Index of Orthodontic

Treatment
Need modified for use in
Epidemiological Surveys :
Modified IOTN



1
Written by
Donald Burden and Cynthia Pine

with assistance
from the BASCD Working Party on
Orthodontics

2
Modified IOTN consists of two
components:
1. Aesthetic Component
2. Dental Health Component

3
Aesthetic Component

Grades 1-7
No Definite Need for treatment

Grades 8-10
Definite Need for treatment
4
5
Recording the Aesthetic
Component

Ask subject to close on their back
teeth
Retract lips
Grade the dental attractiveness of
the anterior teeth



6
Recording the Aesthetic Component

The grade awarded is for overall dental
attractiveness rather than specific
morphological similarity to the
photographs
First impressions are usually correct
Main aim is to differentiate those at
8 - 10


7
Dental Health Component

IOTN has been simplified to two
categories:
Definite Need for Treatment
No Definite Need for Treatment

The subject is examined for specific
conditions and if one is found, a
Definite Need for Treatment is recorded
and no further conditions are sought.


8
Recording the DHC

Examine each subject for:
Missing teeth
Overjets
Crossbites
Displacement of contact points
Overbites
= MOCDO


9
Recording the DHC

Examine the subject using the MOCDO
scale

As soon as a definite treatment need
threshold is reached, then the
examination is stopped

10
MOCDO
Missing teeth
Overjets
Crossbites
Displacement of contact points
Overbites
11
Missing Teeth (teeth not visible)


Congenital absence/traumatic loss
Ectopic teeth
Impacted teeth


12
Missing Teeth
Palatally ectopic canines
Is the canine palpable in the buccal
sulcus?
If not, it is ectopic = Need for
Treatment

13
Missing Teeth
IMPACTED if 4mm or less space
is available between adjacent
teeth

Impacted = Need for Treatment
14
15
Missing Teeth
(Congenital absence/traumatic
loss)
In your opinion, is orthodontic
treatment required to open or
close the space?
If yes = Need for Treatment
16
MOCDO
Missing teeth
Overjets
Crossbites
Displacement of contact points
Overbites
Original Slide No.15
17
Measuring Overjets
Increased overjets (Class II) and
reverse overjets (Class III) are
measured using the metal ruler
18
Positive overjets
Second line (red) 6mm
19
20
Measuring Overjets
Measure to the labial aspect of the most
prominent incisor

Only record Need for Treatment if the
overjet extends beyond the 6mm line
21
22
23
Measuring Reverse Overjets
All four incisors must be in lingual
occlusion
24
Measuring Reverse Overjets
If the reverse overjet falls
exactly on the 4mm (white line)
record in the Definite Need for
Treatment category
25


First line (white) 4mm
Crowding
Reverse overjets
Open bites
26
27
MOCDO
Missing teeth
Overjets
Crossbites
Displacement of contact points
Overbites
28
Crossbites
Can be anterior or posterior, but
mostly posterior.
Check for displacement on closure.
If displacement on closure = Need for
Treatment
29
MOCDO
Missing teeth
Overjets
Crossbites
Displacement of contact points
(crowding)
Overbites
30
Crowding
Only applies to crowding
between permanent teeth

Measure between the contact
points of the two most
crowded teeth

31


First line (white) 4mm
Crowding
Reverse overjets
Open bites
32
33
MOCDO
Missing teeth
Overjets
Crossbites
Displacement of contact points
Overbites
34
Overbite
Deep overbite

Open bite
35
Deep Overbite


Deep overbite causing
gingival or palatal traumatic
injury

= Definite Need for Treatment
36
37
Other Points of the Modified IOTN
Generalised spacing is not
recorded in the Dental Health
Component
38