Fa-25 Handicapping Labiolingual Deviation (Hld) Index Report Form Page 2
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2Handicapping Labiolingual Deviation Index Scoring Instructions
The intent of the Handicapping Labiolingual Deviation (HLD) Index is to measure the presence or absence and the
degree of the handicap caused by the components of the Index and not to diagnose “malocclusion.”
All
measurements are made with a Boley Gauge (or a disposable ruler) scaled in millimeters. Absence of any conditions
must be recorded by entering “0” (refer to attached score sheet).
The following information help to clarify the categories on the HLD Index Report:
Cleft Palate Deformities: Indicate an “X” on the score sheet and do not score any further if present. This condition
is considered to be a handicapping malocclusion.
Deep Impinging Overbite: Indicate an “X” on the score sheet when lower incisors are destroying the soft tissue of
the palate and do not score any further. This condition is considered to be a handicapping malocclusion.
Individual Anterior Teeth Crossbite: Indicate an “X” on the score sheet when destruction of soft tissue is present
and do not score any further. This condition is considered to be a handicapping malocclusion.
Severe Traumatic Deviations: Traumatic deviations include loss of a premaxilla segment by burns or by accident,
the result of osteomyelitis or other gross pathology. Indicate with an “X” on the score sheet, attach documentation of
condition, and do not score any further. This condition is considered to be a handicapping malocclusion.
Overjet greater than 9mm:
If the overjet is greater than 9 mm with incompetent lips or the reverse overjet
(mandibular protrusion) is greater than 3.5 mm with reported masticatory and speech difficulties, indicate an “X” and
score no further.
If the reverse overjet is not greater than 3.5 mm, score under the “Mandifular Protrusion in
Millimeters” item.
Overjet in Millimeters: This is recorded with the recipient’s teeth in centric occlusion and measured from the labial
portion of the lower incisors to the labial of the upper incisors. The measurement may apply to a protruding single
tooth as well as to the whole arch. Round this measurement to the nearest millimeter and enter on the score sheet.
Overbite in Millimeters: A pencil mark on the tooth indicating the extent of overlap facilitates this measurement.
Round off to the nearest millimeter and enter on the score sheet. “Reverse” overbite may exist in certain conditions
and should be measured and recorded.
Mandibular Protrusion in Millimeters: Score exactly as measured from the labial of the lower incisor to the labial of
the upper incisor. The measurement in millimeters is entered on the score sheet and multiplied by five (5). A reverse
overbite, if present, should be shown under “overbite.”
Open Bite in Millimeters: This condition is defined as the absence of occlusal contact in the anterior region. It is
measured from edge to edge in millimeters. Enter the measurement on the score sheet and multiply by four (4). In
cases of pronounced protrusion associated with open bite, measurement of the open bite is not always possible. In
those cases, a close approximation can usually be estimated.
Ectopic Eruption: Count each tooth, excluding third molars. Enter the number of teeth on the score sheet and
multiply by three (3). If anterior crowding is present with an ectopic eruption in the anterior portion of the mouth, score
only the most severe condition. DO NOT SCORE BOTH CONDITIONS.
Anterior Crowding: Arch length insufficiency must exceed 3.5 mm. Mild rotations that may react favorably to
stripping or mild expansion procedures are not to be scored as crowded. Enter five (5) points each for maxillary and
mandibular anterior crowding. If ectopic eruption is also present in the anterior portion of the mouth, score the most
severe condition. DO NOT SCORE BOTH CONDITIONS.
Labiolingual Spread: Use a Boley Gauge or a disposable ruler to determine the extent of deviation from a formal
arch. Where there is only a protruded or lingually displaced anterior tooth, the measurement should be made from the
incisal edge of that tooth to the normal arch line. Otherwise, the total distance between the most protruded tooth and
the lingually displaced anterior tooth is measured. The labiolingual spread probably comes close to a measurement of
overall deviation from what would have been a normal arch. In the event that multiple anterior crowding of teeth is
observed, all deviations from the normal arch should be measured for labiolingual spread, but only the most severe
individual measurement should be entered on the index.
Posterior Unilateral Crossbite: This condition involves two or more adjacent teeth, one of which must be a molar.
The crossbite must be one in which the maxillary posterior teeth involved may either be both paletal or both
completely buccal in relation to the mandibular posterior teeth. The presence of posterior unilateral crossbite is
indicated by a score of four (4) on the score sheet.
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