Intra- and Inter-Examiner Repeatability of Diagnostic Peri-implant Clinical Measurement: A Pilot Study

Despite the crucial role of examiner reliability on quality research and practice, there is still limited literature analyzing factors affecting examiner variability of peri-implant clinical measurements. The present study investigated clinical peri-implant parameters to quantify their repeatability and investigate factors that may affect their accuracy. Thirty-three implants were examined by four operators. Peri-implant probing depth (PD), recession (REC) and gingival index (GI) were measured for agreement and included for analysis. Agreement was quantified using intraclass correlation coefficients (ICC; 95% CI); mixed linear and logistic regressions were used to assess additional variables. The overall inter-examiner agreement was comparable between PD (0.80) and REC (0.78), but significantly worse for GI (0.45) (p<0.001). Similarly, the intra-examiner agreement was similar for PD (0.81) and REC (0.80), but significantly worse for GI (0.57) (p<0.05). The magnitude of PD did not influence agreement. In contrast, increasing disagreement was noted for positive REC (OR: 3.0), negative REC (OR: 4.8) and lower GI (OR: 4.4). The incidence of bleeding on probing and severity of GI increased for deeper PD (0.113 unit increase per mm). Negative and positive values of recession and lower GI were associated with increasing disagreement. Radiographic bone loss, restoration contour and implant diameter did not impact PD accuracy within this study. In conclusion, within the limitations of the study, GI measurements presented higher variability than PD and REC. PD and GI were associated with one another and increased after multiple measurements.

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 < 0.001; Examiner 2: ICC = 0.979; 95% CI = 0.968–0.987; P < 0.001) and inter-examiner (Measurement 1: ICC = 0.933; 95% CI = 0.902–0.958; P < 0.001; Measurement 2: ICC = 0.979; 95% CI = 0.968–0.987; P < 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.

Reliability of qualitative occlusal tooth wear evaluation using an intraoral scanner: A pilot study

Dental wear analysis through the use of an intraoral scanner is a reality of modern dentistry. This study aimed to investigate the reliability of qualitative tooth wear evaluation through three-dimensional images captured with an intraoral scanner and compared to clinical and photographic examinations. Eighteen adult volunteers of both genders (18 to 55 years old) were submitted to clinical exams, intraoral photographs and intraoral scanning protocol using an optical scanner (TRIOS® Pod, 3Shape, Copenhagen, Denmark). Occlusal tooth wear, from second to second premolars, was measured by two evaluators and reevaluated after 30 days, according to a slight modification of the method described by Mockers et al. Weighted Kappa was used to measure intra and inter-examiner agreement. The Friedman test was used to verify the differences among methods. Random and systematic errors were assessed using Bland-Altman plots. All statistical analysis was performed with p<0.05. There was a substantive agreement for clinical (K = 0.75) and photographic exams (K = 0.79) and a moderate agreement for intraoral scanner analysis (K = 0.60) for inter-examiner evaluation. A substantial intra-examiner agreement was obtained for both evaluators. No significant difference between the methods was observed (p = 0.7343 for examiner 1 and 0.8007 for examiner 2). The Bland-Altman plot confirmed no systematic errors between the methods and a random error of 0.25 with the scanner method when compared to clinical assessment. All three methods showed reliability in qualitative occlusal tooth wear evaluation. Intraoral scanning seems to be a sound and reliable tool to evaluate tooth wear when compared to traditional methods, considering the lower inter-examiner agreement and the inherent limitations of this pilot study. Further research will be necessary in order to achieve more robust evidence.

Development of a Radiographic Index for Periodontitis

The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the ‘worst site’ in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér’s V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (K) and 0.802 (K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis.

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

Background For 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. Methods The 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. Results In 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. Conclusion The 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.

Maximum phonation time in the pulmonary function assessment

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.

Inter-examiner agreement in the application of an oral health assessment instrument in hospitalized elderly

ABSTRACT Objectives: to analyze the correspondence between nurse and dental surgeon assessments in the application of an Oral Health Assessment in dental screening of elderly hospitalized patients. Methods: cross-sectional study with elderly patients (n = 54) admitted to University Hospital from the Federal University of São Paulo. Data were collected through the assessment of oral cavity. Descriptive statistical techniques were used to analyze them, using tables and graphs. Results: there was correlation and agreement between nurse and dental surgeon assessments referring to application of an Oral Health Assessment in dental screening of hospitalized elderly. Conclusions: oral Health Assessment in dental screening for hospitalized elderly by nurses demonstrated excellent reproducibility and may be a resource to identify buccal alteration, helping the planning and execution of nurse care associated to oral health.

Age Estimation - 18 Years old I3M Cutoff Value: Specificity Approach Resulting Confidence Increase

Objectives: From an administrative or forensic point of view, the need to estimate the age of living people who do not have hold valid documents is crucial. In this sense 18 years, old cutoff values are of great importance due to civil and criminal imputability in the majority of countries. Different medicine and forensic dentistry methods are used to estimate age. Among them, the development of dental elements is one of the most reliable. This study aimed to apply and discuss sex-specific cutoff 18 years old discriminant ratios advantages over sex-pooled reference value to improve accuracy and specificity over Cameriere et al.’s (2008) method in a Southern Brazilian Sample. Methods: After prior ethical authorization (CAAE: 82403918.0.0000.0075), three experienced examiners measured using Fiji-Image J software, 354 digital panoramic radiographs of individuals aged 14 to 23 years old, to obtain the dental maturity indices (I3m). Based on the sensitivity and specificity criteria (ROC curve), different cutoff values were tested for males and for females. Results: The inter-examiner agreement verified by Intraclass Correlation Coefficient (ICC) was 0.89. Based on post-test results, the 18-year I3m accuracy ranged from 98% to 94% throughout the tested cutoff values, and was 98% for females (I3m =0.09), 96% for males (I3m = 0.07), and 94% for sex-pooled individuals (I3m = 0.08). Sex-pooled sensitivity values where higher when I3m = 0.09, whereas specificity values were higher when I3m = 0.08. Sex-specific cutoff values expressed an increase in female Specificity (+2%) at 0.09 considered the sex-pooled value of 0.08, while best male specificity was observed at 0.08 I3m values. Conclusions: Considering the discriminating objective for estimating the age of 18 years old and its forensic impact, it must be observed the greater importance of the specificity of the test in order to minimize false positives than the overall accuracy. In this sense, we can conclude that even being a forensic reliable option the use of 0.08 sex-pooled I3m ratio, sex specific I3m ratios may be a better option to be used at the local population. Subsequent research on diversified country samples is strongly indicated.