Reliability of attachment loss measurements in a longitudinal clinical trial

In order to appropriately carry out a longitudinal assessment of periodontal attachment loss in individuals with untreated periodontitis, reliable criteria for determining "real" changes in attachment level (AL) are required. In the present study, 25 subjects were to be examined every 2 months for up to 2 years to determine changes in AL and to relate clinical and laboratory criteria to such changes. Trained examiners for the study underwent calibration trials to determine inter-examiner and intra-examiner reliability both before the study and at intervals during the study. It was found that AL measurements were in agreement within 2 mm more than 95% of the time. The calibration trials provided an estimate of the error in attachment loss measurements, since no "real" attachment loss had occurred. From estimates of measurement error, the probability of false positive changes were determined. It was found that acceptable false positive rates (less than 5%) could be achieved if 2 examiners each detected 3 mm change at a given site or if 2 examiners each detected 2 mm change at a site and verified that this change persisted at a subsequent examination. The results of the longitudinal trial were then compared to the probability estimates calculated from the calibration trials. It was found that probabilities of AL changes detected during the longitudinal trial for less stringent conditions than described above (e.g., single examiner, 2 examiners unconfirmed) were similar to to previously estimated false positive rates.(ABSTRACT TRUNCATED AT 250 WORDS)