate index scores. Lastly, the expert opinion was compared to the index scores, to determine the index performance. RESULTS: The preliminary index separately calculates OTN, OTC, and OTP for a patient as the weighted sum of his/her domain scores. The sensitivity of the index for predicting OTN, OTC, and OTP was high (98.1%, 82.9%, and 92.7% respectively), while the variability of each was relatively low (52.1%, 31.2%, and 52.6% respectively). CONCLUSIONS/IMPLICATIONS: The OCI shows promise as a guideline for prioritizing orthodontic care. It will be further refined and validated to enhance its performance and usefulness.

Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review.

The purpose of this study was to systematically review the literature regarding the prevalence of malocclusion and different orthodontic features in children and adolescents. METHODS: The digital databases PubMed, Cochrane, Embase, Open Grey, and Web of Science were searched from inception to November 2021. Epidemiological studies, randomized controlled trials, clinical trials, and comparative studies involving subjects ≤ 18 years old and focusing on the prevalence of malocclusion and different orthodontic features were selected. Articles written in English, Dutch, French, German, Spanish, and Portuguese were included. Three authors independently assessed the eligibility, extracted the data from, and ascertained the quality of the studies. Since all of the included articles were non-randomized, the MINORS tool was used to score the risk of bias. RESULTS: The initial electronic database search identified a total of 6775 articles. After the removal of duplicates, 4646 articles were screened using the title and abstract. A total of 415 full-text articles were assessed, and 123 articles were finally included for qualitative analysis. The range of prevalence of Angle Class I, Class II, and Class III malocclusion was very large, with a mean prevalence of 51.9% (SD 20.7), 23.8% (SD 14.6), and 6.5% (SD 6.5), respectively. As for the prevalence of overjet, reversed overjet, overbite, and open bite, no means were calculated due to the large variation in the definitions, measurements, methodologies, and cut-off points among the studies. The prevalence of anterior crossbite, posterior crossbite, and crossbite with functional shift were 7.8% (SD 6.5), 9.0% (SD 7.34), and 12.2% (SD 7.8), respectively. The prevalence of hypodontia and hyperdontia were reported to be 6.8% (SD 4.2) and 1.8% (SD 1.3), respectively. For impacted teeth, ectopic eruption, and transposition, means of 4.9% (SD 3.7), 5.4% (SD 3.8), and 0.5% (SD 0.5) were found, respectively. CONCLUSIONS: There is an urgent need to clearly define orthodontic features and malocclusion traits as well as to reach consensus on the protocols used to quantify them. The large variety in methodological approaches found in the literature makes the data regarding prevalence of malocclusion unreliable.