Erbe Christina, Temming Teresa, Ohlendorf Daniela, Schmidtmann Irene, Ferrari-Peron Priscila, Mundethu Ambili, Wehrbein Heinrich
Department of Dentofacial Orthopedics & Orthodontics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Department of Orthodontics, Clinic of Dentistry, Philipps University Marburg, Marburg, Germany.
PLoS One. 2025 May 6;20(5):e0322528. doi: 10.1371/journal.pone.0322528. eCollection 2025.
BACKGROUND/OBJECTIVES: To analyze the inter-rater reliability of three different plaque indices with regard to raters' orthodontic experience.
MATERIALS/METHODS: The study analyzed 50 photographs of patients with maxillary and mandibular multibracket appliances (MB), captured via Digital Plaque Imaging Analysis (DPIA) for plaque assessment. Three indices - the modified Turesky index (TQH index), Attin index, and modified bonded bracket index (mBB index) were used. Fourteen evaluators with varying orthodontic experience levels (four with limited, five with moderate, and five with extensive experience) assessed the images.
The highest agreement among the evaluators in terms of ICC was obtained using the Attin index and the mBB index. The TQH index yielded the poorest agreement among evaluators. Orthodontic experience had no significant effect on inter-rater reliability. The evaluators with little orthodontic experience scored best in agreement with the Attin index, and the evaluators with much orthodontic experience scored best with the Attin and mBB indices. No difference was observed between the three plaque indices among the evaluators with moderate orthodontic experience.
Consistent classification of subjects into the same oral hygiene category by multiple raters using a plaque index was difficult. Consequently, calibration of raters in practice may lead to a more unanimous classification of patients into the same oral hygiene category. A disadvantage of the classification of plaque values into oral hygiene categories was posed by the category boundaries. These resulted in two plaque indices being less consistent than was the case in reality.
CONCLUSIONS/IMPLICATIONS: We recommend the use of an orthodontic plaque index (Attin index) or a combined dental and orthodontic plaque index (mBB index) in patients with an MB. The TQH index, considered the international standard plaque index, is less appropriate for application in these patients. Training and calibration of evaluators are of great importance when applying conventional plaque indices.
背景/目的：分析三种不同菌斑指数在不同正畸经验评估者之间的评分者间信度。
材料/方法：本研究分析了50张上颌和下颌多托槽矫治器（MB）患者的照片，通过数字菌斑成像分析（DPIA）进行菌斑评估。使用了三种指数——改良的图尔斯基指数（TQH指数）、阿廷指数和改良粘结托槽指数（mBB指数）。14名正畸经验水平不同的评估者（4名经验有限、5名经验中等、5名经验丰富）对图像进行了评估。
在组内相关系数（ICC）方面，评估者之间使用阿廷指数和mBB指数时一致性最高。TQH指数在评估者之间的一致性最差。正畸经验对评分者间信度没有显著影响。正畸经验少的评估者在与阿廷指数的一致性方面得分最高，正畸经验丰富的评估者在阿廷指数和mBB指数方面得分最高。正畸经验中等的评估者在三种菌斑指数之间未观察到差异。
使用菌斑指数让多个评估者将受试者一致分类到相同的口腔卫生类别中很困难。因此，在实践中对评估者进行校准可能会使患者在口腔卫生类别上的分类更加一致。将菌斑值分类到口腔卫生类别中的一个缺点是类别边界问题。这导致两种菌斑指数的一致性比实际情况要低。
结论/启示：我们建议在使用MB矫治器的患者中使用正畸菌斑指数（阿廷指数）或联合的牙齿和正畸菌斑指数（mBB指数）。被视为国际标准菌斑指数的TQH指数不太适合应用于这些患者。在应用传统菌斑指数时，评估者的培训和校准非常重要。
