Zahid`s Study Notes

IOTN RuIer
Modified IOTN*

IOTN have two components:
$ Aesthetic Component (AC)
% DentaI HeaIth Component (DHC)
A. Aesthetic Component (AC)
Grade 1-7: NO treatment (NT)
Grade 8-10: Definitive need of treatment (DNT)
Method of recording aesthetic component:
1, Ask pt to close teeth on posteriors
2. Retrected lips
3. Grade overall attractiveness of anterior teeth rather then specific morphological similarities to photographs
4. st impression is usually correct
5. Focus is to differentiate those at 8-10 then DEFINITVE NEED OF TREETMENT
B. DentaI HeaIth Component (DHC)
For DHC again IOTN has been simpIified in to two categories:
1. DEFINITVE NEED OF TREETMENT
2. No DNT
The Subject is examined for 5 specific conditions and if one is found a DNT is recorded and no further
condition is sought

Method:
Examine each subject for:
MOCDO

Missing
Over jet
Cross bite
DispIacement of "Contacts Points" (of two most imbricate teeth)
Overbite
Recording the DHC
1. Examine using mocdo ScaIe
2. As soon as DNT reached examination stoped
3. IOTN RuIer is required

It has a white Iine at 4mm and a red Iine at 6mm.
White Iine is for reverse over jet
Crowding
Open Bite
Reverse over jet (ROJ)
Red Iine is at 6mm represent positive over jet
Over jet (if greater then red) = Need for Treatment (DNT)
AppIication of MOCDO SCALE
1 . Missing Teeth(InvisibIe)
A. CongenitaIIy/TraumaticaIIy absent:
If Iess then white line is the space left, if in your opinion treatment is required to open or close the
space then DEFINITVE NEED OF TREETMENT
B. Ectopic Canines
s canine palpable on bucal sulcus if not DEFINITVE NEED OF TREETMENT

C. Impacted
f at or less then white line space available, then DEFINITVE NEED OF TREETMENT
2.Over Jet
Measure oj up to IabiaI aspect of the most prominent incisor
A. Increased (CIass 2)
if >6 more then red Iine DEFINITVE NEED OF TREETMENT
B. Reversed (CIass3)
All four incisors must be in lingual occlusion.
If ROJ faII on white Iine (4mm) DEFINITVE NEED OF TREETMENT
3. Cross Bites
Can b anterior or posterior but mostly posterior
Check for the displacement on closure if yes DEFINITVE NEED OF TREETMENT

4.DispIacement of contact points
Only applies to crowding in permanents
Measured between contact points of two most crowded anterior teeth
f the most crowded tooth is beyond white line DEFINITVE NEED OF TREETMENT
5. Overbite:
C. Deep

Causes trauma to gingival or palatal tissue
D. Open
f beyond white line then DEFINITVE NEED OF TREETMENT
Note : Generalised spacing is not recorded in DHC.
Ref: pcwww.liv.ac.uk written by Donald Burden and Cynthia Pine with assistance from BASCD working party on orthodontics
with thanks.
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Reading a ruIer:
Upper Ieft haIf: positive over jet=a
0-2 over jet upto 3.5mm up to normaI grade 1
3-i overjet 3.5-6 mm incompetent Iips grade 3 since positive over jet=a so 3a
2-c - do- compitent Iip grade 2 -do- so 2a
4 6-9mm 4a
5 > 9mm 5a
Lower Ieft haIf:
now reverse overjet =b
and reverse overjet with maticatory/speech defect=m
1 up to 1mm = 2 since reverse overjet =b so 2b
3 >1 but < 3.5mm -do- 3b
4 >1 but < 3.5mm with masticatory and speech defect 4m
4 > 3.5 with no m 4b
5 >3.5 with masticatory or speech defect 5m
Right side is for contact dispIacement
DispIacement of "Contacts Points" (of two most imbricate teeth) =d
1 dispIacement <1 mm minor grade 1
2 >1 to < 2 grade 2 2d
3 >2 to < 4 mm grade3 3d
4 >4 grade4 4d

MiddIe
Open bite e; or deep bite f
4f
4e
3f

3e
2e
2f
aII other are seIf expIanatory
MOCDO
Missing teeth (I= impacted ,h= hypodotia)
5i=

5h=

4h=
Over Jet a/b or m
5 a =
4.a =
3.a=
2.a=
5m=
4m=
4 b=

3.b=

2.b=

(d)
4 d=
3d=

2.d=

(c)
Check for the displacement on closure if yes definitive need for treatment
4c=
3.c=

2c=
(e=open&f=deep)
4.f=
3.f=

2.f=

and
4e=

3.e=

2.e=

CIinicaI Significance:
ExampIe: