Index of Orthodontic Treatment Need (IOTN)

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DONE BY : ALIA IMAD ALES ES

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Index of Orthodontic Treatment Need (IOTN)

Many attempts have been made in the past to develop indices of malocclusion. The index of orthodontic treatment need was developed in the United Kingdom to assess both dental health and aesthetics, primarily for clinical purposes.1 The Index of Orthodontic Treatment Need (IOTN) was developed by Shaw, Richmond and O'Brien at Manchester Dental School in the 1990's. They were based on a number of existing orthodontic indices. Since then the UK NHS has introduced their use to limit access to orthodontic care. The index of orthodontic need has been around for 15 years. Although other indices for orthodontic services have been used, the UK is yet to formally adopt the IOTN.2 IOTN has two components - Dental Health Component (DHC) and Aesthetic Component (AC). In the NHS ( National Health Services) patients must score IOTN 4 or 5 for treatment. In patients with IOTN 3 the aesthetic component is applied, those patients with an IOTN DC score of 3 AND an IOTN AC score of 6 or greater, qualify for treatment.

The Dental Health Component (DHC) has 5 Grades. Grade 1 (None) 1 Extremely minor malocclusions including contact point displacements less than 1 mm. Grade 2 (Slight) 2aIncreased overjet greater than 35 mm, but less than or equal to 6 mm with competent lips. 2bReverse overjet greater than 0 mm but less than or equal to 1 mm. 2cAnterior or posterior crossbite with less than or equal to 1 mm discrepancy between retruded contact position and intercuspal position. 2dContact point displacements greater than 1 mm but less than or equal to 2 mm. 2eAnterior or posterior open bite greater than 1 mm but less than or equal to 2 mm. 2f Increased overbite greater than or equal to 35 mm without gingival contact. 2gPre- or post-normal occlusions with no other anomalies (includes up to half a unit discrepancy).
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Lunn H, Richmond S, Mitropoulos C. The use of the index of orthodontic treatment need (IOTN) as a public health tool: a pilot study. Community Dent Health. 1993 Jun;10(2):111-21.

C. M. de Oliveira. The use of IOTN in orthodontic services. Br Dent J 2003; 195: 704-706

Grade 3 (Borderline need) 3a Increased overjet greater than 35 mm, but less than or equal to 6 mm with incompetent lips. 3b Reverse overjet greater than 1 mm, but less than or equal to 35 mm. 3c Anterior or posterior crossbites with greater than 1 mm, but less than or equal to 2 mm discrepancy between retruded contact position and intercuspal position. 3d Contact point displacements greater than 2 mm, but less than or equal to 4 mm. 3e Lateral or anterior open bite greater than 2 mm, but less than or equal to 4 mm. 3f Deep overbite complete on gingival or palatal tissues, but no trauma. Grade 4 (Need treatment) 4h Less extensive hypodontia requiring pre-restorative orthodontics or orthodontic space closure to obviate the need for a prosthesis. 4a Increased overjet greater than 6 mm, but less than or equal to 9 mm. 4b Reverse overjet greater than 35 mm with no masticatory or speech difficulties. 4m Reverse overjet greater than 1 mm but less than 35 mm with recorded masticatory and speech difficulties. 4c Anterior or posterior crossbites with greater than 2 mm discrepancy between retruded contact position and intercuspal position. 4l Posterior lingual crossbite with no functional occlusal contact in one or both buccal segments. 4d Severe contact point displacements greater than 4 mm. 4e Extreme lateral or anterior open bites greater than 4 mm. 4f Increased and complete overbite with gingival or palatal trauma. 4t Partially erupted teeth, tipped and impacted against adjacent teeth. 4x Presence of supernumerary teeth. Grade 5 (Need treatment) 5i Impeded eruption of teeth (except for third molars) due to crowding, displacement, the presence of supernumerary teeth, retained deciduous teeth and any pathological cause. 5h Extensive hypodontia with restorative implications (more than 1 tooth missing in any quadrant) requiring pre-restorative orthodontics. 5a Increased overjet greater than 9 mm. 5m Reverse overjet greater than 35 mm with reported masticatory and speech difficulties. 5p Defects of cleft lip and palate and other craniofacial anomalies. 5s Submerged deciduous teeth.

The Aesthetic Component (AC) The NHS does realise that some children need orthodontic treatment just because their teeth look really bad. The Aesthetic Component is a scale of 10 colour photographs showing different levels of dental attractiveness 'ugly scale'. The grading is made by the orthodontist matching the patient to these photographs. The photographs were arranged in order by a panel of lay persons.