Intra-examiner Reliability Research Articles

Is there a relationship of nasal septum deviation with pharyngeal airway dimension and craniocervical posture?

ABSTRACT Objective This study aimed to evaluate the effects of nasal septum deviation on the pharyngeal airway and craniocervical posture measurements using cone beam computed tomography (CBCT). Methods This retrospective study analyzed the CBCTs of 25 patients with and without nasal septum deviation. Various parameters defining the pharyngeal airway and craniocervical and facial skeletal morphology were measured and compared between the groups after confirming intra-examiner reliability. Results Compared to the control group, the group with nasal septum deviation had a statistically significantly shorter nasopharyngeal length (p < 0.001), longer vertical airway length (p < 0.002), and larger cervical column curvature angle (p < 0.006). Conclusion Children with a nasal septum deviation of 4 mm or more on their CBCT scan are susceptible to unfavorable pharyngeal airway and craniocervical postural changes.

Test-retest reliability of isometric and isokinetic wrist strength

BackgroundThe isokinetic dynamometer has been considered the gold-standard measurement of muscle performance. However, the reliability for the isometric and isokinetic wrist flexor and extensor strength using the Biodex isokinetic dynamometer has not been reported to date. This study evaluated test-retest reliability of isometric and isokinetic wrist strength using the Biodex System 3 isokinetic dynamometer. MethodsThis is a test-retest reliability study. Peak concentric and isometric torque was determined of the dominant limb wrist flexor and extensor of healthy individuals using the Biodex Multi-Joint System 3 dynamometer. The participants were evaluated by the same examiner in two different sessions separated by an interval of two to seven days. Reliability was investigated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimum detectable difference (MDD). ResultsTwenty healthy subjects participated in the study. The ICCs for concentric and isometric torque of the wrist flexor and extensor ranged from 0.79 to 0.91, revealing excellent intra-examiner test-retest reliability; SEM ranging from 0.4 to 1.5; and MDD ranged from 1.12 Nm to 4.17 Nm. ConclusionsExcellent intra-examiner test-retest reliability was found regarding peak concentric toque of the wrist flexor and extensor at an angular velocity of 45°/s as well as isometric torque of the wrist flexor and extensor in healthy individuals measured using the Biodex System 3 isokinetic dynamometer.

Intraoral scanner featuring transillumination for proximal caries detection. An in vitro validation study on permanent posterior teeth

ObjectivesTo assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam). MethodsNinety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N1=158). Histological assessment was used as the reference standard. ResultsAll methods showed excellent intra-examiner reliability (κintra ≥0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (κinter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30). ConclusionsThe intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages. Clinical significanceConsidering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.

Accuracy of linear measurements performed with two different software in cone-beam computed tomography scans of dry human mandibles

Objectives: The present study aimed to assess the accuracy of linear measurements performed with two different CBCT software .(Romexis® software and ONDEMAND 3 D software). Methods: The sample consisted of 15 human mandibles marked with radiopaque markers of gutta-percha balls (size 80, 1.5 mm long) which were glued on the marked anatomical landmarks with cyanoacrylate gel, ten linear measurements were conducted on the dry mandibles using digital caliper to provide gold standard meaurments.The mandibles were scanned by using Planmeca ProMax 3D Mid and images exported into digital imaging and communication in medicine (DICOM) format to a DVD then imported in to two software programs.The same ten linear measurements were conducted on the scanned images by using measure length tool of both romexis and Ondemand software programs. Results: Intra-examiner reliability of gold standard and image measurements were found to be excellent, Inter-examiner reliability of physical and Romexis® software was found to be excellent (ICC>0.9) and the Inter-examiner reliability of physical and ONDEMAND 3 D software was found to be poor (ICC <0.5) Conclusions: Romexis® software is more reliable method for planning surgical procedure in the dental practice than ONDEMAND 3 D software. Keywords: Linear measurements, CBCT, dry mandible and software programs.

Clinical and Radiographical Measurements of Supraeruption and Occlusal Interferences in Unopposed Posterior Teeth

This study compared the supraeruption of teeth for study casts (SCs) and panoramic radiographs (PRs) and its relation to tooth type, arch, facial sides, presence of occlusal interferences, and type of tooth movements. A total of 65 patients with their SCs and PRs were recruited. Supraerupted tooth type, arches, sides involved, and the presence of occlusal interferences were recorded. The SCs for supraerupted teeth were photographed, and supraeruption from PRs was recorded from the patients' files. The values were transferred to a software program and assessed. The highest frequency was observed among the younger-age group and molars in both arches. Working side (WS) and retruded cuspal position (RCP) interferences were recorded the highest. Supraeruption values of 0.7-1.2 mm accounted for 47.5% (38) of the total. Tilting and tipping of teeth were the highest, followed by buccolingual displacement. Kappa tests showed good intraexaminer reliability and Bland-Altman plot showed 95% confidence interval band. No significant differences were observed in the supraeruption values between the type of tooth among different subgroups of SCs and PRs. Significant differences were recorded between the types and sites of teeth, with a higher ratio observed in molar teeth, mandibular arch, and young age group. RCP and WS were the most recorded occlusal interferences and buccolingual displacement, and tilting and tipping were the most noticeable occlusal tooth movements. Diagnosis and measurements of supraeruption are essential, useful, and significant steps before treatments for replacement of missing tooth/teeth as well as corrections of occlusal interferences during different mandibular movements.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes.

Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA). One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores. The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01. The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

Three-dimensional volumetric evaluation of dental pulp cavity/tooth ratio in anterior open bite malocclusion using cone beam computed tomography.

To assess and compare pulp cavity/tooth volume ratio of maxillary permanent teeth between patients exhibiting anterior open bite malocclusion and those exhibiting anterior normal overbite using cone beam computed tomography (CBCT). 3D dental images from 44 patients aged between 15 and 29years were analyzed. The DICOM files of all dental images were imported into an image processing software for calculating pulp cavity volume and tooth volume. Differences of pulp cavity volume, tooth volume, and pulp cavity/tooth volume ratio of each tooth type from both types of occlusions were analyzed using the independent t test. The intra-class correlation coefficient was used to evaluate intra-examiner reliability. The means of pulp cavity/tooth volume ratio in anterior open bite group were significantly greater than those in anterior normal overbite group (central incisor p = 0.001; lateral incisor p = 0.00025 and canine p = 0.004). The means of root canal/root volume ratio in anterior open bite group were significantly greater than anterior normal overbite group (central incisor p = 0.00001; lateral incisor p = 0.00007; and canine p = 0.001), whereas there were no significant differences of the means of pulp chamber/crown volume was observed. Anterior open bite malocclusion might lead to an increase of the pulp cavity volume and decrease of the tooth volume due to occlusal hypofunction. Orthodontic force should be carefully determined in anterior open bite patient due to the greater root canal volume and lesser root volume.

Are social stories beneficial for oral health promotion in preschool children with special healthcare needs?

Design A 24-month randomised, two-armed, double-blinded, parallel controlled trial.Methods Participants were recruited from educational centres for children with special healthcare needs (SHCN) aged 2-6 years. Out of the 37 special needs schools in Hong Kong, 19 were randomly selected, of which 16 met the inclusion criteria. Further exclusions occurred if the child was absent, no consent was signed or if they did not meet the inclusion criteria. All participants received standardised tooth brushing instructions. The test group were given validated social stories, while the control group utilised standard leaflets issued by the Department of Health. The resources were used both in education centre sessions in three phases and at home by parents. The oral health-related behaviours were assessed before and after interventions as well as dmft index. Caries was assessed via dmft at baseline and phase 3 (at 24 months). The severity of existing caries was assessed using the International Caries Detection and Assessment System. If existing carious lesions progressed from one stage to a more advanced stage, it was defined as progression. At baseline and each of the three follow-up visits, oral hygiene and gingival health were assessed using the modified gingival index and simplified debris index. Oral health behaviours assessed included tooth brushing performance (assessed by number of tooth brushing steps and duration/frequency), between-meal snacking (assessed by frequency) and dental visit experience (assessed as favourable if the child attended at least annual visits). It was then determined if these behaviours had improved. Data analysis utilised generalised estimating equations, negative binomial regression and binary logistic regression. Kappa statistics were used to test intra-examiner reliability on 10% of randomly selected participants.Results There was no significant difference in caries experience between the two groups after 24 months. The results suggest children in the test group displayed improved tooth brushing performance, better oral hygiene and more frequent dentist visits. Children from higher socioeconomic backgrounds also showed better oral hygiene compared to those from lower socioeconomic backgrounds.Conclusions Social stories may be useful resources to improve oral health-related behaviours in children with SHCN.

STATIONARY INTRAORAL TOMOSYNTHESIS IN PROXIMAL CARIES DETECTION: AN EX-VIVO STUDY

<h3>BACKGROUND</h3> Research on radiographic detection of proximal caries has shown high specificity but low sensitivity, especially for early caries lesions. Stationary intraoral tomosynthesis (s-IOT) shows promise in caries detection, utilizing multibeam carbon nanotube source array technology and a direct intraoral detector to acquire images at similar radiation dose to standard bitewings and generating stacks of parasagittal image slices with an iterative reconstruction algorithm. <h3>OBJECTIVE(S)</h3> This study aimed to compare the diagnostic accuracy of s-IOT and conventional digital bitewing modalities for the detection of proximal caries lesions. <h3>STUDY DESIGN</h3> Extracted permanent posterior teeth (n = 64) with proximal surfaces scored between 0 and 4 in the International Caries Detection Assessment System were mounted in phantom heads for imaging. Eight observers, each with 2 or more years of radiology specialty training, scored surfaces on a 5-point Likert scale for caries presence and depth using s-IOT images and digital bitewings, in a standardized viewing format. Fifty percent of specimens will be repeated for intra-examiner reliability assessment. Results will be compared with a histologic gold standard and analyzed by logistic regression and receiver operating curve (Az value). The study is currently in progress, with final results expected by August 2020. <h3>RESULTS</h3> Pilot test results with 3 observers showed s-IOT to have a sensitivity of 49.6% and specificity of 86.1%, with interobserver agreement of 0.433. The conventional bitewing modality had a sensitivity of 47.9% and specificity of 83.3%, with interobserver agreement of 0.380. <h3>DISCUSSION/CONCLUSIONS</h3> Based on preliminary data, the 2 imaging modalities showed small differences between sensitivity, specificity, and interobserver kappa reliability, indicating that s-IOT is comparable to digital bitewings for the detection of proximal caries.

Rehabilitative ultrasound imaging of the levator scapula muscle at rest and during contraction: Technical description and reliability

BackgroundAltered scapular muscle activity is associated with abnormal scapular motions and shoulder pain. Hence, quantification of these activities is a challenging issue. Objectives: The purposes of this study were to establish the reliability of measuring levator scapula muscle thickness and to examine how thickness of this muscle changes with contraction. MethodsTwenty-one asymptomatic individuals (mean age 22.29 ± 2.17 years) participated in this study. Three separate ultrasound images of the levator scapula muscle were captured at the neck-shoulder junction at rest and during a loaded isometric contraction. The procedures were repeated twice, four to seven days apart to establish intra-rater test-retest reliability. Interclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine the reliability, and a paired t-test was performed to examine the difference in muscle thickness between two conditions. ResultsThe results demonstrated that intra-examiner reliability was good at rest (ICC = 0.88, SEM = 1.16 mm) and excellent during loaded isometric contraction (ICC = 0.95, SEM = 0.91 mm). Furthermore, the thickness of levator scapula muscle significantly increased from rest to the loaded isometric contraction (Effect size = 1.99, P < 0.001). ConclusionThis study demonstrates that the thickness of the levator scapula muscle can be measured reliably at the neck-shoulder junction. Furthermore, ultrasound measures can reliably detect changes in muscle thickness from rest to a contracted state. Therefore, if the need exists to evaluate muscle morphology before and after any treatment strategy, thickness measurement of levator scapula can be determined reliably using ultrasound.

3D-Printed Teeth with Multicolored Layers as a Tool for Evaluating Cavity Preparation by Dental Students

Accurate assessment of dental student performance during preclinical operative mannequin courses is an essential milestone within the educational process. Training on novel, multicolored 3D-printed teeth resulted in higher performances of the students in comparison to training on standard, monochromatic plastic teeth. However, low reliability of students’ grading using standard, monochromatic plastic teeth was reported. The aim of this study was to verify whether the use of 3D multicolored teeth can (1) provide better inter- and intra-examiner reliability, and (2) assess the effect of instructors’ experience on their reliability. The novel tooth analogs consisted of digitally planned and 3D-printed plastic teeth containing green, yellow, and red stratifications according to increasing depths of preparation. Thirty-seven dental students performed three Class I preparations on the 3D-printed teeth, and these underwent blind evaluation by two examiners of varied experience at two timepoints. The data were compared with preparations done on conventional (monochromatic) plastic teeth. Results indicated excellent inter-examiner reliability on 3D-printed teeth (0.768 &lt; ICC &lt; 0.929), but only moderate reliability with conventional plastic teeth (0.314 &lt; ICC &lt; 0.672). The examiner having more experience was found to show higher intra-examiner reliability (ICC = 0.716 and 0.612 using 3D-printed teeth and conventional teeth, respectively) than the less experienced examiner (ICC = 0.481 and 0.095 using 3D-printed teeth and conventional teeth, respectively). The novel, multicolored 3D-printed teeth can provide more objective evaluation of cavity preparation compared with conventional plastic teeth.

Reliability of a computational model for evaluating thoracoabdominal mobility in newborns: a cross-sectional study.

The present study aimed to verify the inter and intra-examiner reliability of an interactive custom-made MATLAB® App for bio-photogrammetric analysis of thoracoabdominal mobility in newborns and compare the respiratory rate (RR) results between the automatic MATLAB® App and its manual counterpart. This is a cross-sectional study conducted in 27 healthy newborns of both sexes (gestational age between 37 and 41weeks and up to 72h of life) who did not cry during data acquisition. Chest and abdominal areas of the subjects in the supine position were analyzed through 60s videos, totaling 30,714 photograms. All photograms were analyzed by three examiners on three different occasions. Analysis of variance (ANOVA) and intraclass correlation coefficient (ICC) were applied, adopting a 95% confidence interval and significance level of α = 0.05. Reliability was excellent for intra (ICC 0.81-0.96) and inter-examiner correlations (ICC 0.84-0.99) between the chest and abdominal areas, in both inspiration and expiration, with no differences between them. Evaluation of newborns' thoracoabdominal mobility using the custom-made MATLAB® App for bio-photogrammetric analysis exhibited good to excellent intra- and inter-examiner reliability and an excellent correlation between manual and automatic models for measuring RR. Thus, it proved to be an objective and practical tool for bedside thoracoabdominal mobility assessment in different clinical situations involving neonatal care.

Reliability of 2D kinematics during landing of volleyball athletes after exhaustion

IntroductionIt is possible to quantify changes in movement patterns through kinematic analysis of landing, especially to quantify changes in pre and post exhaustion situations, however the reliability of this post exhaustion analysis is not known. ObjectiveTo verify the inter and intra-examiner reliability of two-dimensional kinematic analysis during the landing of a vertical jump of volleyball athletes, pre and post exhaustion protocol. ExperimentalThirty volleyball athletes were recruited, and kinematic analysis was performed during landing, pre and post exhaustion protocol. The angular measurements analyzed were: 1) frontal plane: knee valgus and 2) sagittal plane: anterior trunk inclination, knee flexion and tibiotarsal angle, performed by two examiners. The reliability calculation used the intraclass correlation coefficient (ICC), in addition to the error of measurement (SEM), the coefficient of variation (CV) and the minimum detectable difference (MDD). ResultsRegarding reliability: ICC = 0.95–0.98 (pre) and ICC = 0.83–0.98 (post exhaustion). The CV presented heterogeneous values for the knee valgus and the inclination of the trunk, both pre and post protocol. The SEM from all angles presented values that varied from 0.74°-2.33° and the MDD ranged from 2.55°-5.54° pre protocol and 2.05°-6.45° post protocol. Conclusion2D kinematic evaluation can be used during landing, before and after the application of an exhaustion protocol, but professionals should pay attention to the angles of the knee valgus and the inclination of the trunk, as they have a large CV.

Is Infrared Thermography Reliable to Assess Pain in the Trapezius Muscle Region?

Objective: The aim of this study was to evaluate the inter- and intra-examiner reliability of infrared thermography (IT) in skin temperature analysis of people with pain complaints in the upper trapezius muscle. Methods: A total of 82 subjects (24.8 ± 6.9 years; 63.8 ± 13.1 kg) of both genders who had moderate (VAS-3) or severe pain in the upper trapezius muscle were evaluated. Skin temperatures of four areas (ROIs) were analyzed by IT using a FLIR camera (model T640SC - Sweden). Each evaluator performed two area analyses at different times. Results: The evaluation of the four areas indicated a very strong overall intraclass correlation coefficient (ICC) for both intra-examiner (Examiner 1: ICC = 0.936; 95% CI = 0.905–0.959; P &lt; 0.001; Examiner 2: ICC = 0.979; 95% CI = 0.968–0.987; P &lt; 0.001) and inter-examiner (Measurement 1: ICC = 0.933; 95% CI = 0.902–0.958; P &lt; 0.001; Measurement 2: ICC = 0.979; 95% CI = 0.968–0.987; P &lt; 0.001). The ICC was regular on ROI 3 in the measurement 1 inter-exam test, and the ROI 1, ROI 2, and ROI 4 values were strong; all points were very strong in measurement 2. The ICC was rated from strong to very strong for both examiners in the intra-examiner test at all points. Conclusion: IT was reproducible in measuring the upper trapezius muscle skin temperature, and the intra and inter-examiner agreement levels can be used as a reliable tool in clinical practice.

Inter, intra-examiner reliability and validity of inertial sensors to measure the active cervical range of motion in patients with primary headache.

We analyzed the inter- and intra-examiner reliability of Werium inertial sensors and the cervical range of motion (CROM) instrument for the measurement of active CROM (AcROM) in patients with primary headache. Another objective is to analyze the validity of the inertial sensors (Werium). The literature has reported symptomatology features in patients diagnosed with primary headache similar to that of patients with cervicogenic headache. The International Classification of Headache (ICHD-III) established the presence of reduced AcROM as a diagnostic criterion for cervicogenic headache. Several instruments are used for this measurement, with limitations in their applicability in daily clinical practice. A prospective longitudinal repeated measures study was conducted to assess the intra- and inter-rater reliability and validity of Werium inertial sensors in 20 adults with chronic primary headache. For the inter-rater analysis, the intraclass correlation coefficient (ICC) values were above 0.75 for all movements, indicating a good level of reliability. For the intra-rater results, the ICC values obtained by the Werium inertial sensors for all cervical movements were good for rater A (ICC >0.80) and rater B (ICC >0.84). For the validity, the ICCs obtained by the Werium inertial sensors compared with the CROM instrument for all cervical movements were moderate for both raters (ICC > 0.70, respectively). Values obtained in the standard error of measurement, minimum detectable change at 90% and limits of agreement also indicated good agreement. Werium inertial sensors have shown good to excellent reliability results, both intra- and inter-examiner (ICC > 0.75). Likewise, when the sensors were compared with another validated instrument (CROM device) they obtained high reliability results (ICC > 0.70). These results plus its relatively low price and ease of use allow us to recommend it in daily clinical practice to measure AcROM in patients with chronic primary headache.

Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions.

To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA. A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis. The participants' mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = -0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = -0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW. Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA. Fernandes Fagundes NC, d'Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627-1634.

Reliability of 2 methods in maxillary transverse deficiency diagnosis

The objective of this research was to evaluate the reliability of 2 methods (Andrews' Element III analysis and Yonsei transverse analysis) in maxillary transverse deficiency diagnosis. Plaster casts and cone-beam computed tomography images of 80 outpatients with skeletal Class I malocclusion (29 males and 51 females, mean age, 20.16±8.22years) were selected. Maxillary and mandibular width were measured, respectively, and independently by 2 examiners at an interval of 2weeks, using Andrews' Element III analysis and Yonsei transverse analysis. Intraclass correlation coefficients and Bland-Altman plots of intraexaminer and interexaminer reliability were evaluated. After diagnosis, Cohen's kappa statistics were calculated to evaluate the diagnostic agreement. The intraclass correlation coefficients were all above 0.85, indicating good to excellent reliability. Compared with Andrews' Element III analysis, Yonsei transverse analysis had higher intraexaminer and interexaminer reliability in both maxillary and mandibular width measurements. Thirty-one to 42 of the patients were diagnosed with maxillary transverse deficiency by 2 examiners using 2 methods. The intraexaminer and interexaminer Cohen's kappa values of Yonsei transverse analysis were all higher than those of Andrews' Element III analysis. Both Andrews' Element III analysis and Yonsei transverse analysis had good to excellent reliability and substantial diagnostic agreement. Yonsei transverse analysis had higher reliability in maxillary and mandibular width measurements and higher diagnostic agreement, compared with Andrews' Element III analysis.

A radiographic method for distinguishing noncavitated from cavitated proximal carious lesions: A proof of concept clinical trial

We propose a new topical radiographic contrast method for distinguishing noncavitated from cavitated radiolucencies. Laboratory tests and a pilot clinical trial were designed to test the feasibility and efficacy of the method. Twenty-two adults with 27 proximal radiolucencies had conventional bitewing (BW) examinations. After exclusion, 21 surfaces were evaluated. A concentrated solution of sodium iodide was placed in the interdental spaces via a microsyringe and BWs were again exposed. A class II cavity preparation was made in the adjacent tooth and polysiloxane impressions were made of the study surfaces. The impressions were scanned by visible light, creating a high resolution 3D replica. Cavitations, if present, were measured. Nine surfaces were noncavitated and 12 surfaces were cavitated. The microsyringe dispensed a variable volume of liquid, which affected the accuracy of the test. The sensitivity for cavitation was 50%, specificity was 88.9%, and accuracy was 66.7%. This compares to a reported 60% sensitivity, 62% specificity, and 62% accuracy for BW examinations. Intraexaminer reliability for classifying noncavitated or cavitated lesions using the kappa test was 0.649. This method needs improvement but was an advance over conventional BWs and could result in reduction of restorations in low- and high-risk patients.

Interpretation of Root Canal Anatomy of Maxillary and Mandibular Permanent Canines in Saudi Subpopulation: A Cone-Beam Computed Tomography (CBCT) Study.

The objective of this investigation was to evaluate the root canal anatomy of permanent canines in a Saudi subpopulation utilizing CBCT. A total of 1328 CBCT images of maxillary (634) and mandibular (694) permanent canines were collected from Saudi patients who visited the College of Dentistry at King Saud University in Riyadh. The images were analyzed for root and canal numbers, canal configuration types, and symmetry between the bilateral canine teeth in each arch. Gender, age, and tooth position were recorded. The Kappa test was used for both inter- and intraexaminer reliabilities. Data were analyzed with the chi-square test at a P value ≤ 0.05. There were no two-rooted teeth in maxillary canines, and 1.89% had two canals. Double roots and double canals in mandibular canines were found in 2.88% and 9.94% of the teeth, respectively. Type I canal configuration was more common in maxillary canines (97.94%) compared to mandibular canines (92.07%). Maxillary canines showed higher bilateral symmetries of root and canal numbers and canal configuration types (100%, 98.1%, and 97.9%, resp.) compared to mandibular canines (97.1%, 90.1%, and 92.1%, respectively). The majority of maxillary and mandibular canines had a single root with a single canal and type I canal configuration. Mandibular canines are characterized by having more than one root and canal and alterations in root canal configurations compared to maxillary canines.

Brazilian Portuguese version of the Amsterdam infant stool scale: a valid and reliable scale for evaluation of stool from children up to 120\u2009days old

BackgroundFor newborns and infants wearing diapers the difficulties in characterizing the appearance of the stool are significant, since the changes in consistency, quantity, and color of the stool are higher than in other age groups. The Amsterdam Infant Stool Scale (AISS) was created and validated in 2009, providing a specific tool for the evaluation of the stool of children up to 120 days old. However, to be used in clinical practice and scientific investigations in Brazil, it is mandatory to perform the translation and cross-cultural adaptation process for Brazilian Portuguese language. Thus, we aim to perform the translation and cross-cultural adaptation of AISS into Brazilian Portuguese and to evaluate the psychometric properties of the translated version.MethodsThe process of translation and cross-cultural adaptation was performed according to the internationally accepted methodology, including: translation, summary of translations, backtranslation, preparation of the pre-final version, application of the pre-test and determination of the final version. The evaluation of the psychometric properties was performed through the application of Brazilian Portuguese AISS, by five examiners (including child health field specialists and a literate adult lay on the subject), analyzing 238 stool photographs of children under 120 days old. The intra and inter-examiner agreement values were determined using kappa statistic. The validity of the criterion was investigated through correlation analysis (Kendall’s coefficient) between the classifications determined by the non-specialist examiner and the expert examiners.ResultsIn all 30 tests performed between different examiners, there was an agreement considered as at least moderate (kappa values above 0.40). The intra-examiner reliability was considered as substantial (kappa> 0.6). There was a statistically significant correlation (p < 0.05) between the classifications determined by the examiners considered as specialists and the examiner considered as non-specialist.ConclusionThe Brazilian Portuguese AISS version proved to be valid and reliable to be used by healthcare professionals and the general public in the evaluation of stool from children up to 120 days old.