Di Gianfilippo Riccardo, Pini Prato GiovanPaolo, Franceschi Debora, Castelluzzo Walter, Barbato Luigi, Bandel Alessandra, Di Martino Maria, Pannuti Claudio M, Chambrone Leandro, Cairo Francesco
Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Pacific Academy of Periodontal and Implant Research, Bellevue, Washington, USA.
J Periodontol. 2025 May;96(5):467-477. doi: 10.1002/JPER.24-0173. Epub 2024 Aug 26.
To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements.
Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT.
RD, KTW, and RT showed excellent overall intra-operator agreement (> 0.93), and from good to excellent overall inter-operator agreement (> 0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35).
Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement.
As digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination. Standardized photographs of thirty-four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared. Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento-enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks. The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.
评估在比较椅旁测量与摄影测量时，2018年牙龈退缩缺损（GRD）分类的诊断可重复性如何应用。
对34例GRD进行拍照，并由4名盲法操作者进行评估。对于每个病例，操作者在椅旁和照片上分别测量两次退缩类型（RT）、退缩深度（RD）、角化组织宽度（KTW）、牙龈厚度（GT）、牙骨质-釉质界（CEJ）的可检测性以及根台阶（RSs）的存在情况。计算RD和KTW的组内相关系数（ICC）及95%置信区间（CI）；GT、CEJ和RS采用Kappa及95%CI；RT采用二次加权Kappa及95%CI。
对于临床测量和摄影测量，RD、KTW和RT在操作者内总体一致性极佳（>0.93），操作者间总体一致性良好至极佳（>0.80）。GT、CEJ和RS的一致性较低。除RS的操作者间一致性在临床测量时为0.72、摄影测量时为0.45外，每个变量的总体临床和摄影一致性差异均在0.1以内。临床测量与摄影测量之间总体一致性最低的是CEJ（0.28）和RS（0.35）。
构成2018年GRD分类的变量在临床和照片上均可重复，一致性相当。对于KTW、RD和RT，总体一致性较高；对于GT、CEJ和RS，临床和摄影测量的总体一致性较低。椅旁评估与摄影评估之间，大多数变量的一致性为中等至极佳，CEJ和RS的一致性为中等。
随着数字诊断技术的发展以促进临床诊断测量，我们旨在评估与传统临床检查相比，根据2018年GRD分类，口腔内摄影诊断牙龈退缩缺损（GRD）的有效性。拍摄了34例GRD病例的标准化照片。4名盲法操作者在临床环境中对相同的牙龈退缩进行了两次评估，并用照片进行了两次评估。计算了临床和摄影环境中操作者内和操作者间的测量重复性，并对两种环境进行了比较。退缩深度和角化组织宽度等连续测量，以及邻面附着高度（退缩类型）的评估，在临床和摄影方面均显示出极佳的一致性。牙龈厚度以及牙齿解剖标志（如牙骨质-釉质界和根台阶的存在）的可检测性的一致性较低。总体而言，椅旁评估与摄影评估之间的一致性通常良好，但在评估牙齿解剖标志时较低。构成2018年GRD分类的变量在临床和摄影环境中均可重复，一致性水平相当。然而，牙龈厚度以及评估牙齿解剖标志时的一致性始终较差。
