Partido Brian B, Webb Chadleo, Carr Michele P
J Dent Hyg. 2018 Dec;92(6):33-39.
The purpose of this study was to evaluate the efficacy of calculus detection between a thin and curved ultrasonic inserts (UI) as compared to the Old Dominion University (ODU) 11/12 explorer. Three clinical dental hygiene faculty members were recruited to participate as calibrated raters for the presence of calculus in a group of 60 patient volunteers. Inclusion criteria were: adults aged >18 in good health, and no history of a professional prophylaxis within the past six months. Raters used an ODU 11/12 explorer, thin and curved UIs to evaluate 4 surfaces on Ramfjord index teeth for the presence of subgingival calculus. Data were analyzed for intra- and intrerrater reliability, sensitivity, and specificity. Interrater reliability for calculus detection with an ODU 11/12 explorer and a thin UI was demonstrated with an Intraclass Coefficient (ICC) of .782, confidence interval (CI) 95%. An ICC of .714, CI 95% was demonstrated with the ODU 11/12 explorer and curved UIs. Intra-rater reliability was shown with mean Kappa averages in the full agreement range (Kappa=.726, n=2,160, <0.01) for use of the ODU 11/12 explorer versus the thin UI as well as versus curved UIs (Kappa=.680, n=2160, <0.01). Sensitivity was 75%, specificity 97%, PPV 81%, and NPV 94% when the thin UI was used and sensitivity measured 65%, specificity 98%, PPV 81%, and NPV 95% when curved UIs were used. Calculus detection was comparable when using the ODU 11/12 explorer, a thin UI and curved UIs on patients with limited amounts of calculus among the three clinicians. Efforts may be focused on developing tactile sensitivity for calculus detection in addition to calculus removal when using thin and curved ultrasonic instruments. Future studies should investigate calculus evaluation utilizing a variety of ultrasonic insert designs, varying amounts of calculus, and levels of clinical experience.
本研究的目的是评估与老自治领大学（ODU）11/12探针相比，细弯型超声工作尖（UI）在牙结石检测方面的效果。招募了三名临床口腔卫生教员作为校准评估者，对60名患者志愿者进行牙结石检查。纳入标准为：年龄大于18岁的健康成年人，且在过去六个月内无专业洁治史。评估者使用ODU 11/12探针、细弯型超声工作尖对Ramfjord指数牙的4个面进行龈下牙结石检查。对数据进行了评估者间和评估者内信度、敏感度和特异度分析。使用ODU 11/12探针和细弯型超声工作尖进行牙结石检测时，组内相关系数（ICC）为0.782，95%置信区间（CI），显示出评估者间信度。使用ODU 11/12探针和弯型超声工作尖时，ICC为0.714，95% CI。使用ODU 11/12探针与细弯型超声工作尖以及弯型超声工作尖相比，评估者内信度在完全一致范围内的平均Kappa值显示（Kappa = 0.726，n = 2160，<0.01）。使用细弯型超声工作尖时，敏感度为75%，特异度为97%，阳性预测值为81%，阴性预测值为94%；使用弯型超声工作尖时，敏感度为65%，特异度为98%，阳性预测值为81%，阴性预测值为95%。在三位临床医生中，对于牙结石量有限的患者，使用ODU 11/12探针、细弯型超声工作尖进行牙结石检测的结果相当。在使用细弯型超声器械进行牙结石清除时，除了清除牙结石外，还应致力于提高对牙结石检测的触觉敏感度。未来的研究应利用各种超声工作尖设计、不同牙结石量和临床经验水平来研究牙结石评估。
