PERIODONTAL CLINICAL EXAMINATION: CALIBRATION OF FIRST-YEAR RESIDENTS

1. PERIODONTAL CLINICAL EXAMINATION: CALIBRATION OF FIRST-YEAR RESIDENTS N. Beaini, B. Leblebicioglu, DN. Tatakis, A. Mariotti, L. Claman.The Ohio State University, Columbus, OH, USA 809 Results Abstract Objectives: The purpose of this study was to assess the outcomes of a protocol used to train and calibrate first-year residents in a graduate periodontics program. Methods: Following focused and detailed didactic instruction, a clinical calibration exercise was performed. Patient selection criteria were: periodontitis (2 quadrants), each quadrant with ≥ 5 teeth (at least 1 molar), 2 sites with gingival recession, 4 pockets  5 mm (at 2 interproximal sites and at 3 different teeth). Exclusion criteria were systemic diseases, antibiotic prophylaxis needs, and local factors impeding probing. Each resident measured probing depths (PD) and gingival margin location (GM), using a UNC probe on six sites per tooth. All measurements were taken twice (repeated by the examiner to assess intra-examiner differences, or by examiner and gold standard trainer to assess inter-examiner differences). Results from 24 first-year residents (last 6 consecutive years) were statistically analyzed for intra- and inter-examiner differences. Results: Mean intra-examiner difference in PD and GM was 0.390.23 mm and 0.340.17 mm, respectively. For PD, intra-examiner duplicate measurements were 973% and 991% within 1 and 2 mm, respectively. The corresponding GM results were 982% and 991%. The PD and GM mean inter-examiner differences were 0.640.18 mm and 0.780.2 mm, respectively. For PD, inter-examiner duplicate measurements were 926% and 983% within 1 and 2 mm, respectively. The corresponding GM results were 889% and 982%. The PD and GM inter-examiner differences were significantly greater than the respective intra-examiner differences (P<0.001). Conclusion: Intra-examiner differences in PD and GM are smaller compared to inter-examiner differences. Intra- and inter-examiner differences compare favorably with values previously reported for examiner calibration. These results suggest that the instituted calibration protocol is effective. Intra- examiner Inter- examiners Methods Clinical data collection For each resident, a calibration patient was recruited. For intra-examiner measurements, the maxillary right and mandibular left quadrants were probed and the GM was located in two separate sets of measurements by each resident (same clinical session; approximately 30 minutes between two repeats). For inter-examiner calibration the maxillary left and mandibular right quadrants were probed and GM was located in two separate sets of measurements, one set by the resident and one set by the gold standard calibrator (approximately 30 minutes between two examinations). All inter-examiner errors 2mm were reconciled. Actual recorder was a dental assistant who was blinded for specific examination. CAL was calculated by adding PD and GM for specific tooth sites. Introduction Conclusion Patient selection The current classification used for determining the severity of various forms of periodontal diseases is mainly based on a single clinical parameter, e.g: clinical attachment level (CAL). However, the clinician is required to record two parameters [probing depth (PD) and the location of gingival margin (GM)] to calculate CAL. Various problems related to probing techniques include probe angulation, applied forces and visual errors in identifying the cemento-enamel junction. The purpose of this study was to assess the outcomes of a protocol used to train and calibrate first-year residents at the Ohio State University Graduate Periodontics Program. Specific aims included: 1- Developing a standardized method to teach how to measure CAL. 2- Determining the intra-examiner differences in clinical parameters. 3- Determining the inter-examiner differences in clinical parameters between first- year residents and a gold standard (single full-time faculty with years of experience in periodontal clinical examination and calibration exercises). • Intra-examiner differences in PD and GM are smaller compared to • inter-examiner differences. • Although the percentage of errors in repeats in various measurements is small, it has an additive effect in CAL calculations for both intra- and inter-examiner differences. • Intra- and inter-examiner differences compared favorably with values previously reported for examiner calibration. Inclusion criteria: * Adults * Chronic Periodontitis (at least 2 quadrants), * Each quadrant with ≥ 5 teeth (at least 1 molar), * At least two sites with gingival recession, * 4 pockets  5 mm (at 2 interproximal sites and at 3 different teeth). Exclusion criteria: * Systemic diseases, * Antibiotic prophylaxis needs, * Local factors impeding probing impeding probing or determination of the CEJ, * Patients with extensive restorations, * Severe inflammation. References 1- Hill EG, Slate EH, Wiegand RE, Grossi SG, Salinas CF. Study design for calibration of clinical examiners measuring periodontal parameters. J. Periodontol. 2006: 77: 1129-41 2- Reddy MS, Palcanis KG, Geurs NC. A comparison of manual and controlled-force attachment-level measurements. J. Clin. Periodontol. 1997: 24: 920-926 Statistical Analysis Acknowledgement The error of repeated examinations was analyzed using a repeated measures ANOVA. The absolute value of the difference was used because of an equal distribution of errors both in the positive and negative direction could cancel to a mean error approximately zero. Supported by OSU College of Dentistry Pre-Doctoral Research Program and the Division of Periodontology