Avaliação da preferência do paciente e do cirurgião dentista entre enceramento diagnóstico convencional e digital / Assessment of patient and dentist preference between conventional and digital diagnostic waxing

Este estudo foi descritivo e teve como objetivo avaliar os enceramentos diagnóstico convencional e o digital, baseados no mesmo Planejamento Digital do Sorriso em 2D, realizado através de um protocolo fotográfico. Foram selecionados 20 pacientes, que foram moldados com alginato para obtenção dos modelos de estudo convencional e foram também escaneados para a obtenção do modelo virtual utilizado para o enceramento digital. O planejamento 2D foi então enviado ao laboratório de prótese juntamente com os modelos em gesso e os modelos virtuais, realizando então os enceramentos diagnósticos. A prova destes enceramentos foi realizada por meio de um ensaio restaurador seguindo uma ordem aleatorizada. A avaliação do ensaio restaurador foi feita sob a preferência de um dentista avaliador experiente e especialista em prótese dentária e do paciente através de questionário. Foi avaliada também, a preferência do paciente em relação às técnicas de impressão: analógica e digital. As respostas foram tabuladas e submetidas a teste estatístico. Os pacientes mostraram preferência pelo enceramento diagnóstico convencional em relação ao digital em 65% dos casos. Os pacientes mostraram preferência pelo método de impressão digital em relação ao convencional em 80% dos casos. O dentista avaliador mostrou preferência pelo enceramento convencional em 50% dos casos e pelo digital em 50% dos casos(AU)

This study was descriptive and aimed to evaluate the conventional and digital diagnostic waxing, based on the same 2D Digital Smile Planning, performed through a photographic protocol. Twenty patients were selected, who were molded with alginate to obtain the conventional study models and were also scanned to obtain the virtual model used for digital waxing. The 2D planning was then sent to the prosthesis laboratory together with the plaster models and the virtual models, performing the diagnostic waxing. The testing of these waxing was performed by a restorative assay following a randomized order. The evaluation of the restorative trial was made under the preference of an evaluating dentist and the patient through a questionnaire. It was also evaluated the patient's preference over printing techniques: conventional and digital. The answers were tabulated and subjected to statistical test. The patients showed preference for the conventional waxing over the digital one in 65% of the cases. Patients showed a preference for the fingerprint method over the analog in 80% of the cases. The evaluating dentist showed a preference for analogous waxing in 50% of cases and digital for waxing in 50% of cases(AU)

A long-term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges: CBCT analyses, soft tissue alterations, aesthetic ratings, and patient-reported outcomes.

BACKGROUND: Although many studies have been published on single implants, long-term data remain scarce. PURPOSE: To evaluate immediately restored single implants after at least 8 years of follow-up in terms of buccal bone, soft tissue alterations, aesthetic ratings, and patient-reported outcomes. MATERIALS AND METHODS: This prospective cohort study included patients who were consecutively treated with an immediately restored single implant installed in an extraction socket (IIT) or a healed ridge (CIT) in the anterior maxilla. Biomaterials were never used. CBCTs were taken at study termination, soft tissue alterations, and Pink Esthetic Score were evaluated between 1 year and study termination using standardized clinical images. Patient satisfaction was also registered. RESULTS: About 11/16 initially treated patients in the IIT cohort (10 men, 6 women; mean age 45) and 18/23 initially treated patients in the CIT cohort (12 men, 11 women; mean age 40) could be evaluated after more than 8 years. A buccal bone wall less than 2 mm was found at all implant sites. A thin buccal bone wall less than 1 mm was found at 42% of the implant sites. In the CIT cohort, 8 patients had a missing buccal bone in the crestal area, although bone was present at the time of surgery. Alveolar process deficiency significantly deteriorated (P ≤ .046), whereas vertical soft tissue levels and PES remained stable over time in both cohorts. Patients expressed high overall satisfaction. CONCLUSIONS: Substantial dimensional changes may be expected at the buccal aspect of single implants inserted in the premaxilla. As a result, contour augmentation procedures at the time of implant placement should be considered to counteract these bone alterations, even when implants are fully embedded in bone upon insertion.

Functional, esthetical, and periodontal determination of the dentition in 35- to 44-year-old Brazilian adults.

AIMS: The aims of the present study were to evaluate oral health status among Brazilian adults aged 35 to 44 years with regard to functional dentition based on four different definitions and classify dentition configurations using a dental functional status classification system. METHODS: The sample was composed of 9564 individuals who participated in the 2010 National Oral Health Survey. The definitions were "well-distributed teeth" concept (WDT), the World Health Organization functional dentition concept (FDWHO), functional dentition classified by esthetics and occlusion (FDClass5), and functional dentition classified by esthetics, occlusion, and periodontal status (FDClass6). Dentitions were classified on six sequential, accumulative levels (anyone reaching level VI necessarily met the criteria on all previous levels): I-≥one tooth in each arch; II-≥10 teeth in each arch (WDT) or ≥20 teeth present (FDWHO); III-all 12 anterior teeth present; IV-≥3 premolar posterior occluding pairs (POPs) present; V-≥one molar POP bilaterally (FDClass5); VI-all sextants with Community Periodontal Index <3 and/or loss of attachment ≤1 (FDClass6). RESULTS: The prevalence rates of the different definitions of functional dentition ranged from 42.6 % (FDClass5) and 40.3 % (FDClass6) to 72.9 % (WDT) and 77.9 % (FDWHO). CONCLUSIONS: The oral health status of Brazilian adults exhibited considerable variation due to the different definitions of functional dentition, and less than half of Brazilian adults met all the criteria of function. CLINICAL RELEVANCE: The indication and planning of prosthetic rehabilitation should not only be based on the absence of teeth but also the distribution and periodontal status of the teeth present.

The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study.

PURPOSE: To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis. MATERIALS AND METHODS: Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement. RESULTS: Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75. CONCLUSION: The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.

Evaluation of the influence exerted by different dental specialty backgrounds and measuring instrument reproducibility on esthetic aspects of maxillary implant-supported single crown.

OBJECTIVE: To evaluate the influence exerted by different dental specialty backgrounds as well as the validity and reproducibility of the Pink Esthetic Score/White Esthetic Score (PES/WES) and the modified Implant Crown Aesthetic Index (mod-ICAI) on the assessment of esthetic aspects of maxillary implants supported single-tooth prosthesis. MATERIAL AND METHODS: A total of fourteen examiners (Two orthodontists, two prosthodontists, two oral surgeons, two periodontists, two dental technicians, two dental assistants, and two postgraduate students in Implant Dentistry evaluated 20 photographs of single-implant-supported crowns and five photographs of unrestored teeth of esthetic zone in a two part study. The examiners assessed the photographs with each index (Pink Esthetic Score/White Esthetic Score and modified Implant Crown Aesthetic Index), twice with a week's interval. Orders of photographs were rearranged in the second assessment. RESULTS: Kruskal-Wallis test results showed significant differences among all the six specialties (P ≤ 0.001). DAs and periodontists had significantly better ratings than other specialties with both indices. Prosthodontists had the lowest mean rank scores regardless of the index. Interobserver agreement was also lowest between the two prosthodontists (4-28%), rest of the groups had low-to-moderate agreement (20-80%) when limited allowance was accepted. With mod-ICAI, more interobserver agreement was noted within the specialty group than with PES/WES. CONCLUSIONS: The PES/WES and the modified ICAI can be reliable estimates of esthetic outcomes. The assessor degree of specialization affected the esthetic evaluation with both the PES/WES and the modified ICAI. DAs and periodontists were identified to provide more favorable ratings than other specialties while prosthodontists were most critical in this study. With modified ICAI, more interobserver agreement within specialty resulted. The interexaminer agreement may be increased if more tolerance of 1-2 points is considered.

Occlusal characteristics and orthodontic treatment need in black adolescents in Salvador/BA (Brazil): an epidemiologic study using the Dental Aesthetics Index.

OBJECTIVE: The objective of this article is to evaluate the need of orthodontic treatment, prevalence and severity of the malocclusions in individuals of black ethnicity in a representative sample of schoolchildren of the city of Salvador/Brazil, as well as to verify if the malocclusion was affected by socio-demographic conditions such as age and gender. METHODS: The reference population was constituted of schoolchildren with age between 12 and 15 years, enrolled in public and private schools. The malocclusion was evaluated in 486 students of black ethnicity, with ages varying from 12 to 15 years, selected in random sample in multiple stages. The adopted significance level was 1% and the power of the test was 90%. A questionnaire registering demographic characteristics was filled out by each individual. The Dental Aesthetics Index (DAI) was used by previously calibrated examiners (kappa 0.89), according to criteria of the World Health Organization. RESULTS: It was verified that most of the individuals (76%) had little or any need for orthodontic treatment. About 24% showed a condition of severe malocclusion, culminating in a vital need for orthodontic treatment. The main occlusal characteristics found in the group with high need of orthodontic treatment were dental crowding and accentuated overjet. The age was positively related to the improvement of the maxillary overjet and to the presence of crowding. CONCLUSION: The development of public politics that aim the insertion of orthodontic treatment among the procedures of health programs, with the implementation and development of specialized centers, is fundamental.

Orthodontic treatment need for Brazilian schoolchildren: a study using the Dental Aesthetic Index.

OBJECTIVE: To determine the normative orthodontic treatment need among 12-year-old Brazilian schoolchildren, in the municipality of Juiz de Fora, Minas Gerais, Brazil, and compare with the need as perceived by the children themselves and their parents or caregivers, assessing putative associated sociodemographic factors. METHODS: Four hundred and fifty one children without a previous history of orthodontic treatment were randomly selected from a population of 7,993 schoolchildren regularly attending the public and private educational sectors of the municipality of Juiz de Fora, Minas Gerais, Brazil. RESULTS: The prevalence of normative orthodontic treatment need in 12-year-old children, assessed with the Dental Aesthetic Index (DAI) was 65.6% (n = 155). The need perceived by the caregivers was 85.6%, and by the children was 83.8%. Only the perception by the caregivers maintained a significant correlation with the normative need of treatment when adjusted to the parents' schooling and economical level (p = 0.023). CONCLUSIONS: There is a high prevalence (65.6%) of malocclusion requiring orthodontic treatment in 12-year-old Brazilian schoolchildren. The most prevalent malocclusions in the study were: Crowding, Class II molar relationship and increased overjet. There was no significant correlation between the Index of Orthodontic Treatment Need - Aesthetic Component (IOTN-AC) related to dental aesthetic perception and the normative treatment need assessed with the DAI.

Occlusal characteristics and orthodontic treatment need in black adolescents in Salvador/BA (Brazil): an epidemiologic study using the Dental Aesthetics Index

OBJECTIVE: The objective of this article is to evaluate the need of orthodontic treatment, prevalence and severity of the malocclusions in individuals of black ethnicity in a representative sample of schoolchildren of the city of Salvador/Brazil, as well as to verify if the malocclusion was affected by socio-demographic conditions such as age and gender. METHODS: The reference population was constituted of schoolchildren with age between 12 and 15 years, enrolled in public and private schools. The malocclusion was evaluated in 486 students of black ethnicity, with ages varying from 12 to 15 years, selected in random sample in multiple stages. The adopted significance level was 1% and the power of the test was 90%. A questionnaire registering demographic characteristics was filled out by each individual. The Dental Aesthetics Index (DAI) was used by previously calibrated examiners (kappa 0.89), according to criteria of the World Health Organization. RESULTS: It was verified that most of the individuals (76%) had little or any need for orthodontic treatment. About 24% showed a condition of severe malocclusion, culminating in a vital need for orthodontic treatment. The main occlusal characteristics found in the group with high need of orthodontic treatment were dental crowding and accentuated overjet. The age was positively related to the improvement of the maxillary overjet and to the presence of crowding. CONCLUSION: The development of public politics that aim the insertion of orthodontic treatment among the procedures of health programs, with the implementation and development of specialized centers, is fundamental.

OBJETIVO: averiguar a necessidade de tratamento ortodôntico, prevalência e severidade das más oclusões em indivíduos negros numa amostra representativa de escolares da cidade de Salvador/BA (Brasil), além de determinar se as más oclusões eram afetadas por condições sociodemográficas como idade e sexo. MÉTODOS: o desenho epidemiológico foi transversal, e a população de referência se constituiu de escolares com idades entre 12 e 15 anos, matriculados em escolas de primeiro e segundo graus, públicas e privadas. Participou do estudo um total de 486 indivíduos sorteados em amostra probabilística em múltiplo estágio. O nível de significância adotado foi de 1% e o poder do teste foi de 90%. Aos participantes foram aplicados questionários registrando características demográficas e, depois, avaliados por examinadores previamente calibrados (Kappa 0,89), utilizando-se o Índice de Estética Dentária (IED) segundo critérios da Organização Mundial de Saúde. RESULTADOS: constatou-se que a maioria dos indivíduos (76%) observados nesse estudo possuía pouca ou nenhuma necessidade de tratamento ortodôntico. Cerca de 24% apresentaram uma condição de má oclusão severa, acarretando uma imprescindível necessidade de tratamento ortodôntico. As principais características oclusais encontradas no grupo com maior necessidade de tratamento ortodôntico foram apinhamento dentário e overjet maxilar acentuado. A idade foi positivamente relacionada com a melhora do quadro do overjet maxilar e com a presença de apinhamento dentário. CONCLUSÃO: torna-se fundamental o desenvolvimento de políticas públicas que objetivem a inserção do tratamento ortodôntico entre os procedimentos dos programas de saúde, com a implementação e desenvolvimento de centros especializados.

Orthodontic treatment need for Brazilian schoolchildren: a study using the Dental Aesthetic Index

OBJECTIVE: To determine the normative orthodontic treatment need among 12-year-old Brazilian schoolchildren, in the municipality of Juiz de Fora, Minas Gerais, Brazil, and compare with the need as perceived by the children themselves and their parents or caregivers, assessing putative associated sociodemographic factors. METHODS: Four hundred and fifty one children without a previous history of orthodontic treatment were randomly selected from a population of 7,993 schoolchildren regularly attending the public and private educational sectors of the municipality of Juiz de Fora, Minas Gerais, Brazil. RESULTS: The prevalence of normative orthodontic treatment need in 12-year-old children, assessed with the Dental Aesthetic Index (DAI) was 65.6% (n = 155). The need perceived by the caregivers was 85.6%, and by the children was 83.8%. Only the perception by the caregivers maintained a significant correlation with the normative need of treatment when adjusted to the parents' schooling and economical level (p = 0.023). CONCLUSIONS: There is a high prevalence (65.6%) of malocclusion requiring orthodontic treatment in 12-year-old Brazilian schoolchildren. The most prevalent malocclusions in the study were: Crowding, Class II molar relationship and increased overjet. There was no significant correlation between the Index of Orthodontic Treatment Need - Aesthetic Component (IOTN-AC) related to dental aesthetic perception and the normative treatment need assessed with the DAI.

OBJETIVO: determinar a necessidade normativa de tratamento ortodôntico em escolares brasileiros de 12 anos de idade, no município de Juiz de Fora, Minas Gerais, e compará-la à necessidade percebida pelos responsáveis e crianças da amostra, avaliando potenciais fatores sociodemográficos associados. MÉTODOS: quatrocentos e cinquenta e uma crianças, sem história de tratamento ortodôntico, foram selecionadas, aleatoriamente, de uma população de 7.993 escolares matriculados na rede de ensino pública e particular da cidade de Juiz de Fora. RESULTADOS: a prevalência da necessidade normativa de tratamento ortodôntico em crianças de 12 anos de idade, utilizando o Índice de Estética Dentária (DAI), foi de 65,6% (n = 155). A percepção da necessidade pelos responsáveis foi de 85,6% e pelas crianças foi de 83,8%. No entanto, somente a percepção dos responsáveis teve uma correlação significativa com a necessidade normativa (p = 0,023). CONCLUSÕES: existe uma alta prevalência (65,6%) de má oclusão com necessidade de tratamento ortodôntico em escolares brasileiros de 12 anos de idade. As más oclusões mais prevalentes no estudo foram apinhamento, relação molar de Classe II e sobressaliência maxilar. Não houve uma correlação significativa entre a percepção da estética dentária por meio do IOTN-AC (Index of Orthodontic Treatment Need) e a necessidade de tratamento normativo avaliada por meio do DAI.

Comments on: Cardoso, C.F.; Drummond, A.F.; Lages, E.M.B.; Pretti, H.; Ferreira, E.F.; Abreu, M.H.N.G. The Dental Aesthetic Index and Dental Health Component of the Index of Orthodontic Treatment Need as Tools in Epidemiological Studies. Int. J. Environ. Res. Public Health 2011, 8, 3277-3286.

In regard to the article entitled "The Dental Aesthetic Index and Dental Health Component of the Index of Orthodontic Treatment Need as Tools in Epidemiological Studies" by Cardoso et al. [1] which checks the validity and agreement of two scales for orthodontic treatment need, we would like to draw your attention to a number of discrepancies in the design and methodology which have affected the results. [...].

The use of occlusal indices in high-impact literature.

UNLABELLED: Malocclusion is difficult to define because individuals and cultures vary widely in their perceptions of what constitutes an occlusal problem. A number of occlusal indices have been devised but, probably because of this perceptual problem, none has ever emerged as a standard. OBJECTIVE: The main objective was to review the use of the principal occlusal indices. BASIC RESEARCH DESIGN: The PUBMED database was searched for the main occlusal indices employed, journals with an impact in dentistry and specialist orthodontics journals. RESULTS: The occlusal indices most frequently employed were IOTN (163 studies), PAR (132 studies), DAI (68 studies) and ICON (32 studies). The journals publishing the greatest number of studies using these occlusal indices are those specialising in orthodontics. CONCLUSIONS: In the high-impact scientific literature, the indices in greatest use are IOTN, followed by PAR, DAI and ICON. DAI and IOTN are mainly used in epidemiological or prevalence studies, while PAR is generally used for longitudinal studies. IOTN is used more in Europe. DAI is used worldwide; though least in Europe.

The Dental Aesthetic Index and dental health component of the Index of Orthodontic Treatment Need as tools in epidemiological studies.

The present study assesses the validity and reproducibility of two occlusal indices for epidemiological studies--the Dental Aesthetic Index (DAI) and the Dental Health Component of the Index of Orthodontic Treatment Need (DHC-IOTN) for the identification of orthodontic treatment needs. The total of 131 study models was examined by an examiner (orthodontic specialist) for the determination of the DAI and DHC-IOTN. Thirty days later, further assessment was performed to determine the reproducibility. The duration of each exam was measured in seconds with a stopwatch. The indices were compared by a panel of three experts in orthodontics to evaluate validity. The intra-examiner reliability evaluation resulted in an intraclass correlation coefficient of 0.89 for the DAI (95% CI = 0.64 to 1.0) and 0.87 for the DHC-IOTN (95% CI = 0.56 to 0.96). The time spent on the evaluation of the DHC-IOTN was less than the time spent on that of the DAI (P < 0.001). The accuracy of the indices, as reflected by the area under the receiver-operating characteristic curve, was 61% for the DAI (95% CI = 51 to 70; p = 0.037) and 67% for the DHC-IOTN (95% CI = 58 to 77; p = 0.001). Both indices presented good reproducibility and validity.

Reliability and validity of the Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: This study evaluated the reliability and validity of the Orofacial Esthetic Scale (OES)-an instrument assessing self-reported orofacial esthetics in prosthodontic patients. MATERIALS AND METHODS: The OES has seven items addressing direct esthetic impacts in the orofacial region, as well as an eighth global assessment item. The response format was a 0 to 10 numeric rating scale (very dissatisfied to very satisfied with appearance, respectively). OES summary scores ranged from 0 (worst score) to 70 (best score). Test-retest reliability (n = 27) and internal consistency (n = 119) were assessed. Content validation (asking patients about their satisfaction with the questionnaire content, n = 119) and discriminative validation (comparing OES scores between patients and healthy controls, n = 119) were performed. Convergent validity was assessed by correlating patients' own OES scores (n = 29) with ratings from a consensus expert group (n = 4) and with the Oral Health Impact Profile (OHIP) esthetic-item summary score (n = 119). RESULTS: Test-retest reliability was excellent for the OES scores (intraclass correlation coefficient = .96). Internal consistency was satisfactory for esthetically impaired patients (n = 27, Cronbach alpha = .86). Patients rated their satisfaction with the questionnaire content as 7.8 +/- 1.3 units on a 0 to 10 numeric rating scale (0 = very dissatisfied, 10 = very satisfied). OES scores discriminated esthetically impaired patients (31.4 units) from healthy controls (45.9 units, P < .001). OES scores correlated well with other measures of the same construct (r = .43 for patients' own assessment with an assessment by experts using the OES, r = -.72 for a correlation with the OHIP's three esthetic-related items). CONCLUSIONS: The OES, developed especially for prosthodontic patients, exhibited good score reliability and validity.

Development of an Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model. MATERIALS AND METHODS: After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. RESULTS: Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES. CONCLUSIONS: The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

[Research methods in dentistry 10. Assessment of orthodontic treatment need]. / Onderzoeksmethoden in de tandheelkunde 10. Het bepalen van de orthodontische behandelingsbehoefte.

Approximately one third of the Dutch population has an objective need for orthodontic treatment. Yet, patients mostly seek treatment because of aesthetic reasons. Recent social developments and the increased attention for aesthetics ask for ways to objectively measure treatment need. This is not only important because of the risks of orthodontic treatment, but also because of financial reasons. In this article indices to verify treatment need, i.e. the Index for Orthodontic Treatment Need (IOTN), de Dental Aesthetic Index (DAI) en de Index of Complexity, Outcome and Need (ICON), are discussed. All three indices seem to lead to a reduction of treatment need, especially in borderline cases. They can serve as 'neutral' instruments to discuss treatment need with patients and as instruments to allocate financial resources for orthodontic care.

Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index.

BACKGROUND: When limited resources are available for orthodontic treatment, it is important that those with the greatest need receive treatment. AIMS: The aims of this study were to determine the orthodontic treatment needs of Nigerian children and young adults attending a University Hospital as outpatients, and to determine if a relationship exists between social class and orthodontic treatment need. METHODS: Of 148 consecutive patients attending a hospital department for orthodontic treatment, 136 were children and young adults (67 males, 69 females) between 6 and 18 years of age. These subjects were assessed with the Dental Aesthetic Index (DAI), and classified into two social classes with the Standard Occupational Classification. RESULTS: Almost 30 per cent of the children and young adults presenting for treatment had "no/little" need of orthodontic treatment, 20 per cent had DAI scores between 26 and 30 indicating that treatment was "elective", 15 per cent had a "desirable" need for treatment, and 35 per cent had a "mandatory" need for treatment. There was a significant association (p < 0.05) between treatment need and social class: more subjects from the lower social classes (semi-skilled and unskilled occupations) needed orthodontic treatment than subjects from the higher social classes (professional, managerial, and skilled occupations). CONCLUSION: The study has shown that not all outpatients presenting/referred for orthodontic treatment "need" treatment. Patients from the semi-skilled and unskilled occupations were more likely to need orthodontic treatment than patients from the professional, managerial and skilled occupations.