Comparative evaluation of preventive and interceptive orthodontic treatment need in children aged 6, 9 and 12 years in Central India

Introduction

Several genetic and environmental factors play a part in the development of malocclusion. The long duration taken for the development of occlusion makes it challenging to pin point the involvement of certain factors in the development of malocclusion. Preventive orthodontics is the action taken to preserve the integrity of what appears to be normal at a specific time.¹ Ricketts (1976) suggested that in many cases, malocclusion can be prevented or at least intercepted.² Interceptive orthodontics includes the measures that prevent the progression of a potential malocclusion into a severe type. These procedures are undertaken after the appearance of a malocclusion.

The objective assessment of malocclusion is crucial to document the prevalence and complexity of the malocclusion. Thus, to determine this critical aspect of treating malocclusion, over the years, there are many indices that determine the need for orthodontic treatment.³ Identifying and determining the problem’s severity are the two crucial aspects of screening patients for early orthodontic treatment. Thus, to determine this critical aspect of treating malocclusion, over the years, there are many indices that determine the need for orthodontic treatment. Older indices like the treatment priority and occlusal index measured the severity of the malocclusion.⁴ The dental aesthetics index is used to rate the aesthetics of the patient. Index of orthodontic treatment need (IOTN), peer assessment rating (PAR) and dental aesthetic index (DAI) are the most frequently used indices today.⁵ Although there are many shortcomings to these indices, it is always recommended to use them for categorizing the malocclusion and to determine its severity.

All these indices can be applied to only permanent dentition or do not help categorize the need for preventive and interceptive orthodontic treatment. Apart from the index for preventive and interceptive orthodontic treatment need (IPION), there is no index that can calculate the need for early orthodontic treatment.⁶ The IPION was developed for categorizing malocclusion and determining the need to undergo preventive or interceptive orthodontic treatment in children aged 6 and 9 years old and later modified for 12-year-old children.⁷

Thus, with the primary objective of comparing the preventive and interceptive orthodontic treatment needs in children aged 6, 9 and 12 years, we conducted this study.

Methods

Data collection

After obtaining written informed consent from the legal guardians of the children for inclusion in the study, a total of 384 patients were selected randomly from the patients coming to the OPD of Orthodontics and Dentofacial Orthopedics at Datta Meghe Institute of Higher Education and Research or in screening camps arranged in schools in and around Wardha.⁷ The institutes involved in arranging these camps were Sharad Pawar Dental College, Alphonsa School, School of Scholars and New English School. The camps were arranged by the Department of Public Health Dentistry of Datta Meghe Institute of Higher Education and Research. The arrangement of the camps was done after obtaining permission from the head of the institute. An intraoral examination of the patient was done. The patients were categorized into three groups, namely; Group I (6 years old), Group II (9 years old) and Group III (12 years old). Figure 1 depicts the graphical representation of the method followed. Each group was further divided into boys and girls, on the basis of external body characteristics.

Figure 1. Graphical representation of the method followed.

IPION, index for preventive and interceptive orthodontic treatment need.

The patients were screened for the age group of 6-12 years. All the patients presently undergoing or who had undergone orthodontic treatment were excluded. Patients suffering from systemic conditions were also excluded.

Five intra oral standard photographs were taken using cheek retractors and a mirror. The photographs consisted of one frontal, buccal in occlusion and occlusal photographs. The clinical examination was done to evaluate the functional components of the index. A vernier caliper was used to measure the parameters on the dental models, and the presence of caries was detected using an explorer on the patient itself.⁶

The final scores of the IPION for Group I and Group II were calculated according to the IPION-6 and IPION-9 index given by Coetzee,⁶ and that for Group III was calculated according to IPION-12 index by Nerurkar et al.⁷ Each component had a specific weighing score, which depended on the severity of the malocclusion it caused. The scores of these components are added to get a final score.

The score of each component was calculated by the product of the component score and the weighting factor.

= Component score × weighing factor

The patient’s total score was then determined by the summation of the scores of each component.

= ∑ (Component score × weighing factor)

The results from this study were then statistically analyzed according to the observations.

Results

On comparing the orthodontic treatment need in the 6-, 9- and 12-year-old age groups, the following results were obtained. A total of 36.72% of the children from group I had no need for treatment, 39.06% of the children needed moderate treatment, and 24.22% of the children needed definite orthodontic treatment. In group II, 28.13% of the children did not require any treatment, 43.75% needed moderate treatment, and 28.13% had a definite need for treatment. In group III, 40.63% of the children had no need for any orthodontic treatment, 39.06% needed moderate treatment, and 20.31% needed definite treatment (Table 1 and Figure 2).

Figure 2. Graphical representation of distribution of patients according to treatment need.

IPION, index for preventive and interceptive orthodontic treatment need.

On comparing the mean IPION scores of different age groups the following results were obtained. The mean IPION score for 6-year-old children was 9.6406, for 9-year-old children it was 10.6484 and for 12-year-old children it was 8.4688. When the mean IPION scores of group I were compared with those of group II, a non-significant association was found. Similarly, no association was found when the IPION scores for group I were compared with that of group III children. When these scores for group I children were compared with that of group III children a significant association was found (Table 2).

On comparing the mean IPION scores of different sexes the following results were obtained. The mean IPION score for 6-year-old boys was 11.39, whereas that for girls was 8.27. A significant difference was found when these scores were compared. The mean IPION score for 9-year-old boys was 10.85, whereas that for girls was 10.34. The mean IPION score for 12-year-old boys was 9, whereas that for girls was 7.90. No significant difference was found between the sexes in group II and group III (Table 3).

Discussion

A total of 156 children needed moderate treatment, and 93 needed definite treatment. A total of 64.84% of children needed early orthodontic treatment. Subramaniam et al.,⁸ and Prabhakar et al.,⁹ showed similar results. According to them, 63% of children required early orthodontic treatment. A similar prevalence of need for treatment was obtained by Tungaraza et al.,¹⁰ who concluded that 67.2% of Turkish children needed either moderate or definite treatment. Contradicting results were obtained by Onyeaso,¹¹ who conducted their study in Nigeria and concluded that the need for preventive and interceptive orthodontic treatment was seen in 27% of children. Büyükbayraktar and Doruk,¹² also obtained contrasting results. They studied Turkish children and observed that 95.5% of children needed treatment. Rapeepattana et al.,¹³ gave contrasting results compared to those obtained in this study. They concluded that 96% of the children needed treatment.

A comparison was made between mean IPION scores of 6- and 12-year-old children. The mean score for the 6-year-old children was 9.6406 and for the 12-year-old children it was 8.4688. When compared with each other, there was no significant association between the scores of 6- and 12-year-olds. Because there was no index earlier for evaluating the preventive and interceptive treatment needs in 12-year-old children, there is no study in the literature to compare with the results of the present study.

A comparison was made between the mean IPION scores of 6- and 9-year-old children. The mean IPION score for the 9-year-old group was 10.6484 and that for 6-year-old group was 9.6406. When a comparison was made between the two groups, no significant association was found. Contrasting results were obtained by Galui and Pal,¹⁴ who concluded that there is a significant difference between the scores obtained in the 6-year-olds and that in 9-year-old children. They also concluded that IPION-9 scores were greater than the IPION-6 scores.

A comparison between the mean IPION scores of 9- and 12-year-old children. The mean IPION score for the 9-year-old group was 10.6484 and that for the 12-year-old group was 8.4688. When a comparison was made between these groups a significant difference was observed. Because there was no index earlier for evaluating the preventive and interceptive treatment needs in 12-year-old children, there is no study in the literature to compare with the results of the present study.

The mean IPION score in the 6-year-old boys was 11.39, and that of the girls was 8.27. The scores in the 9-year-old group were 10.85 in boys and 10.34 in girls. In the 12-year-old group, the mean IPION scores were 9.88 in boys and 7.30 in girls. There is no study in the literature to compare with the results of the present study.

The main limitation of the study is the fact that radiographic analyses were not performed, which could be used for confirming the presence or absence of unerupted or supernumerary teeth.