基于牙片的全科医生对修复干预决策。

Decision-making of general practitioners on interventions at restorations based on bitewing radiographs.

机构信息

Federal University of Pelotas, Graduate Program in Dentistry, Gonçalves Chaves, 457, 5th floor, Pelotas, RS, 96015560, Brazil; Radboud University Medical Centre, College of Dental Sciences, Preventive and Restorative Dentistry, Ph van Leydenlaan 25, PO Box 9101, 6500HB, Nijmegen, The Netherlands.

Radboud University Medical Centre, College of Dental Sciences, Preventive and Restorative Dentistry, Ph van Leydenlaan 25, PO Box 9101, 6500HB, Nijmegen, The Netherlands.

出版信息

J Dent. 2018 Sep;76:109-116. doi: 10.1016/j.jdent.2018.07.003. Epub 2018 Jul 9.

DOI:10.1016/j.jdent.2018.07.003

PMID:30004002

Abstract

OBJECTIVE

The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry.

METHODS

This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used.

RESULTS

For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision.

CONCLUSION

The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision.

CLINICAL SIGNIFICANCE

This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.

摘要

目的

本研究旨在比较普通牙科医生（GDP）基于对修复近中面的咬翼片分析做出的决策与龋病学和修复牙科专家的诊断和临床决策。

方法

这是一项基于实践的研究，使用了 7 家普通牙科诊所的数据库。从电子患者档案中选择了后牙咬翼片，并选择了 770 例近中面修复的病例。其中 50%的病例导致修复决策，另一半病例由 GDP 决定监测。三位专家进行了放射学评估。结果变量为诊断和治疗决策的一致性。使用 Cohen 的 kappa 统计量。

结果

对于专家来说，对于诊断标准，观察到了中等至大量的内部检查者之间的一致性，并且对于治疗分配，每位专家的 kappa 值分别为 0.77、0.79 和 0.88。GDP 与大多数专家之间关于继发龋的一致性在 67%至 83%之间。在 GDP 治疗的 385 例病例中，有 173 例被专家决定进行监测，而 GDP 决定进行监测的 8 例被决定进行治疗。专家与 GDP 之间在继发龋检测方面的一致性为中度，在治疗决策方面的一致性为一般。