Awareness of the age related situation as to the malocclusion prevalence in population and orthodontic treatment need is very important and useful for planning an orthodontic care, especially taking into account the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree of severity of malocclusion and the need of orthodontic treatment in three different age groups of population in Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds (n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results. In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations were chosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was determined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontic treatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds. Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.publishersversionPeer reviewe

Liepa, Andra

Pugaca, Jolanta

Rogovska, Irena

Urtane, Ilga

English

Awareness of the age related situation as to the malocclusion prevalence in population and orthodontic treatment need is very important and useful for planning an orthodontic care, especially taking into account the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree of severity of malocclusion and the need of orthodontic treatment in three different age groups of population in Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds (n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results. In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations were chosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was determined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontic treatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds. Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.Peer reviewe

Riga Stradins university

Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 2. 3 5The severity of malocclusion and need for orthodontictreatment in correspondence with the ageIlga Urtane, Jolanta Pugaca, Andra Liepa, Irena RogovskaIlga Urtane – D.D.S., PhD., professor, Head of Department of Orth-odontics, Director of Institute of Stomatology,Riga Stradins University, Riga, Latvia.Jolanta Pugaca – D.D.S., Department of Orthodontics, Institute ofStomatology, Riga Stradins University, Riga,Latvia.Andra Liepa – D.D.S., Assoc. prof., Department of Orthodontics,Institute of Stomatology, Riga Stradins Univer-sity, Riga, Latvia.Irena Rogovska – M.D., PhD, (University of Tampere), Medical Sta-tistics Consultant, Institute of Stomatology, RigaStradins University, Riga, LatviaAddress correspondence to prof. I.Urtane: Institute of Stomatology,Dzirciema 20, Riga LV-1007, Latvia.E-mail: iurtane@latnet.lvSCIENTIFIC ARTICLES  Stomatologija, Baltic Dental and Maxillofacial Journal, 8:35-8, 2006SUMMARYAwareness of the age related situation as to the malocclusion prevalence in population and orthodon-tic treatment need is very important and useful for planning an orthodontic care, especially taking intoaccount the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree ofseverity of malocclusion and the need of orthodontic treatment in three different age groups of populationin Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds(n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results.In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations werechosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was deter-mined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontictreatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds.Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.Key words: severity of malocclusion, orthodontic treatment need, ICON (The Index of Complexity Out-come and Need)INTRODUCTIONGlobal tendencies and paradigm shifts in clinical orth-odontics point to the change in the age distribution andin the categories of individuals who receive the benefitfrom orthodontic treatment, such as the children and ado-lescents, as well as adults and even elderly patients withmalocclusions [1; 2].Changes in morphogenesis and physiology ofdentofacial structure over time [3] and an increased con-cern for dental appearance and orthodontic treatment withage have become apparent rather than inadequate deci-sions and a provision of care during childhood and ado-lescence [4].Orthodontic treatment in adults is seen to be morecommon in clinics, nevertheless the data of severity ofmalocclusion and the need of orthodontic treatment inthe adult population are still insufficient. Most studieson the need for orthodontic treatment in Latvia [5]  and inother countries have been conducted on groups of chil-dren and adolescents. In Latvia it would be especiallyimportant  to study young and middle age groups as theyare representing the generation that is about to leave theprofessional orthodontic care.The present study is a part of the cross-sectionalsurvey on oral health in randomly selected samples ofage groups 12-13; 18 and 35-44 yr. old. The objective ofthis study was to assess and compare the severity ofmalocclusion and professionally defined need of orth-odontic treatment in different age groups.MATERIALS AND METHODSThe study sample was randomly selected based onthe data from the Latvian Central Bureau of Statistics,targeted in accordance with age and encompassed 356subjects. The size of the study population was calcu-lated according to the age and gender distribution of in-dividuals in the general population. Age distribution ofstudy population described in Table 1.The survey was carried out in seven urban and sevenrural regions of Latvia. ICON score was used for the as-sessment of severity of malocclusion and orthodontictreatment need. Three calibrated examiners (AA; JP; IJ)screened all the subjects using the ICON. The Index ofComplexity, Outcome and Need (ICON) has been devel-oped based on the average opinion of 97 practising spe-cialists orthodontists from nine countries and approvedas being appropriate for the international use [6; 7; 8]. Itis a single assessment method to quantify complexity,outcome and need of orthodontic treatment. The ICONconsists of five components: the Aesthetic Component(AC), upper and lower crowding/spacing assessment,3 6 Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 2.presence of a crossbite, degree of incisor open bite/over-bite, and the manner of fitting of the teeth in the buccalsegment in terms of the anterior-posterior relationship.Each component was measured in all patients. The needfor orthodontic treatment was defined as having an ICONscore of 43 and greater. Severity of malocclusion wasassessed by the following ICON score intervals: <29 light;29-50 moderate, 51-63 middle, 64-77 severe, >77 very se-vere. ICON values score less than 31 were assessed as anacceptable occlusion without any need for orthodontictreatment.In order to provide the accuracy use of ICON, morethan 4 missing teeth and prosthetic restorations were cho-sen as an exclusion factor for the age group 35-44 years.The possible reasons for the absence of these teethwere defined as: 1) severe caries; 2) due to trauma; 3)genetically missing. If the teeth had been extracted be-cause of previous orthodontic treatment necessity, theywere not included in this group.The cuspal relationships were scored according toSCIENTIFIC ARTICLES I. Urtane et al.the ICON protocol. Scoring zone included the canines,premolars and molar teeth. In case where 1 or 2 teeth weremissing the worst score in terms of anterior posterior re-lationships were measured: in case of cusp to cusp rela-tionship the score was – 2; in case of other cusp relation-ship up to – score 1.Statistical analysisThe data were analyzed using descriptive and ana-lytical methods for analysis. Mean values, SD of ICONvalues as well as proportion of individuals with differentICON scores were calculated for all age groups.The proportion of subjects in different age groupswith the need of orthodontic treatment and the propor-tion of subjects with a different severity of malocclusionwere assessed using two-way and multi-way frequencytables. Statistical significance of differences in propor-tion was tested by means of Pearson χ2 test. Mean valuesof ICON scores in different age groups were comparedusing ANOVA. Differences of mean ICON values betweenthe age groups were tested using Bonferroni test for sta-tistical significance.RESULTSIn the assessment of the severity of malocclusionand need for orthodontic treatment among adults in theage group 35-44 years we faced the problem of a largeTable 1. Age distribution of the study population Age groups n  (% ) 12-13 46 11.8 18 32 8.2 35-44 278 71.5 Total 356   T ab le 2.1. M is sing teeth in  age  grou p  35 -4 4  yr.  C riteria  n  %  N o m ore  than  4  m issing teeth  109  39 .2%  M issing 5 -8   te eth  96  34 .5%  M issing 9 -12 teeth  44  15 .8%  M ore than  12 m iss ing teeth  29  10 .5%  T otal  278  100   Table 2.2. Missing teeth with prosthetic restorations  in  age group 35-44 yr. Criteria n %  No more than 4 missing teeth 31 25.6% 5-8 missing teeth 42 34.7% 9-12 missing teeth 28 23.2% More than 12 missing teeth 20 16.5% Total 121 100  Table 2.3. Missing teeth, without prosthetic restorations  in age group 35-44 yr. Criteria n %  No more than 4 missing teeth 78 49.7% 5-8 missing teeth 54 34.4% 9-12 missing teeth 16 10.2% More than 12 missing teeth 9 5.7% Total 157 100  Table 3. Distribution of mean ICON values by age group (≤4 missing teeth in age group 35-44) ICON Age group Mean SD n 12-13 35.8* 15.97 46 18 39.9* 15.58 32 35-44 35.2 16.1 78 Statistical significance p<0.01  Table 4. Treatment need according to the ICON values < 31 > 43 Age group n %  n %  12-13 19 63.3 11 36.7 18 9 40.9 13 59.1 35-44 35 63.7 20 36.4 Statistical significance p<0.001  Table 5. Distribution of the complexity grade by age group (1= easy; 2=mild; 3=moderate; 4= difficult; 5= very difficult) 1 2 3 4 5 Age group n %  n %  n %  N %  n % 12-13 19 41.3 19 41.3 5 10.9 2 4.3 1 2.2 18 8 25.0 15 46.9 7 21.9 1 3.1 1 3.1 35-44 29 37.2 35 44.9 8 10.3 6 7.7 0 0.0 Statistical significance p<0.01  Table 6. Mean ICON values by age groups and gender ICON Males Females Age group Mean SD Mean SD 12-13 33.7 15.8 36.6 16.4 18 40.4 14.7 39.6 16.8 35-44 35.8 14.8 34.7 17.1  Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 2. 3 7I. Urtane et al. SCIENTIFIC ARTICLESnumber of missing teeth. Adults were divided accordingto the number of missing teeth to facilitate the screeningprocess. (Tables 2.1; 2.2; 2.3.). Out of 278 adults in theage group 35-44 there were 78 individuals included withno more than 4 missing teeth. In adults the loss teethmost often was observed in buccal segments. Typicallythe first molars were missing and the second molars weretipped mesially. In some individuals  premolars were foundto be missing.Since the proportion of individuals with previousorthodontic treatment was small (18% among 18 yearsold and 1.44% in age group 35-44) they were not excluded.Mean values of ICON values in the age groups arepresented in the Table 3.Overall there was a statistically significant differ-ence between the mean ICON values in all age groups.However, 1% significance level was observed only com-paring the mean ICON values between the age groups12-13 and 18.The mean value in the age group 12-13 was 35.8, inthe age group 18 it was the highest – 39.9 and in the agegroup 35-44 it was similar to the younger group – 35.2.(Table 3).Professionally defined orthodontic treatment needaccording to the ICON value (with score >43) presentedsome significant differences between age groups. A largerproportion of the 18 year old group was determined to bein need of orthodontic treatment in comparison to thegroup 12-13 and 35-44 year olds (Table 4). The associa-tion expressing the orthodontic treatment need in the agegroups was statistically significant (p<0.001).Table 5 presents the distribution complexity of orth-odontic treatment according to the age groups.Majority of the individuals in the age group 12-13years had a complexity grade easy and mild and only asmall proportion of individuals had difficult complexitygrade (Table 4.). In the age group of 18 years the majorityof individuals had a complexity grade mild (46.9%), andeasy and moderate complexity grade was observed re-spectively 1,8 and 2,1 times less frequently. Only a verysmall proportion of individuals in this age group had com-plexity grade – very difficult. In the adult group of 35-44years, mild complexity grade was observed more often. Itwas followed by easy and moderate complexity grade andan increase by 7.7% with complexity grade difficult. Therewere no individuals in this age group with complexitygrade – very difficult.  The greatest number of individu-als in all groups represented mild complexity grade oftreatment. Overall the following relationship of statisticalsignificance was observed: the number and severity ofmalocclusion are increasing with the age.Overall there was a statistically significant differ-ence of mean ICON values between both genders. How-ever, no statistical significance was observed among dif-ferent age groups between males and females (Table 6).DISCUSSIONMost studies on severity of malocclusion and needfor orthodontic treatment have been described regardinggroups of children and adolescents. The need of profes-sionally defined orthodontic treatment, assessed accord-ing to ICON (with score >43) in our study in the age group12-13, was similar to the findings in other studies in Latvia[5] as well as in England and Wales [9;10;11;12]. Onlyfew studies on orthodontic treatment need in young andmiddle age adult groups are available [13;14;15] and find-ings of studies between countries cannot be directly com-pared not only because of the difference in the assess-ment methods, but also due to the difference in the studydesign and the access to orthodontic treatment in publiccare system.In our study the highest orthodontic treatment needwas presented in the age group of 18 year olds. It couldbe explained by the lack of orthodontic treatment in child-hood (previous treatment 18%), the development of skel-etal discrepancies during growth or the relapse after orth-odontic treatment.However, a lower proportion of individuals with needfor orthodontic treatment was observed in the age group35-44, comparing to the age group 12-13 and 18 could beinfluenced by exclusion of subjects with more than 4 teethmissing in the age group of 35-44 years and this findingcould not be referred to the overall sample. A significantdifference in the age group is determined by the distribu-tion of the complexity grade, where the tendency of sever-ity of malocclusion to increase with age has been observed.In UK and Norway studies where missing teeth werenot the exclusion factor for the assessment of the sever-ity of malocclusion, data for orthodontic treatment needin middle age adult group significantly differed.In UK study the mean ICON values for 30-40 yearold males was 58, 4 and for females 51, 8 [16] which wassignificantly higher if compared to our data in the agegroup 35-44.In Norway, a professionally defined need for orth-odontic treatment according to the NOTI (Need for Orth-odontic Treatment Index) among 18 and 35 year olds wasclassified as larger proportion of the 35 year olds to be inneed of treatment compared to the 18 year olds [14]. Forthe age group of 35 year olds, the treatment needs fororthodontically treated individuals were 35% and fororthodontically untreated this indicator was 37%. In ourstudy following to ICON index in the age group of 35-44year olds, orthodontic treatment need was quite similar36,4%.Taking into account the literature and present data,there could be a reason for the assumption that the se-verity of malocclusion and complexity of orthodontictreatment need is increasing with the age. Actually, it isnecessary to do a more detailed investigation on the fac-tors influencing the development of the severity of mal-occlusions and requiring an interdisciplinary approachof treatment on adults in future.CONCLUSIONS1. Orthodontic treatment need is considerably high inall age groups.2. All groups presented mainly moderate severity ofmalocclusion what corresponds with mild complex-ity grade of orthodontic treatment.3. Complexity grade or orthodontic treatment has ten-dency to increase with age.3 8 Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 2.SCIENTIFIC ARTICLES I. Urtane et al.1. Zachrisson BU. Orthodontic treatment in a group of elderlyadults. World J Orthod  2000; 1: 55-70.2 . Zachrisson BU. Global trends and paradigm shifts in clinicalorthodontics. World J Orthod 2005; 6 (Suppl):  3-7.3 .  Opperman LA, Gakunga PT, Carlston DS. Genetic factors in-fluencing morphogenesis and growth of sutures and synchon-droses in the craniofacial complex.  Sem Orthod 2005; 11:199-208.4.  Stenvik A, Espeland L, Bernet GP, Eriksen HM. Attitudes tomalocclusion among 18- and 35-year-old Norwegians. Com-munity Dent Oral Epidemiol 1996; 24: 390-3.5. Liepa A, Urtane I, Richmond S, Dunstan F. Orthodontic treat-ment need in Latvia. Eur J Orthod 2003, 25: 279-82.6 . Richmond S. The need for cost-effectiveness. J Orthod  2000,27: 267-9.7 . Richmond S, Daniels CP. International comparisons of profes-sional assessments in orthodontics: Part 1 – treatment need.Am J Orthod Dentofac Orthop 1998a, 113: 180-185.8 . Richmond S, Daniels CP. International comparisons of profes-sional assessments in orthodontics: Part 2  – treatment out-come. Am J Orthod Dentofac Orthop 1998b, 113: 324-8.9 . Brook PH, Shaw WC. The development of an index of orth-REFERENCESodontic treatment priority. Eur J Orthod 1989; 11: 309-20.10. Burden DJ, Holmes A. The need for orthodontic treatment inthe child population of the United Kingdom. Eur J Orthod1994; 16: 395-9.11. Office for population Censuses and Surveys, Social Survey Divi-sion; 1994; Children’s dental health in England and Wales 1993.Her Majesty’s Stationery Office, London,12. Stenvik A, Espeland L, Mathisen A. A longitudinal study onsubjective and objective orthodontic treatment need. Eur JOrthod 1997;19: 85-92.13. Stenvik A, Espeland L, Berset GP, Eriksen HM. Attitudes tomalocclusion among 18 and 35 year-old Norweigians. Commu-nity Dent Oral Epidemiol 1996; 24: 390-314. Stenvik A, Espeland L, Berset GP, Eriksen HM, Zachrisson BU.Need and desire for orthodontic (re-)treatment in 35-year-oldNorwegians. J Orofac Orthop 1996; 57: 334-42.15. Soh J, Sandham A. Orthodontic Treatment need in Asian adultmales. Angle Orthod 2004; 74: 769-73.16. Koochek AR, Yeh MS, Rolfe B, Richmond S. The relationshipbetween Index of Complexity, Outcome and Need, and patientsperceptions of malocclusion: a study in general dental practice.Br Dent J 2001; 191: 325-9.Received: 20 02 2006Accepted for publishing: 27 06 2006

The severity of malocclusion and need for orthodontic treatment in correspondence with the age

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The severity of malocclusion and need for orthodontic treatment in correspondence with the age

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Riga Stradins university