Intra-examiner Reproducibility Research Articles

Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth.

IntroductionAlthough selective caries tissue removal decreases the number and diversity of bacteria, stops the caries process, and reduces the risk of pulp exposure, the studies on the minimally removal of caries tissue are limited and further clinical research is necessary in this field.AimThis study aimed to evaluate through clinical and radiographic assessments the in vivo response of the dentin-pulp complex of human deciduous teeth after either partial or total caries removal (TCR).Materials and methodsA total of 49 deciduous molars of children aged between 5 and 9 years were carefully selected. The teeth were divided into two groups: Group I: Partial removal of caries; group II: Total removal of caries. Clinical and radiographic evaluations were performed during the period of 4 to 6 months after the procedure. The intraexam-iner reproducibility was determined by Kappa test. Fisher’s exact test was used to determine the statistical difference between groups.ResultsAll teeth showed clinical success during the 4- to 6-month evaluation period. The radiographic evaluation showed 94.2 and 89.6% of success rate in groups I and II respectively. Radiographic results did not show statistically significant differences between the studied groups (p > 0.05).ConclusionThe partial caries removal (PCR) showed satisfactory clinical and radiographic outcomes, suggesting that this minimally invasive approach might replace the TCR when correctly indicated.How to cite this article: Mello B, Stafuzza TC, Vitor L, Rios D, Silva T, Machado M, Oliveira TM. Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clin Pediatr Dent 2018;11(3):188-192.

Evaluation of the relationship between sleep bruxism and pulpal calcifications in young women: A clinico-radiological study.

PurposeThis study was performed to investigate the relationship between sleep bruxism (SB) and pulpal calcifications in young women.Materials and MethodsA total of 100 female participants between 20 and 31 years of age who were referred to our radiology clinic for a dental check-up, including 59 SB and 41 non-SB patients, were sampled for the analysis. SB was diagnosed based on the American Academy of Sleep Medicine criteria. All teeth were evaluated on digital panoramic radiographs to detect pulpal calcifications, except third molars, teeth with root canal treatment, and teeth with root resorption. Binary logistic regression analysis was used to determine the risk factors for pulpal calcifications. The Spearman correlation coefficient was applied and the Pearson chi-square test was used for categorical variables. To test intra-examiner reproducibility, Cohen kappa analysis was applied. P values <.05 were considered to indicate statistical significance.ResultsA total of 2800 teeth were evaluated (1652 teeth from SB patients and 1148 from non-SB patients), and 61% of patients had at least 1 dental pulpal calcification. No statistically significant relationship was found between SB and pulpal calcifications (P>0.05). In SB patients, the total number of pulpal calcifications was 129, while in non-SB patients, it was 84. Binary logistic analysis showed that SB was not a risk factor for the presence of pulpal calcifications (odds ratio, 1.19; 95% CI, 0.52–2.69, P>.05).ConclusionNo relationship was found between SB and pulpal calcifications.

Use of artificial primary teeth for endodontic laboratory research: experiments related to canal length determination

BackgroundDue to the scarcity of exfoliated/extracted human primary teeth with complete roots, artificial teeth were developed as an alternative to be used for educational and laboratory research purposes. This study aimed to assess the feasibility of using artificial primary teeth for conducting laboratory research through an experiment related to canal length determination, comparing artificial teeth with natural teeth.MethodsThirty anterior and 21 posterior artificial teeth, and the same number of natural primary teeth were selected. After preparing the access cavity, the root canal length was determined by two examiners twice using three different methods: radiography and two electronic apex locators. Then, the actual root canal length was measured by inserting a K-file up to the apical foramen (reference standard). Accuracy was calculated using Bland-Altman analysis and intraclass correlation coefficient (ICC). The inter- and intra-examiner reproducibility was also calculated using the ICC.ResultsThe methods using the electronic apex locators showed better accuracy in both artificial and natural teeth. Trends observed with artificial primary teeth were similar to those observed with natural teeth, except for the results in artificial anterior teeth.ConclusionsThe model of artificial teeth might be a good alternative for educational purposes; however, improvements are necessary to employ these teeth for research purposes when considering experiments for canal length determination.

Reproducibility of a New Computerized Planimetric Method for the Measurement and Assessment of Removable Dental Prostheses Plaque.

The aim of this study was to evaluate the reliability and agreement of a new computerized planimetric method (CPM) for the measurement and assessment of plaque on all types of removable dental prostheses (RDPs). From a database containing 780 images taken following a standardized method for 65 RDPs, 55 images were randomly selected for image analysis. Adobe Photoshop software was used according to standard operating procedure (SOP) by one main examiner two times in different sessions, and one time by three additional examiners. To estimate the intra- and interexaminer reliability, intraclass correlation coefficient ICC(2,1) were used. Three parameters were used to estimate agreement: standard error of measurement (SEM), smallest detectable change at the 95% confidence level (SDC95%), and limits of agreement (LoA) according to the Bland-Altman method. In all steps of the image analysis, both intra- and interexaminer reliability were excellent, with ICC(2,1) values > 0.85 at the 95% confidence level. The intra- and interexaminer values for both the SEMagreement and SDC95% were ≤ 6% and ≤ 17%, respectively. The Bland-Altman analysis revealed a satisfactory level of agreement. This study shows excellent inter- and intraexaminer reproducibility, a satisfactory level of examiner agreement, and acceptable measurement error. Furthermore, the method can be used with all types of RDPs. The CPM is more suitable for clinical research because of its objectivity, reliability, high level of standardization, and ability to detect and quantify small changes in plaque.

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Pit and fissure caries presents diagnostic challenges due to its anatomical complexity and fluoride exposure. ICDAS II is a coding system for caries detection using clinical visual inspection. It identifies carious lesions by the change in colour, texture and surface integrity. Magnification might facilitate better detection of the lesions by enhancing the visual acuity. Thus, the objective of this study is to compare the reliability and validity of ICDAS II in detection of occlusal caries, with and without magnification, by using histological standard&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This single blinded, randomized study included 334 unrestored extracted human premolars and molars. Two examiners independently scored pit and fissure caries status using ICDAS II criteria without magnification and later under 6 x magnification using surgical microscope. The samples were sectioned and lesions were scored using the ERK histological criteria, under Stereo microscope. The scores of the examiners were correlated with the histological scoring. Kappa statistics and Spearman correlation coefficients were performed. Optimal sensitivity, specificity of visual and enhanced visual examination was calculated by Receiver Operating Characteristic Curve (ROC). Likelihood ratios (LR) were also calculated. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The kappa values for Inter examiner reproducibility of visual and enhanced visual examination under microscope were 0.638-0.694 and for histological examination it was 0.979. Intra examiner reproducibility for visual and enhanced visual examination was 0.665 – 0.594. There was a strong relationship between visual, enhanced visual and histological examinations. Spearman’s correlation coefficient of ICDAS-II visual and enhanced visual examination for each examiner, to ERK histological scores was 0.869-0.848. The sensitivity and LR+ for visual and enhanced visual examination was decreased as the ICDAS score was increased and specificity and LR- increased with increased ICDAS score&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Reliability and validity of ICDAS scoring in detecting occlusal caries under magnification did not differ from clinical visual inspection&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;

Mesial and distal alveolar bone morphology in maxillary canines moved into the grafted alveolar cleft: Computed tomography evaluation.

The aims of this study were to qualitatively assess the mesial and distal alveolar bone of maxillary canines mesially moved to replace absent lateral incisors in patients with unilateral cleft lip and palate after secondary alveolar bone graft and to assess the reproducibility of the proposed cone-beam computed tomography (CBCT) method. The sample comprised CBCT examinations of 30 patients with unilateral cleft lip and palate from 1 center. CBCT images were taken at least 6months after comprehensive orthodontic treatment. The noncleft side was used as the control group. Using axial sections, scores from 0 to 4 (bone absence to complete bone filling, respectively) were given to the mesial and distal alveolar bones of the maxillary canines. Interexaminer and intraexaminer reproducibility was assessed using kappa statistics. Intergroup comparisons were performed using Wilcoxon tests. Interexaminer and intraexaminer agreement was excellent. Intergroup comparison identified smaller scores at the cervical and middle root levels of the cleft side mesial alveolar bone of the maxillary canines. At the cleft side, 85 mesial sites showed favorable scores (3 or 4); 1 had a score of 1, and 4 had scores of 2. At the distal surface, 78 sites were evaluated, and only 1 site received a score of 1. The noncleft side had scores of 4 for all sites. The new CBCT scale showed good reproducibility. CBCT axial sections are reliable for a qualitative appraisal of alveolar bone in a grafted alveolar cleft. Mesial bone defects can be observed in maxillary canines moved into grafted areas after comprehensive orthodontic treatment, especially at the cervical root half.

Intrasession repeatability of pachymetry measurements with RTVue XR 100 optical coherence tomography in normal cornea

PurposeTo assess intra-observer reproducibility and repeatability of corneal pachymetry measurements with RTVue XR-100 anterior segment optical coherence tomography (AS-OCT) in normal cornea. MethodsEighty-four eyes of 84 healthy volunteers were enrolled for this study. A single examiner performed 3 successive corneal pachymetry mappings with RTVue XR-100 AS -OCT in a single session. One eye was randomly selected for the analysis. Intrasession intraexaminer reproducibility and repeatability were calculated for the minimum corneal thickness (MCT), central corneal thickness (CCT, central 0–2mm), pericentral (2–5mm) and peripheral (5–6mm) annular zones of cornea, in the pachymetry mapping protocol by intraclass correlation coefficient (ICC), coefficient of variation and test retest variability. ResultsThe mean CCT was 497.08±32.83µm and MCT was 490.28±32.87µm. ICC was 0.994 for CCT and 0.983 for MCT in central 2mm zone. ICC in the pericentral 2–5mm zones and 5–6mm zone was lower than that in central 2mm zone, but were still over 0.961 in 2–5mm zone and had ICC of 0.85 in 5–6mm zone. ConclusionIn normal cornea, corneal thickness measurements produced highly repeatable pachymetry measurements at the central and paracentral zones (up to 6-mm diameter) which could be because of the high resolution and faster image acquisition with RTVue XR-100 OCT.

Diagnostic validity of ICDAS and DIAGNOdent combined: an in vitro study in pre-cavitated lesions.

In a continuous process such as caries, it is important to possess criteria or instruments that allow the lesions to be diagnosed at early stages so that preventive or interceptive treatments can be applied before cavitation takes place. The present study seeks to assess the diagnostic efficacy of the International Caries Detection and Assessment System (ICDAS II) criteria and the DIAGNOdent laser fluorescence (LF) pen in occlusal caries lesions, using histological sections as the gold standard. Sixty-four permanent teeth were examined by two researchers who previously performed and calibrated both the ICDAS II criteria and the use of DIAGNOdent pen. The teeth were then cut into sections and observed under an optical microscope. The sensitivity values were 0.82 (ICDAS II) and 0.85 (LF). The specificity values were 1.00 (ICDAS II) and 0.53 (LF). The intraexaminer reproducibility was 0.892 for ICDAS II and 0.912 for the DIAGNOdent, so it was high for both diagnostic methods. However, the DIAGNOdent pen showed greater sensitivity and the ICDAS criteria more specificity. It was concluded that both methods are efficacious individually but combining the two is recommended to improve the diagnosis.

Three-Dimensional Assessment of Temporomandibular Joint Using MRI-CBCT Image Registration

PurposeTo introduce a new approach to reconstruct a 3D model of the TMJ using magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) registered images, and to evaluate the intra-examiner reproducibility values of reconstructing the 3D models of the TMJ.MethodsMRI and CBCT images of five patients (10 TMJs) were obtained. Multiple MRIs and CBCT images were registered using a mutual information based algorithm. The articular disc, condylar head and glenoid fossa were segmented at two different occasions, at least one-week apart, by one investigator, and 3D models were reconstructed. Differences between the segmentation at two occasions were automatically measured using the surface contours (Average Perpendicular Distance) and the volume overlap (Dice Similarity Index) of the 3D models. Descriptive analysis of the changes at 2 occasions, including means and standard deviation (SD) were reported to describe the intra-examiner reproducibility.ResultsThe automatic segmentation of the condyle revealed maximum distance change of 1.9±0.93 mm, similarity index of 98% and root mean squared distance of 0.1±0.08 mm, and the glenoid fossa revealed maximum distance change of 2±0.52 mm, similarity index of 96% and root mean squared distance of 0.2±0.04 mm. The manual segmentation of the articular disc revealed maximum distance change of 3.6±0.32 mm, similarity index of 80% and root mean squared distance of 0.3±0.1 mm.ConclusionThe MRI-CBCT registration provides a reliable tool to reconstruct 3D models of the TMJ’s soft and hard tissues, allows quantification of the articular disc morphology and position changes with associated differences of the condylar head and glenoid fossa, and facilitates measuring tissue changes over time.

Reproducibility and Normative Values of the Parameters of a New Hand-Held Digital Pupillometer

We evaluated the intra-examiner reproducibility and determined the standard values of pupil parameters using the PLR-3000 pupillometer (NeurOptics Inc). Generally good reproducibility was obtained, except for the T75 parameter. The standard values may be useful to distinguish various neurological abnormalities in clinical practice.

Performance in vitro of apex locators in determining root length in primary molars

ABSTRACT Objective: The aim of the study was to evaluate performance of digital radiographic and two electronic apex locators, Propex II and Root ZX in root canal length determination in primary molars. Methods: 25 primary molars were divided into two groups, G1 without root resorption and G2 with root resorption. The exams were performed using all methods by two experienced examiners, with 1-week interval. The gold standard was determined by visual examination. The methods were statistically analyzed regarding the values of reproducibility and correlated with the gold standard by Pearson´s correlation coefficient. Results: The root canal length determination coincided with gold standard in 22.7% for Root ZX, 17.5% for Propex II and 12.5% for digital radiography. Correlation values were higher in G1, the Root ZX presented the highest values. In G2 the digital radiography showed the lowest correlation. In G1, the intra-examiner reproducibility values ranged from 0.925 to 0.523, and interexaminer 0.863 to 0.670. In G2, the values of intra-examiner reproducibility ranges from 0.864 to 0.097, and inter was 0.774 to 0.379. Conclusion: It was concluded that the methods performance varying according to examiner's experience. The Root ZX presented the highest reproducibility and accuracy.

Development of the portuguese version of the instrument for assessing hygiene - HI23

Hand hygiene is part of standard precautions and it has been emphasized that education of this practice depends on the individual’s experience in general hygiene. The Hygiene Inventory (HI-23) assess the domains General Hygiene, in the fields of Hands, Personal, Household and Food. Aim: To make the transcultural adaptation of the HI-23 scale for Portuguese–Brazil and to investigate and describe the hygiene behavior according to the HI-23 scale among dental students. Material and Methods: The cross-cultural adaptation process consisted in five steps: two translations, two back translations, review committee, pre-test with a population sample, and reproducibility and reliability of the instrument adapted. For the intra-examiner reproducibility it was applied kappa statistics. The statistical Cronbach's alpha verified the reliability of the HI-23 scale adapted to Portuguese. The adapted instrument was applied to 292 students of Dentistry from 1st to 5th year of graduation from a Faculty of Dentistry. Results: There was good reproducibility (0.43≥k≥0.81) and good internal consistency (Cronbach's alpha=0.75) for the questions of the questionnaire. The adapted instrument applied among academics, showed that students have good and adequate hygiene pattern for most questions, except for the hygiene in the preparation of food and utensils used to prepare them, in the time spent washing hands, and cleanliness regarding the exchange of clothing (pants/skirt). Conclusion: The transcultural adaptation of the instrument for the Brazilian version was successfully obtained. The instrument can be safely applied to measure the profile of hygiene among professional of the health area.

Variables affecting the inter- and intra-examiner reliability of ICDAS for occlusal caries diagnosis in permanent molars.

The aims of this study were to assess the validity and reproducibility of the International Caries Detection and Assessment System (ICDAS) in detecting occlusal caries in permanent molars and to investigate variables that can affect the reproducibility of ICDAS. Five experienced, trained, and calibrated investigators examined the occlusal surfaces of 142 extracted permanent molars, ranging from sound to cavitated dentine caries. All visual examinations were conducted under standard conditions. Examinations were repeated after a period of 1 and 3 months from the initial examination. After all examinations were completed, teeth were sectioned and histologic validation was undertaken. Maximum kappa statistics were used to assess bias among examiners and linear weighted kappa was used to assess inter- and intra-examiners' reproducibility. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve were obtained at D3 threshold. Differences in the marginal homogeneity were observed for the general dentist. Kappa for intra-examiner reproducibility ranged between 0.66 and 0.81 and the inter-examiner reproducibility ranged between 0.42 and 0.75. ICDAS score of ≥3 presented the best Spearman's correlation coefficient (0.69) at Downer's histologic classification D3. Corresponding sensitivity and specificity values at that level were 0.73 and 0.95, respectively. While variables like the interval of time between teeth examinations did not affect the intra-examiner reproducibility, examiners' specialty influenced inter-examiner's reproducibility over time. ICDAS presented acceptable intra-examiners reproducibility in detecting occlusal caries over time. However, there was a clear effect for examiner's specialty and clinical experience on the inter-examiner's reproducibility of the ICDAS system at different time intervals.

Lateral facial profile may reveal the risk for sleep disordered breathing in children—The PANIC-study

Objective. To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. Materials and methods. The present study sample consisted of 382 children 6–8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. Results. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000–0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951–0.992. Conclusion. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students.

BackgroundThe aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants—38 dental students and 38 pediatric dentistry students—in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course.ResultsA single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975–0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001).ConclusionsThe e-learning strategy has the potential of improving students’ knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire.

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP).ObjectiveTo test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents.Material and MethodsDiagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics.ResultsThe sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840).ConclusionsThe Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

Tooth size discrepancies in Class II division 1 and Class III malocclusion requiring surgical–orthodontic or orthodontic treatment

To compare mean anterior (AR) and mean overall (OR) tooth size ratios, prevalence of clinically significant tooth size discrepancies (TSDs) and correlation between AR and OR in subjects with Class II division 1 and Class III malocclusion treated by surgical-orthodontic or orthodontic means. Retrospective, cross-sectional. State-funded and private clinics. From pre-treatment cohorts of 770 surgical and 610 non-surgical subjects, Class II division 1 and Class III malocclusion groups were identified with 60 surgical and 60 non-surgical subjects, comprising 30 males and 30 females, in each. AR and OR were calculated by landmarking digital models. Differences in AR and OR and their relationship were analysed using two-way analysis of variance (ANOVA) and a correlation coefficient, respectively. The proportions of the surgical and non-surgical groups with a TSD were assessed using logistic regression. Intra-examiner reproducibility involved re-landmarking 30 randomly selected image sets and differences in ARs and ORs were compared using a paired t-test. Random error was assessed using the intraclass correlation coefficient (ICC). Analyses were performed using SAS (SAS Institute Inc., Cary, NC, USA) at the 5% level of significance. There were no statistically significant differences associated with the measurement of either the mean AR (P = 0·913) or the mean OR (P = 0·874). ICC values were very high (AR = 0·95; OR = 0·90). Differences existed between both Class II and Class III surgical (AR: P<0·001; OR: P<0·001) and non-surgical groups (AR: P = 0·012; OR: P = 0·003). The AR and OR relationship was strong (correlation coefficient = 0·72). The highest percentage of clinically significant TSDs was seen in the AR of both Class II and Class III surgical groups (23·3%). In the cohort examined: AR and OR differed significantly for malocclusion groups. The prevalence of clinically significant TSDs did not differ significantly between surgical and non-surgical groups although the highest percentage of clinically significant TSDs was recorded for AR in Class II and Class III surgical cases. AR and OR were closely related.

Cone beam computed tomography in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate

To quantify the treatment outcome of secondary alveolar bone grafting (SABG) in individuals with unilateral cleft lip and palate using cone beam computed tomography (CBCT) and to reveal needs for improvement in surgical technique. CBCT images taken 6 months after SABG of 35 patients were analysed. Vertical and horizontal bone supports of the grafted bone at three levels of the roots of the adjacent teeth were classified, the height of the nasal floor was compared with the unaffected side, and the inter- and intraexaminer reproducibility of these evaluations was assessed. The grafted bone filled the defect in all three vertical measurement levels in 34 per cent. The labiopalatal thickness of the grafted bone was good in at least one-third of the root length in 66 per cent and fair in 34 per cent. Typically, the bone graft was deficient in the apical and palatal direction. Clear asymmetry in the nasal floor was found in 72 per cent. Kappa values indicated excellent agreement for all but one measured parameter. This is a preliminary study involving only a limited number of study subjects. Our results showed mainly a good or fair treatment outcome. Deficiency of the bone graft was observed mostly in the apical and palatal areas of the defect. Asymmetry of the nasal floor was observed frequently. Careful insertion of the bone graft towards the palatal and apical direction of the cleft is recommended.

Reproducibility of horizontal extraocular muscle insertion distance in anterior segment optical coherence tomography and the effect of head position

To investigate the reproducibility of horizontal extraocular muscle insertion distance measurements in anterior segment optical coherence tomography (AS-OCT) and to evaluate the effect of eye position on the measurement. The right eyes of 30 healthy young subjects underwent AS-OCT. Varying eye positions were used and the muscle insertion distance was measured by two independent examiners who each measured the insertion distance twice. The measurement was performed for the lateral rectus and medial rectus muscles with the eye rotated 40°, 50°, and 60° to the midline of the instrument. Reproducibility was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman plot. The lateral rectus insertion distance was smallest with 50° rotation and the medial rectus insertion distance did not show a consistent pattern in regards to gaze position. The differences in insertion distance between different eye positions were not statistically significant for both muscles. The inter- and intraexaminer ICC reproducibility values were excellent for both lateral and medial rectus insertion distance measurements. Inter- and intraexaminer reproducibility were excellent for lateral and medial rectus muscle insertion distance measurements using AS-OCT. The measurements tended to be smallest with the 50° position in lateral rectus measurement; however, medial rectus measurements were variable.

Laboratory testes with quality data in dentistry.

In laboratory tests, just following the manufacturer’s instructions of materials or equipments may not be enough to obtain reliable data. Thus, intra and inter-examiners studies may be required. The aim of this study was to illustrate the application of the Intraclass Correlation Coefficient (r) in a study related to the color changing and hardness of composite resin conducted by two examiners. The color and hardness of 10 specimens of composite resin were evaluated by a colorimetric spectrophotometer and hardness tester, respectively, at two different times. Two trained examiners performed two measurements with an interval of one week. Specimens were stored in artificial saliva at 37±1ºC for 7 days. The Intraclass Correlation was used for analysis of intra and inter-examiner reproducibility. The intra-examiner reproducibility was 0.79, 0.44 and 0.76 for L, a and b color coordinates for the examiner 1 and 0.84, 0.23, 0.21 for examiner 2. For hardness, r-values were 0.00 and 0.23 for the examiner 1 and 2, respectively, showing unsatisfactory agreement on color and hardness evaluation for both examiners. It was noted that only the observation of protocol for use of equipment and examiners training were not sufficient to collect reliable information. Thus, adjustments in the experimental protocol were made and devices were produced to standardize the measurements. The reproducibility study was performed again. For examiner 1, values as 0.90, 0.59 and 0.79 were verified for L, a and b coordinates and, for examiner 2 were obtained values of 0.90, 0.75, 0.95. In relation to hardness, r-values of 0.75 and 0.71 were obtained for examiners 1 and 2, respectively. The inter-examiner reproducibility was 0.86, 0.87, 0.91 for L, a and b coordinates and 0.79 for hardness. It was concluded that intra and inter-examiner calibration is essential for obtaining quality measurements in laboratory tests.