F1000ResearchF1000Research2046-1402F1000 Research LimitedLondon, UK10.12688/f1000research.133555.1Research ArticleArticlesComparative evaluation of preventive and interceptive orthodontic treatment need in children aged 6, 9 and 12 years in Central India
[version 1; peer review: 1 not approved]
NerurkarSumukhConceptualizationData CurationFormal AnalysisInvestigationMethodologyWriting – Original Draft PreparationWriting – Review & Editinghttps://orcid.org/0000-0002-2468-8001a1KambleRanjitConceptualizationSupervisionValidationVisualizationWriting – Original Draft PreparationWriting – Review & Editing1
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, Indiasumukh170297@gmail.com
Background: Preventive and interceptive orthodontics are most commonly advocated in patients to reduce the prevalence of malocclusion. The objective assessment of malocclusion is crucial to document the prevalence and complexity of cases. To determine this critical aspect of treating malocclusion, numerous indices have been developed over the years that determine the need for orthodontic treatment. The index for preventive and interceptive orthodontic treatment need (IPION) is one such index that calculates the need of a patient to undergo preventive and interceptive procedures. Due to the paucity of studies that compare this important aspect of preventing malocclusion in different age groups, we have conducted this study.
Methods: A total of 384 children aged 6, 9 and 12 years were divided into three groups and evaluated for their need to undergo treatment. The IPION was used to determine this treatment need. The mean IPION score was used to classify the patient into, ‘no need’, ‘moderate need’ and ‘definite need’ of treatment. The children in each group were also divided according to their biological sex. The numbers of children in each group were then compared using Chi-squared test and the mean IPION scores were compared using ANOVA.
Results: In the group of 6-year-old children, 63.28% of them needed some type of treatment, in the group of 9-year-old children, 71.88% of them needed treatment and in the group of 12-year-old children, 59.37% of the children needed treatment.
Conclusions: The results of the study showed a high proportion of children requiring preventive and interceptive treatment. It was also noted that there was no difference in the treatment need in 6- and 9-year-old children, but it decreased in the 12-year-old group. The study also concluded that the mean IPION scores in boys aged 6 years old was significantly greater than girls aged 6 years old.
Interceptive orthodonticspreventive orthodonticsIPIONserial extractionIOTNDAIThe author(s) declared that no grants were involved in supporting this work.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.
MethodsStudy design
After obtaining clearance from the Institutional Research Ethics Committee of Datta Meghe Institute of Higher Education and Research, the ethical approval letter was obtained on 15th December 2020 (reference number DMIMS (DU)/IEC/2022/345), an analytical cross-sectional study design was followed. Data collection commenced on 27
th June 2021.
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.
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.
Study size
The sample size was calculated according to the formula n = N * X/(X + N - 1). Where X = Zα/2
2 p(1 - p) /MOE
2, Zα/2
2 was taken as 1.96, the MOE was considered as 5%. The population of the region was considered as 100,000 and the sample proportion was 50%. According to the data, the authors considered the sample size to be 383.
Statistical methods
The data are presented as the mean
± SD of the IPION scores and as percentage of children in each group. Statistical analysis was done using descriptive and inferential statistics using ANOVA test (followed by the Bonferroni correction), Chi-squared test and Kappa Statistic.
IBM SPSS Statistics (RRID:SCR_016479) version 27 and GraphPad Prism (RRID:SCR_002798) version 7.0 were used for statistical analysis. p < 0.05 was considered to indicate a statistically significant difference.
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).
Distribution of patients according to treatment need.
Data are presented as the number of children in each group. IPION, index for preventive and interceptive orthodontic treatment need; NS, not significant.
Need
IPION-6
IPION-9
IPION-12
χ2-value
No need
47 (36.72%)
36 (28.13%)
52 (40.63%)
5.05
P = 0.28, NS
Moderate need
50 (39.06%)
56 (43.75%)
50 (39.06%)
Definite need
31 (24.22%)
36 (28.13%)
26 (20.31%)
Total
128 (100%)
128 (100%)
128 (100%)
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).
Comparison of mean IPION scores of different age groups.
Data are presented as the mean IPION scores in each group. IPION, index for preventive and interceptive orthodontic treatment need; NS, not significant; S, significant.
Scoring index
Mean IPION score
P-value
Group I
vs. Group II
IPION-6
9.6406
0.50118, NS
IPION-9
10.6484
Group I
vs. Group III
IPION-6
9.6406
0.39358, NS
IPION-12
8.4688
Group II
vs. Group III
IPION-9
10.6484
0.04151, S
IPION-12
8.4688
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).
Relationship between mean treatment need scores and sex.
Data are presented as the mean IPION scores in each group. IPION, index for preventive and interceptive orthodontic treatment need; NS, not significant; S, significant.
Sex
IPION-6
IPION-9
IPION-12
Male
11.39
10.85
9
Female
8.27
10.34
7.90
p-value
0.0326, S
0.6899, NS
0.2312, NS
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.
Data are available under the terms of the
Creative Commons Attribution 4.0 International license (CC-BY 4.0).
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10.5281/zenodo.779464210.5256/f1000research.146552.r202532Reviewer response for version 1LiHuang1Referee
Nanjing University, Nanjing, Jiangsu, China
Competing interests: No competing interests were disclosed.
The author conduced the study to compare this important aspect of preventing malocclusion in different age groups. Although this study is quite interesting, but still need to address the following questions：
Please specify the index for preventive and interceptive orthodontic treatment need (IPION), the reference is from the PhD thesis. Does any published paper used in this index?
What is the clinical meaning for this study? Children aged 6, 9 need some type of treatment, it does not mean they need orthodontic treatment at that time. Some malocclusion can be delayed to permanent dentition, considering their treatment duration time and economic burden.
The reference 7 was not published?
Is the work clearly and accurately presented and does it cite the current literature?
Partly
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Partly
Is the study design appropriate and is the work technically sound?
Partly
Are the conclusions drawn adequately supported by the results?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
Reviewer Expertise:
Orthodotics
I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.