Royal College of Surgeons in Ireland
Closing the Gap for children with prominent front teeth.pdf (2.71 MB)

Closing the Gap for children with prominent front teeth

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posted on 2019-11-22, 18:19 authored by Ciara Scott

This OD project was introduced in one large HSE Regional Orthodontic Unit. It was a process change project to improve the quality of delivery of care for children very prominent front teeth, with Index of Orthodontic Treatment Need (IOTN5a)

Many growing IOTN5a patients have a ‘window of opportunity’ when treatment with a functional appliance(twin-block)will be most efficient and most effective. Orthodontic treatment for non-growing IOTN5a patients is often less ideal for the patient, the clinician and may involve surgery which is more expensive for the service.

Allocating patients to treatment from the sequential waiting list for IOTN5a is unbalanced due to the wide variation in patient age and clinical urgency on the IOTN5a waiting list. Quality management can reduce variation in systems and improve processes.

The aims and objectives of this OD project were to develop a standardised clinical protocol using NCEC Guidance for clinicians to apply at assessment of IOTN5a patients. This was based on the best clinical evidence for the timing of treatment and the evidence for cost-minimisation and cost-effectiveness of treatment.

Using the HSE Change Model, the new process was implemented, using the protocol to record an indicative date for treatment to start.A key performance indicator was developed to measure compliance with protocol and to measure the new quality standard.

A balanced score card evaluation outlines the benefits of the change from the different stakeholders’perspective. The process change was successful in improving IOTN5a patient’s access to functional appliance treatment. Further mainstreaming and evaluation of outcome measures and is required.

This quality improvement is patient-centred but benefits all the stakeholders. There is s cost-benefit to the service by providing treatment at the most efficient and effect time.


First Supervisor

Jenny Hogan


A Dissertation submitted in part fulfilment of the degree of MSc Leadership and Management Development, Institute of Leadership, Royal College of Surgeons in Ireland 2016.

Published Citation

Scott C. Closing the Gap for children with prominent front teeth [MSc Thesis]. Dublin: Royal College of Surgeons in Ireland; 2016.

Degree Name

  • MSc Leadership and Management Development

Date of award


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