Inter-examiner Agreement Research Articles

Use of Bauru Yardstick in Patients With Complete Bilateral Cleft Lip and Palate at an Indian Center.

To evaluate dental arch relationship in treated bilateral cleft lip and palate (BCLP) cases at an Indian cleft center using the Bauru yardstick. Digital photographs of the dental cast of 50 consecutively treated patients (28 males and 22 females) with nonsyndromic BCLP at an Indian cleft center were rated by 2 examiners as per the Bauru yardstick for the 12-year-old age group. The average age group was 12 ± 0.62 years. All cases were treated with same surgical protocol. The inter-examiner agreement between the 3 examiners was found to be very high, with weighted kappa values ranging from 0.894 to 0.951. The intraexaminer agreement between the 2 examinations for all the examiners was also found to be very high, with weighted kappa values ranging from 0.894 to 0.931. Seventy-eight percent of patients were rated with a Bauru yardstick score of 1+2. In addition, 10% of patients were rated with a score of 3, 8% as 4, and 4% as 5. The overall Bauru yardstick score for the center was 2.36. The protocol followed for the repair of BCLP cases by the center was found to be a good regimen in regard to the Bauru yardstick score.

Feasibility of Using the General Movements Assessment of Infants in the United States

ABSTRACTAims: To pilot the practicality of administering the Prechtl General Movements Assessment of infants (GMA) in the Neonatal Intensive Care Unit (NICU) setting and at home to infants at risk for developing cerebral palsy (CP). Additional aims included assessing inter-rater reliability and comparing GMA predictions to AIMS motor assessment at 12 months. Methods: 12 “at risk” infants were recruited by convenience sample. Video recordings were obtained in the NICU and provided by parents after discharge. These recordings were analyzed by two trained examiners to assess infants in the writhing and fidgety movement periods (birth to 16 weeks). Infants were assessed at 12 months corrected age using the Alberta Infant Motor Scale (AIMS) with scores lower than 5th centile considered a motor delay. Results: 33 of 42 videos (79%) were of sufficient quality to permit interpretation and there was 97% inter-examiner subcategory agreement and 100% overall developmental trajectory (abnormal/normal) agreement. The GMA demonstrated a sensitivity of 60% and a specificity of 100% in predicting AIMS score (age appropriate or delayed). Conclusions: Clinical feasibility of GMA obtained in the NICU was demonstrated however feasibility of parents providing video samples after discharge was not demonstrated, indicating a need for a parent-friendly method.

Validation studies in forensic odontology – Part 1: Accuracy of radiographic matching

As part of a series of studies aimed at validating techniques in forensic odontology, this study aimed to validate the accuracy of ante-mortem (AM)/postmortem (PM) radiographic matching by dentists and forensic odontologists. This study used a web-based interface with 50 pairs of AM and PM radiographs from real casework, at varying degrees of difficulty. Participants were shown both radiographs as a pair and initially asked to decide if they represented the same individual using a yes/no binary choice forced-decision. Participants were asked to assess their level of confidence in their decision, and to make a conclusion using one of the ABFO (American Board of Forensic Odontology), INTERPOL (International Criminal Police Organisation) and DVISys™ (DVI System International, Plass Data Software) identification scale degrees. The mean false-positive rate using the binary choice scale was 12%. Overall accuracy was 89% using this model, however, 13% of participants scored below 80%. Only 25% of participants accurately answered yes or no >90% of the time, with no individual making the correct yes/no decision for all 50 pairs of radiographs. Non-odontologists (lay participants) scored poorly, with a mean accuracy of only 60%. Use of the graded ABFO, DVISYS and INTERPOL scales resulted in general improvements in performance, with the false-positive and false-negative rates falling to approximately 2% overall. Inter-examiner agreement in assigning scale degrees was good (ICC=0.64), however there was little correlation between confidence and both accuracy or agreement among practitioners. These results suggest that use of a non-binary scale is supported over a match/non-match call as it reduces the frequency of false positives and negatives. The use of the terms “possible” and “insufficient information” in the same scale appears to create confusion, reducing inter-examiner agreement. The lack of agreement between higher-performing and lower-performing groups suggests that there is an inconsistency in the cognitive processes used to determine similarity between radiographs.

Perception of parents and self-reports of children regarding the impact of traumatic dental injury on quality of life.

Traumatic dental injuries occur frequently among young children. The aim of this study was to evaluate the impact of traumatic dental injuries on oral health-related quality of life (OHRQoL) in preschool children using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). This study involved 769 five-year-old children enrolled at public and private preschools. Two examiners underwent a training process which involved the determination of interexaminer and intra-examiner agreement (Kappa statistic) for all clinical conditions (K>0.82). Descriptive statistics were performed, followed by Poisson regression analysis (α=5%). The prevalence of the impact of oral problems on OHRQoL was 32.9% and 42.2% according to the parents/caregivers and children, respectively. Based on the children's self-reports, the occurrence of two or more injured teeth (PR=1.30; 95% CI: 1.04-1.64), toothache (PR=1.68; 95% CI: 1.35-2.09), and a low level of parent's schooling (PR=1.54; 95% CI: 1.24-1.91) exerted impacts on OHRQoL. For the reports of parents/caregivers, the occurrence of non-complicated TDI (PR=0.66; 95% CI: 0.44-0.98), toothache (PR=8.03; 95% CI: 5.92-10.88), and a low level of parent's schooling (PR=1.60; 95% CI: 1.17-2.17) remained associated with the final model. The impact of oral problems on the OHRQoL of the preschool children was high. A greater number of injured teeth, the presence of toothache, and socioeconomic factors were associated with poorer OHRQoL, based on the reports of both the parents/caregivers and the children. The occurrence of non-complicated TDI was a protective factor for OHRQoL.

Gonioscopy in the dog: inter-examiner variability and the search for a grading scheme.

To investigate inter-examiner variability in gonioscopic evaluation of pectinate ligament abnormality in dogs and to assess level of inter-examiner agreement for four different gonioscopy grading schemes. Two examiners performed gonioscopy in 98 eyes of 49 Welsh springer spaniel dogs and estimated the percentage circumference of iridocorneal angle affected by pectinate ligament abnormality to the nearest 5%. Percentage scores assigned to each eye by the two examiners were compared. Inter-examiner agreement was assessed following assignment of the percentage scores to each of four grading schemes by Cohen's kappa statistic. There was a strong positive correlation between the results of the two examiners (R=0·91). In general, Examiner 1 scored individual eyes higher than Examiner 2, especially for eyes in which both examiners diagnosed pectinate ligament abnormality. A "good" level of agreement could only be achieved with a gonioscopy grading scheme of no more than three categories and with a relatively large intermediate bandwidth (κ=0·68). A three-tiered grading scheme might represent an improvement on hereditary eye disease schemes which simply classify dogs to be either "affected" or "unaffected" for pectinate ligament abnormality. However, the large intermediate bandwidth of this scheme would only allow for the additional detection of those dogs with marked progression of pectinate ligament abnormality which would be considered most at risk of primary closed-angle glaucoma.

Temporomandibular disorder: otologic implications and its relationship to sleep bruxism.

IntroductionTemporomandibular disorder is an umbrella term for various clinical problems affecting the muscles of mastication, temporomandibular joint and associated structures. This disorder has a multifactor etiology, with oral parafunctional habits considered an important co-factor. Among such habits, sleep bruxism is considered a causal agent involved in the initiation and/or perpetuation of temporomandibular disorder. That condition can result in pain otologic symptoms.ObjectiveThe aim of the present study was to investigate the relationship between temporomandibular disorder and both otologic symptoms and bruxism.MethodsA total of 776 individuals aged 15 years or older from urban areas in the city of Recife (Brazil) registered at Family Health Units were examined. The diagnosis of temporomandibular disorder was determined using Axis I of the Research Diagnostic Criteria for temporomandibular disorders, addressing questions concerning myofascial pain and joint problems (disk displacement, arthralgia, osteoarthritis and osteoarthrosis). Four examiners had previously undergone training and calibration exercises for the administration of the instrument. Intra-examiner and inter-examiner agreement was determined using the Kappa statistic. Individuals with a diagnosis of at least one of these conditions were classified as having temporomandibular disorder. The diagnosis of otologic symptoms and bruxism was defined using the same instrument and a clinical exam.ResultsAmong the individuals with temporomandibular disorder, 58.2% had at least one otologic symptom and 52% exhibited bruxism. Statistically significant associations were found between the disorder and both otologic symptoms and bruxism (p < 0.01 for both conditions; OR = 2.12 and 2.3 respectively). Otologic symptoms and bruxism maintained statistical significance in the binary logistic regression analysis, which demonstrated a 1.7 fold and twofold greater chance of such individuals have temporomandibular disorder, respectively.ConclusionThe logistic regression analysis demonstrated strong associations between the disorder and both otologic symptoms and bruxism when analyzed simultaneously, independently of patient age and gender.

Oral Problems and Self-Confidence in Preschool Children.

The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.

Diagnostic accuracy of phosphor plate systems and conventional radiography in the detection of simulated internal root resorption

Objective: To evaluate the performance of conventional radiography and photostimulable phosphor (PSP) plate in the detection of simulated internal root resorption (IRR) lesions in early stages.Materials and methods: Twenty single-rooted teeth were X-rayed before and after having a simulated IRR early lesion. Three imaging systems were used: Kodak InSight dental film and two PSPs digital systems, Digora Optime and VistaScan. The digital images were displayed on a 20.1″ LCD monitor using the native software of each system, and the conventional radiographs were evaluated on a masked light box. Two radiologists were asked to indicate the presence or absence of IRR and, after two weeks, all images were re-evaluated. Cohen’s kappa coefficient was calculated to assess intra- and interobserver agreement. The three imaging systems were compared using the Kruskal–Wallis test.Results: For interexaminer agreement, overall kappa values were 0.70, 0.65 and 0.70 for conventional film, Digora Optima and VistaScan, respectively. Both the conventional and digital radiography presented low sensitivity, specificity, accuracy, positive and negative predictive values with no significant difference between imaging systems (p = .0725).Conclusions: The performance of conventional and PSP was similar in the detection of simulated IRR lesions in early stages with low accuracy.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone.

Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries. To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely. The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses. The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available. The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Validity of the American Board of Orthodontics Discrepancy Index and the Peer Assessment Rating Index for comprehensive evaluation of malocclusion severity.

To assess the validity of the American Board of Orthodontics Discrepancy Index (ABO-DI) and Peer Assessment Rating (PAR) Index in evaluating malocclusion severity in Chinese orthodontic patients. A stratified random sample of 120 orthodontic patients based on Angle classification was collected from six university orthodontic centres. Sixty-nine orthodontists rated malocclusion severity on a five-point scale by assessing a full set of pre-treatment records for each case and listed reasons for their decision. Their judgement was then compared with ABO-DI and PAR scores determined by three calibrated examiners. Excellent interexaminer reliability of clinician judgement, ABO-DI and PAR index was demonstrated by the Intraclass Correlation Coefficient (rho= 0.995, 0.990 and 0.964, respectively). Both the ABO-DI and US-PAR index showed good correlation with clinician judgement (r=.700 and r=.707, respectively). There was variability among the different Angle classifications: the ABO-DI showed the highest correlation with clinician judgement in Class II patients (r=.780), whereas the US-PAR index showed the highest correlation with clinician judgement in Class III patients (r=.710). Both indices demonstrated the lowest correlations with clinician judgement in Class I patients. With strong interexaminer agreement, the panel consensus was used for validating the ABO-DI and US-PAR index for malocclusion severity. Overall, the ABO-DI and US-PAR index were reliable for measuring malocclusion severity with significantly variable weightings for different Angle classifications. Further modification of the indices for different Angle classification may be indicated.

Inter-arch digital model vs. manual cast measurements: Accuracy and reliability

Objectives: The purpose of this study was to evaluate the accuracy and reliability of inter-arch measurements using digital dental models and conventional dental casts.Methods: Thirty sets of dental casts with permanent dentition were examined. Manual measurements were done with a digital caliper directly on the dental casts, and digital measurements were made on 3D models by two independent examiners. Intra-class correlation coefficients (ICC), a paired sample t-test or Wilcoxon signed-rank test, and Bland–Altman plots were used to evaluate intra- and inter-examiner error and to determine the accuracy and reliability of the measurements.Results: The ICC values were generally good for manual and excellent for digital measurements. The Bland–Altman plots of all the measurements showed good agreement between the manual and digital methods and excellent inter-examiner agreement using the digital method.Conclusion: Inter-arch occlusal measurements on digital models are accurate and reliable and are superior to manual measurements.

Performance of cone beam computed tomography and conventional intraoral radiographs in detecting interproximal alveolar bone lesions: a study in pig mandibles

BackgroundCone beam computed tomography (CBCT) has been largely used in dentistry. Nevertheless, there is lack of evidence regarding CBCT accuracy in the diagnosis of early periodontal lesions as well as the correlation between accuracy and lesion size. The aim of this study was to evaluate accuracy of CBCT and conventional intraoral radiographs in detecting different-sized interproximal bone lesions created in pig mandibles. The hypothesis was that CBCT accuracy would be superior to radiographs in detecting incipient bone lesions.MethodsTwenty swine dry mandibles were used, totalizing 80 experimental sites. Four groups were created according to exposure time to perchloric acid 70–72%: controls (no exposure), 2-hour exposure, 4-hour exposure, and 6-hour exposure. Standardized CBCT and conventional intraoral radiographs were taken and analyzed by two trained radiologists. The presence of lesions in the dry mandible was considered the gold standard. Sensitivity, specificity, and accuracy in detecting different-sized bone lesions were calculated for CBCT and intraoral radiographs.ResultsAccuracy of CBCT ranged from 0.762 to 0.825 and accuracy of periapical radiography ranged from 0.700 to 0.813, according to examiner and time of acid exposure. Inter-examiner agreement varied from slight to fair, whereas intra-examiner agreement varied from moderate to substantial.ConclusionsCBCT performance was not superior to that provided by conventional intraoral radiographs in the detection of interproximal bone loss.

In vitro performance of near infrared light transillumination at 780-nm and digital radiography for detection of non-cavitated approximal caries

ObjectivesTo evaluate the ability of a Near Infrared Light Transillumination (NILT) device to detect non-cavitated approximal caries lesions; and to compare its performance to Digital Radiography (DR). MethodsThirty human extracted premolars (sound to lesions into the outer one-third of dentin) were selected. Lesion depth was confirmed by micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DR and NILT (CariVu™, DEXIS, LLC, Hatfield, PA, USA) examinations were performed and repeated by three trained and calibrated examiners. Sensitivity, specificity, area under ROC curve (Az), inter- and intra-class correlation coefficients (ICCs) for each method, and correlation among the methods were determined. ResultsICCs for intra-/inter-examiner agreement were substantial for NILT (0.69/0.64), and moderate for DR (0.52/0.48). Sensitivity/specificity for NILT and DR were 0.68/0.93 and 0.50/0.64, respectively. Az for NILT was 0.81, while for DR it was 0.61. Spearman correlation coefficient with μ-CT for NILT (0.65, p<0.001) demonstrated moderate association, while that of DR suggested no association (0.19, p=0.289). ConclusionWithin the limitations of this in vitro study, NILT demonstrated a potential for early approximal caries detection. NILT and DR performed the same regarding the accuracy for non-cavitated approximal caries detection; however, NILT was superior to DR in terms of repeatability, agreement and correlation with μ-CT. Clinical significanceA commercial version of NILT was recently introduced as a non-irradiative adjunctive caries detection method. It uses near infrared (NIR) light at 780-nm to transilluminate teeth and captures live images from the occlusal surface. This study demonstrates that NILT can be used as an alternative to radiography for non-cavitated approximal caries detection.

Interexaminer reliability study of a standardized myofascial diagnostic technique of the superior thoracic inlet

Regional fascial motion palpation is often incorporated by osteopathic practitioners to enable them to identify superior thoracic inlet (STI) myofascial somatic dysfunction motion patterns; however without standardized instruction, diagnostic outcomes may vary between examiners. This study proposes a protocol for diagnosing the STI motion pattern that standardizes examiner hand placement, palpatory discrimination, posture, and relative body positioning. The study design incorporated useful infrastructure recommended by the Fédération Internationale de Médecine Manuelle (FIMM) including protocol agreement steps prior to conducting the formal interexaminer reliability study with the goals of attaining >80% interexaminer agreement and kappa values >0.6 for each cardinal plane. The agreement phase comprised of testing 52 participants acquired agreements of 92.3% (rotation), 88.9% (translation), and 94.2% (sagittal). Kappa value testing involving an additional 82 participants obtained values of 0.65 (rotation), 0.59 (translation), and 0.70 (sagittal). Such kappa values endorse fair-to-excellent positive interexaminer correlations, demonstrating utility of this standardized palpatory protocol for STI myofascial dysfunctional diagnosis.

The effect of various factors on the dental arch relationship in non-syndromic unilateral cleft lip and palate children assessed by new approach: a retrospective study

BackgroundCleft lip and palate (CLP) is one of the most common birth defects. Multiple factors are believed to be responsible for an unfavorable dental arch relationship in CLP. Facial growth (maxillary) retardation, which results in class III malocclusion, is the primary challenge that CLP patients face. Phenotype factors and postnatal treatment factors influence treatment outcomes in unilateral cleft lip and palate (UCLP) children, which has led to a great diversity in protocols and surgical techniques by various cleft groups worldwide. The aim of this study was to illustrate the dental arch relationship (DAR) and palatal morphology (PM) of UCLP in Bangladeshi children and to explore the various factors that are responsible for poor DAR and PM.MethodsDental models of 84 subjects were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69 (SD 2.46) years. The DAR and PM were assessed blindly by five raters using the EUROCRAN index (EI). Kappa statistics was used to evaluate the intra- and inter-examiner agreement, chi square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR and PM.ResultsThe mean EUROCRAN scores were 2.44 and 1.93 for DAR and PM, respectively. Intra- and inter-examiner agreement was moderate to very good. Using crude and stepwise backward regression analyses, significant associations were found between the modified Millard technique (P = 0.047, P = 0.034 respectively) of cheiloplasty and unfavorable DAR. Complete UCLP (P = 0.017) was also significantly correlated with unfavorable DAR. The PM showed a significant association with the type of cleft, type of cheiloplasty and type of palatoplasty.ConclusionThis multivariate study determined that the complete type of UCLP and the modified Millard technique of cheiloplasty had significantly unfavorable effects on both the DAR and PM.

Evaluation of Pink and White Esthetic Scores for Immediately Placed and Provisionally Restored Implants in the Anterior Maxilla

To evaluate the esthetic result of immediately placed implants with immediate provisional restorations in the anterior maxilla using the pink esthetic score (PES) and white esthetic score (WES). The records of patients were evaluated retrospectively. The evaluation was carried out by two examiners using 12 evaluation criteria. The average PES value from the evaluation of 53 images obtained from the 53 selected patients (22 men and 31 women) was 8.63 ± 2.4 (range, 1-14), whereas the average WES value was 6.92 ± 1.67 (range, 2-10). The mesial papilla had the highest average PES (1.39 ± 0.4) and the distal papilla had the lowest PES (0.87 ± 0.54). Texture had the highest average WES (1.54 ± 0.34) and tooth shape had the lowest average WES (1.25 ± 0.43). Treatment with immediate implants providing immediate provisional restoration in the anterior maxilla yields good clinical esthetic outcomes, as assessed by PES/WES values. The PES and WES values showed strong intraexaminer agreement, but weak interexaminer agreement.

Detection of Apical Root Cracks Using Spectral Domain and Swept-source Optical Coherence Tomography

IntroductionThis study aimed to evaluate the ability of 2 optical coherence tomographic (OCT) systems to detect apical dentinal microcracks. MethodsTwenty extracted human single-rooted mandibular incisors were selected. After root canal preparation with an R40 Reciproc file (VDW, Munich, Germany), the specimens presenting apical microcracks were identified using micro–computed tomographic (micro-CT) scanning as the gold standard. Then, the apical portions of the roots were imaged with spectral domain OCT (SD-OCT) and swept-source OCT systems, and the resulting images were blindly evaluated by 3 independent examiners to detect microcracks. The diagnostic performance of each OCT device was calculated, and statistical analysis was performed. ResultsBased on the micro-CT images, 12 (60%) roots presented dentinal microcracks in the apical region. The images generated by the OCT systems were able to show microcrack lines at the same location as the corresponding micro-CT cross sections. Although the diagnostic performance of the SD-OCT device was superior, there were no statistically significant differences between the 2 OCT devices (P > .05). Interexaminer agreement was substantial to almost perfect for the SD-OCT system and moderate to almost perfect for the swept-source OCT system, whereas intraexaminer agreement was substantial to almost perfect for both OCT devices. ConclusionsThe detection ability verified for both OCT systems renders them promising tools for the diagnosis of apical microcracks.

Comparison of clinical values between cone beam computed tomography and conventional intraoral radiography in periodontal and infrabony defect assessment

The use of CBCT for periodontal diagnosis and treatment plan is limited. The aim of this study is to compare the assessment of periodontal conditions and infrabony defects between conventional intraoral radiography (IOR) and CBCT. The study included 25 subjects who had periodontitis and at least two infrabony defects. All subjects received clinical periodontal examination, IOR and CBCT. Three periodontists assigned periodontal diagnosis and prognosis of each tooth. For teeth with infrabony defects, the number of defect walls and treatment was determined. IOR and CBCT assessment was compared. There were 666 teeth and 123 infrabony defects. The overall concordance between IOR and CBCT for periodontal diagnosis, prognosis, infrabony defect type and infrabony defect treatment were 79.3%, 69.5%, 44.7% and 64.2%, respectively. IOR underestimated diagnosis, prognosis and the number of infrabony defect walls at 16.4%, 24% and 37.4%, respectively. IOR and CBCT had poor concordance for periodontal regeneration (43.3%). Tooth extraction was more prevalent when assessed by CBCT (35.0% vs 22.7%). CBCT had excellent interexaminer agreement (Fleiss' kappa 0.87-0.94) and higher percentage of complete agreement among examiners than IOR for all assessments. IOR underestimated the severity and prognosis of periodontal disease. CBCT was superior to IOR for evaluation of infrabony defect morphology and treatment. CBCT provides excellent agreement among examiners on periodontal and infrabony defect assessment.

Incidence of Dentinal Defects on the External Apical Root Surface after Instrumentation with WaveOne Reciprocating Files at Different Working Lengths

IntroductionThe aim of this in vitro study was to identify the formation of dentinal defects on the external apical root surface of teeth instrumented at different working lengths by using WaveOne reciprocating files. MethodsSixty human single-rooted mandibular premolars were divided into 3 groups (n = 20) according to the file used for instrumentation: WaveOne Small (WOS), premolars presenting mechanical resistance to the penetration of #10 K-file 1 mm short of the apical foramen; WaveOne Primary (WOP), this limit easily reached with #10 K-file; and WaveOne Large (WOL), this limit easily reached with #20 K-file or higher. A closed system and a muffle were created to allow alternating sessions of root canal instrumentation and image acquisition. The teeth were further divided according to 3 different working lengths: 1 mm short of the apical foramen, flush with the apical foramen, and 1 mm beyond the apical foramen. Micrographs of the external apical root surface of each specimen at baseline and after instrumentation up to each working length were examined for the presence of dentinal defects. Inter-examiner agreement was evaluated by using Pearson correlation test, and the Kruskal-Wallis test was used to analyze intragroup and intergroup differences (P < .05). ResultsInter-examiner agreement was high in all experimental groups (r = 1.0000, r = 0.8885, and r = 0.7867 for WOS, WOP, and WOL, respectively). There was no significant difference in the number of teeth with dentinal defects in the intergroup (P = .8119) or intragroup analyses (P = .9309, .8648, and .4772 for WOS, WOP, and WOL, respectively). ConclusionsInstrumentation with different WaveOne files up to different working lengths was not associated with the formation of dentinal defects.

Is a Basic Erosive Wear Examination (BEWE) reliable for recording erosive tooth wear on 3D models?

ObjectivesTo assess the reliability of the BEWE index on 3D models and to compare 3D-assessed erosive tooth wear scores with clinically detected scores. MethodsIn total, 1964 members of the Northern Finland Birth Cohort 1966 participated in a standardized clinical dental examination including the Basic Erosive Wear Examination (BEWE) and dental 3D modelling at the age of 45–46 years. Of those examined, 586 were randomly selected for this study. 3D models were assessed using the same BEWE criteria as in the clinical examination. Calculated kappa values as well as the prevalence and severity of erosive wear according to the clinical examination and 3D models were compared. Re-examinations were performed to calculate intra- and inter-method and −examiner agreements. ResultsThe BEWE index on 3D models was reproducible; the mean intra- and inter-examiner agreement were 0.89 and 0.87, respectively, for sextant level, and 0.64 and 1, respectively, for BEWE sum scores. Erosive tooth wear was recorded as more severe in 3D models than in the clinical examination, and inter-method agreement was 0.41 for severe erosive wear (BEWE sum>8). The biggest inter-method differences were found in upper posterior sextants. ConclusionsThe BEWE index is reliable for recording erosive tooth wear on 3D models. 3D models seem to be especially sensitive in detecting initial erosive wear. Additionally, it seems that erosive wear may be underscored in the upper posterior sextants when assessed clinically. Due to the nature of 3D models, the assessment of erosive wear clinically and on 3D models may not be entirely comparable. Clinical significance3D models can serve as an additional tool to detect and document erosive wear, especially during the early stages of the condition and in assessing the progression of wear. When scoring erosive wear clinically, care must be taken especially when assessing upper posterior sextants.