PEER ASSESSMENT RATING ( PAR ) index
• This index was developed by Richmond et al . (1992). It was formulated over a series of six meetings
in 1987 with a group of 10 experienced orthodontists .
• This index was developed to record the malocchision at any stage of treatment
• The concept is to assign a score to various occlusal traits which make up a malocclusion The
individual scores are summed to obtain an overall total , representing the degree a case deviates from
normal alignment and occlusion
. • Study models used with a specifically designed ruler for this index. The ruler has all the information
summarized which makes meas urement quick and easy to perform.
• The score zero indicates good alignment and higher scores ( rarely beyond 50 ) indicates increased
levels of irregularity .
• The difference between the pretreatment and posttreatment scores representing the degree of
improvement as a result of orthodontic intervention and active treatment.
• There are 11 components of the PAR index
1. Upper anterior segment
2. Lower anterior segment
3. Upper right segment
4. Upper left segment
5. Lower right segment
6. Lower left segment
7. Right buccal occlusion
8. Left buccal occlusion
9. Overjet
10. Overbite
11. Centerlines
• Each dental arch is divided into three recording segments left and right buccal segments and the
anterior segments
Reliability
It has been reported that the PAR index has an excellent reliability within intra and inter-examiner
agreement (Richmond et al., 1992).
Buccal and anterior segments
Buccal segments start from the mesial anatomical contact point of the first permanent molar to the
distal anatomical contact point of the canine
Anterior segments starts from the mesial anatomical contact point of the canine on one side to the
mesial anatomical contact point of the canine on the opposite side .
o The occlusal features recorded are crowding, spacing, and impacted teeth.
o Displacements are recorded at the shortest distance between contact points of adjacent teeth
parallel to the occlusal plane with the exception of the displacements that are present
between the first second and third molars. This is because of the fact that the contact points
are very broad and are extremely variable within the normal range
o In case of potential crowding in the mixed dentition, average mesio - distal widths are used to
calculate the space deficiency. Impac ted teeth are recorded when the space available for the
tooth is equal or less than 4 mm
o Dis placed contact points due to poor restoration are not recorded and the same for contact
points between deciduous teeth. Orthodontic extraction spaces are not recorded.
o Spacing in the anterior segment resulting from extraction , agenesis or avulsion of incisors or
cuspids is recorded as follows:
- If closing space the space is recorded
- If opening space and restore it , the space is not recorded unless it is less than or equal to 4
mm
Buccal occlusion
o This is recorded for both right and left sides in occlusion in three dimensions . A - P ,
vertical and transverse .
o The recorded zone is from the canine and to the last molar whether this was the
first , second or third molar
o Temporary developmental stages and submerging deciduous teeth are excluded.
Overjets
oThe recording zone starts from the distal anatomical contact point of
the lateral incisor on one side to the distal anatomical contact point of the
lateral incisor on the other side
o The most prominent aspect of any one incisor is recorded with a ruler
held parallel to the occlus al plane.
o Overjets and crossbites are recorded here. The sum of the two scores
is the total score for this component . If there is a positive overjet and
incisors or canines in crossbite the scores should be added together
Overbite
o The vertical overlap or open bite of the anterior teeth is recorded .
o The tooth with the greatest overlap is recorded .
olf OB and AOB are present , then they should be added .
Center lines
Records the centerline discrepancy in relation to the lower central
incisor .
If a lower incisor has been extracted, the measurement is not recorded.
Advantages
1) Reliable.
2) Easy and quick considering the PAR ruler is used.
3) May be used for all types of malocclusion, treatment modalities, and
extraction / non-extraction cases.
4 ) The score provides an estimate of how far a case deviates from the normal
5 ) Good tool in measures during the perceived degree of improvement and
therefore the success of treatment. Thus, it is an indicator for clinical
performance
Disadvantages
1) It is not an index of treatment need.
2) It provides a single summary score for all the occlusal anomalies . Thus, it is
insensitive and can mis judge individual patient need . Therefore , it is better
to weigh each malocclusion individually .
3). The reliability of the upper left and right segments was found to be low and
this was referred to the fact that the upper teeth varies in size. The larger teeth
cause a broader contact points which makes inaccurate recording of the scores
(Richmond et al. 1992).
4). Hamdan and Rock (1999) suggested the limitation of PAR index to be
• Overjet high weighing
• Overbite low weighing
Outcome assessment
There are basically three methods of assessing outcome using the PAR Index.
The first is to record the reduction in PAR score . 22 point reduction indicates
great improvement .
The second method is to calculate the percentage change . A percentage
improvement of greater than 70 % can be considered as a good standard of
orthodontic treatment. While , 30-70% reduction represents an improvement .
Less than 30% reduction is either considered as becoming worse or no
improvement.
The final method of assessment is to use the graph ( nomogram )
