IOTN and PAR Flashcards
Aim and Objective of IOTN?
- what it is
- How it works
- practical uses
Use of health index
- To identify treatment need
- To identify priority group
- To identify treatment change
- To plan healthcare service
Why have Indices?
- Health cost
- Manpower
- Benefit to patient of treatment
- Outcome measure
What are the requirement health index?
- Reliable- Can be used repeatedly
- Valid- measures what it is meat to
- Acceptable- Profession and public
- Requires minimum of judgement/easy to learn
- Administratively simple - Cheap to use
What is IOTN?
- Ranks occlusal traits according to their severity
- Attempts to identify patients who would most likely benefit from orthodontic treatment
- A means by which patient are assessed as to whether they qualify for NHS Orthdontic treatment
How many components of IOTN?
2
- Dental health Component (DHS)
- Asthetic Component (AC)
Dental Health Component
- 5 Categories of severity
1- No need
2- Little / no need
3- Moedrate / Boderline need
4- Need
5- Severe need
DHC- Hierarchical Scale
- MOCDO
- Missing (h)
-Overjet (a)
-Crossbite, Displacement of contact point (d) - Overbite (f)
IOTN Conventions
CROWDING
- Contact point displacement
- Anatomical contact point
- Not measured b/w deciduous teeth
Impacted 5i
- Space for unerupted tooth </= 4mm
Impeded eruption (4t)
- If tooth has erupted but short of space so tip against neighbouring tooth scored.
Spacing
- Not measured unless tooth deviate from line of arch
Submerging Deciduous teeth 5s
- 2 Cusps still visible or tip to adjacent teeth
Reverse Overjet
- All 4 incisors in lingual occlusion to record reverse Overjet
Aesthetic Component ( Evan’s and Shaw)
- 1987
- Scored out of 10
- 1-4 None/ slight
- 5-7 Moderate / borderline
- 8-10 Need
Good Point
- Valid
- Reliable
- Easy to use
Bad point
- Class II div 1 - AC
- Complexity not assessed
- Some version of crowding - no score
- Evidence for DHC
4x
- Presences of supernumerary teeth
4b
- Reverse Overjet greater than 3.5 mm with no speech or masticatory difficulties.
4m
- Reverse Overjet greater than 1 least than 3.5mm with speech and masticatory difficulties
4e
- Lateral and anterior open bite greater than 4mm
4l
- Lingual crossbite with no function occlusal contact in one or both buccal segment
4f
- Increased and compete overbite with gingival / palatal trauma
4t
- Partial erupted teeth , Tip and impacted against adjacent teeth
PAR Index. (Richmond. Manchester)
Peer assessment rating
- Objective
- Quatitative
- Malocclusion and treatment effect
- Use study model - Pre Tx - Post Tx
How to score study model ?
- Labial segment
- Buccal segment
- Overjet
- Overbite
- Centreline
Labial Segment
- Score 0- 5
0 - 0-1
1 - 1.1-2
2 - 2.1- 4
3- 4.1- 8
4- >8
5- Impacted
Buccal segment
- Anterior posterior
- vertical
Transverse
Buccal segment - Anterior posterior
- 0- Good interdigitation
- 1 - less than 1/2 unit
2 - 1/2 unit
Vertical
- 0- No open bite
1- greater than 2mm lat open bite
Transverse
- 0- No crossbite
- 1-Crossbite tendency
- 2–Single tooth cross bite
- 3 greater than 1tooth crossbite
4- greater than 1 tooth scissor bite
PAR- Overjet
0 0-3mm no crossbite
1 3.1-5mm edge to edge
2- 5.1- 7 single tooth crossbite
3- 7.1- 9 2 teeth crossbite
4- >9 greater than 2 teeth crossbite
PAR- centreline
- 0 - Coincidence 1/4 width lower incisor
1 - 1/4- 1/2 lower incisor width
2- > 1/2 lower incisor
Weighing value
- Labial Segment x 1
- Buccal segment x1
- Overjet x6
- overbite x2
Central line x4
Total
What’s the target of PAR
- 70% Reduction
- End of treatment score <5
National Audit suggest
-75% cases reduced >70% greatly improved
- 3 % cases reduced < 30% worse / no difference
PAR NHS requirement
- All ortho must submit their cases for PAR evaluation
- 20 cases per year
- 10% of remainder case load
