A identificação da necessidade de tratamento ortodôntico utilizando os índices de necessidade de tratamento ortodôntico e de estética dental

Abstract

The objectives of this study were to evaluate the applicability of the Dental Aesthetic Index (DAI) and the dental health component of the Index of Orthodontic Treatment Need (DHC) for diagnosis of malocclusion and treatment need. It was compared the ability to identify malocclusion using the two indexes in study models of an orthodontics clinic. Initially, it was performed a narrative review on the several methods of obtaining the gold standard for orthodontic treatment need in validation studies of occlusal indexes. Subsequently the validity and reproducibility of the Dental Aesthetic Index (DAI) and the dental health component of the Index of Orthodontic Treatment Need (DHC) were assessed, regarding the treatment decision, and the correlation between them. Moreover, the time spent was recorded for each test, in the two indexes. The calculated sample consisted of 131 study models of the oral cavity of patients aged 12-15 years. The models were randomly selected from a universe of 198 models of the file of the discipline of orthodontics FO / UFMG. The sample was examined by a researcher (an expert in orthodontics) to determine the DAI and DHC indexes. After thirty days, a new evaluation was performed to determine the ability of malocclusion identification, made by the McNemars chi-square test and the reproducibility was calculated using the intraclass correlation coefficient. The same study models were examined by three experts in the field of orthodontics for determining the gold standard of the measurements performed, establishing the diagnosis by consensus. The experts examination was compared with the gold standard to the assessment of the validity of the indexes by using measures of sensitivity, specificity, positive predictive value, negative predictive value and accuracy. The two indexes are reproducible to assess the need for orthodontic treatment, have poor validity and moderate correlation. The time spent with DHC (59.52 seconds) was less than the time spent with the DAI (118.97 seconds). There was no significant difference in measuring the need for treatment between the DAI and the DHC of the IOTN (p> 0.05). The accuracy of the DHC was 0.60 (95% IC 0.50 to 69) and the DAI 0.53 (95% IC 0.43 to 0.63). The results of this study demonstrate that the two indexes are reproducible to assess orthodontic treatment need and have moderate correlation. However they showed poor accuracy related to the decision to treat established by the experts (gold standard). There is no consensus in the literature about the best method to define the gold standard of orthodontic treatment need.