NATIONAL CENTER %dOS 2 

For HEALTH STATISTICS INumber Z#5 

PROPERTYOF TM? “ 

PUBLICATIONSBRANCH 

EDITORIAL LIBRARY 

VITAL and HEALTH STATISTICS 

DATA EVALUATION AND METHODS RESEARCH 

Orthodontic 

Treatment 

Priority Index 

A description of the development of a system for 

studying malocclusion in population groups. Through 

the use of multiple regression equations the findings 

from the field examination procedure consisting of 

10 obiective components are weighted and summed to 

a single number on a 10-point scale of case severity. 

A computer program for data processing is included. 

Washington, D.C. December 1967 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Heolth Service 

John W. Gardner Wil Iiam H. Stewart 

Secretary Surgeon General 
Public Health Service Publication No. 1000-Series %,%. 25 

For sale by the Superintendent of Documents, U.S. Government Printing Office 

Washington, D. C., 20402- Price 40 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D.WOOLSEY,DIRECTOR 

PHILIP s. LAWRENCE, SC.D., ihsochte Director 

OSWALD K. SAGEN, Ph.D.,Assistant Director for Health Statistics Development 

WALT R. SIMMONS, M.A., Assistant Director for Research and Scienfiific Development 

ALICE M. WATERHOUSE, M.D.,Medical ConsuUant 

JAMES E. KELLY, D.D.s.,DentaZ Adwisor 

LOUIS R. STOLCIS, M.A., Eaecutiwe officer 

DONALD GREEN, informationOfficer 

DIVISION OF HEALTHEXAMINATIONSTATISTICS 

ARI’HUR J.h4cDOWELL, l)i?ecto~ 

JAMES T. BAIRD, JR.,Cbie/,Analysis and ~eports Branch 

HENRY W.MILLER, Cbie/,operations and Quality control Branch 

PETER V. HAMILL, M.D.,Medical Advisor 

LAWRENCE E.VAN KIRK, D.D.S.,Dental Advisor 

Public Health Service Publication No. 1000-Series 2-No. 25 

Libra~ of Congress Catalog Card Number 67-60072 
FOREWORD


This study was begun as part of the Burling. 

ton Orthodontic Research Project of the University 

of Toronto and remains an essential part of the 

Canadian research. Interest in a treatment priority index- an index of the handicapping extent 

of malocclusion—began at Burlington when the 

need arose to decide objectively whether preventive treatment had reduced malocclusion below a level that might be considered of public 

health significance. A description of the proposed 

Treatment Priority Index (TPI) appeared in an 

annual report of the Burlington Orthodontic Research Centre. 1 

At about the same time, the Health Examination Survey, a major program of the National 

Center for Health Statistics, was making plans 

for its second cycle of examinations. In Cycle 1, 

a national probability sample of adults aged 18 

through 79 years was examined with primary 

emphasis on cardiovascular disease, arthritis 

and rheumatism, and other chronic diseases. 

Cycle 11 would survey a sample of children 6-11 

years old and would focus on factors related to 

growth and development. 

The dental examination would place special 

emphasis on the assessment of occlusion because of its importance in this age group. But 

unlike most other areas of the dental examination, no single survey assessment procedure had 

gained widespread acceptance. or use. The items 

under consideration, when used together for the 

HES examination, would be a potpourri of timetested clinical signs and symptoms, each in itself capable of producing interesting and useful 

data, but missing by a considerable distance the 

most important and most needed statistic of allan estimate of the extent and severity of malocclusion in the population. 

Now, the component parts of the TPI were 

quite similar to items already proposed for the 

Health Examination Survey and offered no new or 

untested measurement procedures. What was new 

was the potential ability of the index to summarize these heretofore disconnected clinical signs 

and symptoms into a single number on a 10-point 

scale of case severity and therefore make estimates of the severity of malocclusion in ~pulation groups, The value of such an index could not 

be overlooked and, to speed up the developmental 

work and the writing of a computer program for 

processing the results of Cycle 11, financial 

assistance was provided by NCHS. Mr. Tavia 

Gordon, Assistant Chief, Division of Health 

Examination Statistics, participated by conveying 

the needs of the survey and, along with Dr. James 

E. Kelly, Dental Advisor to NCHS, aud Dr. Lawrence Van Kirk, Jr., Dental Advisor, Division of 

Health Examination Statistics, assisted Dr. 

Grainger through discussion and consultation. 

James E. Kelly, D.D.S.


Dental Advisor


National Center for Health Statistics


Lawrence E. Van Kirk, Jr., D.D.S.


Dental Advisor


Division of Health Examination Statistics


iii

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SYMBOLS 

Data not available 

Category not applicable 

Quantity zero 

Quantity more than O but less than 0.05----

Figure doesnot meet standardsof 

reliabilityor precision 

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* 

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CONTENTS 

Foreword 

Introduction 

Source of Data and Developmental Meth&--------------------------------

Considerationof the Nature of Handicapping Malocclusion 

Establishment ofa Scale for Expressing Case Severity 

Selection and Interrelations of Recording Items 

Development of Regression Equation for Estimating Treatment Priority 

Scores 

Relation of Treatment Priority Indexto Age------------------------------

Computerized Mark Sense Examination System 

Manual Field Examtiation Forms 

Summary 

References 

Detailed Tables 

Appendix I. Definitions of Recording Items 

Appendix II. Definition of Malocclusion Syndromes by Factor Analysis----

Appendix III. Development of Regression Equation 

Appendix IV. IBM 7010 Fortran, Malocclusion ProcessorPage 

111


1


1 

1 

2 

5 

9 

14 

15 

15 

18 

18 

20 

29 

31 

39 

42 
This is a ~eport on the research development of a means of objectively 

assessing the degvee of ?um&cap due to malocclusion in temns of a 

Treatment Priority Index. The wcwk is based on the study of the interrelationships of 10 manifestations of malocclusion as they occuvvedin 

37’5 12-year-old children with no history of orthodontic tveatment. The 

group constitutes a representative sample of childven, primavily of 

Anglo-Saxon origin, j%om three Ontam”o communities. 

The method was to define the natuval groupings of manifestations which 

tended to occur jointly and which might be refevred to as syndromes. A 

judgment of the severity of the ?nalocclu.sion for each child was obtained 

through direct examination by orthodontic specialists. The highest values in a 10-point scale indicated sevme malocclusion. Using multiple 

regression methods, formuihs were developed for estimating the judgment scoyes from the objective measurements. The comelation between 

the calculated score and the actual clinical judgment was comparable 

to that between two sets of clinical judgments. It is suggested thut the 

index may be useful in epidemiolo~”cal studies, as well as in initial 

screening of populations to determine the needfor treatment while providing a rowgh description of the case type. 

A fully compwtem”zed data -pvocessin.g system and a manual form on 

which to record and calculate the Treatment Priority Index arepvovided, 

vi

ORTHODONTIC TREATMENT PRIORITY INDEX


R. M. Grainger, D. D.S., M.SC.D., D. D. P. H., Faculty of Dentistry, University of Toronto 

INTRODUCTION 

The last decade has seen increasing interest 

in the development of indexes of occlusal status 

and many useful and interesting methods have 

been put forward. 2-7 No one method appears to 

be equally suitable for the use of epidemiologists, 

public health program planners, and clinicians. 8~9 

Consequently it was felt that a renewed effort was 

needed to develop an assessment procedure that 

would objectively express the severity of malocclusion in clinically descriptive terms and, at the 

same time, would be simple enough to be used by 

individuals without specialty training. 

The present interest in a treatment priority 

index, that is, an index of the degree of handicapping malocclusion, began in connection with 

the Burlington Interceptive Orthodontic Research 

Project, lo where the need arose to decide objectively whether treatment had reduced the defect to below the level of public health significance. 

It was soon recognized thereafter that the same 

method would be useful for population surveys 

of the epidemiologic type and also as a screening 

device in public health programs. 

This study describes the development and 

use of a simple method of assessing the severity 

of the most common types of malocclusion and 

hence provides a means for ranking individuals 

according to their severity of malocclusion, their 

degree of handicap, or their priority for treatment. 

Although each ranking implies a different purpose, 

each quite obviously assesses the same thing. 

SOURCE OF DATA AND 

DEVELOPMENTAL METHOD 

A storehouse of invaluable records, particularly for a developmental study, is available at 

the Burlington Orthodontic Research Centre. Sets 

of dental casts are on file from across-sectional 

sample of children of the town at ages 3, 6, 8, 10, 

and 12 years. In each age group, 85 to 90 percent 

of the children at that age are included. In addition, 

for two groups serial dental casts were made 

annually for a period of 10 years. The 3- year-olds 

in the cross-sectional sample became the serial 

experimental group on which preventive orthodontic procedures would be performed as needed. 

The 6-year-olds became the serial control group. 

These unique records are valuable for study because they are representative of all the types of 

occlusion in a typical community and also because, for these children, there had been very 

little treatment that might obscure the natural 

patterns of malocclusion. 

Consideration of the Nature of 

Handicapping Malocclusion 

Strictly speaking, malocclusion is any disharmonious variation from the accepted or theoretical normal arrangement of the teeth. But, in 

nature some degree of variation among individuals 

of a species is always present; hence the statement must be qualified as to the critical amount 

of variation which constitutes malocclusion. For 

the purpose of this study the ideal occlusion was 

taken to be the norm and the pint from which 

variation is measured. 

It is not so much the amount of variation of 

linear measurements from their respective norms 

that causes malocclusion, but more importantly 

the inconsistent variation of parts. Thus it does 

not matter if all measurements of a face are large 

compared with a set of skeletal norms; this merely 

means that the whole face is large. But when one 

measurement tends to be small while the rest are 

larger than average, there is disharmony, and if 

the disharmonious part is closely related to the 

masticator structure, there is a great likelihood 

of malocclusion. Neither does lack of complete 

harmonious conformity to norms necessarily 

constitute a malocclusion, as is shown in making 

1 
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d. :IT.11I es, where the production of minor variations Table A. Number and percent distribution 

to give a lifelike appearance is a fine art. How- of 375 12-year-old children, by clinically case severi-ty scores: <“.,;-, tl, ~ degree of tolerated disharmony needs lington, 

judged

Brantf ord, and Orangeville,

Burto h: cwrefully determined for a specific popula- Ontario 

tion group if a realistic public health measure of 

hanclic:?I)ping defects is to be obtained. Percent .,

,,, r careful consideration of what consti- Judgment Number distri­ score 

tutes a handicapping anomaly from both profes- but ion 

sional and lay standards, the Burlington project 

staff agreed upon the following as prerequisites Total 375 100,0: for determining a handicap: 

0 5.9 1. Unacceptable esthetics. 1 - % 12.3 

2. Significant reduction in the masticator func- 2“------- 68 18. L 

tion.	 72 19.2 

:---------------------- 44 11.7 3.	 A traumatic condition which predisposes to 5 40 10.7 

tissue destruction in the form of periodontal :; 9.6 

disease or caries. ?----------------------

8 16 ::; 4. Speech impairment. 9 2 0.5 

5.	 Lack of stability so that the present occlusion 10--------------------- . 

will not be maintainable over a reasonable period of time. 

6.	 In addition there exists a class of rare but 

gross, traumatic defects such as cleft palate, 

harelip, and pathological or surgical injuries For practical purposes, it was agreed that six 

which are unquestionably of very high treat- conditions should be detectable either through a 

ment priority. measurement or because of the obvious severity 

of the condition. Neither the cost nor the difficulty 

of treatment would be considered in rating the 

handicap. 

Malocclusion 

Severity Scale Interpretation 

Establishment of a Scale for Expressing 

D Virtually classic normal occlusio Case Severity 

1 Figure 1 illustrates an arbitrary scale beMinor manifestations and treatmen tween zero and ten that was selected as a means 2 need is slight of expressing the degree of handicap or the priorit y 3 of treatment which should be given. It was assumed 

4 that case severity is a continuum and that no cut5 Definite malocclusion but treatmen off point existed below which treatment might be 

(3 I elective said with certainty to be unnecessary. The scale 

would express the degree and relative importance 

7 of the six conditions mentioned above as they OC8 ----------Severe handicap, treatment highl curred in a given individual. 

9 I desirable Theoretically, if snough trained personnel 

were available, it would be possible to undertake 

(-l Very severe handicsp with treatmen surveys of populations by simply recording msndato ry judgments of the individual person’s position on 

the scale. The high cost of employing orthodonFigure 1. Arbitrary seal e for expressing case tists, even if they were available, makes this 

severi ty by means of a simple integer val ue be- approach impractical. The alternative of mathetween zero and ten. matically estimating the judgments from objective 

2

observations became the principal goal of the 

study. 

In order to develop the estimating equations, 

a set of clinical judgments was needed. The dental 

casts of 203 12-year-old children in the Burlington collection and an additional 172 children in the 

nearby communities of Brantford and Orangeville 

were exqmined by members of the Burlington Project staff and the judgments recorded (table A). 

The clinical judgments of case severity are in 

no sense absolute. Rather, they are subject to 

considerable inter- and intra-examiner error. 

10 

9 

8 

7 

6 

5 

4 

3 

2 

I 

0 

Figure 2 shows the degree of agreement between 

two orthodontists on the Burlington staff for 95 

cases. The product moment correlation r is +.84; 

the average difference is 1.35; and the standard deviation of the differences 1.40. Thus 19 out 

of 20 times, the examiners differed by as much 

as 2.8 points on a 10-point scale. However, a 

mathematically calculated estimate of case severity that differs no more from the judgment 

score of Orthodontist A than orthodontist A dif. 

fers from Orthodontist B has certain advantages: 

(1) the priority estimate mathematically computed 

0 1	 2 3 4 5 6 7 8 9 10 

FIRST CLINICIAN’S JUDGMENT OF SEVERITY 

Figure 2, Relation between treatment priority judgments by two independent orthodontists for 95 cases 

from the Burl ington cross-section control group of 12-year-old children. 

3 
- - - - - - - -- -- - - - - -- - -

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Table B. Distribution-of 10 manifestations of malocclusion and normalized scores for


375 12-Year-old -. children Burlingtc , Brantford, and Orar eville, or ario


Upper Lower Congen­


ital


overjet overjet incisor 

fT fT f T f T f T 

1.9 27 98.9 50 24 98.9 50 97.9 50 

6.7 34 0.5 74 ::; 1.0 76 0.8 ;; 

26.4 42 0.5 78 46,9 :; ... 1.3 

24.3 49 .*. 20.5 60 . � 00 .*. 

16.3 55 ... 2.4 69 . . . . � .. 0.8 57 .,. 1.6 74 � . . ... 7.5 62 .*. ... .,. ,.. - - -,- - - - - -- 4.5 66 ... ... . . . ... :-----------------------------

9----------------------------- 1.6 70 

T � 

... 

.,. 

... ... . ,,. 

. . . 

,,, 

... 

Measurement1 anterior anterior Cverbite Openbite missing


10---------------------------- . ... ... . . . .,. w :


Mean--- 3.54 0.02 2.01 0.01 0.04 

Variance----------------------- 3.83 0.03 0.77 0.01 0.06 

Standard deviation 1.96 0.16 0.87 0.10 0.25 

Posterio Posterio


cross-
 Disto- Mesio- cross- bite, Tooth


bite,


Measurement to bucca li;~ual 

ment 

f 7

— f T f 7— < 

— f T 

61.3 4 97.9 5 95.2 4 4 50.4 

10.4 5 0,3 7 1.6 6 6 11.2 

16.8 1.3 6 7, 16.8 

3.2 2 k; ? 7 4.3 

clusion clusion maxillar maxi.llar displace-


8.3 6


..


..


.*


T
 ..


..


..


— ~


Mean-------------------------- 0.8


Variance---------------------- 1,6,


Standard deviation 1.21


Isee Appendix I for definitions.


f=frequency; T=normalized score calculated
 s= 10.


from thebasicrecordingswouldbe reproducible,


hence more usefulfor epidemiologic
work, (2)


lesstrainedpersonnel
 couldbeusedforexamining,


(3)thebiasofthecalculated
scorewouldbecome


definedaftera periodofuse andhencecouldbe


offsetbyknowledgeable interpretation
 ,butthebias


4


.. H ; 7’ ;.; .. 0.5 7 .. .. 0.3 7( 0. 2:9 .. .. .. 1.6 .. .. .. ., .. ., ;::
 .. .. .. 0.5
 —— — —


0.01 0.1( 

0.1’ 0.2 

0.4’ 0.41 

from areas in normal distribution Z= 50,


insubjective clinical
 assessmentsisnotconstant,


thusnotcorrectable,
 and (4)acalculatedseverity


score couldbe usefulasbasicdatainestimating


the need and costsoftreatmentbyapanelofex­


perts.

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Selection and Interrelations 

of Recording Items 

The items to be observed either from casts 

or direct clinical examination were selected because of their bearing on the six points used to 

determine the degree of handicapping. The items 

were rigidly restricted to those that describe an 

occlusion anomaly, excluding factors bearing on 

etiology such as habits, or underlying measurements which are related to malocclusion but are 

not malocclusion per se, such as arch width. 

Moreover, a few manifestations of malocclusion 

such as midline diastema and slight asymmetry 

were rejected as being of little public health 

significance. Ten manifestations were chosen 

to be of primary importance. An eleventh recording item was included for special cases in 

which measurements seem inappropriate. The 

rare but severe defects such as cleft palate and 

other gross dento-facial anomalies would be repmted here and automatically assigned the highest case severity score. For definitions of these 

recording items, see Appendix L 

1. Upper anterior segment overjet. 

2. Lower anterior segment overjet. 

3.	 Overbite of upper anteriors over lower anteriors. 

Table C. Analysis of 105 pairs of replicated 

S.D. of distribution of 

differences Recording item between pairs 

Anteri.or over.jet .969


Anterior under jet----------


Anteri.or overbite .412


Anterior openbite .526 

Congeni.tal tnissing incisor- ..-

Df.stoclusion .572 

Mesioclusi.on .265 

Posterior crossbite, 

maxillary to buccal---- 1.28 

PosCeri.or crossbite, 

maxillary to lingua l------ .701 

Tooth displacement 1.86 

S.D. -standard deviation. 

4. Anterior openbite. 

5. Congenital absence ofincisors. 

6.	 Distoclusion as determined from buccal segments. 

7.	 Mesioclusion as determined from buccal segments. 

8.	 Posterior crossbite with maxillary segment 

to buccal of normal cusp relation. 

9.	 Posterior crossbite with maxillary segment 

to lingual of normal cusp relation. 

10. Displacement of individual teeth. 

11.	 Cleft palate, traumatic conditions, and other 

gross facial anomalies. 

The frequency distributions of the 10 recording items for the same 12- year-old children that 

were given judgment ratings for severity by the 

Burlington staff are shown in table B and in the 

detailed tables for other age groups with data from 

the dental examination of the National Center for 

Health Statistics’ Health Examination Survey. 11 

(It is important to notice that the distribution of 

measurements and scores was similar for the 

Burlington research data and the HES data.) The 

average changes in the observations with age are, 

no doubt, anatomically real and indicate the need 

for slightly different standards or interpretations 

for different ages. 

examinations (21 cases by 5 examiners) 

95 percent Confidence range 

confidence as a percent of Order of 

range for possible range of recording
 scores
 recording relia­


repro- bility


ducibility Range ?ercent


+1.94 12 mm. 16.2 3 

k .82 

fl.o(j 

5 points 

5 mm. 16.4 

21.2 

: 

..- *1*14 4 points 28..5 8 

k ..54 4 points 13.5 1 

&2.56 10 teeth 25.6 7 

*1.40 10 teeth 14.0 2 

*2.72 15 points 18.1 5 

5 
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Table D. Classification of 126 cases having manifestations of malocclusion of a clini. 

tally significant degree: Burlington, Brantford, and Orangeville, Ontario 

Recording item and


clinically significant degree


- .-

Maxillary overjet, 5 mm. and over---------­


.——


Mandibular overjet, 1 mm. and over--------­


.-— -——


Overbite, score 3 or over


();enbite, 1 mm. and over------------------­

—.— 

Cmgenital incisor, score 1 or over-------­


- .—.--.—— 

I)istoclusion,score 3 or over-------------­


-—.. 

Mesioclusion, score 3 or over-------------­


.--———— 

Posterior crossbite, maxillary to buccal,
 score 1 or over---------------------------


Posterior crossbite, maxillary to lingual,


score 1 or over---------------------------


Tooth displacement, score 4 or over--------

Observed frequency of combination


Totals-------------------------------


Disto- Disto- 1


clusions elusions Mesioclusions
 with with no
 overjet overjet


58	 I 8 I 

Some ideaof the reproducibilityof there­


cording items was obtained by analysis ofreplicated examination of 21 cases by five different 

orthodontists. This gave 105 pairs ofreplications 

for each of the 10 recording items. ’l%eresuhx 

given in table C are, of course, directly applicable 

to the particular cases and examiners involved, 

but they do indicate where the most difficulty is 

encountered and where the most concentrated 

w.dibrationeffort wouldbeneeded wheninstructing 

new examiners. The most difficulty seemed to 

ariseinrecordingdistoclusion,
 posterior crossbite, and anterior openbite. 

As a first exploration of the interrelationship of the first 10 recording items, aclassification of the various combinations of defects of 

severity sufficient tobeof some signiflcancewaa 

tabulated. The critical severity levels for the 

various defects weredeterminedcompletely arbitrarily on an individual basis, and it is not suggested that these truly represent the levels of 

severity considered to be ofpublic healthsignifi6

Table D. Classification of 126 cases having manifestations of malocclusion of a clinitally significant degree: Burlington, Brantford, and Orangevi-lle, Ontaric-Con. 

Condensed table


Neutroclusion Overbite, Cross- Congen­


displacements overjet ita1
 cases bites incisor 0+0 c 

I/


I/


I/


I/


2 4 1 1 

11 2 

21 11 1 1 I I

I 

cance. The levels used, as defined in table D, At the extreme right of tableD is a condensation 

were: of the main blocks which correspond well with .- earlier work.Lz 1. Maxillary overjet- ------5 mm.and over 

2. Mandibular overj et -----l mm. andover It is unlikely that the severity judgments set 

3. Overbite ---------------score of30rover by the clinicians would bedirectly related to any 

4* Openbite--------------.l mm. orover specific single measurement change because the 

5, Congenitally missing clinicians were told to judge the cases without, 

incisors--------------l or more 

as it were, performing a formal diagnosis. Nor 

6. Distoclusion -----------score of30r4 canitbe assumed that thegrossestdefect was the 

7. Mesioclusion -----------score of30r4 cause of the high judgment score because more 

8,9. Posterior crossbite -----countof 1 or more 

moderate variation of another factor could con10. Tooth displacement -----scoreof 4orover ceivably be more important clinically. The judg7

--------

---------- --------

--------- --------------

----------

---------

----------

ments then must ineachcase applytoa specific


combinationofobservations.


In AppendixII,confirmation
of the pattern


of combinations(syndromes)originally
 proposed


and presentedintableD was undertakenby mul­


tiplegroupfactoranalysis.
TableIoftheappendix


shows the resultsofanalyzing a correlation
 ma­


trixofphicoefficients.
 The generalmakeup ofthe


rotatedfactors
was foundsimilartothesyndromes


intableD. The conclusion
 isthatifthecaseswere


separatedintothree sets—(1)the distoclusion


group, (2)the mesioclusiongroup,and (3)the


neutroclusion
group-it would be reasonableto


assume thatthejudgmentexpressedtheseverity


of thesesyndromes and hence thatmultiplere-


gressionmethods couldbe employedtoestimate


the score from the appropriatecombinations
of


individual
 observations.


Table E. Results of multiple regression calculations for estimating the clinician’s


judgment using squares of predictors for distoclusion, neutroclusion, and mesio­


clusion cases


Buccal segment re­
 lation, recording


item,l and judgment
 score


Distoclusion cases 

Upper overjet---------
 Upper overbite


Distal molar score----


Posterior srossbite,


maxillary to buccal-­


Displacement


Judgment score


Neutroclusion cases,


Upper overjet


Overbite


Openbite--------------
 Posterior crossbite,


maxillary to buccal-­


Posterior crossbite,


maxillary to lingual-


Displacement


Judgment score--------


Mesioclusion cases


Lower overjet


Openbite--------------
 Mesial molar score----
 Posterior crossbite,.


maxillary to lingual-


Displacement


Judgment score--------


T value 

for test


(egres- of Standard Vertical 

Mean S.D. sion 

coeffiregres-. partial Multiple intercept sion R 

cient coeffi- r constant


cient


21.12 22.30 .052 9.76 .588 

5.37 4.72 ,134 5.63 .386 

4.69 5.55 .067 2.96 .215 .795 1.58 

0.61 3.54 ,115 3.88 .277 

7.57 

3.96 

16.32 

2.31 

.023 

.0. 

3.40 

... .245 

� 0. I 

8.18 9.44 .088 13.71 .619 

3.42 

0.01 

3.03 

0.10 

.066 

.222 

3.25 

0.34 

.184 

.020 I 

0.15 1.70 .184 5.00 .276 .855 0.33 

0.17 1.23 .251 4.79 .266 I 3.62 1:.;; .112 19.06 .739 

1.76 9 .*. � .. .** 

0.07 0.49 .475 2.14 .256 

0.03 0.17 .100 0.14 .017 

1.41 3.38 .260 6.20 .610 .835 1.33 

0.10 0.51 .403 1.63 .198 

3.34 10.62 .059 5.75 .581 

1.97 1.56 ... .** � .* 

‘All squared except judgment scores.
 S.D.—standard deviation.

Development of Regression Equation for 

Estimating Treatment Priority Scores 

In the work of developing a computing equation, squares of the individual recording items 

were used to provide better separation of the very 

severe cases and to decrease the treatment priority for cases with several minor defects that 

should not, even in combination, constitute a severe handicap. 

It was recognized that the weights or importance of items differ according to the combination of other items present. To illustrate, 5 millimeters of anterior overjet is not an extreme 

h~ndicap in a neutroclusion case but in combination with a slight distoclusion, it confirms the 

diagnosis of the syndrome and raises the importance of the findings. Alternately, a mild upper 

anterior overjet occurring in a case tending toward 

mesioclusion in the buccal segments may be an 

indication that the mesioclusion is of rather low 

severity and less likely to become worse. 

The regression of the measurements is only 

crudely linear with respect to clinical handicapin fact, obvious break points exist. As examples, 

horizontal overjet becomes more critical at the 

point where the lower lip can reside behind the 

upper anterior teeth. Vertical overbite becomes 

suddenly severely handicapping when the lower 

teeth begin to impinge on the upper soft tissues. 

To compute the regression equations and determine the correlation of the judgment scores 

with the measurements, three subsets of records 

for the 12-year-old children were prepared according to the anteroposterior buccal segment 

relationship. In the distoclusion and mesioclusion 

sets, the groups used were all those individuals 

with some degree of distal or mesial molar defects, plus a few dozen very low priority scored 

cases in order to increase the effective range of 

variation. Under these circumstances the judgment score could be assumed to relate to the 

severity of the syndromes present. This would 

not have been so if the entire group of 375 had 

been used in each case. Calculations were made 

for the three molar relation groups using the 

BIMD # 6 program on the IBM 7094. Table E 

shows the resulting constants. 

While the results were generally good in 

terms of the multiple correlation coefficients 

which compare favorably with bet ween-examiner 

correlation (fig. 2), deficiencies were apparent 

upon examination. First, the regression lines did 

not pass through the origin because the positive 

vertical intercept constants combined with positive regression coefficients dictate that no estimate can fall below these values. Second, when the 

three equations were used in parallel on all 

cases, it was seen that the distoclusion equation 

gave estimates that were too low for the individuals with only one or two degrees of distoclusion. 

The neutroclusion formula provided a fairly suitable estimate of these low-degree distoclu;ion 

cases but was much too high if used for full 

distoclusion dentitions. Third, there were a fair 

number of very gross discrepancies. Upon examination it was evident these must be recording or 

judgment errors but they were included throughout 

the work because the source of the errors could not 

be verified. Fourth, the mesioclusion cases were 

rather poorly estimated as only a handful of serious cases were available. 

The problem of the vertical axis intercept 

constant divergence from zero can be explained 

in terms of the fact that zero score had been taken 

as normal for the overjet and overbite. In the 

next round of calculations anterior overjet normal 

was to be taken as 2 millimeters and overbite 

as one-third so that all estimates might be reduced 

by this amount and some presumably to actual 

zeros. 

The misfit of the distoclusion equation for 

cases with only slight buccal segment change and 

the value of the neutroclusion equation for these 

cases raisedthe problem of determining the buccal 

segment score cutoff point where one equation 

would be substituted by the other. What was needed 

was a single equation in which the weights for 

overjet, overbite, and displacement would gradually decrease as a function of the higher degrees 

of distoclusion. It was speculated also that the 

same need might exist while progressing from neutroclusion to mesioclusion. Consequently, another 

set of multiple regression computations was done 

using seven groups instead of three in whi:h all 

cases included in a group had the same type of 

buccal segment relation and the same degree of 

variation. 

For these calculations the data were rearranged so that anterior overjet-underjet and 

9 
-----------------

----------------- ------------------ ------------

---------

--------

------- ----------------

------

---------------

Table F. Calculated regression coefficients and smooth valuesl for seveng buccal se=­
 ment relations


Buccal segment relation 

Variable I I I 

Distal Distal Mesial Mesial 

4 3 1 2 

Sample size 217


Y intercept 4.% 3.:; 3:g 1.;? 0.12 2.% 0.:: 

MultipleR .64 .68 .69 .86 .59 .87 

Judgment average 5.78 5.09 4.98 3.68 1.99 2.33 3.69 

Regression coefficients


Anterior horizontal .03 .05 .08 .13 .24 -*22 ,08 

Anterior vertical----------- .09 .28 .16 .04 .26 .20 .35 

Posterior crossbi-te, 

maxillary to buccal .14 ... .11 .10 .16 -2.61 ,14 

Posterior crossbite, 

maxillary to lingual .96 -.76 .09 . . . .27 -.34 ... 

Displacement .01 .01 .02 .03 .11 .03 .62 

Smoc.:hed weightsl


Anterior horizontal3-------- .03 .05 .08 ,14 .24 .14 .08 

Anterior verti_ca14---------- .09 .11 .15 .19 .23 .19 ,15 

Posterior crossbite,. 

maxillary to buccal~------- .14 .14 .14 .14 .14 .14 .14 

Posterior crossbi.te,~ maxillary to lingual .26 ,26 .26 .26 .26 .26 .26 

DisplacementG .01 .02 .03 .06 .10 .06 .03 

Y intercept~---------------- 5.17 3.95 2.72 1.50 0.27 1,50 2.72


lpreli,minarY expressions from Appendix III used to construct smooth weights. 

‘No data were available for the obviously missing two higher degrees of mes3_oclu-


sion groups. 

8Horizontal (yl–Y2– 2.())2e-(1”4+ ‘“53(Y6+Y7)) 

4Vertical (Y3-Y4 - 1 .0)2 ~ - (1.4 + 0.25(Y6 + Y,)) 

5Crossbites were-weighted averages.


6Displacement (y )2 e - (2.28 + 0.61y6
+ .23Y7] 

7yintercept =.;;+ 1.2(Y6+ Y~) 

overbite-openbite
 would be continuousscales


going from positiveto negative.
However pos­


teriorcrossbite
was notconsidereda continuum,


becausethetwo typescan occurinthesameindi­


vidual.Both types were observedin the same


neutroclusion individuals
 buttherewas ahigher


tendencyforbuccalcrossbite
inthedistoclusions


and lingual crossbiteinthemesioclusions.
 Conse­


quently,thesewere leftas separateitemsalong


withthetoothdisplacement score.Thebuccal
seg­


meritscorewas droppedfromthecalculations
 be­


causeallcasesinthesame groupwouldhavethe


same score and the contribution
 of thisfactor


would be contained inthevertical intercept
con­


stant.


Table F givestheresultsofthecalculations


forthe seven groups and preliminarysmoothed


outregression coefficients.
 The smoothingoutwas


10

----------

-------------------

Table G. Final smoothed weights according to buccal segment relations


Buccal segment relation


Variable Distal	 Neu- Mesial
 tral


Posterior crossbite, maxillary 

43 2 1 0 1 2 3 4 

Horizontal componentl .07 .10 .14 .19 .26 .19 ,14 .10 .07 

Vertical component2-------2---- .24 .31 .39 .51 .65 .51 .39 .31 .24 

Posterior crossbi.te,maxillary 

to bucca13-------------------- .14 .14 .14 .14 .14 .14 .14 .14 .14 

to Iinguals I

.26 .26 .26 .26 .26 .26 .26 .26 .26 

Di.splacement,4------------------.01 .02 .04 .07 .12 .08 .06 .05 .04 

Constant~---------------------- 5.07 3.95 2.72 1.50 0.27 1.50 2.72 3.95 5.07 

lHorizontal (Yl– Y2 - 3.0)2e- (1.34 + .32 (Y6 + Y7)) 

2Vertical (Y3-Y4-l.5)2e - (.43 + .26(Y6 + Y,)) 

3Crossbites were wei,ghtedaverages.


4Di.splacement(Y10)2e -(2.28 + .61Y6 + .23Y7) 

~Vertical intercept constant 1.2(Y6+Y7)+ .27


accomplished by expressing the regression co- was + .795. Thescatterdiagram isshownin figure 

efficients as exponential functions of the antero- 3.Veryfewcasesjudged70rhigherarenotcalcuposterior buccal segment relation. After further latedtobe 6 or higherandvariationinthelower 

adjustments (see Appendix III), theequationbelow end ofthescaleisjudgedtobeeflessconsequence 

was derived and it was thought that a reasonable in thatthe importantthingis forthecalculated 

estimate of the clinical judgment was provided. score tobe reasonablylinearand tobe selective 

for the severe cases.There are a fairnumber


J==O.271.2(~+Y7)+ 

of renegades.For most.cases eithera gross
 +


clericalerror or an obviouslygross clinical


judgmenterrormustbetheprimaryexplanation.
 A


(~- Y2–3.0)2e- (1.34+ .32(Y6+ Y,)) + second source of discrepancywas thatclinical 

e- ’043 Y,,2+ judgmentsofdeepoverbitecases(scores4and5) (Y3_y4_l,5)2 + .26( Y6+Y7))+ .14Y82+.26 

were generally lower than those calculated and 

lower than could be accepted. Discussion of 

y102e- (2.*8+ .61 (Y6 + .23 Y,)) 

specific cases with the clinicians led to their 

agreement that deep overbite cases were likely 

underestimated when being considered from the 

Table G gives the resulting regression co- esthetic viewpoint and that higher scores were 

efficients according to anteroposterior buccal more compatible. Athirdreasonfor discrepancies 

segment relation. is that the esthetic handicap, for example of a cerWhen the formula was used on 386 cases tain degree of crowding or of overjet, differs ac­

(375 12-year-old controls plus 11 additional cording to the facial type or lip fullness which may 

mesioclusion cases which became availableclini- hide or emphasize the defect. It is not claimed 

tally), the correlation with the clinical judgment at this stage that the weighting of the factors is 

11

� 

13 

r = “ 795 

12 � 

. 

II 

10 –—— –—— –—— ‘—— ‘—— ——— ——– L ‘— -—— –—— 

7 

, ,. %~ 

.. 

6 *. 

, 4. , � . 

1 5 . 

. , , .8 � . 

.09 , . . . 4	 . * . �� 

,. � . v t # * 

3 

.. 

m r. 

1 

!2% . a01

I HI I I I I I I I I I

0 I 2 3 4 5 6 7 8 9 10 

CLINICAL JUDGMENTS 

Figure 3. Relation between calculated scores and clinically judged scores for 386 12-year-old children.


(375 controls+ll extra mesioclusion cases which became available clinically)


12

Maxillary Maxillary INCISOR 

to to RELATION Under et Overjet 

buccal lingual 

u I I Overbite ODenbite 

igure ~. Method used tosort cases inta syndromes corresponding to factor analysis in appendix table I. 

perfect, but minor adjustments in the equation elusion characteristics which cause the high 

can be made in the Iight of experience. score. In terms of a flow diagram, figure 4gives 

The final equation produces an objective the method of sorting cases according to the 

measure of the handicap in thepublichealth sense dominant defect and in a way that is compatible 

but does not indicate the syndrome or main maloc- with the syndromes defined in appendix table 1, 

13 
-- - - -- -- - - - - - - - - - -- - -- - - - - - - -

---------------- --- - - - - - -- - - - - -- - - - -- -- - -- -- - - - - - - -- -- --- - --- - -- -- - --- - - -

-- - - - - - -- - - -- - - -- - -

----------------

------

Table H. Distribution of Treatment Priority index for 375 12-year-old children, by 

syndrome: Burlington, Brantford, and Orangeville, Ontario 

Syndrome 

Public Tooth displacement Anterior Treatment Priority Total health Index 

norms 1 

Over- Open- Under- Over - Bufcal Lingua 1 bite bite jet jet VI II Iv v 111 

.--

o - - - - . - - -- . . . . . . . . . . . . . . . . . . 3:;2 L---------------- 21.2 

5?:; 

28.5 

. . . 

. . . 

. . . 

. . . 

. . . 

. . . 

. . . . . . . . . . . . . . . . . . 8.4

:------------------- 8.0 

11.3 

5.1 

. . . 

16.7 

. . . 

14.3 

. . . 

34.5 

. . . . . . . . . 

5 5.5 . . . 14.3 17.2 50.6 3;:: 

6 . . . 33.; 24.1 25.; 50.0 23.5 

::; . . . 16.7 2::: 10.3 75.0 9.8 

;------------------- . . . 21.4 10.3 9.8 

9 ;:; . . . 33.; 14.3 3.4 7.8 

10------------------ 2.3 . . . 7.1 0.0 11.8 

Number -------------- 375 269 14


Mean 2.87 1.60 6.8! 7.00 5.:; 6.5! 5.9: 6.%


Standard deviation-S- 2.34 0.82 1.79 1.80 1.40 0.52 0.71 2.00


tandard error 0.12 0.05 0.73 0.48 0.26 0.26 0.49 0.28


Table H shows the syndrome breakdown and 

priority rating for the 375 12-year-olds in the 

basic tabulation for survey findings. Included are 

the averageTreatment PriorityIndex, itsstandard 

error, and a percent distribution of childrenby 

index score for the group as awholeand for subgroups by syndrome. 

RELATION OF TREATMENT PRIORITY 

INDEX TO AGE 

The frequency distributions of the treatment 

priority scores and the scores sorted by syndromes are given in table J for the ~urlington 

serial controls at ages 6, 9, 12, 14,and 16 years, 

and for some parents. The detailed tables give 

the individual syndromesummaries overthesame 

ages, except syndromeV, prognathism, for which 

there were nocases .Thereisageneral increasing 

average Treatment Priority Index of abut one 

point from the youngest to the oldest age groups. 

The trend shown is, of course, influenced 

by the fact that the norms for some oftherecording items differ considerably with age from 

the values for the 12-year-olds used in construtting the index (table B). ‘l%e age trends 

seem, by inspection, to be most associated with 

syndromes I and VI which involve tooth displacement. For older ages the only comment needed 

is that the syndrome picture becomes less clear 

due to increasing tooth loss. 

For younger ages, three considerations are 

necessary: (l) until the permanent teeth are fully 

erupted, final tooth displacement syndromes are 

not observable, hence this syndromepicturemust 

be incomplete; (2) there is aneedto consider the 

severity of the malocclusion as it is currently 

present at the specific age; and (3) even more 

important is to attempt to project from the recordings how severe the anomalies will be at a 

later age if left untreated. This is the argument 

for expressing syndromes at early ages as estimates of the ultimate conditions at, say, age 12 

years. It is better to use the same formula at all 

ages and to learn to interpret the results, It can 

be stated that because failure to detect syndromes 

at younger ages is due to failure of the syndromes 

to manifest themselves in terms of the 10 items 

14

-- -- --- -- --- ----- ---

-- -- --- -- -- --

-- -- -- ---- --

- - - - - - -- - - - - - -- -- - - - - - - - - - -- - - - - - - - - - - - - - - -- -- - - -- - - - -- --- -- - -- -- - -- -- --- -- -- - -- -- - ----- --- --

-- -- - - - - - - - - - - - -- - - - - -

----------------------

------------------------ ---------- --------------

Table J. Distribution of Treatment Priority Index by specified ages: Burlington — serial

control group - -

Treatment Priority Index 6 years 9 years 12 years 14 years 16 years Parents 

o
 - - ---- -


1--- -- ---- - --.. -


--------- - --- --


$----------------------------


4 - - -- - -

2 -- -.. - - . - -

i-----------------------------

9 .- - - -

10--------------------------

Sample 

Mean 

Standard deviation 

Standard error 

0.0 5.6 

3;:: 2::: 2::; 2::; 25.6 25.0 

32.7 24.0 24.5 20.0 ;;.: 25.0 

13.4 20.7 18.0 17.5 22.2 

5.6 15.3 11.6 13.1 11:6 

5.6 8.2 6.3 11.6 ::: 

2.5 u 4.3 2.3 

0.8 ::; R 

::: ;:; 0.0 M 

0.4 ;:; 2.1 0.6 2.3 ::: 

1.8 0.4 1.3 0.0 2.3 8.3 

284 242 238 160 

2.30 2.69 2.85 2.56 3.% 3.;: 

2.02 1.87 2.14 1.77 2.82 4.68 

0.12 0.12 0.14 0.14 0.43 0.78 

recorded, the errorisoneoffalsenegatives—i.e., 

the tendency will be to underrate malocclusion 

at early ages rather than to overrate it. 

The final answer totheproblemof accurately 

predicting the degree and type of malocclusion at 

later ages from early signs must come through 

detailed studyof each syndrome and probablywill 

necessitate inclusion ofadditionaletiologic observations not included in this study of late clinical 

manifestations. As an example, a recent study by 

Scott 13 has indicated the importance of the discrepancy in incisor width and the space from cuspid to cuspid as an index of crowding. 

COMPUTERIZED MARK SENSE 

EXAMINATION SYSTEM 

A very convenient method of carrying out the 

Treatment Priority Index in field surveys has been 

developed, using an IBM mark sense card and a 

computer program. The card is shown in figure 5 

and the computer program, written in IBM 7010 

Fortran, given in Appendix IV, is used to compile 

the data. A summary of the computer output is 

given as table K. The IBM cards are marked with 

a special graphite pencil and the cards punched 

automatically on an IBM 514 punch in columns 1 

to 20 after which the electronic computer completely finishes the survey report. Instructions 

for setting up the cards for insertion into the 

computer are also given in Appendix IV. 

MANUAL FIELD EXAMINATION 

FORMS 

Figure 6 gives a form on which the examinations may be entered and the Treatment Priority 

Index calculated. It is used as follows: 

1.	 Observe the first molar relation and place 

a check mark in the column heading which 

applies. 

2. On the left hand margin circle the appropriate measurement in millimeters for the 

horizontal incisor relation. Note that if 

this measurement is 2-4 millimeters it 

is considered normal with weight zero. 

3. Also on the left hand margin circle the 

appropriate score for vertical incisor 

relation and for tooth displacement. An 

upper incisor overbite from zero to twothirds is considered “normal with weight 

zero. Also displacement scores zero and 

one are discarded with weight zero. 

4.	 Find the appropriate weights for the first 

three items at the junction of the row and 

15

Table K. Distribution of Treatment Priori.tvIndex for 375 12-vear-old children. . bv . occlusion szrouD: -. Burlington, Brankford, and Orangeville, Ontario 

Treatment Priority Index


Occlusion Sample Average S.E. 

group TPI 0 1 2 3 4 5 6 7 8 9 10 

Total--- 37.5 2,87 0.12 2.5 38.6 21.2 8.4 8.0 5.5 5.2 3.4 2.9 2.1 — _ -

&o 

malocclusion


syndrome


Normal oc-
 elusion------ 1.60 0.05 3.4 51.8 28.5 11.3 5.1


Malocclusion


syndrome


Buccal displacement---- 6.87 0.73 16.7 33.3 16.7 33.3 

Lingual diaplacement---- 7.00 0.48 14.3 14.3 21.4 21.4 14.3 

Overbite------ 5.63 0.26 34.5 17.2 2i:i 10.3 10.3 3.4 

Openbite------ 6.51 0.26 25.0 75.0 

Prognathism--- 5.94 0.49 50.0 50.0 

Retrognathiam- 6.71 0.28 5.6 31.4 23.5 9.i 9.i 7.; 

Congenital---- ... ... 

S.E.—standard error.


Figure !5. Mark sense card for field surveys of Treatment Priority Index.


16

ma AGE......................... 

� .., ............. � O....*. mEAmENTPRIoRITr INDEX 

\ NationalCenterfor HealthStatistics SEX........................... ................ . ..0..... \ ana 

Mm. .,,. . . . . . . . . . . . . . . . . . Univerai~ Of Toronto CASE NO. ....................... 

. . . . . . . . . . . . . . . . . . . \	 /-COMMUNITY.........................
 r 

(6)Distoclusion Ii (7)Mesioclusion


e
 u 9 c1 CASE m
 g d ;~ ; : ; is ;$ 2 16 INDICATBD
 FIRSTMXAR RELATION E $$ r Weights BYTaE


Chooseappropriatecdunrn ‘3 :: .Z “ DCMINANT


~ ;: $: ; 0 ~ ~: $: ! DEFECT
 $ m me . ‘h m ‘$! N +9 No + + No ;3 N 

ml g 9+ 2.0 3.& 5.4 9.3 10+ 9.3 5.4 3.4 2.0 

9 1.4 2.5 4.0 6.9 10+ 6.9 4.0 2.5 1.4 (1) UppsrOverJet SYNDROMEIII 8 1.0 1.8 2.s 4.8 8.0 4.0 2.8 1.8 1.0 mom­ ii 7 .6 1.1 L8 3.0 5.1 3.0 1.8 1.1 .6 G 6 .4 .6 1.0 1.7 2.9 3..7 1.0 .6 .4 2-4!nu 5 .2 ..5 .4 .8 1.3 ..9 .4 .3 .2 

NORMAL i ScoreO 1 .2 .3 .4 .8 1.3 .8 .4 .3 .2 

o .4 .6 1.0 1.7 2.9 1.7 1.0 .6 .4 

(2) LOwerOverjet 

1 

2 

3 

.6 

1.0 

1.4 

1.1 

1.0 

2.5 

1.8 

2.8 

4.0 

3.0 

4.8 

6.9 

5.1 

8.0 

10+ 

3.0 

4.8 

6.9 

1.8 

?.8 

4.0 

1.1 

1.8 

2.5 

.6 

1.0 

1.4 

SYNDROMEV 

PROGNAT7iISM 

3+ 2.0 3.4 5.4 9.3 10+ 9.3 5.4 3.4 2.0
 [


2,9 3.8 4.8 6.2 6.0 6.2 4.8 3.8 4.9 M (3) Overbitein crown ~+ II
 1.5 2.0 2.4 3.2 4.1 3.2 2.4 2.0 1.5 S2NDR01.E


0VBRBIT3
 2/3.3/3 .5 .7 .9 1.1 1.5 1.1 .9 .7 .5
 ~
 i


.5 .7 .9 1.1 1.5 1.1 .9 .7 .5 SYNDROMEIV 

i 1.5 2.0 2.4 3.2 4S 3.2 2.4 2.C 1.5 OPENBITE 

I (4) openbiteinrm. z-4 

4+ 

2.9 

4.9 

3.8 

6.3 

4.8 

_7.9 

6.2 

10+ 8.0 

10+ 

6.2 

10+ 

4.8 

7.9 

3.8 

6.3 

2.9 

4.9 

Cowrtteethretded 2 .1 .1 .2 .3 �4 .3 .2 .1 .1 IS DISltXXUSIONAN D/OR 1.1 .7 .4 .3 .2 POSTERIORCR)SSBITS $%%.: %Kcl : :: :: :: 1:: 1.9 1.2 .9 .5 .3 MAX. 7XIBCCCAL 5 .5 .8 1.2 1.9 3.0 1.9 1.2 .8 .5 ill Countteeth rotatea 6 .7 1.1 l.0 2.8 4.3 2.8 La 1.1 .7 ~Y=%E 

� 45° or Aisplwed 

~!l more than 2nmI)x2 � 7 1.0 

.2 1.3 

1.5 

1.9 

2.4 

3.1 

3.9 5.9 4.9 7.7 

3.9 2.4 

4.9 3.1 

1.5 

1.9 

1.0 

3..3 ma. ~a. 

Max. 

I 

Max. 

VI 

mtal (o,1 no � ~ score) 

:+ X ::: ::: ;:: w ::: ::$ %: ;:: -ion Collapse 

Synarome Synarome 

CONST.WT 5.17 3.95 2.72 1.50 0,27 1.EJJ 2.72 3.95 5.17 

(3)CONG32iITALUMISSING NO. o 1 2 I 2+ SYNDROM2VII 

INCISORS WEIGST o 7 8 9 

(FJk MAX. m NO. o 1 2 3145 6 7 18 Innre 

$;d HJCCA7J WEIGRT o �1 .6 1.3 2.2 I3.5 5.0 6.9 19.0 I 10 

i !~! ‘u%, “~~GRT :!.: :0 :3 :21:5 .:4 T 

OTHER DEFK!T .._- ___________________ -—-— ——-——--——-—-

Arbitrwy Weight 

swoFwEIGm8 D3TREAlKmT PRIoRI’IY IGmx 

L 

Figure 6. Manual examination and calculating form for deriving the Treatment Priority Index,


17

5. 

6. 

7. 

8. 

9. 

column and enter this in the column to the


right.


Transpose the constant for the correct


column to the right.


Circle the correct scores for congenitally


missing incisors and posterior crossbite.


Transpose the appropriate weights to the


right hand column.


Add information on any other rare defects,


such as cleft palates, that are observed.


If a rare defect has been observed that


seriously modifies the index, add an


arbitrary weight to ensure that the index


will indicate its severity.


10.	 Add the weighting column to derive the 

Treatment Priority Index. 

The syndrome type is indicated by the 

dominant weight and the syndrome may be circled 

to be used as a crude description of the case. This 

does not constitute a diagnosis but does give an 

idea of the nature of the defect involved. 

The Treatment Priority Index derived from 

the manual form will not be exactly the same as 

that derived by solution of the full equation by 

computer due to rounding-off errors but may be 

equated for all practical purposes. 

The values in the manual form, figure 6, are 

the observed values multiplied by the appropriate 

regression coefficients. The constants are, of 

course, the vertical axis intercepts. Figure 6 suggests that a simplification might be ~ssible. 

Many of the weights are negligible, hence, values 

corresponding are not worth recording. Also there 

is a level or point in the scale for most of the 

recording where clinical significance has been 

reached and recording much higher levels may 

be of only slight value. Thus future consideration 

may be given to recording the manifestations as 

dichotomies or at the most trichotomies, eliminating the labor of recording many relatively normal conditions. 

SUMMARY 

This is a report on the research development 

of a means of objectively assessing the degree of 

handicap due to malocclusion in terms of a Treatment Priority Index. The work is based on the 

study of the interrelationships of 10 manifestations 

of malocclusion as they occurred in 375 12-yearold children with no history of orthodontic treatment. The group constitutes a representative sample of children, principally of Anglo-Saxon origin, 

from three Ontario communities. 

The method was to define the natural groupings of manifestations which tended to occur 

jointly and which might be referred to as syndromes and then, by regression methods, to determine weighting factors appropriate to each 

syndrome. A fully computerized data processing 

system and a manual form on which to record and 

calculate the Treatment Priority Index are provided. 

The index may be useful in epidemiologic 

studies, as well as for initial screening of populations to determine need for treatment while providing a rough description of the case type. 

REFERENCES


lBurlington OrthodonticResearch Centre’:Progress Report No. 5. Faculty of Dentistry, University of Toronto, 1960. 

(mimeographed) 

2Bjork, A., Krebs, A., and SoIow, B.: Method for epidemiological registration of malocclusion. Acts Odont. Scund. 

22:27-41, Feb. 1964. 

3

Canadian Dental Association’: Canadian Dental Survey 

Manual. A System for Recording and Statistical Analysis at 

the Community, Provincial and National Level. July 1959. 

4Draker, H. L.’: Handicapping labio-lingual deviations, 

a proposed index for public health purposes. Am. J. Orthod. 

46:295-305, Apr. 1960. 

5

Elsaeser, W. A.’: Studies of dent.n-facial morphology. 

1. A simple instrument for appraising variations. Angle Orthod. 

21(3): 163-171, ihdy 1951. 

6

Poulton, D. R., and Aaronson, S. S.: Relationship be- . 

tween occlusion and periodontal statue. Am. il. Orthod, 47: 

690-699, Sept. 1961. 

7

Van Kirk, L. E., Jr., and Pennell, E. H.’: Assessment 

of malocclusion in population groups. Am. J. Pub. Health 

49(9): 1157- 1163,” Sept. 1959. 

8

Grainger, R. M.: Indexing Handicapping Malocclusions. 

Working paper for meeting of Expert Committee on Dental 

Health, World Health Organization, Geneva, 1961. 

18 
I 

i 

‘Cirainger, R. M.: The Statistical Basis for International 

Dental Epidemiology. World Health Organization Document 

No, PA/98.6& 

10Popovioh, F., and Grainger, R. M.’: One community’s 

orthodontic problem, in R. E. Meyers and P. Jay, eds., Orthodontics in Mid-Century. St.Louie. C. V. Mosby Co., 1959. 

11National Center for Health Statietice’: preliminary unpublished data. 

12Orainger, R. M.: Interrelations of malocclusion syndromes.in Advance8 in Oral Bio20gy (in press). 

13~ott, L.: Pereonal communication. 

—000 

14 

Harman, H. H.’: Modern Factor Analysis. Chicago. University of Chicago Press, 1960. 

15Petere, C. C., and Van Voorhis, W. R.’: Statistical Procedures and Their Mathematical Bases. New York. hkGrawHill Book Co., 1940. 

16Thurstone, L. L.’: Multiple Factor Analysis, A Development and Eapansion of the Vectors of Mind. Chicago. University of Chicago Press, 1947. 

17BIMD: Computer programs. Division of Biostatistics, 

Department of Preventive Medicine & Public Health, School 

of hiedicine, University of California, LOSAngeles, Dec. 1961. 

_- -

19

-------------------------

-------------------------

--------------------------

----------------------------------------

---------------------

--------------------------------------------

--------------------------------------------

-----

-----

--------------------

------

------

-----------------------

-----------------------

-----------------------

DETAILED TABLES 

Page


Table 1.


2.


3.


4.


5.


6.


7.


8.


9.


10. 

11. 

12.


13.


14.


15.


16.


Distributions of upper anterior overjet measurements,by specified ages: Burl­


ington Project and Health ExaminationSurvey trial data


Distributions of lower anterior overjet measurements,by specified ages: Burl­


ington Project and Health ExaminationSurvey trial data


Distributions of overbite measurements, by specified ages: Burlington Project


and Health ExaminationSurvey trial data ------.---.-.-


Distributions of openbite measurements, by specified ages: Burlington Project


and Health Examination Survey trial data


Distributions of number of congenitally missing incisors, by specified ages:


Burlington Project and Health ExaminationSurvey trial data


Distributions of distoclusionscores, by specified ages: Burlington Project and


Health ExaminationSurvey trial data


Distributionsof mesioclusion scores, by specifiedages: BurlingtonProject and


Health Examination Survey trial data


Distributions of posterior crossbite,number of maxillary teeth to buccal, by


specified ages: Burlington Project and Health ExaminationSurvey trial data


Distributions of posterior crossbite, number of maxillary teeth to lingual, by


specified ages: Burlington Project and Health Examination Survey trial data


Distributionsof tooth displacementscores, by specified ages: BurlingtonProj­


ect and Health Examination Survey trial data------------------------------------


Distributions of Treatment Priority Index less than 4.5 (publichealth normal),


by specified ages: Burlingtonuntreated seri,alcontrol group


Distributionsof Treatment Priority Index for syndrome I, buccal crossbite and


displacement,by specified ages: Burlingtonuntreated serial control group


Distributionsof Treatment Priority Index for syndrome VI, lingual crossbite and


displacement,by specified ages: Burlingtonuntreated serial control group


Distributionsof Treatment Priority Index for syndrome II, anterior overbite, by


specified ages: Burlingtonuntreated seriai control group


Distributionsof Treatment Priority Index for synd’’oiie
 IV, anterior openbite, by


specified ages: Burlingtonuntreated serial COIIt~OL ~roup


Distributions of Treatment Priority Index for syndi;me III, retrognathism,by


specified ages: Burlingtonuntreated serial control group


21


21


22


22


23


23


24


24


25


25


26


26


27


27


28


28


20 
------

-----

-----

Table 1. Distributionsof upper anterior overfiet measurements, by specifiedages: Burlington


Proje&~ and Health Exam~nation Survey trial dat~


6 7 8 9 years 10 11 12 years 14 16 Parents


years years years years years years years


Upper Serial Cross anterior con- sec­ overjet trol tion 

Bur1. HEsl ~sl Bur1. HEs HEs HEs Burl. Burl. Bur1. Bur1. Burl. 

o mm----- 5.2 10.9 2.5 2.8


1 mm----- 22.6 ::; ;:; M 2::? ::: 2:::


27.1 16.1 24,3 31.4 24.3 25.3 27.7 26.5 23.0 16.1 30.9 32.0 

: :==: 10.1 19,1 17.3 20.2 22.8 23.8 21.0 19.7 11.2 23.8 5.0 

5 mm----- 2.9 ;:; 10,5 12.4 10.3 13.9 10.5 10.9 4.3 

6 mm----- 3.5 8,2 3.3 6.1 5.5 n 1.2 ;:: ::: 

::: 2.5 4.5 5.3 ;:: ::: 2.5 4.7 0.6 

; RL---- 0.3 2.2 ;:: 0.4 l.i 

9 nml----- 0.3 H 0.4 ;:; ::; ;:; 0.4 ::; 1.0 

10 mm----- 1.3 0.; 0.3 0.2 1.0 

11 mm----- 0,1 O.i 0.5 0.2 H 

12 mm----- 0,2 

13 mm----- 2.; 0.2 0.2 

Sample----

~ean------ 302 

2,44 

394 

2.27 

267 

3.40 

247 

3.34 

603 

3,48 

402 

3.80 

408 

3.69 

238 

3.29 

213 

3.68 

160 

2.17 

43 

3.14 2.% 

Variance-- 1,54 8.94 4.33 2,46 4.71 3.10 3.84 2.46 4.08 1,93 1.44 2.82 

Standard 

deviation 1,24 2.99 2.08 I-.57 2.17 1.76 1.96 1.57 2.02 1.39 1.20 1.68 

2 mm----- 34.8 1;:: 1::! 24.4 1;:$ 16.4 1;:: 23.1 2;:; 32.9 28.6 28.0


lUPPer anterior overjet waa not examil,edfor primary dentitions in HES data.


Table 2. Di.atributiona
of lower anterior overjet measurements, by specifiedages: Burlington


Project and Health Examination Survey trial data


6 7 8 9 years 10 11 12 years 14 16 ?arents 

years years yearz years years yeara years


Lower Serial Cross


anterior con- see­


overjet trol tion


I Bur1. I-Id Burl., HBs HEs HEs Burl. Burl. Burl Burl Burl. 

0 mm----- 99.9 99.2 99.3 98.6 99.2 99.3 99.7 99.2 98.6 99.3 97.7 100.0 

1 mm----- 0.3 0.8 0.7 0.8 0.7 0.2 0.2 0.8 0.9 0.6 2.3 

2mm ,-----1 0.3 0.4 - 0.2 0.5 

0,2 ==!= 

Sample---- 302 394 267 247 603 402 408 238 213 160 43 36 

Mean------ 0.01 0.0 0.01 0.02 0.01 0.01 0.0 0.01 0.02 0.01 0.02 

Variance-- 0.014 0.0 .006 ).026 0.006 0.029 0.0 0.008 0.029 0.006 0.023 ... 

Standard 

deviation 0.120 0.0 .083 ).155 0.083 0.167 0.0 0.089 0.170 0.077 0.151 ...


lLower anterior overjet was not examined for primary dentitions in HES data.


21

---------

-----

------

------

-----

Table 3. Distributionsof overbitemeasurements,by specifiedages: BurlingtonProject and Health


ExaminationSurvey trial data


— 

6 7 8 9 years 10 11 12 years 14 16 

years years years 

Overbite


Burl. HES1 HESl Burl.


0--------- 10.O . 2.0 

1 62.4 25.3 29.5 10.1 

2--------- 17.6 23.5 42.6 42.4 

3--------- 9.3 5.8 12.3 14.5 

4--------- 0.3 0.5 0.4 

5--------- 0.3 1

O*5 -

Sample---- 302 394 267 247 ~ean--.---. 1,28 0,94 1,53 1,38 

Variance-- 0,656 1,,040 0,846 1,21 

Standard 

deviation 0,810 1.02 0,915 1.10 

years years years years 

Parents 

Serial Cross 

con- sectrol tion 

HEs HES HEs Burl. Burl. Burl. Burl. Burl. 

14.4 4.7 6.4 2.5 0.8 2.0 6.1 

24.4 24.3 24.0 36.5 23.9 49.7 52.4 70.7 

46.7 55.3 52.9 47.5 50.2 39.2 38,1 22.2 

13.4 14.9 14.7 13.0 24.4 9.2 7.1 

0.7 0.5 1.7 0.4 1.8 2.4 1.0 

0.2 1.4 

603 402 408 238 213 160 

1,61 1,82 1,82 1,72 2,05 1.63 1.% 1.:: 

I, 846 0,563 0,689 0,548 0,608 0,533 0,518 0,348 

I,
920 0.754 0.834 0.739 0.780 3,727 0.718 0,585


10verbitewas not recorded for primary dentitions in HES data.


Table 4. Distributionsof openbitemeasurements,by specifiedages: BurlingtonProject and Health


6 7 8 

years years years 

Openbite T

Burl. HES HES
 ---1 

o nm------ 92.3 96.0 95.0 

1 mm------ 5.6 3.3 3.0 

2 mm------ 2.0 0.8 1.1


3 Urn 0.7


Sample---- 302 394 267


Mean 0.10 0,05 0,07


ExaminationSurvey trial data


9 years 10 

years 

11 

years 

12 years 14 

years 

16 

years Parents 

Serial Cross con- sectrol tion 

Burl. HEs HEs HEs Burl. Burl. Burl. Burl. Burl. 

98.2 95.7 95,2 96,0 98,3 100,0 99.3 !37.7 95.0 

1.6 3.0 3.2 3.4 1.7 - 2.3 2.0 

0,2 1,2 0.2 - - - 2.0 

0.5 0.2 0.6 . 

247 603 402 408 238 213 160 43


0,02 0,05 0,06 0,04 0,02 0.01 0,02 0,%


Variance-- 0,130 0,063 0.137 0,017 ,084 0,078 0,058 0,017 8,* 0,053 0,023 0,096


Standard


devia­


tion 0.356 0,251 0.365 0,125 ,285 0.277 0.243 0.129 ,,, 0.233 0,151 0,312


22

--- ---

--

--- --- ---

--- --- ---

--- --- ---

--- --- ---

---

---

---

---

---

---

---

---

-----

------ ------ --------

-------

-----

Tal?le5. Distributionsof number of congenitallymissinginciaora,by specifiedagea: BurlingtonProj­


ect and HealthExamination-Survey
trial-data


6 years 7 8 9 years 10 11 12 years 14 16


years years Parents
 years years years


Number of


congenitally Serial Cross 

missing con- secBurl. HEs HBs HEs Burl. HES HES HEs Burl. Burl. Bur1. Burl. Burl. 

0-------- 99.6 99.4 99.6 97.7 99.3 100.0 97.9 

1-------- 0.3 -- .

- - 0.4 0.4 0.9 0.6 - 2.3 

+ 

2-------- 1.4 

incisorsl 

years 1 trol tion 

3--------


Sample 302 . . . -L . . . . . . 247 . . . . . . . . . 238 213 160 43 36

Mean 0.0 . . . . . . . . . . . . . . . . . . 0.0 0.38 0.01 0.02 

Variance---- 0.0 . . . %: . . . . . . . . . 0.0 0.063 0.006 ..; 0.023 

Standard 

deviation-- 0.0 . . . z 0.0 . . . . . . . . . 0.0 0.250 

4--+

0.077 ... 0.151 

lB~15ngtOn countsderivedusing radiographs.


Table 6. Distributionsof distoclusion scores, by specified agea: Burlington Projectand Health


ExaminationSurvey trial data


6 years 7 8 9 years 10 11 12 years 14 16 Parents yeara years years years years years 

Disto­


cluaion Seria1 Croaa
 con- sec­
 score
 trol tion


Burl. HEs HBs HEs Burl. HEs HEs HEs	 Burl. Burl. Burl. Burl. Burl. .— 

0-------- 71.6 77.2 64.5 61.7 50.1 64,5 62,2 60.0 61.3 56.8 68.2 65.1 78.4 

1-------- 13,8 6.2 12.1 10,8 20.8 11.4 11,4 15.2 14.7 10.8 11.6 18.6 13.5 

-
 10.1 12.6 17.5 20.9 22.2 16.0 20.1 14.7 17.2 21.1 13.4 11,6 8.1


3-------- 3.0 1.3 2.5 3.7 5,3 3.6 3.5 3.7 2.9 2.8 4.3 2.3 

4--.----- 1,3 2.7 3.0 2.6 1.6 4.0 6.4 3.8 8.4 2.4 2,3 -

Sample--- 302 373 

Mean 0.48 0.46 

394 

0.67 

267 

0.74 

247 

0.88 

603 

0.70 

402 408 

0.62 0.81 

238 

0.73 

213 

0.95 

160 

0.61 o.% 0.% 

Variance- 0.7.920.922 1.082 1,166 1.061 1.232 0,865 1.464 1.704 1.664 1.188 0.903 0.372 

Stan~d 

tion---- 0.893 0.955 1.04 1.08 1.03 1.11 0.926 1.21 1.31 1.29 1.09 0.947 0.610 

23


2
------- ------ ------ -------

--------- ----

-------- ---------- ------

---------

----- ---- ------ -------

------ ---

-------------

------

-------- ---------- ------

---------

Table 7. Distributionsof mesioclusionscores, by specifiedagea: BurlingtonProject and Health Examination


Survey trial data


-

6 yeara 7 s 9 yeara 10 11 12 years 14 16 Paren&s years yeara years yeara yeara yeara 

Mesiocluaion Serial Croaa 1 score con- sec­ trol tion 

Burl. HEs HEs HEs TI 

HES HEs 

I 

Burl.
 HEs Burl. Burl. Bur1. Burl. Bur1.

0 92.1 80.4 95.0 91.8 92.9 92.9 99.1 97.3 

1.5 4.2 4.6 2.7 

;-------------- 2:$ 1:;: 1.7 ::; 2.5 0.; . 

0,3 1.6 ;:: 1,0 0.5 . 

:------------- 2.1 0.4 1.0 0.7 I I 

Sample 

14ean 

302 

0.10 

373 

0.41 

394 

0.16 

267 

0.10 

247 603 

0.04 0.10 

402 408 

0.15 0.13 

238 

0.10 

213 

0.02 

160 

0.18 0.!; o.% 

Variance 0.152 0.828 0.548 0.212 0.053 0.203 0.336 0.281 0.137 0.036 0.292 0.250 0.026 

Standard 

deviation 0.391 0.912 0.735 

.— 

0.459 0.2261 0.452 0.584 0.526 -J— 0.370 0.190 0.542 0.497 0.162 

Table 8. Distributionsof posterior croaabite, number of maxillary teeth to buccal, by specified~gea:


BurlingtonProject and Health ExaminationSurvey trial data
 -

Posterior 

croaabite, 

6 years 1718 

years yeara 

9 years : 10 12 years 14 

years 

16 

yeara Parents 

number of --l L maxillary Serial Croaa 

teeth to con- sec- bucca1 trol tion 

Burl. 1HBs HEs HBs Bur1. HEs HEs HEs Burl. Burl. Burl. Burl. Bur1. 

lL------------


9-------


0---- 97.5 99.2 99.2 94.9 98.0 98.0 95.6 92.9 95.8 92.0 

0.7 0.3 0.9 4.3 

;------------- ): 0,3 N ::: ::; ::: ;:: 3------------- A:; 0.4 0.2 0.2 0.7 0.8 ::$ ;:2 

4------- 0.3 0.2 0.5 0.6 

5-------.-- - 0.; 

6------------- - 0.5 

1o------------ Ii .


Sample 

lIean 

302 

0.05 

373 

0.01 

394 

0.01 

267 

0.01 

247 

0.06 

603 

0.03 

402 

0.03 

408 

0.09 

238 

0.112 

213 

0.117 

160 

0.13 0.!: 0.;! 

Variance 0.109 0.017 0.014 0.020 0.102 0.084 0.068 0.212 0.203 0.423 0.270 0.250 0.040 

Standard 

devia- tion 0.330 T 0.130 0.122 0.141 0.318 0.291 0.260 0.463 0.447 0.650 0.524 0.497 0.222

24

---- -------

----

----------- -------------

----

-------- ---------- ------

-------------------- -------------- ----------- --------- --------------------

-----------

----------

---------

---------

---------------

-------------

-----------

Table 9. Distributionsof posteriorcrossbite, number of maxillary teeth to lingusl, by specifiedages:


BurlingtonProject and Health ExaminationSurvey trial data
 _ — 

Posteribr 

6 years 7 

years 

8 

years 

9 years 10 

years 

11 

years 

12 yeara 14 

years 

lb 

yeara Parents 

crosabite, 

number of Serial Cross 

ye:;;ls&y con- sectrol tion 

lingual T 

HEs HEs Burl. HEs HBs HEs Burl. Burl. Burl. Burl. Burl. =-l-= 

0--------- 96,2 97.3 9:.: 89.8 93.5 90.7 92.4 93.0 94.4 93.2 97.9 --.-.- 0.7 0.8 4.1 2.5 4.2 4.2 3.8 3.7 2.3 2.0

i------------- 1.3 0.3 2:0 2.5 1,7 2.2 1.9 2.3 . -------- 1.7 0.8 1.6 ::; 1.4 M L---------- 0.3 ::: ::; ;:? 

0.2 0.5 0.2 0.1 iL-------- 0.; 0.2 

O.i 2.5 :------------- 0.3 

O.i 0.; 0.2 

9---------

1o------------


Sample 302 373 394 267 247 603 402 408 238 213 160 

Uean 0.08 0.09 0.17 0.16 0.12 0.21 0.14 0.20 0.13 0.12 0.08 0.;: 0.:: 

Variance 0.212 0.397 0.490 0.533 0.240 0.578 0.449 0.624 0.281 D.230 0.137 1.188 0.020


Standard


deviation---- 0.4561 0,625 0.700 0,733 0;489 0.760 0.673 0.787 0.533 D.480 D.366 1.09 0.141


——


Table 10, Distributions of tooth displacementscores, by specifiedagea: BurlingtonProject and Health


ExaminationSurvey trial data


6 7 8 9 years 10 11 12 years 14 16 Parents 

years years years years year a years years 

Tooth displacement Serial Cross score con- sectrol tion 

Burl, HEs HEs Burl. HEs HEs HEs Burl. Burl. Burl. Burl. Burl. 

0--------- ----------. 46.9 63.0 60.0 24.6 63.6 64.7 56.8 23.5 37.6 17.2 18.2 

1 19.1 12.1 15.0 19.9 11.5’ 10.0 12.7 20.2 16.4 13.5 13.6 N 2 -.---- 20.4 1;.; 14.6 33.3 10.0 10.0 9.6 18.5 17.4 24.5 22.7 27.3 

3--------- . 3.0 18.3 5.0 5.4 13.4 4.6 19.0 20.4 26.3 

4--”------ -. ::; 3.8 8.0 ;:: 3.7 6.6 9.2 11.6 6.8 21.2 

1.0 R 1.7 3.2 7.1 ::; 8.0 6.8 6.1 

2-------------------- 0.5 ;:: ;:: M 3.8 3.3 6.8 ......... 0.3 0.8 0.5 ::: M 2.1 2.4 ::: 2.3 ::; ;-------------------- 0.4 ::!) 2.0 

9-----------

10------------------- . .-------- - 0.; 

0.5 0.; i:; 

0.5 ~:: 

0:2 

U 

0.4 ::; 

0.5 

1.; 2.i 

ii-------------------

13------------------- 0.; -----.---- - 0.; 

iL9---------------- -

20------------------- 0.; 

Sample 302 394 267 247 603 402 408 238 213 160 43 

Mean----------------- 1.06 0.82 0.95 2.14 0.89 1.04 1.33 2.25 1.97 2.4S 2.59 3.:: 

Variance 1.538 1.850 3.497 2.560 2.190 3.803 4.666 4.326 5.290 3.534 $.452 2.789 

Standard 

deviation 1.24 1.36 1.87 1.60 1.48 1.95 2.16 2.08 2.30 1.88 2.11 1.67 

25

---------------- ---

-------------------------------------------

-------- ---------------------

-------------------------------------- --------------------------- --------------------------------

---------------------------------------

--------------------------- -------

---------------- -------- --------

--------- ---------

--------------------------------------

--------------------------- ---------------- -------- --------------------------------

Table 11. Distributionsof Treatment Priority Index less than 4.5 (publichealth normal), by


specified agea: Burlingtonuntreated serial control group


Age neareat birthday


Treatment Priority Index Parents


6 9 12 14 16


years years years years years


0 to 0.5--------------------------------------------- 5.3 6.1 5.9 8.6 0.0 6.9 

0.5 to 1.5 .-------------.----.---- 37.1 26.4 29.2 35.2 33.3 31.0 

1.5 to 2.5-------------------------------------------38.0 29.4 30.8 25.0 36.4 31.0 

2.5 to 3.5-------------------------------------------15.5 25.4 22.7 21.9 18.2 27.6 

3.5 to4.5 4.1 12.7 11.4 9.4 12.1 3.4 

Number in sample ----.--- 284 242 238 160 43 36 

Number of cases 245 197 185 128 

Percent of cases of sample 86.2 81.4 79.3 80.0 76? 80?; 

Average TPI.------- -. 1.68 2.05 1.98 1.83 1.96 1.92 

Standard error 0.06 0.08 0.08 0.09 0.18 0.19 

Table 12. Distributionsof Treatment Priority Index for syndrome I, buccal crossbite and dis­


placement, by specifiedages: Burlingtonuntreated serial control group


Age nearest birthday


Treatment Priority Index Parents


6 9 12 14 16


years years years years years


4.5 to 5*5 -------.- 14.3 25.0


5.5 to 6.5-------------------------------------------
100.0 100.0 28.6 50.0 100,0 66.7

6.5 to 7.5--”--------”----------------”-------------- . 25.0 

7.5 to 8.5-------------------------------------------

8.5 to 9.5------------------------------------------- . . 33.3 

9.5 to 10.5.........--------....................----- 42.9 . 

-

10.5+ .------- .------- . 14.3 . 

Number in sample -------.-.-------- - 284 242 238 160 43 36


Number of cases 2 7 4 3


Percent of cases of sample 0.: 2,:


Average TPI--.----- ----.--- -. ..0 5’?6: 7%’ 5% ... 5%


Standard error --.---- ... 0.36 1.08 0.44 .*O 0.96

-------------------------------------------

--------------------------------------------

-------------------------------------------

-----------------------------------------

---------------------------------

----------------------

------------------------------------------------

------------------------------------- -------------------------------------- --------------------------- --------------- ---------------------------------------

-----------------------------------------

---------------------------------------

------------------------------------------

-------------------------------------------

-------------------------------------

------------------------------------------------

--------- ----------

--------------------------------------

--------------------------- ------------------

Table 13. Distributionsof Treatment Priority Index for syndromeVI, lingual crossbite and dis­


placement,by specifiedages: Burlingtonuntreated serial control group


-

Age nearest birthday


Treatment Priority Index ‘arents


6 9 12 14 16


years years years years years


4.5 to 5.5 100.0 33.3 12.5 20.0 

5,5 to 6.5 50.0 50.0 20.0 

6.5 tO 7.5 16.7 20.0 

7.5 to 8.5 40.0 

8.5 to 9.5-!”-------- 12.5


9.5 to 10.5,-------------------- - . 12.5 

10.5+ . 12.5 . 100.0 

Number in sample 284 242 238 160 43 36


Number of cases 6 8 5


Percent of cases of sample 0,: 2.:


Average TPI--------------------------- ,,. 4% 6% 5% ... ...
 Standard error .,, 0,25 0,78 0,56 ... .*.


Table 14. Distributionsof Treatment Priority Index for syndrome II, anterior overbite,by speci­


fied ages: Burlingtonuntreated serial control group


*
 I I


Age nearest birthday


Treatment Priority Index Parents 

6 9 12 14 16 

years years years years years 

i 

4.5 to 5.5-- 22.2 44.4 28.6 42.9 -1 - 5.5 to 6.5-- I 44.4 55,6 42.9 28.6


6.5 tO 7,5------------------------------------------ 22.2 14.3 

7.5 to 8.5 14.3 14.3 

I 

8,5 to 9.5 I 

9.5 to 1O.5-* ----I 11.1 . 14.3 100.0 -

10.5+


Number in sample .........--------- 284 242 238 160 43 36 

Number of cases 9 9 7 7 -

Percent of cases of sa~le 2.; 

Average TPI--------- .-------------- 5% 4% 5% 5% � O. � 00 

Standard error---------------------------------------0.44 0.18 0.37 0.69 ... . . . 
-----------------------------------------

-----------------------------------------

-------------------------------------

-------------------------------------- ---------------------------

---------------------------------------

--------------------------------------------

-------------------------------------

-------------------------------------- ---------------------------

---------------------------------------

Table 15. Distributionsof Treatment Priority Index for syndrome IV, anterior openbite, by specified ages: Burlingtonuntreated serial control group 

Age nearest birthday


Treatment Priority Index Parents


6 9 12 14 16


years years years years years


5,5 to 6.5-- 35.7 33.3 -


6.5 to 7.5-- 28.5 -


7.5 to 8.5------------------------------------------- 7.1 66.7 - -


8.5 to 9.5-------------------------------------------


9.5 to 10.5------------------------------------------


Lo.5+------------------------------------------------ 28.6 - 100.0


Number in sample 284 242 238 160 43 36


Number of cases 14 3


Percent of cases of sample 2.;


Average TPI------------------------------------------7% ... 6% ... ... ...
 Standard error 0.87 ... 0.46 ... ... ...


Table 16. Distributionsof Treatment Priority Index for syndrome III, retrognathiam,by specified


ages: Burlingtonuntreated serial control group


Age nearest Lirthday


Treatment Priority Index Parents


6 9 ~~ 14 16 

years years years years years 

4.5 to 5.5-------------------------------”-----------23.1 27.3 5.9 33.3 20.0 

5.5 to 6.5-------------------------------------------38.5 22.7 41.2 11.1 80.0 

6.5 to 7.5 7.7 22.7 41.2 33.3 

7.5 to 8.5-------------------------------------------15.4 4.5 5.9 22.2 . 

8.5 to 9.5------------------------------------------- 7.7 18.2 

9.5 to 10.5------------------------------------------ - . 

lo.5+------------------------------------------------ 7.7 4.5 5*9 100.0 

Number in sample 284 242 238 160 43 36 

Number of cases 13 22 17 9 5 2 

Percent of cases of sample 11.6 

Average TPI------------------------------------------5% 6?6; 5X 5% 4.78 12% 

Standard error 0.53 0.48 0.37 0.37 0.18 2.17 

28

APPENDIX 1. DEFINITIONS 

For use in the Burlington Research Project, selected manifestations of malocclusion were used as recording items. For initial recording purposes, these 

items were defined as follows. 

Ho?+zontul incisor ~elutionsh@.-The maxillary 

incisors may protrude beyond the lower incisors in the 

horizontal direction (Item 1. overjet) or vice versa 

(Item 2. underjet). Have the subject close together his 

posterior teeth; place a ruler horizontally at the midline against the labial central incisor surfaces of the 

less protrusive “arch and measure to the outside of the 

incisor tip (fig; I). If the central incisors are not in 

similar anterior position, take an. average judgment. 

Figure 1. Method of measuring horizontal incisor rela­


tionship.


Vertical incisor relationship.— Excluding cases 

where the incisors are not close to being completely 

erupted, have the subject close MS ~sterior teeth and 

observe whether the central incisors overlap on the 

vertical direction (Item 3. overbite) or if they are still 

spaced (Item 4. openbite). Note the amount of overbite 

according to the horizontal position of the incisor tip 

of the most prominent arch. Judge the amount of openbite if present in millimeters (fig. II). 

Congenitally missing permanent incisovs (Item 

5).-This could not be determined with certainty without 

radiographs but if at age 12 the teeth were obviously not 

in sight, the count was recorded. 

Anteroposterior buccal segment relation (Item 6. 

distoclusion, neutroclusion, or Item 7. mesioclusion).– 

Describe the anteroposterior position of the lower teeth 

to the upper teeth, paying particular attention to the relation of the upper and lower first permanent molars 

and, if present, the deciduous second molars (fig. 111). 

OF RECORDING ITEMS 

Scolv 

h

Bitingm softtissw overbite 5€

:€

x€

It Pass.dlowergbgiml margk owrbit~ &€

B ..-&€ 1€

E 

Figure I1. Method of examining and recording vertical


incisor relationship as overbite in thirds of tooth ~


crown and openbite in mill imeters.


Figure Ill. Buccal segment relationships for permanent


and mixed dentitions used in interpreting the antero­


posterior molar relationship.


29

-------

For each side of the mouth observe the degree of deviation from neutroclusion in terms of cusp units of the 

first molar. If the displacement on a side is such that 

the lower tooth cusp fits into the upper groove to the 

posterior of its normal position, the score is 2 for distoclusion on that side. If the lower tooth cusp fits into 

the groove to the anterior of the normal position, 2 is 

scored for mesioclusion. For partial displacement in 

either posterior or anterior direction such that the 

cusps do not fit into grooves but are roughly halfway 

or cusp to cusp, 1 is scored for distoclusion or 1 for 

mesioclusion. The scores for each side are added to 

give a single score unless one side was scored as 

mesioclusion and the other distoclusion, in which case 

the scores are separately recorded. In cases of doubt 

because of mutilation or extraction of molara, make the 

best judgment of the case status. 

Postes-ioY cross bite. —Disregarding single tooth 

malposition, record the number of teeth involved in a 

posterior arch crossbite. Figure IV illustrates how the 

crossbite is judged as buccal (Item 8) or lingual (Item 

9) according to the position of the upper teeth to the 

Figure IV. Method of judging posterior crossbite In


terms of maxi11ary teeth to mandibular teeth.


lower teeth. The true underlying cause, i.e., which arch 

was really displaced, is ignored. Record the count of 

the number of teeth out of normal relation. 

Tooth displacement. –hleasure the amount of troth 

displacement (Item 10), using the method of Van Kirk 

and Penne117 (fig. V). A score of 1 is given for each 

tooth with a minor degree of malposition or rotation 

and a score of 2 for teeth in major malposition or rotation. Record the sum of the scores for the whole 

aroh 

aligment 

Minor rotatiom 

or displaoament a score zero 

Scored ae 

~ 

@jQQMinordisdaoamant 

abolli 2m 

ecore 1 

C@’-’
 Q--J

Major displacement 

mnohmra than 

+ 2 tilwa


EEEGEZJH


Minor rotation 

about 45° score 1 

./ 

&i@ti(J .’ 

lia~or iwt.ation 

mwh Mre than 

kso 

Figure V. Method of scoring the amount of tcoth displacament according to the number of teeth in minor or major rotation or displacement. 

ooo— 

30 
---------------

--------------- -----------------------------

----------------------------- ------------------- -------------------------

-------------------------

------------------------

-----------------------------

-------------------

---------------

--------------- -----------------------------

----------------------------- ------------------- -------------------------

-------------------------

-------- -----------

----------------------------- -------------------

ConAPPENDIX Il. DEFINITION OF 

BY FACTOR 

Inan earlier work,usingtheBurlington
 orthodontic


researchdata,some 21 syndromesweredescribed.
 The


directmethod forthedevelopmentof theOrthodontic


TreatmentPriority indexwas todemonstrate
themajor


MALOCCLUSION SYNDROMES 

ANALYSIS 

syndromes by factoranalysis and,ifpossible,
 tocom­


putetheamountofeachpresentinan individual
 by re­


gressionmethodsfollowing
outof thefactoranalysis


model.14 This method provedimpm.sible
asno satis-


Table 1. Multiple group factor analysis of crude and maximized phi coefficients for 375 12-


year-old children and suggestednames for syndromes: Burlington,Brantford, and Orangeville,


Ontario


Multiple group rotated factorl’2


Recording item 

I II III IV v VI 

Upper anterior overset


Lower anterior overset


Overbite


Openbite


Congenital incisor


Distoclusion


Mesioclusion


P;~~~;;or crossbite,maxillary to


.-----


P;;~g;~lr crossbite,maxillary to


Tooth displacement


Maximized phi’s


.18 1,00 

.61 

.20 .99 

.34 

.61 .20 .27 .33 

.37 .27 .22 

.80


.77 

.82 

.42 .75 

Disto- Mesio- Displace- Suggestedname of syndrome clusion Overbite Overjet genital
 cLusion ment
 complete incisor


1 II III IV v VI 

Upper anterior overset


Lower anterior overset


Overbite


Openbite


Congenital incisor


Distoclusion


Mesioclusion


P;~~~;or crossbite,maxillary to
 -.---------


Posterior crossbite,maxillary to


lingual


Tooth displacement


Crude hi fs 

.20 .55 

.47 

.36 .19 

.47 

.41 

.55 .17 

.17 .15 

.20 .19 .34 

.51


.15


Con-
 Disto- )verjet Openbite Underjet Displace- Suggestedname of syndrome disto- mesio- mesio­
 genital
 clusion :lusion clusion clusion ment incisor


lThe order of factors generated from the crude and maximized phi matrices differed, and the 

columns were rearranged to make the similarityof the factorsmore apparent. 

‘Values under .15 were omitted.


31

Table II. Product moment correlationvalues for raw scores, normalf,zedscores, and normalized
 score correlationscorrected for coarse grouping error for 375 12-year-oldchildre~BurlLngton,


Brantford, and Orangeville,Ontario


Recording item


Upper anterior overjet


Lower anterior overjet


Overbite


Openbite


Congenital incisor


Distoclusion


Mesiocluaion


Posterior crossbite,


maxillary to buccal


Posterior crosabite,


maxillary to lingual


Tooth displacement


1 2 3 I 4 5 6 

.313 -.178 .203 .011 -.083 .501 

.321 -.244 .230 .003 -.098 .476 

.513 -.289 .243 .005 -.115 .513 n .108 .019 -.010 -.014 .010
 � � 179 .032 -.010 -.015 -.011

.400 ‘1-.039
 -.015 -.021 -.014

.205 -.238 .086 .352


.202 -.186 .072 .355


.393 -.237 .087 .393
 .142-.015 -.070


.09 -.015 -.077
 Ilz.25 -.022 -.099


7 8 9 10


-.084 .026 -.004 .074


-.108 .043 .010 .069


-.119 .045 .011 .071


—.


.226 -.019 -.022 .095


.315 -.023 -.025 .077


.400 -.028 -.031 .091


-.134


-.110


-.125


.238


.188


.251


-.019


-.022


-.027


.060 -.115 .125 

.122 -.110 .144 

.131 -.121 .152 

.141 -.023 .033 

.111 -.026 .018 

.140 -.033 .022 

.041 .135 -.026


.051 .135 -.015


.062 .166 -.018


.130 -.073 .207


.148 -.071 .186


.161 -.080 .200


.111 YZ 

.115 .018 

.134 .020 

w 

I 

I€

I€

.07 -.036


.05 -.024


.166 -.029
 4 

.366’ -.092


.352 -.108


.513 -.125


I .a,
) 

.——t


I


‘1.054 ,082 

.069 -.055 .082 

.161 .wwv .086 

u!, , 

-.042


II.111.181
 .u: .164 

.176


.180


.177


.200


J


row 

factory or reproducible factor pattern could be produced, principally hecauae a proper expreeaion of the 

intercorrelations could not be obtained. 

Table II shows three product moment matrices for 

raw data, normalized data, and data normalized and 

corrected for coarsegrouping usingthemethod ofPeters 

and Vsn Voorhie.15 A matrix ofadjustedphi coefficients 

is given in table 111.Clearly the latter caaesprovided 

the higher correlations generally and these two were 

used for the factor analysis where theesaentialpurpoae 

was to reflect the intrinsic relationships which would 

hold ifthe data were recorded perfectly onacontinuoua 

undistorted scale. The phi coefficient matrix ie probably 

NCY1’E:
 Values in diagonal cells are estimates of conmnmality.The top two are multtple R’s and the 

third is the highest values. 

the most reliable becauae only it hringa out fully the 

obviously expected complete negative correlations between factors I and 11, 111 and IV, and VIand VII. 

The factor analysis model chosen was the multiple 

group analysis, as discussed in Harmar.,14 because 

sensitive examination of the interrelationships wasdeaired rather than reduction of the dimension of the 

matrix. A very important point in the use of factor 

analysis is thedecision regarding thevalueto be subatituted for one in the diagonal of t.hesymmetrical correlation matrix. These values represent the communality or the amount of the variance of each item which 

is related to the other items. A simple method used 

32 
-----

-----

-----

-----

-----

-----

-----

-----

-----

Table III. Phi coefficients for 375 12-year-old children: Burlington, Brantford, and Orangeville, 

Ontario 

Recording item 1 2 3 4 5 6 7 8 9 10 ,— 

Upper anterior overjet 

MaxinAzed phi coefficient- 1.000 -1.000 .246 .014 .522 .340 -.108 .121 .191 .066 

Crude phi coefficient 1.323 -.122 .221 .002 .052 .323 -.043 .038 .066 .060

Maximized 

Lower anterior 

phi coefficientoverjet 1=

-.053 -.016 

It

-.008 -.577 .640 -.051 -.063 -.087

Crude phi coefficient _-@! -.007 -.011 -.006 -.067 .199 -.020 -.022 -.010 

Overbite 

+ -t -+ 

Maximized phi coefficient- l:;!: -1.000 .421 .289 -.216 .122 -.135 .092 

Crude phi coefficient I-.193 .047 .247 -.095 .043 -.052 .075 I 

Openbite 

Maximized phi coefficientCrude phi coefff.cient 

Congenital incisor 

Maximized phi coefficientCrude phi coefficient 

Distoclusion 

Maximized phi coefficientCrude phi coefficient 

Mesioclusion


Maximized phi coefficient-


Crude phi coefficient


~Q 

maxillary to buccai 

Maximized phi coefff.cientCrude phi coefficient----

Posterior crossbite, 

maxillary to lingual 

Maximized phi coefficientCrude phi coefficient 

Tooth displacement 

Maxinized phi coefficientCrude phi. coefficient 

successfully by Thurstone16 is to use thelargestcorrelation in the particular row and this value was used 

in the present work. If communalities arechosen tobe 

too large, the matrix is not reduced enough; iftoo 

small, not enough factors are generated. 

Results of the factor analysis using the BIMD#17 

program17 on the IBM 7094 at theInstituteof Computer 

Science, University of Toronto, are given intable IV. 

Theae are based on the transformed and coarse grouping adjusted matrix in row three of table H. 

-+ -t-

-.o16 -.577 .460 .124 .114 .185 

-.009 -.095 .203 .068 .057 .029 

+ -t-

.522 .211 -.081 .474 -.063 .185 

.150 .020 -.020 .150 -.018 .017 

--+ -+ 

.577 -.523 .419 -.238 .105 

.323 -.196 .125 -.077 .100 

--t 

.640 .033 .154 .101 

.203 .026 .136 .036 

.485 -.063 .485 

.150 -.057 .139 

+ 

.646 .646 

.204 .204 

-tI .646 

.204 

It was highly interesting to see that the factor 

analysis defined two types of distoclusion andmesioclusion: a tooth-displacement syndrome and a congenitally-missing-incisor syndrome. No factor for 

overjet occurring in the neutroclusion cases couldbe 

defined. As stated above, ithad been hoped to calculate 

the syndromes directly from these factor loadings but, 

hecause the correlation matrix was observed to beless 

than ideal, this was abandoned. Further explorationof 

the syndromes, interms ofphicoefficients, wascarried 

33

----

-----------

----------- -------------------------

------------------------- ---------------

---------------------

---------------------

-----------------------

---------------------- ---------------

Table IV. Multiple group factor analysis of 10 malocclusion manifestations, using n~r~lized
 scores and product moment correlationcoefficientsadjusted for coarse grouping, for 375 12­


year-old children: Burlington,Brantford, and Orangeville,Ontario


Rotated multiple group factor


Recording item


I II 111 IV v VI VII 

Upper anterior overjet -:;; .22 -.03 .08 .01 .07 -.03 

Lower anterior overjet -.64 .08 .08 .00 .09 .04 

Overbite -.33 .01 .47 -.05 .29 .08 -.04 

Openbite .02 -.08 -.51 .04 .19 -.01 -.02 

Congenital incisor .08 .03 .08 -.42 .10 .00 .00 

Distoclusion -.63 .00 .25 .10 .24 ,19 .05 

Mesioclusion .03 -.58 -.32 -.07 .02 .04 -.06 

Posterior crossbite,maxillary 

to buccal -.09 -.01 -.08 -.05 .42 .06 .00 

Posterior crossbite,maxillary 

to lingual -.00 -.03 -.13 -.35 -.21 .27 -.03 

Tooth displacement -.11 -.08 .05 -.04 .09 .46 .00 

Disto- Mesio- Mesio-


Suggestedname clusion clusion clusion Congeni- Disto- Tooth Complex
 tally clusion dis- mesio­
 of syndrome with with with iuis
 lower sing without place- clusion
 overjet overjet 

open- incisors overjet ment
 bite


Table V. Phi coefficientsfrom appendix table II rearranged to make the clusteringmore apparent


2 47 9


2 x -.02 .64 -.06 

4 ..02 x .46 .11 

7 332 .64 .46 X .15

9 -.06 .11 .15 x


10 333 -,09 .19 .10
 .65 

1 I..00 .01 -.11 .19


3 -.05 -1.00 -.22 -.14


5 -.01 -.02 -.08 -.06


6 -.58 -.58 -.52 -.23


8 -.05 .12 .03 -.06


10 1 3 5 6 8


I 

-.09 -1.00 -.05 -.01 -.58 -


.19 .01 -1.00 -.02 -.58


-A!-l 

.65 

x .07 .09 .19 .11 .49 + 

.07 x .25 .52 .34 .12 

.09 .25 x .42 .29 .12 

.19 .52 .42 x .21 .47 

.11 .34 .29 .21 x .42 

.49 .12 .12 .47 .42 x 

NOTE: These clusters are not com letely unrelated or perfectly defined: e.g., the relation


between factors 8 and 10 is large, +.19, butveryhwwith!), -.06. The relation of factor 8 to


all others in the larger system is positive and hence it was so placedalthough it representsa
 correlativelink between the two clusters.


34

------------------------------

----------------------------- ------------------- -------------------------

---------------------

-------------------------

-------------------------

------------------------ -------------- --------------------

----------------------

---------------------

--------------------

Table VI. Rotated multiple group factor analysis of distoclusionsystem of phi’s from table V


9 

Rotated multiple group factorl


Recording item I 

I II III Iv v VI I 

I 

Overjet -.24 -.77 

Overbite -.40 .27 -.29 

Congenital incisor -.79 -,21 

Distoclusion -.18 .19 

P:;~~m crossbite,maxillary to .-------- -,19 .23 .76 -.24 

P~;:e;?d& crossbite,maxillary to ........--------------.------ ,15 -,82


Dispfacement .91 .17 -.20 

Iverjet, Distoclusion
 Disto- lverbite without
 Disto- rooth :lusion :ooth


clusion dis- with dis- inde- overjet, or
 Suggestedname of syndrome with place- nmwding )lace Iendent overbite,


of probably from
 overjet ment and no ment disto- partial tooth
 )verjet .lusion drift


%alues under .15 were omitted.


NOTE: The fact that some columns are negative and some positive is of no interpretivesignifi­
 cance.


outas belowbutbecausethephimatrixwas obtained a completenegativecorrelation
 betweenciistoclusion


from a 2 x 2 dichotomy,factorloadingsfrom phi’s and mesioclusion,
 butitis clearthatalow degreeof


couldnotbe useddirectly forregression calculations. each can occur inthesame mouthunilaterally;
 hence,


Perusalof thephicoefficient matricesintableIII they are not completelymutuallyexclusive.
 Factor


willrevealthecompleteinversecorrelation between analysis
of thecrudeandthemaximizedphimatrices


factorsI and II,and 111and IV.One mightanticipate isshownintableI.Themaximizedcaseistheoretically


Table VII. Rotated multiple group factor analysis of mesioclusion system of phi’s from table V


Rotated multiple group factorl


Recording itetn


I 11 III Iv v VI 

Overjet .75 

Openbite .68 .18 

Con enital incisor .19 .54 

Mesfoclusion .23 .20 

Posterior crossbite,maxillary 

to buccal .78 -.16 

Posterior crossbite,maxillary 

to lingual .21 -.75 

Displacement ,84 .26 -.32 

Mesio- Mesio- MesioOpe;~~e 

Tooth cIUSion Tooth clusion clusion displace- with Suggestedname of syndrome displace- mderjet displace- with with ment not 

ment and ment underjet openbite related to 

>penbite only only mesioclusion


lValuesunder .15 were omitted.


35

----------------------------------------------- ------------------------------------------------- -----------------

---------------- ---------------------------------------

----------------------------------------------- ------------------------------------------------- -----------------

---------------- ---------------------------------------

Table VIII. Adjusted phi coefficf.ent matrix and multiple group factor analyais compiled for 217 cases with normal buccal segment relation 

Phi matrix 

Recording item 

Horizontal


Vertical


Posterior crossbi.te, maxillary to buccal


Posterior crossbite, maxillary to lingual


Tooth displacement


Horizontal


Vertical


Posterior crossbite, maxillary to buccal


Posterior crossbite, maxillary to lingual


Tooth displacement


Suggested name of syndrome 

{~Diagonal items are substituted by highest in row. 

8 9 10 

# .416 -.368 -.368 -.416 

-.157 ;:;;; -.162 .327 

-.368 .128 #:;% -.103 .194 

-.368 -.162 -.103 #. 368 -.204 

-.416 .327 .194 -.204 #.416 

Rotated multiple group factor 

I II =-l-J-

-.329 -.518 -.419 -*107 

.520 -.082 .104 -.082 

.164 -.079 .601 .010 

-.149 .708 -.150 -.009 

.610 .040 .213 .180 I 

overbi.teOverjet- Lingual Buccal Di.splacedisplace- cross- cross- ment 

ment bite bite 

preferred and it defines three distoclusion syndromes, 

a mesioclusion syndrome, and a tooth-displacement 

syndrome not related to buccal segment relation. The 

crude phi analysia separated the mesioclusion cases 

into two groups. In order to more clearly seethe subdivisions of thedistoclusion, mesioclusion, andneutrocluaion systems, the complete matrix of phi’s was 

rearranged in table V by observation of the clusters. 

The mesioclusion cluster is in the upper left, the distoclusion cluster in the lower right, and the remaining 

items apparently not correlated to either cluster are 

in the center. The mesial and distal systems areobviously mutually exclusive because they re!present opposite extremes for several factors. 

A further step was to carry out separate factor 

analysis of thetwomajor clusters of coefficients from 

table V but including also the crossbite and displacement items. With the highest row values used as 

communalities, the factor analysis results for the two 

sets are shown in tables VI and VII. For clarity, all 

low factor loadings were omitted, 

The distoclusion system (table VI) has factors I, 

III, and IVwhich are quite aimilar tothoae basedon the 

product moment correlation matrix I,V, and VI (table 

IV). In addition, anoverjet-overbite factor (column V, 

table VI) not related to buccal segment relation was 

detected. The mesioclusion system (table VII) had 

factors IV. V. and II si.~ilar to factors II. HI.andVII 

in table IV, and, in adcMion, an openbite-crossbitedisplacement factor not related to buccal segment 

position. Thus it was suspected that the overjet-overbite syndrome and the tooth-displacement-crossbite 

syndromes could be found in neutroclusion cases. 

The neutroclusion caseswere sorted outandprocessed accordingly. The phi matrix and the multiple 

group factor analysis for neutroclusion casesareshown 

in table VIII. The anterior vertical andhorizontalrelations were used in continuous scale form with underjet 

and openbite given negative signs. Theoverjet-overbite 

syndrome appears and alsotwosyndromes representing 

the crossbites. They are not clearly identical with 

factors II, IV, and V of table VI or 1, HI, and VI of table 

VII. The difference isthatin table VHI tooth displacement was more strongly related to the horizontal and 

vertical incisor defect than to crossbite. This is not 

illogical because, for example, anterior overjet occurs 

in distoclusion cases mainly because of the jaw displacement, but in neutroclusion cases it most likely 

involves changes in tooth position. These findings are 

compatible with more detailed study of theinterrelationship of malocclusion syndromes by Grainger.19 

Thus it was suspected that if sets ofcases which 

were homogeneous regarding anteroposterior buccal 

segment relation were analyzed, using the horizontal 

36 
-----------

---

-----------

--

-----------

---

---

-----------

Table IX. Factor analysis of homogeneousbuccal segment relationshipgroups


Rotated multiple group factorl 

Buccal segment relation and recording item I II III IV v 

Distal, 3 or 4


Horizontal(xl-x2-3)---


Vertical(x3- x, -l.5)---


Posterior croasbite,


maxillary to buccal---


Posterior crossbite,


maxillary to lingual-­


Displacement


Dietal. 1 or 2 

Horizontal(xl-x2-3)---


Vertical (x3-xA-l.5)---


Posterior crossbite


maxillary to buccai


Posterior crossbite,


maxillary to lingual-­


Displacement


Normal


Horizontal(xl-x2-3)


Vertical(x3-x4- l.5)--


Posterior crossbite,


maxillary to buccal---


Posteri.orcrossbite,


maxillary to lingual-­


Displacement


Fleaial,1, 2, 3, or 4


Horizontal(xl-x2-3)


Vertical(X3-X4-l.5)


Posterior crossbite,


maxillary ko buccal---


Poaterior croaabite,


maxillary to lingual-­


Displacement


-.33 -I-.42 +.52


+.52


-I-.16 -.60


-.15 +.15 -.71


+.61 -.21 +.18


+.79 +.23


+.92 -.16 +.37


+.18 +.68


+.15 +.79 -.16


+.97 +.17


+.42


+1.00


+.21 +.81


+.18 +.97


+.78 +.20 +.46 +.64


+.62


-.26 +.68


+.64


+.20 +.70


Anterior Anterior


vertical, horizontal,


displace- displace- Distoclusion horizontal with reverae crossbite
 Suggested name ment and ment and


of syndrome	 maxillary maxillary All classes of displacement croasbite systems
 to buccal to lingual


posterior posterior


crossbite croasbite


lValuesunder .15were omitted.


3?

and vertical incisor factors in continuous scale form 

and squaring all items, that a similar factor pattern 

might be present in all sets. Table IX gives the multiple 

group factors for four sets based on phi coefficient 

matrices and it will be observed that the situation was 

much simplified. Factor I represents a vertical defect 

accompanied by tooth displacement and in the distoclusion cases, posterior crossbite with the maxilla to 

the buccal. This factor was less clear in the neutroclusion cases and not defined in mesioclusion. Factor 

II was clearly a horizontal displacement defect accompanied by posterior crossbite with maxilla to the 

lingual and it was clearly defined in all four sets. Factor III was present only in distoclusion cases, and less 

clear but horizontal incisor relation and posterior 

“crossbite with maxilla to the buccal dominated the picture and there was no tooth displacement. Factors IV 

and V were tooth displacement factors not involving 

either vertical or horizontal incisor position but again 

accompanied by posterior crossbites. 

It is felt that the closest description of the clinical 

syndromes-the factor analysis of phi coefficients for 

the whole set of 375 cases—is given by table 1, but 

that for the purpxe of computing regression equations, 

separation into groups with homogeneous buccal segment relations presented an advantage because the similarity of the factor patterns would permit use of one 

equation in all cases. This lead was followed in Appendix 

III. 

38 
� 

� � 

APPENDIX Ill. DEVELOPMENT OF REGRESSION EQUATION 

A unique problem aroae when the three equations the lead mom factor analysis of sets of data which were 

(table E) expressing the regression of judgment scores homogeneous in buccal segment relation, seven equaon the recording items fo~ three anteroposterior buccal tions were derived (table F). 

segment relationships had to be combined, Following 

MOLAR RELATION 

I HORIZONTAL o“~ 

! } 7 z=- 1.4 -.53MR 

.2 -2 

.1 -4 a 

o e 

(1 

o I 2 3 4 

& .35 i1- Fi (), 

o I 2 3 4 

2 � VERTICAL 

w 

G 

K 

~ ,2 0 

0 

c1 I o 

I DISPLACEMENT 

““~ 

.2 -2, -2.28 + .61MR 

00 ( 

.1 ) -4 � 

o 

ee � 

o 

o I 2 3 4 

MOLAR RELATION 

Figure V1. Regression coefficients of table F plotted according to molar rel at ion and 1east squares fitted 1i near 

expressions of kg .~ according to molar relation from which smooth weights of table F were obtained. 

39 
--------------------

-------------------- --------------------------- ---- ------------------ --------- --------------------------- ----------------------------------- ----

-------- ------------------------ --------------------- ----

--- ----------------------------- -------------------------

There was a general pattern toward lower re- natural logarithm of both sides of the equation, 

gression coefficients in the columns to the left or right Loge R = -(a+ bX) would produce a linear equation. 

of the normal buccal segment types expressing the The right half of figure VI shows diagrams plotting 

higher intercorrelations of items in the distal and mesial transformed regression coefficients on the buccal segmolar relation cases. Some irregular cases are ex- ment scores. The lines drawn in and the equations 

plainable on the basis of the ~mall samples for distal given were least squares fit, as shown in table X. In the 

3, and mesial 1 and 2 groups (table F). The vertical lower part of the table the first iteration smoothed reintercept value for the neutroclusion column is nearly gression coefficients are arrayed and below, the expozero and rises as expected with the degree of mal- nential expressions which produce the smoothed coposition of the buccal segments. The pattern of change efficients according to the buccal segment score for a 

in the regression coefficients is shown graphically in the particular case.


left half of figure VI. ‘Ihe task of smoothing out the The preliminary equation was tried on the 375 cases


regression coefficients and combining the seven equa- and the worst discrepancies studied. The regression


tions into one was undertaken as follows. coefficient for the horizontal incisal relation seemed to


From the gener~i shape of the curves it was de- be too small in mesioclusion cases so a scale shift 

termined that an exponential expression (subtracting 3 instead of 2 from the continuous variable, 

~ – Y2) was used, and the weights recalculated. ‘l%e 

coefficient for the vertical component was obviously ~= e-(a+bX) also too low in the mesioclusion cases and a similar 

small scale change was made by using the constant 1.5 

might be useful, where R represents a regression co- instead of 1. In addition, it was clear that even in the 

efficient and x the buccal segment relation. Taking the neutroclusion cases the coefficient 0.26 was too small 

Table X. Cslculatf.on of smoothed regression coeff ‘lcients in f i.gure VI 

(example is f9r vertical component) 

Regres- Lo& W 

Molar relat3.on aim 

Sample coeffi- N.Mli N.MR: N.Wf N.MR.Wt 

cient 

MR N w w’ 

“o-. - . . --- . - .------”. . . . 217 .26 -L*3 -282,1 

1- . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . 38 .04 -3.2 3i -121.6 -121.i 

:. .“-------

.........---- :: 

13 

,16 

.35 

-1.8 

-1.0 

1:; 

26 

-:; ;.: -219,6 

-26.0 --------. 11 .28 -1.3 -14:3 -42,9 

: . 32 .09 -2.4 Iii -76,8 -307.2 

Totals 

Correction factors for arbitrary mean zero 384 359 957 -636,8 -;;;.5 

Corrected sums of $quares ?$? .mid , 

1..-,----------------- .20 -1.6 -19,2 -19.2 

1


Slope - 14L2/621--0.23


Weighted average molar relation 359/384
=0.935 

Weighted average Log, W - 636.8/384=’1.66


Y intercept 1.66-(.935x.23)=1.44


Equation #’= -1.44 + (- .23MR) 

Molar relation Calculated average Calculatedregression coefficient 

Log, W =-(- 1.44 + (- .23MR)) 

o. -,------- -1.44 ,24
 .--.”----.......
 -1,67 ,19


~


;---------------------------------------- -1.90 .15
 ..---,.
 --,. -2,13 .12


4...--”.- ...----- -2,36 ,09

for an extreme overbite of 5 (actual impingement had casem This was also suggested in” table IX where the 

to be rated as handicapping), By a simple calculation twth displacement syndromes had major importance 

in the mesioclusion set. Accordingly, the regression 

8/(5-1.5)2 - b coefficient was doubled for these columns and separate 

weights used for Yfiand Y, in the expression 

it was seen that the coefficient would need to be 0.64 

for the neutroclusion cases and the smwth values for ~ - (2,28 + .61Y6 + .2~y7). 

the other columns raised proportionately. 

Finally the evidence was that tooth displacement The final weights and the exponential expressions 

should have more sigrdflcance in the mesioclusion for deriving them have been given in table G. 

41 
APPENDIX IV. IBM 7010 FORTRAN, MALOCCLUSION PROCESSOR 

TPS GRAINGER 

Z!I?w 

Input may be from Mark Sense Cards, figure 5, punched as below or 

from National Health Survey Card 33 (HES II -33 Dental). 

A. Punching Format for Mark Sense Cards (Two-column integers)


Col. 1, 2 upper anterior overjet in mm


Col. 3, 4 lower anterior overjet in mm


Col. 5, 6 overMte in crown thirds


Col. 7, 8 openbite in mm


Col. 9,10 number of congenitally missing incisors


Col. 11,12 distoclusion score


Col. 13,14 mesioclusion score


Col. 15,16 number of teeth in posterior crossbite maxilla to buccal


COL 17,18 number of teeth in posterior crossbite maxilla to lingual


Col. 19,20 tooth displacement score


Col. 66 sex, male 1, female 2


Col. 67,68 age in years


Col. 69-72 identification number


B. Alternate Input Card 33 NHS H Dental


A subroutine called in converts data to input form A if a 1 is 

punched in column one of problem card. If in mark sense format, column 

one of problem card is left blank. “ 

Order of Input: 

System cards as required by the specific operating system”


Program deck


First problem card


Data deck


End of group card (-1 in CO1.1, 2)


Second problem card


etc. etc. 

Problem card: 

Col. 1 Punch a 1 if input NHS card #33, if mark sense format, leave blank. 

Cd. 2 If data from NHS cards are to be punched in mark sense format, 

punch a 1, otherwise leave blank. 

Col. 3	 Punch O, TPS and identification only. 

Punch 1,, TPS and syndromes and identification. 

Punch 2, TPS, syndromes, raw data and identification 

will be printed or punched as called for. by CO1.4 and 5. 

Col. 4 Punch 1, if output by individual cases is to be punched on cards.


Col. 5 Punch 1, if output by individual cases is to be printed, otherwise leave blank.


Col. 8,9 Leave blank.


Col. 10 to 72 Alphameric message identifying the pack.


This program was first developed in IBM 7094 Fortxan IV which is also available. 

42 
TPI Program Listing 

COMMON KW(7) ,Y(l8),~TLE(ll),S~D(9),SAM(9),T(9),~(9),SE(9),AV(9) 

1,ID,FREQ(9 ,11) 

2 FORMAT(711 ,!2 ,1OA6,A3) 

5 FORMAT(1X,41HOPERATOR MESSAGE WATCH FOR PUNCHED OUTPUT ) 

22 FORMAT(1H1,43HANALYSIS OF ORTHODON’IIC TREATMENT NEEDS FOR/lX,10A6, 

1A3) 

1 READ(1 ,2)(KW(I),I-1 ,7),K,(TITLE(L),L-1,11) 

100 DO 106 I -1,9 

SYND(I) = 0.0 

101 SAM(I) -0.0 

102 T(I) -0.0 

103 TX(I) = 0.0 

104 SE(I) = 0.0 

105	 IX) 106 N = 1,11 

FREQ(I,N) = 0.0 

106 CONTINUE 

3 IF(KW(5)+KW(4)) 6,6,4 

4 WRITE(3,5) 

6 IF(KW(l)) 14,14,8 

8 CALL RESORT(SIG) 

9 IF(SIG+l.0) 25,21,10


10 LW=KW(4)


11 Jly=Kw(5)


12 CALL COMP


13 GOT08


14 CALL BURL(SIG)


15 IF(SIG+l.0) 25,21,16


16 LW = KW(4)


17 JW - KW(5)


18 CALL COMP


19 Go m 14


21 WRITE(3,22) (TITLE(L),L=l,ll)


23 CALL OUTPUT


24 GOTO1


25 smP


26 END


SUBROUTINE SUMRY(INK) 

COMMON KW(7),Y(18),~TLE( ll),S~D(9),SAM(9),T(9),~(9),SE(9),AV(9) 

1,1D,FREQ(9,11) 

SYND(INK) = SYND(l) 

1 SAM(INK) = SAM(INK) + 1.0 

2 T(INK) - T(INK) + SYND(INK) 

3 TX(INK) = TX(INK) + (SYND(INK)**2) 

4 IF(SYND(INK)-1O.5)7 ,5,5 

5N=11 

6GOT08 

7 N = IFIX(SYND(INK)+l.5) 

8 FREQ(INK,N) = FREQ(INK,N)+l.O 

9 RETURN 

10 END 

43 
1

2

3

4

5

6

7

8

9

10

11

12

SUBROUTINE BURL(SIG) 

COMMON KW(7),Y(l8),~TLE(ll),S~U9),SAM(9),T(9),m(9),SE(9),AV(9) 

1,ID,FREQ(9,11) 

2 FORMAT(10F2.0,F3 .O,2F2.O,3F3.O,28X,I8) 

1 READ(1,2)(Y(I),I=1,16),ID


3 IF(Y(1))4,6,6


4 SIG= -1.0


5G0’lX17


6 SIG= 1.0


7 RETURN


8 END


SUBROUTINE COMP


DIMENSION BUS


COMMON KW(7),Y(18),TITLE(
 11),WND(9),SAM(9), T(9),TX(9),SE(9),AV(9) 

1,1D,FREQ(9,11) 

117 FORMAT(F5.1 ,59X,18) 

120 FO@fAT(9F5.l,19X,18) 

123 ~ORMAT(8F501 ,1o13 ,18) 

127 FORMAT(1X,F5.1,67X,18) 

130 FORMAT(1X,9F5.1,15X,18) 

133 FORMAT(1X,9F5.1,10F4 

1001 IX3 1002 J= 1,9 

1002 SYND(J) = 0.0 

D031=1,16 

S(I) = 0.0 

CONTINUE 

DO 12 I =1,16 

IF(Y(I))6,8,6 

S(I) = 1.0 

GO TO 12 

TEST = 1.0 

TEMP = SIGN(TEST,Y(I)) 

IF(TEMP) 12,12,11 

S(I) = 1.0 

CONTINUE 

.O,1X,I8) 

B(1) = (Y(l) -t?(2) -3.0) **2 

B(2) = (Y(3) -y(4) -l.5)**2 

B(3) = Y(6)+ Y(7) 

B(4) = Y(8)**2 

B(5) = Y(9)**2 

B(6) = Y(10)**9, 

19 IF(S(l)+S(2)+S(~j+S(4)+S(6)+S(7)+S(8)+S(9)+S(lO).9.O)76,~,76 

20 SYND(l)=0.27+(i.2 *(Y(6)+Y(7))+(B(l)/(2.7 183*(1 .34+( .32*B(3)))) 

l+(B(2)/{2,7183 *(.43+(,26*B(3))))+( .l4*B(4))+(.26*B(5))+ 

2( B(6)/(2.~183*(2 .28+( .61*Y(6))+(.23*Y(7)))) 

211=1 

22 CALL SUMRY(i) 

23 IF(SYND(l)-4.0)58,24,24 

24 IF(Y(5)-1.0)31,29,27 

25 SYND(9) * 7.0 

u 
26 GO TO 31€

27 IF(Y(5)-2.0)31,28,30€

28 SYND(9)= 8.0€

29 GO TO 31€

30 SYND(9)= 9.0€

31 A=((Y(l)-Y(2)-2€ .0)**2)*0.22 

32 B=((Y(3)-Y(4)-1 .0)** 2)*0.50

33 C=(Y(1O)**2)*O.12 

34 IF(A-B)50,35,35 

35 IF(A-C)43,36,36 

36 IF(Y(l)-Y(2)) 40,37,37 

371=8 

38 CALL SUMRY(I) 

39 GO TO 114 

401=7 

41 CALL SUMRY(I) 

42 GO TO 114 

43 IF(Y(6)+Y(9))47 ,44,47 

441=3 

45 CALL SUMRY(I) 

46 GO TO 114 

471=4 

48 CALL SUMRY(I) 

49 GO T13114 

50 IF(B-C)57,51,51 

51 IF(Y(3)-Y(4))55,52,52€

521=5€

53 CALL SUMRY(I)€

54 GO TO 114€

551=6€

56 CALL SUMRY(I)€

57 GO TO 114€

581=2€

59 CALL SUMRY(I)€

114IF(KW(4))124,124,115€

115IF(KW(3)-1)116,119,122€

116WRITB(2,117)SYND(€ 1),ID 

118GO TO 124 

119WRITE(2,120)(SYND(I),I=1 ,9),ID 

121GO ~ 124 

122Do 200I= 1,10 

200M(Y)= I(Y) 

201 WRITE(2,123)SYND( 1),(SYND(I),I=2,9), (M(YY=1,1O),ID 

124IF(KW(5))76,76,125 

125IF(KW(3)-1)126,129,132 

126WRITE(3,127)SYND( 1),ID 

128GO ‘lW76 

129WRITE(3,130)(SYND(I),I=1,9),ID 

131GO ~ 76 

132WRITE(3,133)(SYND(I) J=1,9),(Y(I),I=1 ,1O),ID

76 RETURN 

77 END 

4s 
SUBROUTINE OUTPUT


COMMON KW(7),Y(l8),~TLE(ll),S~~9),SAM(9),T(9),~(9),SE(9),AV(9)


l,ID,FREQ(9,11)-


14 FORMAT(1H0,28HSYNDROME AVER SE SAMPLE ,1OX,23HFREQUENCYDISTR


UBUTIONS )


16 FORMAT(1X,31X,63H0 1 2 3 4 S67 8


1 9 10 ) 

40 FORMAT(1H0,16HTREAT PRIORITYI/10X,2F6.2,1F6.0,11F6.3) 

42 FORMAT(1X,16HNORMAL 0CCLUSION/10X,2F6.2,1 F6.0,11F6.3)


44 FORMAT(1X,16HBUCCALDISPLACNT/10X,2F6.2,1
 F6.0,11F6.3)


46 FORMAT(1X,16HLINGLDISPLACMNT/10X,2F6.2,1F6.0,11F6.3)


48 FORMAT(1X,9HOVERBITE/10X,2F6.2,1F6.0,11F6.3)


50 FORMAT(1X,9HOPENBITE/10X,2F6.2,1F6.0,11
 F6.3)


52 FORMAT~X,llHPROONATHISM/10X,2F6.2,1F6.0,11F6.3)


54 FORMAT(lX,13HRETROGNATFIISM/10X ,2F6.2,1F6.0,11
 F6.3)


1206Do 1210I-1,9


1207DO 1210N =1,11


1208IF(SAM(I))121O,121O,12O9


1209FREQ(I,N)=
FREQ(I,N)/SAM(I)


1210	CONTINUE


m601=l,9


AV(I)
= 0.0


SE(I)=
0.0


60 CONTINUE


1200Do 1205I=1,9


1201IF(SAM(I)-1.0)
 1205,1205,1202


1202AV(I)=T(I)/SAM(I)


1203IF((TX(I)-(T(I)*T(I)/SAM(I)~ /(SAM(I)*
 (sAM(I)-l.0)))1205,1205,1204


1204SE(I)=SQRT((m(I)
 -(T(I)*T(I)/SAM(I)))/(SAM(I)~SAM(I)-l.O)))


1205CONTINUE


13 WRITE(3,14)


15 WRITE(3,16)


“39WRITE(3,40)AV(1), SE(I), SAM(1),
 (FREQ(1,N),N-1,11)


41 WRITE(3,42)AV(2) ,SE(2),SAM(2),(FREQ(2
 ,N),N=l,ll)


43 WRITE(3,44)AV(3) ,SE(3),SAM(3),(FREQ(3
 ,N)
,N=l,11)


45 WRITE(3,46)AV(4),SE(4) ,SAM(4),(FREQ(4,N) ,N=l
,11)


47 WRITE(3,48)AV(5) ,SE(5),SAM(5),(FREQ(5
 ,N),N=l,ll)


49 WRITE(3,50)AV(6) ,SE(6),SAM(6),(FREQ(6,N),N=1
 ,11)


51 WRITE(3,52)AV(7) ,SE(7),SAM(7),(FREQ(7
 ,N),N=l,ll)


53 WRITE(3,54)AV(8) ,SE(8),SAM(8),(FREQ(8
 ,N),N=l,ll)


55 WRITE(3,56)AV(9), SE(9),SAM(9),(FREQ(9,N),N.=1
 ,11)


29 RETURN


30 END


46 
SUBROUTINE RESORT(SIG)


DIMENSIONX(47),J(27),


COMMON KW(7),Y(18),~~E(ll)
 O~~6),SAM(6),T(6),~(6),SE(6),AV(6)


1,1D,FREQ(6,11)


2 FORMAT(15,6Fl.0,F2 .0,2X,6Fl.0,2F2 .0,4X,2F2.0,Fl.0,4F2
 .O,2Fl.O,


1F2.0,2F1.0,F200,2F1
 .0,F2.0,2F100,2F2.0,12F100)


98 FORMAT(412,2X,512 ,13,212,13,3X,13,28X
 ,18)


1 READ(1,2)ID,(X(1),
 F=1,47)


3(K)aF(ID)301,3,3


301


302


60:


4


105


5


6


7


8


9


10


11


12


1s


14 

15


16


17


18


19


20


21


22


23


24


25


SIG* -1.0


GO ‘IO99


SIG= 1.0


Y(1)= A13S(X(14))


Y(2)- ABS(X(15))


IF(X(18))11,11,5
 ‘


IF(X(18)-3.0)6,6,9


Y(4)= 4.O-X(18)


Y(3)-0.0


Go’lull


Y(3)* X(18).3.O


Y(4)-0,0


MOL = X(8)


IF(MOL)1S,13,H


Y(6)= 2.0


GO TO 25


GO TO(16,17,18,19,20,21
 ,22,23,24),MOL


Y(7)-2.0


GO “IO25


Y(7)= 1.0


GO TO 2S


GO TO 25


Y(6)= 1.0


GO ‘X025


Y(6)= 2.0


GtlTO 2S


Y(7)-2.0


GO’1025


Y(7)-1.0


GO ‘N125


GO TO 2S


Y(6)- LO


MOL = X(9)


26 IF(MOL)28,27
 ,28


27 Y(6)=Y(6)+2.O


GO TO 38


_ 28 GO ‘NI(29,30,31,32,33,34,35,36,37
 ),MOL


29 Y(7)- Y(7)+2.O


GO T038


30 Y(7)- Y(7)+1.O


GO ‘m 38


31 GO TO 38


32 Y(6)=Y(6)+1.O


GO TO 38


33 Y(6)-Y(6)+2.O


GO ‘IX)
 38


34 Y(7)=Y(7)+2.O


GO ‘K) 38 

47

35 Y(7)- Y(7)+1.O 

GO T038 

S6 GO TO 38 

37 Y(6)=Y(6)+1.O 

38 NXB - X(10) 

39 IF(NXB)40,41,40 

40 Y(8)=X(10) 

41 NXB = X(H) 

42 IF(NXB)43,45,43 

43 Y(9)- X(n) 

45 NXB - X(12) 

46 IF(NXB)47,48,47 

47 Y(8)=Y(8)+X(12) 

48 NXB = X(13) 

49 IF(NXB)50,51,50 

50 Y(9)- Y(9)+X(13) 

51 Y(lO)-X(36)+X(37)+X(38)+X(39)+2.O*(X(4O)+X(4l)+X(42)+X(43)) 

52 IF(X(19))53,55,53 

53 IF(X(22))54,57,54 

54 Y(n) = ((X(19)+X(22))/2 .0) 

GO TO 58 

55 IF(X(22))56,64,56 

56 Y(n) - X(22) 

GO TO 58 

57 Y(u)= X(19) 

58 IF(X(20))59,61,59 

59 IF(X(21))60,63,60 

60 Y(n)= Y(ll)+((x(20)+x(21))/2 .o) 

GO TO 64 

61 IF(X(21))62,64,62 

62 GO TO 64 

63 Y(U)= Y(11)+X(20) 

64 Y(13)= X(24)+X(27)+X(30)+X(33) 

65 Y(12)= X(23)+X(26)+X(29)+X(32) 

66 IF(Y(11))80,80,167 

167IF(X(25))168,168,67 

67 Kl=((Y(ll)/10.0)+X(23) -X(24)-X(25)+ll.0) *10.O

168IF(X(28))169,169,68 

68 K2=((Y(ll)/10.0)+X(26) -X(27)-X(28)+ll.0)*10.O 

169IF(X(31))170J70,69 

69 K3=((Y(ll)/10,0)+X(29) -X(30) -X(31)+10 .)*10.O

170IF(X(33))71,71,70 

70 K4-((Y(ll)/10.0)+X(32) -X(33) -X(34)+10 .)*10.O

71 IF(K1-K2)73,73,72 

72 Y(14)= K1 

GO T074 

73 Y(14)= K2 

74 F=K3 

IF(Y(14)-F)76,76,75 

75 GO TO 77 
76 Y(14)= K3


77 F.K4


IF(Y(14)-F)79,78,78


78 Go TO 80


79 Y(14)
= K4


80Y(16)= X(35)
*1O.O


90 Y(17)
= X(6)


91 Y(18)= X(7)


92 IX)94I =1,18


93 J(I)=Y(I)


94 CONTINUE


95 ID-IDt(J(18)*100000)+(J(17)*1000000)


96 IF(KW(2))99,99,97


97 WRITE(2,98)(J(I), I=1,4),(J(I),I=6,14),
 J(16),ID


99 RETURN


100END


ooo— 

49

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication Na. 1000 

Sevies 1.	 P)ogra))zs and collection pvoceduves.— Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

SeVies 2.	 Data evaluation and metiwis )esearch. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

SeVies 3. Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Sevies 4. l)ocuments and committee ~e~o),ts.— Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

SeVies 10.€ Data from the Health lntereiew Suvuey. —Statistics on illness, accidental injuries, disability, use of 

hospital ,,medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Sevies 11. Data from the Health Examination Suwey. - t)ata from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Se~ies 12.	 Data fvom the Institutional Population Suvveys. — Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

Sevies 13.€ Data from the Hospital Dischavge Survey. —Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national sample of hospitals.. 

Series 20.	 Data on mortality. —Various statistics on mortality other than as included in annual or monthly 

reports —special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

Series 21.	 Data on mztality, rnan’iage, anddivovce. — Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports— special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

Series 22.	 Data *from the National Natality and Mortality Swveys. —Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201