Assessment of Severity of Malocclusion and Orthodontic Treatment Need Using the Dental Esthetic Index and Angle's Classification: A Retrospective Study

Abstract

Introduction: Angle's classification is the most widely used instrument for evaluation of malocclusion. The dental esthetic index (DAI) is a reliable, valid, and universally accepted cross-cultural index adopted by the World Health Organization (WHO) that links objective, clinical, and subjective esthetic factors to produce a single score that reflects the severity and the treatment needs of the malocclusion. The present study aims to evaluate Angle's classification and DAI to assess the severity of malocclusion and treatment needs. Materials and methods: This retrospective cross-sectional study was done on pretreatment orthodontics records of 145 male patients and 153 female patients in the age-group 9-42 years with malocclusion who had received or were undergoing orthodontic treatment in the orthodontic department clinics of the College of Dentistry, Jazan University. Preorthodontic study casts, orthopantomography, and lateral cephalometric X-rays were analyzed. DAI scores were calculated, and treatment needs were assessed. Angle's classification of malocclusion was also noted. Results: Among patients with normal or minor malocclusion (DAI score <25), a significantly higher percentage of patients were class I (58%) than any other class of malocclusion. Among patients determined to have handicapping malocclusion (DAI score >36), significantly higher percentage of patients were class II/1 (44%) than any other class of malocclusion. Class II/1 showed the highest percentage of definite (24%) (DAI score 26-30), severe (19%) (DAI score 31-35), and handicapping malocclusions (44%) (DAI score >36). A total of 26% of patients had skeletal class I. A total of 38% of patients had skeletal class II. A total of 36% of patients had skeletal class III. Approximately 13% of patients had maxillary canine impactions and 3% of patients had mandibular canine impactions. Conclusion: The study reported 35% of patients were having handicapping malocclusion (DAI >36) and 14% having severe malocclusion (DAI score 31-35). The malocclusion was characterized by a high frequency of anterior crowding. Thus, the complementary use of DAI and Angle's classification, with improvements, helps establish an all-inclusive criterion for screening and prioritizing of patients eligible for receiving subsidized, publicly funded orthodontic care and thus allows better use of limited available resources.