Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany.
Department of Prosthetic Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany.
PLoS One. 2022 May 17;17(5):e0268360. doi: 10.1371/journal.pone.0268360. eCollection 2022.
This comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters' clinical experience influence the agreement.
Fifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet's AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated.
Compared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for "Decayed" were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for "Missing" and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for "Filled". IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet's AC1 using the mode of the blinded raters' assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement.
Assessment of "Decayed", "Missing" and IMPL by IODP showed almost perfect agreement, whereas of "Filled" and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.
本对比研究旨在评估在高修复状态的老年人群中，与临床诊断（CLIN）相比，口腔内数字摄影（IODP）作为 DMFT 和种植体数量（IMPL）评估工具的效果。次要研究问题是，额外评估全景片（PAN-X）或评估者的临床经验是否会影响一致性。
招募了 50 名患者（70.98±7.60 岁）进行标准化 CLIN 和 IODP。临床参考检查者和 10 名盲法评估者在没有和有 PAN-X 的情况下评估照片，以评估 DMFT 和 IMPL。CLIN 被用作参考标准，并分析 DMFT 和 IODP 与 IODP-PAN-X 结果之间的差异。为了评估内部评估者之间的一致性，计算了三个诊断方法 CLIN、IODP 和 IODP+PAN-X 的两两 Gwet 的 AC1。
与 DMFT 为 22.10±3.75（CLIN）相比，盲法评估者评估 DMFT 为 21.54±3.40（IODP）和 22.12±3.45（IODP+PAN-X）。“龋齿”的平均值为 0.18±0.52（CLIN）、0.45±0.46（IODP）和 0.48±0.47（IODP-PAN-X），而“缺失”的平均值为 11.02±5.97（CLIN）、10.66±5.78（IODP）和 10.93±5.91（IODP+PAN-X），“填充”的平均值为 10.90±5.61（CLIN）、10.43±4.85（IODP）和 10.71±5.11（IODP+PAN-X）。IMPL 为 0.78±2.04（CLIN）、0.58±1.43（IODP）、0.78±2.04（IODP+PAN-X）。使用盲法评估者评估的“龋齿”、“缺失”和 IMPL 与 CLIN 相比，Gwet 的 AC1 范围为 0.81 至 0.89（IODP）和 0.87 至 1.00（IODP+PAN-X），而“填充”和 DMFT 的 AC1 分别为 0.29 和 0.36（IODP）以及 0.33 和 0.36（IODP+PAN-X）。临床经验并未影响一致性。
IODP 评估“龋齿”、“缺失”和 IMPL 显示出几乎完美的一致性，而“填充”和 DMFT 则与临床发现显示出适度至中度的一致性。与单独使用 IODP 诊断相比，额外的 PAN-X 评估增加了一致性。考虑到总数值的高度一致性和患者层面的杂项一致性，IODP 可能是评估 DMFT 和 IMPL 的一种合适方法。
