Monitoring orthodontic

treatment
• The outcome of orthodontic treatment can be recorded in terms of
occlusal changes and an attempt has been made to give this an objective
numeric score using the Peer Assessment Rating (PAR) (Richmond et al,
1992a, b).

• This gives an accumulative score,indicating the extent of deviation from a

normal functioning occlusion assessed from dental study casts.

• There is no maximum cut-off level, and the pre- and post-treatment

models should be assessed, which gives a percentage score for the change
with treatment.
• A reduction in the weighted PAR score of less than 30% is considered
to show occlusal changes that are worse or no different.
• A reduction of greater than 30% shows improved occlusal changes,
whilst a PAR reduction of 22 points or greater indicates a greatly
improved occlusal result. This can be plotted on a nomogram
(Fig.1.21),
• which is divided into three sections:
• upper (worse–no difference),
• Middle (improved)
• lower (greatly improved).
• This is useful when looking at the outcome of multiple patients, as it
gives an indication of the quality of treatment an individual or group
of individuals is providing.
Index of Complexity and Orthodontic Need
(ICON)
• Based on the IOTN and PAR indices a single index, the Index of Complexity
and Need (ICON), has been developed to measure both treatment need
and outcome of treatment (Daniels and Richmond, 2000).
• By combining five occlusal traits (IOTN Aesthetic Component)
• crossbite,
• upper arch crowding
• spacing
• buccal segment anteroposterior
• relationships, and anterior vertical relationship) with different
• weightings, anumeric score is given that can be used to ascertain need for
treatment, the complexity
• of the treatment and the improvement resulting from treatment.
• This has been shownto be reproducible for treatment need and
complexity but less so for outcome, due to low levels of agreement
between examiners as to what constitutes acceptable treatment
(Richmond and Daniels, 1998a, b).