Connecticut Dental Health
Partnership (CTDHP)
Orthodontic Seminar
June 20, 2012
Agenda
Welcome!
Time
6:00 - 6:30
6:30 - 7:00
7:00 - 7:45
Topic
Meet and Greet
Dinner
Presentation
- Introduction
- Objectives
- Salzmann scoring presentation
- Case submission procedures
7:45 - 8:00
Question and Answer
2
Objectives
• Introduce CTDHP staff
• Develop a common understanding of the
Salzmann scoring process
• Clarify submission process
• Answer general questions
3
Cases That Do Not Qualify
•Fill out form with appropriate
information
•In Comments section write “patient
does not qualify please deny”
•Mail in with other Pre-authorization
requests
•Do not take x-rays or models for
cases where they are not needed to
diagnose
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Objectives: Salzmann Scoring Process
• 5,210 orthodontic cases submitted CY 2011
Salzmann Score
% of Total
Practitioner CTDHP
Score
Score
% Variance
Average
27.3
23.6
15.6%
Average Approved 70.0%
Cases
28.5
26.4
7.9%
Average Denied
Cases
24.5
17.1
43.2%
30.0%
• Denied cases are an administrative burden to the practitioner and CTDHP
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Salzmann Scoring
Definition:
Handicapping malocclusion and handicapping dentofacial
deformity are conditions that constitute a hazard to the
maintenance of oral health and interfere with the well-being of
the child by adversely affecting dentofacial esthetics, mandibular
function, or speech.
Materials courtesy of the American Association of Orthodontists Library, 1974
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Salzmann Scoring
• E. Intra-Arch Deviations:
1. Missing teeth: scored by actual count of teeth; remaining roots are
scored as missing
2. Crowded teeth: insufficient space for alignment without moving
other teeth in the arch. Crowded refers to tooth irregularities that
interrupt the continuity of the dental arch when the space is
insufficient for alignment. A tooth scored as crowded is not
concomitantly scored as rotated
3. Rotated anterior teeth: insufficient space for alignment of teeth so
malaligned as to interrupt the continuity of the arc of the dental arch
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Salzmann Scoring
E. Intra-arch Deviations: Max & Mand Anteriors
1. Maximum # of Maxillary or Mandibular Anterior teeth
scored is 4 each
2. Maximum score for line one is 8 and for line three is 4
respectively
3. A tooth cannot be rotated and crowded
4. Count spaces not teeth
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Salzmann Scoring
• E.Intra-Arch Deviations: Max & Mand Posteriors
1. Missing tooth must be congenitally missing not just missing from
arch. Remaining roots are scored as missing
2. Crowding: insufficient space for alignment without moving other
teeth in the arch. Crowded refers to tooth irregularities that
interrupt the continuity of the dental arch when the space is
insufficient for alignment. A tooth scored as crowded is not
concomitantly scored as rotated. A maximum of 2 teeth per side
per arch can be counted
3. Rotation: Crown rotated buccally or lingually > 45°
4. Spacing must be evident on both sides of the tooth. A maximum
of 2 teeth per side per arch
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Salzmann Scoring
• Max & Mand Posteriors:
5. Rotated posterior teeth: buccal or lingual surface wholly or
partially faces proximal surface of adjacent teeth
6. Open spacing: crest of interdental papilla is visible. Score each
papilla in incisor section; score posterior teeth when both adjacent
crests of the interproximal papillae are visible
7. Closed spacing: space is insufficient for complete eruption of a
tooth. Cannot have closed spacing and crowding for the same
teeth
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Salzmann Scoring
Intra-arch Deviations:
Top: crowding, spacing,
and missing teeth.
Bottom: anterior
spacing.
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Salzmann Scoring
Intra-arch Deviations:
(A) Method of placing
casts for intra-arch
assessment
(B) Crowded anterior and
posterior teeth
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Salzmann Scoring
F. Inter-Arch Deviations: 1. Anterior Segment
1. Overjet: labioaxial inclination of maxillary incisor teeth with
mandibular incisors occluding on or over palatal mucosa
2. For an incisor to be scored as excess overjet, any portion of the
maxillary incisal edge must be at least 3mm ahead of the opposing
lower incisor
3. Overbite: maxillary incisors occlude on or opposite labiogingival
mucosa or mandibular incisors occlude DIRECTLY on palatal
mucosa
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Salzmann Scoring
F. Inter-Arch Deviations: 1. Anteror Segment
4. Overbite is scored teeth 7, 8, 9, 10 in a ClassII Div 2 occlusion
when these teeth touch lower labial gingiva.
5. Overjet and overbite: score both when mandibular incisors occlude
directly on the palatal mucosa and maxillary incisors are in overjet
6. Openbite: the vertical separation between teeth in opposing dental
arches when the rest of the teeth are in terminal occlusion. Edgeto-edge occlusion is not scored as openbite or crossbite.
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Salzmann Scoring
(A) Overjet- maxillary incisors labial, mandibular incisors over palatal mucosa.
(B) Overbite-mandibular incisors on palatal mucosa.
(C) Overjet and overbite maxillary incisors labial, mandibular incisors on
palatal mucosa.
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Salzmann Scoring
Inter-arch Deviations:
1. Incisors crossbite: maxillary incisors are lingual to mandibular
incisors when posterior teeth are in terminal occlusion.
2. Crossbite of posterior teeth: canines, premolars, and first molars
are buccally or lingually placed out of the entire occlusal contact with
their opposing teeth. Cusp tip is out of the fossa. End-on is NOT
considered a crossbite
3. Open Bite: Erupting teeth cannot be counted as an open bite. Tooth
must be fully erupted.
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Salzmann Scoring
F. Inter-Arch Deviation 2. Posterior Segments
1. Relate Man. To Max. Teeth
– A. Distal Category is for Class II
– B. Mesial Category is for Class III
2. Flush terminal plane not Class II or III
3. Opposing cusp must be over the tip of the opposing cusp
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Not a Class II
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This will qualify as Class II
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Salzmann Scoring
Inter-arch Deviations:
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Salzmann Scoring
(A) Anterior
crossbite
(B) Crossbite of
posterior teeth
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Salzmann Scoring
Mesiodistal Deviations:
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Comments Section
1. Narrative only applies to clinical reasons to
justify the case qualifying for treatment
2. Additional photos, x-rays, etc. that support the
narrative must be included
3. Do not send treatment plan, mechanics to be
employed, etc. as these do not alter the scoring
of the case
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Salzmann Scoring: Example Casts
Overhead View
Left Side View
Bases of models are not parallel, backs are not even
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Salzmann Scoring: Example Casts
Right Side View
Frontal View
Bases of models are not parallel, backs are not trimmed
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Salzmann Scoring: Example Casts
Rear View
Back needs to
be trimmed to
allow
evaluation of
overbite
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Quality of Records
1. X-rays must be printed on PHOTO paper not
copy paper
2. Panoramic radiograph must be relevant timewise in relation to the models
3. Models must be of diagnostic quality and
trimmed in occlusion, W/O wax bite, to ABO
guidelines
4. Poorly trimmed models and models with broken
teeth will be returned ungraded!
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Study Model Packaging
1. The ideal way to ship models is with each
model first placed in a blue fluoride tray, then
bubble wrapped and secured with a rubber
band
2. Do NOT ship the models with wax bite attached
between upper and lower models. Models
become difficult to separate and teeth break
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Salzmann Scoring Sheet
See attached document:
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Returned Orthodontic Submission Form
Member: __________________
Claim #: ___________________
ID#: ____________________
Date: ___________________
Dear Doctor,
Your request for review of orthodontic services for your patient is incomplete as submitted or, in the opinion of the
program’s dental consultant(s), does not appear to be consistent with the criteria of the Connecticut Medical Assistance
Program. To allow proper processing of your request, we are returning your submission and supporting documentation for
the following reasons:
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Client’s name as it appears on their gray CONNECT card is required
Client’s Medicaid ID number as it appears on their gray CONNECT card is required
Dentist’s NPI, TIN and/or SSN identifiers are required on the accompanying claim form
Panoramic radiograph for full X-Ray series is required
Properly completed and scored Malocclusion Severity Assessment, including section “G” on Other Deviations (sample form
enclosed) is required
Diagnostic Casts (models) must be properly trimmed
Radiographs and/or models must be of diagnostic quality
Other
Please resubmit this request with the missing or corrected information and/or materials for further consideration.
Interceptive treatment is not a Medicaid covered service: Patient has mixed dentition and no documentation from referring
general dentists, behavioral health or mental health providers, or other severe deviations affecting the mouth and/or
underlying structures are present as noted in section ‘G’
Please discuss monitoring, future orthodontic therapy and alternative treatment options with your patient at this time
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Thank you for coming!
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