Hintze H, Wenzel A
Department of Radiology, Royal Dental College, Aarhus, Denmark.
Community Dent Oral Epidemiol. 1990 Oct;18(5):256-9. doi: 10.1111/j.1600-0528.1990.tb00071.x.
It was the aim of the present investigation to evaluate the accuracy of clinical examination for the detection of permanent tooth aplasia in the 3rd/4th grade and again 1 yr later and to record the number of children initiating orthodontic treatment in the interval between the two examinations. The validating criterion for tooth aplasia was a panoramic radiograph taken in a routine procedure. 628 children participated in the study. The clinical examinations were performed without knowledge of the radiographic evidence. During the examination children exhibiting symptoms of permanent tooth aplasia were selected for radiography. At both occasions clinical examination was very sensitive for the detection of children with aplasia of permanent incisors (nosological sensitivity = 1.00). It was, however, less sensitive for the detection of children with premolar aplasia (nosological sensitivity = 0.22 at both examinations). The nosological specificity for identification of children without aplasia of incisors and premolars was more than 0.90 at both examinations. Twenty-two children had started orthodontic treatment in the timespan between the two clinical examinations, but only three on the basis of observations on their radiographs alone (aplasia of permanent teeth). The present clinical method would have selected two of these children, thus in only one child postponing panorama screening might have affected treatment prognosis. Between the two examinations all permanent teeth mesial to the permanent second molars had erupted in 181 children who might therefore totally avoid screening radiography.
本研究旨在评估临床检查在检测三年级/四年级儿童恒牙发育不全方面的准确性，并在一年后再次评估，同时记录两次检查期间开始接受正畸治疗的儿童数量。恒牙发育不全的验证标准是通过常规程序拍摄的全景X线片。628名儿童参与了该研究。临床检查在不知道X线片结果的情况下进行。在检查过程中，选择表现出恒牙发育不全症状的儿童进行X线检查。在两次检查中，临床检查对检测恒牙切牙发育不全的儿童都非常敏感（病因学敏感性=1.00）。然而，对于检测前磨牙发育不全的儿童，其敏感性较低（两次检查的病因学敏感性均为0.22）。在两次检查中，识别无切牙和前磨牙发育不全儿童的病因学特异性均超过0.90。在两次临床检查期间，有22名儿童开始接受正畸治疗，但只有3名儿童是仅基于X线片观察（恒牙发育不全）而开始治疗的。目前的临床方法本可以筛选出其中两名儿童，因此，对于只有一名儿童来说，推迟全景X线检查可能会影响治疗预后。在两次检查期间，181名儿童的恒牙第二磨牙近中的所有恒牙都已萌出，因此这些儿童可能完全无需进行筛查性X线检查。
