EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY VOL. 14/4-2013 314 C. Grippaudo*, F. Pantanali*, E.G. Paolantonio*, M.E. Grecolini*, R. Saulle**, G. La Torre**, R. Deli* *Postgraduate School in Orthodontics Università Cattolica del Sacro Cuore, Rome, Italy **Department of Public Health and Infectious Diseases Sapienza University of Rome, Rome, Italy e-mail: cgrippaudo@rm.unicatt.it ABSTRACT Aim The aim of the study was to estimate the prevalence of malocclusion and the need for orthodontic treatment in a sample of 3,017 Italian schoolchildren. Materials and methods Study design: 1,375 males and 1,642 females, aged between 8 and 13 years, were visited in primary and secondary schools. Signs of malocclusion were registered according to an occlusal index by trained and calibrated operators. First the prevalence of malocclusion was calculated in accordance to a scale of need for orthodontic treatment (R.O.M.A. index), which considers both malocclusion signs and risk factors for worsening of malocclusion without any treatment and during craniofacial development. Then the distribution of the most frequent characteristics, signs and symptoms was evaluated both within each risk grade and in the basic sample. Results The overall percentage of children classified as 3, 4 and 5 grade accounted for 75.8% of the sample. The percentage of children classified as 4 and 5 grade are similar to those found in other European countries. The most frequent features found are poor oral hygiene, caries and early loss of deciduous teeth, deviation from full intercuspation, increased overbite and overjet. Conclusion This epidemiological research describes the current orthodontic treatment need in Italy in children with a late mixed dentition. Prevalence of malocclusion in Italian schoolchildren and orthodontic treatment need Introduction Occlusal indices are used to rank malocclusion and identify the individuals in special need for orthodontic treatment, on the grounds of the potential damages malocclusion might cause [Taylor, 1993]. They are introduced to minimise the subjective component of diagnosis and assessment of the malocclusion. Some indices are used also to assess the outcome of orthodontic treatment [Borzabadi-Farahani, 2011]. They have been used successfully in many countries and have provided useful information on treatment need and provision of orthodontic services [Espeland et al., 1992; Richmond, 1993; Richmond and Andrews, 1993; Birkeland et al., 1996]. In countries of Northern and Central Europe (Switzerland, England, Germany, France, Belgium) a great number of surveys have been produced [Josefsson et al., 2007; Chestnutt et al., 2006; Tausche et al., 2004; Souames et al., 2006; Willems et al., 2001; Grabowski et al., 2007], whereas there are few studies about the prevalence of malocclusions and orthodontic treatment need in Southern European countries [Perillo et al., 2010]. In Italy, in the last decades, several studies have been undertaken to report the oral health status in children and adolescents [Angelillo et al., 1990-99], but very few focused on assessment of the prevalence of malocclusion and orthodontic treatment need [Ciuffolo et al., 2005; Nobile et al., 2007]. Occlusal indices have been criticised for not being easy to use, as they require long time, complicated calculations and qualified staff for data collection [Tang and Wei, 1993], lack of items about skeletal problems, and seem appropriate in permanent dentition and in examining patients whose growth is already complete, rather than across all age ranges. However, in young patients orthodontic problems are not restricted to dental disorders, being often accompanied by altered underlying skeletal relationships and closely related to craniofacial growth and development. That is why the age and stage of development of the patient entail different degrees of risk of malocclusion, accompanied by negative effects on the masticatory function. The R.O.M.A. index (Risk Of Malocclusion Assessment index) [Russo et al., 1998] is a tool to assess treatment need in young patients and has been previously validated [Grippaudo et al., 2007]. Unlike other indices, the R.O.M.A. index (Table 1) was specifically devised for use for young patients, in an attempt to rate not only the dental malocclusion, but also skeletal and functional aspects, which in children are determinants of the orofacial development. The aim of this investigation, which follows an earlier study performed on 420 children [Grippaudo et al., 2007], is to use the R.O.M.A. index to estimate the prevalence of malocclusion and the need for orthodontic treatment in a sample of 3,017 school children aged 8-13 in Italy. Keywords Malocclusion; Treatment needs.