The Dental Aesthetic Index (DAI) used to objectively determine the orthodontic treatment need by assessing both clinical and esthetic components. To determine the orthodontic treatment need based on DAI on patients who visited the Dental and Oral Hospital, Faculty of Dentistry, Universitas Indonesia named Rumah Sakit Khusus Gigi dan Mulut Fakultas Kedokteran Gigi Universitas Indonesia (RSKGM FKG UI) orthodontic specialist clinic between 2010 and 2014. Total fifty-two pairs of pretreatment orthodontic study models were used. The assessment was based on ten components of the DAI. Assessment scores were categorized into four levels of orthodontic treatment need. Orthodontic treatment needs were classed as "highly desirable of treatment need" in 36.5% patients, "mandatory treatment need" in 32.7%, "elective treatment need" in 25%, and "no/slight treatment need" in 5.8%. The problems found were mostly anterior mandibular irregularity that was observed in 96.2% patients, anterior maxillary irregularity in 94.2%, abnormal anterior maxillary overjet in 81%, and abnormal molar relationship in 76.9%. The most common DAI-based orthodontic treatment need of patients who visited the RSKGM FKG UI orthodontic specialist clinic belonged to the "highly desirable" class (36.5%). Thus, the patients who who visited the RSKGM FKG UI orthodontic specialist clinic were mostly individuals who needed the treatment when assessed by the DAI. © 2019 Journal of International Dental and Medical Research.