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 Table of Contents  
ORIGINAL RESEARCH
Year : 2022  |  Volume : 14  |  Issue : 6  |  Page : 561-565

Mobile application evaluation of the orthodontic treatment success and the degree of change based on the index of complexity, outcome, and need (ICON)


Department of Orthodontics, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, East Java, Indonesia

Date of Submission26-Mar-2022
Date of Acceptance03-Aug-2022
Date of Web Publication30-Dec-2022

Correspondence Address:
Dr. Arya Brahmanta
Department of Orthodontics, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, East Java
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_68_22

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  Abstract 

Aim: To evaluate the success of orthodontic treatment and the degree of change using the mobile application-based Index of Complexity, Outcome and Need (ICON) score calculation and also inquired the difference of ICON score in time calculation in the results of orthodontic treatment estimated using the mobile application-based method compared with the manual method. Materials and Methods: The present analytic observational study with a cross-sectional approach with a total sampling was performed using 31 pairs of study models in patients treated at the Orthodontic Department of Nala Husada Dental and Oral Hospital, Hang Tuah University, Surabaya, in 2020. The components calculated consisted of the treatment need, complexity assessment, treatment outcome, and the degree of change. The study model was estimated objectively alternating from employing the mobile application to the manual calculation; thus, the results of the calculation time were balanced. The data were analyzed by the independent t-test and Mann–Whitney test (P < 0.05). Results: The results revealed that the independent t-test significance values were P = 0.780 for care needs, P = 0.880 for the assessment of complexity, P = 0.745; P > 0.05 for the treatment outcome, and P = 0.903 for the degree of change. There was a significant difference between manual and mobile application calculation to examine ICON (P = 0.001). Conclusions: The calculation of ICON in the mobile application showed faster performance than the manual method that can be used to evaluate the orthodontics treatment need, complexity assessment, orthodontic treatment outcome, and the degree of change.

Keywords: Android, ICON, Mobile Applications, Orthodontics


How to cite this article:
Brahmanta A, Prameswari N, Handayani B, Syahdinda MR, Hanum F. Mobile application evaluation of the orthodontic treatment success and the degree of change based on the index of complexity, outcome, and need (ICON). J Int Oral Health 2022;14:561-5

How to cite this URL:
Brahmanta A, Prameswari N, Handayani B, Syahdinda MR, Hanum F. Mobile application evaluation of the orthodontic treatment success and the degree of change based on the index of complexity, outcome, and need (ICON). J Int Oral Health [serial online] 2022 [cited 2023 Feb 2];14:561-5. Available from: https://www.jioh.org/text.asp?2022/14/6/561/366437




  Introduction Top


Malocclusion is a dental relationship or jaw connection that deviates from normal.[1],[2] The prevalence of malocclusion in Indonesia has reached 80% of the total population of Indonesian society.[3] Usually, the action taken to treat a malocclusion is an orthodontic treatment with the aim is to improve the arrangement of the teeth and the abnormal jaw relationships; thus, any occlusion, normal function, and good facial esthetics can be achieved.[4],[5]

The success rate of an orthodontic treatment is still diverse between clinicians. Many attempts have been made to reduce the degree of subjective assessment in a malocclusion; one of them is using an assessment of malocclusion index. The malocclusion index can be implemented to assess the severity of malocclusion and the success rate of the treatment objectively.[6] There are several malocclusion indices that are implemented to assess the treatment needs and the outcomes over the years, one of which is Index of Complexity, Outcome and Need (ICON) scoring. ICON provides a value that is more than the other orthodontic indices because it is able to assess the treatment need, results obtained after treatment, case complexity, and degree of change. Furthermore, ICON has five components, each of which has a different weight according to its importance.[7] The first component adapts to the esthetic component of Index of Orthodontic Treatment Needs, maxillary thrust/diastema, crossbite, anterior open-bite/over-bite relation, and buccal segment anteroposterior relations. Additionally, each component can be seen from the study model and progress model.[7]

Patients who require an orthodontic treatment usually have problems such as overjet, anterior or posterior crossbite, contact point displacement, anterior open bite/posterior, deep overbite, overcrowded, irregular teeth, and advanced teeth because they interfere with esthetics, masticatory function, and speech function.[8],[9] Furthermore, there was a significant difference on the obtained ICON scores in the assessment between the study models and the progress model.[10],[11] A manual calculation of ICON score is currently still a gold standard or still frequently used, but as the world progressing into the era of digital technology, a digital calculation method of ICON score using an automatically mobile application-based ICON has been developed, which is able to calculate the treatment needs, treatment outcomes, malocclusion complexity, and the degree of change.[12]

Based on these problems, this study aimed to evaluate the success of orthodontic treatment and the degree of change using the mobile application-based ICON score calculation and also inquired the difference of ICON score in time calculation in the results of orthodontic treatment estimated using the mobile application-based method compared with the manual method.


  Materials and Methods Top


Setting and design

This research was an analytical observational examination with a cross-sectional approach, using 31 pairs of study models from the patients who were treated at the Orthodontic Department of Nala Husada Dental and Oral Hospital, Hang Tuah University, Surabaya, in 2020.

Sampling criteria

There were two sample criteria employed in this investigation. First, it used inclusion criteria of the study model that could be measured using the indices from ICON. The study model consisted of a pretreatment study model and a posttreatment study model; the study model included the period of permanent teeth or the period of mixed teeth, whereas the study model did not experience damage such as broken, cracked, or porous, and the study model has good occlusion. Second, it applied the inclusion criteria of the incomplete study model, which only consisted of one study model (pretreatment or posttreatment only); the study model included the damages such as the cracks, fractures, and porous, and this study model did not have any good occlusion.[13],[14]

Sample preparation and analysis

For the methods, first, the study model was observed and calculated using the indices from ICON manually and automatically by utilizing the mobile application (Faculty of Dentistry, Hang Tuah University, Surabaya, Indonesia). Stopwatch (Stopwatch Professional LCD Strap Type ZSD 808, Indonesia) was employed to assess the time. The patient identity was recorded; then, the pretreatment study model was measured based on the components contained in ICON; they were the measurement of esthetic component, the observation of the presence or absence of crossbite, the checking of the anterior vertical relation, the measurement of the discrepancy of total mesiodistal width in the tooth with the dental arch, and the examination of anteroposterior relation in the buccal segment. Furthermore, posttreatment study model also was investigated with mobile application and manually; then, all scores and times were recapitulated. Additionally, the interfaces of mobile application related to the indices of ICON can be seen in [Figure 1].
Figure 1: The interfaces of mobile application related to the ICON index

Click here to view


Statistical analysis

The data were analyzed by the independent t-test and Mann–Whitney test (P < 0.05) using Statistical Package for Social Science (SPSS) 20.0 version (IBM corporation, Chicago, Indonesia).


  Results Top


It can be seen that the highest percentage of the treatment outcome mode was in the score of acceptable treatment [Figure 2]A. Meanwhile, the highest percentage of the degree of change mode was in the score of quite changeable followed by slightly changed, changed greatly, and did not change and the lowest was a large change [Figure 2]B. Furthermore, the highest percentage of the time duration mode was displayed in the score of quite changeable followed by slightly changed, changed greatly, and did not change and the lowest was a large change [Figure 2]C.
Figure 2: Treatment result: (a) The percentage of the treatment outcome, (b) the percentage of the degree of change, (c) the percentage of the time duration

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Moreover, the slower time appeared in using the manual method than the mobile application with a significantly difference between them (P = 0.001) [Table 1]. There was an insignificant difference in the value of care needs (P = 0.780), complexity assessment (P = 0.880; P > 0.05), treatment results (P = 0.745), and the degree of change (P = 0.903), which were obtained between manual and automatic methods [Table 2].
Table 1: Time calculation using the manual and mobile application-based ICON score calculation methods

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Table 2: The ICON scores from the results of orthodontic treatments using both manual and mobile application calculation methods

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  Discussion Top


This investigation employed smartphones that can be seen as an opportunity to develop ICON calculation using mobile application for both preclinical and clinical stages and used as a medium of education. Furthermore, there was an insignificant difference in the treatment needs, complexity assessment, treatment results, and the degree of change between the manual and mobile application calculation methods. The most cases treated in this study were overcrowded cases and protrusion cases. Crowded teeth are often expressed in the orthodontic patients, and this condition can cause disturbances in a person’s appearance, chewing, and cleaning the teeth.[15],[16]

In addition to the crowded cases, there are also cases of protrusion caused by hereditary factors. Apart from hereditary factors, it is also caused by environmental factors such as incompetent lips, which can affect the position of the upper incisors because of the loss of balance produced by the lips and tongue; thus, the upper incisors are protrusion. Besides, the bad habits such as sucking the fingers can also cause protrusion teeth depending on the patient’s age, growth potential, severity of malocclusion, and patient cooperation during treatment.[17] Moreover, this study also explained that about 25.8% of the study models that had the score of <43, which did not require any orthodontic treatment, which leads to the initial use of index in the orthodontic field to estimate whether the patients should receive any orthodontic treatment or not objectively.[18],[19] Furthermore, an orthodontic treatment may be considered to reduce malocclusion; therefore, the status of requiring treatment is not important.[20]

This investigation showed that there were 16.1% of the study models in which the treatment results were unacceptable because the score was <31. This was due to several factors influencing the results of orthodontic treatment. One of the factors that support the success of orthodontic treatment is the patient’s motivation to undergo the orthodontic treatment. Other things that can affect the success of treatment are pain, a lack of interest, and a long duration of treatment.[21] Meanwhile, crossbites can occur anteriorly or posteriorly that can be corrected using various orthodontic appliances.[2] Therefore, in the future, it is expected that cases of malocclusion in the difficult and very difficult categories are not indicated to be treated by young dentists, and instead, should be immediately referred to orthodontic dentists.[14]

Consequently, this proves that there is no difference in calculating the results of orthodontic treatment between the ICON scoring calculation methods using mobile application-based and the manual one. This mobile application has been tested as valid and can minimize the errors during the calculation process; as a result, the mobile application can be used to calculate the ICON score in the orthodontic treatment. Another example of digital use in dentistry that has similar results to this study is Nemoceph, a computerized cephalometry acting as a cephalometric digital radiograph. In this study, there was not any significant difference both in the manual or digital measurements, which were considered to be more accurate.[22],[23] This proves that digital technology can also be utilized as a valid alternative method.

Accordingly, this result is associated with an earlier study that the main advantage of using software is its speed in carrying out the procedures.[23] On the other hand, in the mobile application-based calculation method, the calculation of the score in pretreatment, complexity assessment, posttreatment, and degree of change will be generated automatically; consequently, it is assessed to be more efficient and faster that it is beneficial for orthodontics treatment outcomes in a daily basis.[24],[25]

There is a limitation in this study such as only single center study has been done with limited study model that used to investigate the accuracy and sensitivity of ICON. However, the further study is still needed to examine and investigate the accuracy and sensitivity of ICON calculation using mobile application in larger population and ethnicity variation.


  Conclusion Top


ICON score calculation in the mobile application is faster than using the manual method that can be used to evaluate the orthodontic treatment needs, complexity assessment, orthodontic treatment outcomes, and degree of change.

Acknowledgements

The authors would like to thank Faculty of Dentistry, Hang Tuah University, and Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia, for the kind support.

Financial support and sponsorship

LPPM Hang Tuah University, Surabaya, Indonesia.

Conflicts of interest

There are no conflicts of interest.

Authors’ contributions

AB, NP, BH, MRS, and FH: concepts, design, definition of intellectual content, literature search, clinical studies, operator, data acquisition, article preparation, editing, and review. Finally, all authors had given their approval for publication.

Ethical policy and institutional review board statement

All procedures were in accordance with the ethical standards of the Research Ethics Committee (CREC) of the Faculty of Dentistry, Hang Tuah University, Surabaya, Indonesia.

Patient declaration of consent

The authors had obtained all appropriate patient consent forms. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. This randomized controlled clinical study was held in the Faculty of Dentistry, Hang Tuah University, Surabaya, Indonesia.

Data availability statement

Data are available on reasonable request.



 
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    Figures

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    Tables

  [Table 1], [Table 2]



 

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