Examiner differences in the assessment of different malocclusions

Area of Science:

• Orthodontics
• Dental Diagnostics
• Public Health

Background:

• Growing emphasis on treatment quality and cost reduction in healthcare.
• Increasing use of indication systems in orthodontics to guide treatment necessity and evaluate success.
• Objective malocclusion assessment is crucial for these indication systems.

Purpose of the Study:

• To evaluate the reliability of examiners in assessing various types of malocclusions.
• To compare the consistency of diagnoses between clinical examinations and dental models.
• To assess inter-examiner and intra-examiner reliability in malocclusion assessment.

Main Methods:

• Clinical and model-based assessment of malocclusions in 180 adults from the Study of Health in Pomerania (SHIP).
• Examinations conducted by calibrated clinicians, including an experienced orthodontist for clinical assessments.
• Model analysis performed by experienced orthodontists, with comparisons including varying experience levels and repeated assessments for intra-individual reliability.

Main Results:

• Examiner reliability varied significantly based on the type of malocclusion assessed.
• Crowding and contact point displacement showed low inter-examiner agreement.
• Crossbite, edge-to-edge bite, deep bite, and enlarged overjet demonstrated higher agreement.
• The greatest discrepancies were observed between clinical examination and model analysis (kappa median 0.57).
• Model examiner comparisons revealed differences, with less experienced examiners showing greater divergence (kappa median 0.61-0.62) compared to more experienced ones (kappa median 0.70).
• Intra-individual comparisons yielded the highest reliability (kappa median 0.82).

Conclusions:

• Examiner reliability in malocclusion assessment is condition-dependent.
• Discrepancies exist between clinical and model-based assessments, impacting diagnostic consistency.
• Orthodontic experience level influences examiner reliability, highlighting the need for standardized training and protocols.
• While intra-individual reliability is high, inter-examiner variability necessitates careful consideration in clinical practice and research.