Objectives: Because subgingival dental calculus in periodontal pockets is associated in the etiopathogenesis of progressive human periodontitis, and is difficult to accurately detect with conventional manual explorers and probing instruments, there is an urgent clinical need for more reliable diagnostic methods for the detection and localization of subgingival dental calculus. A low-power ( 40). Results: A total of 50 root surfaces exhibited a modified SCI score = 0 (no root surface dental calculus detected), whereas 19 root surfaces revealed modified SCI scores = 1 (root surface dental calculus detected in thin deposits, but not in a markedly-raised ledge), and 31 root surfaces had modified SCI scores = 2 (root surface dental calculus detected in a markedly-raised ledge). A high level of both intra- and inter-examiner reproducibility of visible red laser fluorescence intensity readings was found with both tooth root evaluation protocols, despite the marked differences between the two dentist examiners in their educational backgrounds and length of clinical dental care experience, with correlation coefficient values ranging from r = 0.948 to r = 0.999 for duplicate assessments made by the two independent examiners themselves and between them. Mean visible red laser fluorescence intensity values recorded by the two independent examiners with the instrument perpendicularly directed along tooth root surfaces (first evaluation protocol) were 98.9 (standard deviation ± 0.4) and 99.0 (standard deviation ± 0.0), respectively, on dental calculus-positive root surfaces, which were significantly greater than mean values of 10.9 (standard deviation ± 6.0) and 12.3 (standard deviation ± 8.1), respectively, recorded on dental calculus-negative root surfaces (P 40 for visible red laser fluorescence intensity values offered 90% sensitivity, 100% specificity, a 100% positive predictive value, a 90.9% negative predictive value, and an odds ratio relationship of 36.6 [95% confidence interval = 16.7, 80.2] for the presence of dental calculus on tooth root surfaces. Conclusions: These in vitro findings document, for the first time, a high level of intra- and inter-examiner reproducibility of visible red laser fluorescence intensity measurements on human tooth root surfaces, regardless of the whether the instrument is directed either perpendicular or parallel to extracted tooth root surfaces. Dental calculus- positive root surfaces on extracted teeth exhibited significantly higher visible red laser fluorescence intensity scores than dental calculus-negative root surfaces, particularly when dental calculus deposits were present in markedly-raised ledges. In addition, a threshold level of > 40 for visible red laser fluorescence intensity readings offered greater diagnostic accuracy than a threshold level of ≥ 5 for identification of dental calculus on root surfaces of extracted teeth. These findings provide further in vitro validation for use of the visible red laser fluorescence-emitting instrument for detection of dental calculus on root surfaces of human teeth. Additional validation studies, conducted clinically in vivo, on the visible red laser fluorescence-emitting instrument are warranted. / Oral Biology

Com o intuito de estudar in vivo a reprodutibilidade e a comparação de dois índices visuais (Ekstrand et al. (1998) ? E e Nyvad; Machiulskiene e Baelum (1999) ? N) e as medidas de fluorescência a laser AGNOdent®,KaVo - DD) na detecção de sulcos e fossetas descoloridos, um único examinador treinado, após a obtenção do consentimento livre e esclarecido de 28 pacientes, atribuiu os escores E, N e médias de fluorescência a laser de 190 molares decíduos com e sem descoloração em sulcos e fossetas oclusais. A reprodutibilidade dos índices visuais foi calculada a partir do teste kappa Cohen e kappa ponderado (kp), enquanto para as médias do DD foi calculado o índice de correlação de Pearson (rp). Para a comparação entre os índices visuais ainda se calculou a correlação de Spearman (rcs) e para a correlação entre os índices visuais e as médias do DD, foram aplicados o teste t de Student para as dicotomizações de presença de lesão, descoloração e atividade. Finalmente, foi calculada a análise de variância (ANOVA) para comparação entre as médias do DD e os graus de severidade das lesões. A reprodutibilidade dos índices visuais foi substancial (kpE = 0,645) e (kpN = 0,634) e as médias do DD apresentaram correlação de Pearson significativa e altamente positiva (rp = 0,930). A comparação entre os índices visuais também foi positiva e significativa principalmente quanto à severidade (rcs = 0,623) e nas dicotomizações para a presença de lesão (rcs = 0,765) e descoloração (rcs = 0,757). O teste t de Student para as comparações entre os índices e as médias do DD também se apresentaram significativos (p < 0,001) para presença de lesão e descoloração ao contrário dos resultados para atividade. A análise de variância entre os graus de severidade dos índices visuais e as médias do DD mostrou diferenças estaticamente significativas apenas entre os graus de severidade 0 e 1 (E - 2a) para o índice E e 0, 1 (N - 4) e 2 (N - 5) para o índice N. Conclui-se, para sulcos e fossetas descoloridos de molares decíduos, que (1) ambos os métodos (visuais e de fluorescência a laser) mostraram-se confiáveis (2) o DD foi capaz de diferenciar tecidos hígidos de lesões com descoloração e de (3) inativas intactas ou com microcavidades em esmalte. / Aiming at developing an in vivo study of the reproducibility and correlation of two visual indexes (Ekstrand et al. (1998) ? E and Nyvad; Machiulskiene and Baelum (1999) ? N) and the measures of laser fluorescence (DIAGNOdent®,KaVo - DD) for the detection of decolorised pits and fissures, a single trained examiner, after the free and aware consent of 28 patients, opened the scores E, N and laser fluorescence averages of 190 primary molars with and without occlusal discoloration in pits and fissures. The reproducibility of the visual indexes was calculated with basis on the kappa Cohen and weighted kappa (wk) tests, while for the DD averages the Perason´s correlation (rp) was calculated. To provide a comparison among the visual indexes, the Sperman´s correlation (rcs) was calculated, and for the correlation among the visual indexes and the DD averages, the Student´s t test and the one-way analysis of variance (ANOVA) were applied to compare the DD averages and the degree of severity of the lesions. The reproducibility of the visual indexes was substantial (wkE= 0,645) and (wkN= 0,634); the DD averages presented a significant and highly positive Pearson´s correlation (rP= 0,930). The comparison among the visual indexes proved to be positive and significant, mainly in relation to the severity (rcs= 0,623) and the dichotomisations for the presence of lesion (rcs= 0,765) and discoloration (rcs= 0,757). The Student´s t test of for the comparisons among the indexes and the DD averages also proved to be significant (p < 0,001) for the presence of lesion and discoloration, contrary to the activity results. The one-way analysis of variance (ANOVA) among the degrees of severity and DD averages showed significant differences only at the degrees 0 and 1 (E ? 2a) of the E index and 0, 1 (N ? 4) and 2 (N ? 5) of the N index. The conclusions for pits and fissures with discoloration in primary molars are that (1) both methods (visual and laser fluorescence) were reliable (2) the DD was able to diferenciatte sound tissues from lesions with discoloration and (3) inactive intact or with microcavities lesions at the enamel level.

Com o intuito de estudar in vivo a reprodutibilidade e a comparação de dois índices visuais (Ekstrand et al. (1998) ? E e Nyvad; Machiulskiene e Baelum (1999) ? N) e as medidas de fluorescência a laser AGNOdent®,KaVo - DD) na detecção de sulcos e fossetas descoloridos, um único examinador treinado, após a obtenção do consentimento livre e esclarecido de 28 pacientes, atribuiu os escores E, N e médias de fluorescência a laser de 190 molares decíduos com e sem descoloração em sulcos e fossetas oclusais. A reprodutibilidade dos índices visuais foi calculada a partir do teste kappa Cohen e kappa ponderado (kp), enquanto para as médias do DD foi calculado o índice de correlação de Pearson (rp). Para a comparação entre os índices visuais ainda se calculou a correlação de Spearman (rcs) e para a correlação entre os índices visuais e as médias do DD, foram aplicados o teste t de Student para as dicotomizações de presença de lesão, descoloração e atividade. Finalmente, foi calculada a análise de variância (ANOVA) para comparação entre as médias do DD e os graus de severidade das lesões. A reprodutibilidade dos índices visuais foi substancial (kpE = 0,645) e (kpN = 0,634) e as médias do DD apresentaram correlação de Pearson significativa e altamente positiva (rp = 0,930). A comparação entre os índices visuais também foi positiva e significativa principalmente quanto à severidade (rcs = 0,623) e nas dicotomizações para a presença de lesão (rcs = 0,765) e descoloração (rcs = 0,757). O teste t de Student para as comparações entre os índices e as médias do DD também se apresentaram significativos (p < 0,001) para presença de lesão e descoloração ao contrário dos resultados para atividade. A análise de variância entre os graus de severidade dos índices visuais e as médias do DD mostrou diferenças estaticamente significativas apenas entre os graus de severidade 0 e 1 (E - 2a) para o índice E e 0, 1 (N - 4) e 2 (N - 5) para o índice N. Conclui-se, para sulcos e fossetas descoloridos de molares decíduos, que (1) ambos os métodos (visuais e de fluorescência a laser) mostraram-se confiáveis (2) o DD foi capaz de diferenciar tecidos hígidos de lesões com descoloração e de (3) inativas intactas ou com microcavidades em esmalte. / Aiming at developing an in vivo study of the reproducibility and correlation of two visual indexes (Ekstrand et al. (1998) ? E and Nyvad; Machiulskiene and Baelum (1999) ? N) and the measures of laser fluorescence (DIAGNOdent®,KaVo - DD) for the detection of decolorised pits and fissures, a single trained examiner, after the free and aware consent of 28 patients, opened the scores E, N and laser fluorescence averages of 190 primary molars with and without occlusal discoloration in pits and fissures. The reproducibility of the visual indexes was calculated with basis on the kappa Cohen and weighted kappa (wk) tests, while for the DD averages the Perason´s correlation (rp) was calculated. To provide a comparison among the visual indexes, the Sperman´s correlation (rcs) was calculated, and for the correlation among the visual indexes and the DD averages, the Student´s t test and the one-way analysis of variance (ANOVA) were applied to compare the DD averages and the degree of severity of the lesions. The reproducibility of the visual indexes was substantial (wkE= 0,645) and (wkN= 0,634); the DD averages presented a significant and highly positive Pearson´s correlation (rP= 0,930). The comparison among the visual indexes proved to be positive and significant, mainly in relation to the severity (rcs= 0,623) and the dichotomisations for the presence of lesion (rcs= 0,765) and discoloration (rcs= 0,757). The Student´s t test of for the comparisons among the indexes and the DD averages also proved to be significant (p < 0,001) for the presence of lesion and discoloration, contrary to the activity results. The one-way analysis of variance (ANOVA) among the degrees of severity and DD averages showed significant differences only at the degrees 0 and 1 (E ? 2a) of the E index and 0, 1 (N ? 4) and 2 (N ? 5) of the N index. The conclusions for pits and fissures with discoloration in primary molars are that (1) both methods (visual and laser fluorescence) were reliable (2) the DD was able to diferenciatte sound tissues from lesions with discoloration and (3) inactive intact or with microcavities lesions at the enamel level.