Abstract
This chapter focuses primarily on the periodontal measurement sources of variability and on practical issues related to training, calibrating, and monitoring the individuals involved in conducting a clinical trial. It is also provided on overview of statistical methods used to perform evaluation of intra-examiner (comparisons may be made in which the same investigator examines the same subjects two or more times) and inter-examiner reliability (in which different investigators examine the same subjects). Details are also given regarding the reliability studies performed in periodontal research.
References
Aardal E, Holm AC. Cortisol in saliva-reference ranges and relation to cortisol in serum. Eur J Clin Chem Clin Biochem. 1995;33:927–32.
Abbas F, Hart AA, Oosting J, van der Velden U. Effect of training and probing force on the reproducibility of pocket depth measurements. J Periodontal Res. 1982;17:226–34.
Abrahamsson I, Soldini C. Probe penetration in periodontal and peri-implant tissues. An experimental study in the beagle dog. Clin Oral Implants Res. 2006;17:601–5.
Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988–1994. J Periodontol. 1999;70:30–43.
Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994. J Periodontol. 1999;70:13–29.
Axtelius B, Edwardsson S, Theodorsson E, Svensäter G, Attström R. Presence of cortisol in gingival crevicular fluid. A pilot study. J Clin Periodontol. 1998;25:929–32.
Barendregt DS, Van der Velden U, Reiker J, Loos BG. Clinical evaluation of tine shape of 3 periodontal probes using 2 probing forces. J Clin Periodontol. 1996;23:397–402.
Bartko JJ. Measurement and reliability: statistical thinking considerations. Schizophr Bull. 1991;17:483–9.
Bergmann A, Deinzer R. Daytime variations of interleukin-1beta in gingival crevicular fluid. Eur J Oral Sci. 2008;116:18–22.
Bessa Rebelo MA, Adriana Corra de Queiroz A. Gingival indices: state of art. In: Panagakos FS, Davies RM, editors. Gingival diseases – their aetiology, prevention and treatment. InTech, São Paulo. 2011; p. 41–54.
Birek P, McCulloch CA, Hardy V. Gingival attachment level measurements with an automated periodontal probe. J Clin Periodontol. 1987;14:472–7.
Birkeland JM, Jorkjend L. The influence of examination of the assessment of the intra-examiner error by using the plaque and gingival index systems. Community Dent Oral Epidemiol. 1975;3:214–6.
Blieden TM, Caton JG, Proskin HM, Stein SH, Wagener CJ. Examiner reliability for an invasive gingival bleeding index. J Clin Periodontol. 1992;19:262–7.
Buduneli E, Aksoy O, Köse T, Atilla G. Accuracy and reproducibility of two manual periodontal probes. An in vitro study. J Clin Periodontol. 2004;31:815–9.
Bulthuis HM, Barendregt DS, Timmerman MF, Loos BG, van der Velden U. Probe penetration in relation to the connective tissue attachment level: influence of tine shape and probing force. J Clin Periodontol. 1998;25:417–23.
Caton J, Greenstein G, Polson AM. Depth of periodontal probe penetration related to clinical and histologic signs of gingival inflammation. J Periodontol. 1981;52:626–9.
Chamberlain AD, Renvert S, Garrett S, Nilvéus R, Egelberg J. Significance of probing force for evaluation of healing following periodontal therapy. J Clin Periodontol. 1985;12:306–11.
Cicchetti DV, Heavens JR. A computer program for determining the significance of the difference between pairs of independently derived values of kappa or weighted kappa. Educ Psychol Meas. 1981;41:189–93.
Clark WB, Magnusson I, Namgung YY, Yang MCK. The strategy and advantage in use of an electronic probe for attachment measurement. Adv Dent Res. 1993;7:152–7.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–20.
Daly C, Mitchell D, Grossberg D, Highfield J, Stewart D. Bacteraemia caused by periodontal probing. Aust Dent J. 1997;42:77–80.
Daly CG, Mitchell DH, Highfield JE, Grossberg DE, Stewart D. Bacteremia due to periodontal probing: a clinical and microbiological investigation. J Periodontol. 2001;72:210–4.
Deas DE, Moritz AJ, Mealey BL, McDonnell HT, Powell CA. Clinical reliability of the “furcation arrow” as a diagnostic marker. J Periodontol. 2006;77:1436–41.
Deinzer R, Mossanen BS, Herforth A. Methodological considerations in the assessment of gingival crevicular fluid volume. J Clin Periodontol. 2000;27:481–8.
Dombret B, Matthijs S, Moradi Sabzevar M. Interexaminer reproducibility of ordinal and interval-scaled plaque indices. J Clin Periodontol. 2003;30:630–5.
Eaton KA, Rimini FM, Zak E, Brookman DJ, Newman HN. The achievement and maintenance of inter-examiner consistency in the assessment of plaque and gingivitis during a multicentre study based in general dental practices. J Clin Periodontol. 1997;24:183–8.
Egelberg J. Oral hygiene methods the scientific way (synopses of clinical studies). 1st ed. Sweden: OdontoScience; 1999. p. 271–8.
Eickholz P, Steinbrenner H, Lenhard M, Marquardt M, Holle R. Interexaminer reliability of the assessment of clinical furcation parameters as related to different probes. Eur J Oral Sci. 1999;107:2–8.
Feldman RS, Douglass CW, Loftus ER, Kapur KK, Chauncey HH. Interexaminer agreement in the measurement of periodontal disease. J Periodontal Res. 1982;17:80–9.
Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76:378–82.
Fleiss JL, Chilton NW. The measurement of interexaminer agreement on periodontal disease. J Periodontal Res. 1983;18:601–6.
Fleiss JL, Gordon J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33:613–9.
Fleiss JL, Cohen J, Everitt BS. Large sample standard errors of kappa and weighted kappa. Psychol Bull. 1969;72:323–7.
Fleiss JL, Nee JCM, Landis JR. Large sample variance of kappa in the case of different sets of raters. Psychol Bull. 1979;86:974–7.
Fleiss JL, Mann J, Paik M, Goultchin J, Chilton NW. A study of inter- and intra-examiner reliability of pocket depth and attachment level. J Periodontal Res. 1991;26:122–8.
Gibbs CH, Hirschfeld JW, Lee JG, Low SB, Magnusson I, Thousand RR, Yerneni P, Clark WB. Description and clinical evaluation of a new computerized periodontal probe – the Florida probe. J Clin Periodontol. 1988;15:137–44.
Goodson JM, Kondon N. Periodontal pocket depth measurements by fiber optic technology. J Clin Dent. 1988;1:35–8.
Goulet JP, Clark GT. Clinical TMJ examination methods. J Calif Dent Assoc. 1990;18:25–33.
Gröndahl K, Sundén S, Gröndahl HG. Inter- and intraobserver variability in radiographic bone level assessment at Brånemark fixtures. Clin Oral Implants Res. 1998;9:243–50.
Grossi SG, Dunford RG, Ho A, Koch G, Machtei EE, Genco RJ. Sources of error for periodontal probing measurements. J Periodontal Res. 1996;31:330–6.
Hansen AM, Garde AH, Persson R. Sources of biological and methodological variation in salivary cortisol and their impact on measurement among healthy adults: a review. Scand J Clin Lab Invest. 2008;68:448–58.
Hausmann E. Radiographic and digital imaging in periodontal practice. J Periodontol. 2000;71:497–503.
Hefti AF. Periodontal probing. Crit Rev Oral Biol Med. 1997;8(3):336–56.
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.
Hou GL, Hung CC, Yang YS, Shieh TY, Tsai CC. Radiographic alveolar bone loss in untreated Taiwan Chinese subjects with adult periodontitis measured by the digital scanning radiographic image analysis method. Dentomaxillofac Radiol. 2003;32:104–8.
http://en.wikipedia.org/wiki/Fleiss%27_kappa. Fleiss’ kappa.Accessed on 22 Feb 2010.
Jeffcoat MK. Current concepts in periodontal disease testing. J Am Dent Assoc. 1994;125:1071–8.
Jeffcoat MK, Jeffcoat RL, Jens SC, Captain K. A new periodontal probe with automated cemento-enamel junction detection. J Clin Periodontol. 1986;13:276–80.
Kawamura M, Fukuda S, Inoue C, Sasahara H, Iwamoto Y. The validity and reproducibility of an oral rating index as a measurement of gingival health care and oral hygiene level in adults. J Clin Periodontol. 2000;27:411–6.
Khocht A, Chang KM. Clinical evaluation of electronic and manual constant force probes. J Periodontol. 1998;69:19–25.
Kida IA, Astrøm AN, Strand GV, Masalu JR. Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania. BMC Oral Health. 2006;6:5.
Kinane DF, Riggio MP, Walker KF, MacKenzie D, Shearer B. Bacteraemia following periodontal procedures. J Clin Periodontol. 2005;32:708–13.
Kingman A, Albandar JM. Methodological aspects of epidemiological studies of periodontal diseases. Periodontol 2000. 2002;29:11–30.
Koo KT, Polimeni G, Albandar JM, Wikesjö UM. Periodontal repair in dogs: analysis of histometric assessments in the supraalveolar periodontal defect model. J Periodontol. 2004;75(12):1688–93.
Kudielka BM, Hellhammer DH, Wüst S. Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology. 2009;34:2–18.
Lafzi A, Mohammadi AS, Eskandari A, Pourkhamneh S. Assessment of intra- and inter-examiner reproducibility of probing depth measurements with a manual periodontal probe. JODDD. 2007;1:19–25.
Lang NP, Cullinan MP, Holborow DW, Heitz-Mayfield LJA. Examiner training: standardization and calibration in periodontal studies. In: Giannobile WV, Burt BA, Genco RJ, editors. Clinical research in oral health. 1st ed. Hoboken: Wiley-Blackwell; 2010. p. 159–75.
Larsen C, Barendregt DS, Slot DE, Van der Velden U, Van der Weijden F. Probing pressure, a highly undervalued unit of measure in periodontal probing: a systematic review on its effect on probing pocket depth. J Clin Periodontol. 2009;36:315–22.
Löe H, Silness J. Periodontal disease in pregnancy. 1. Prevalence and severity. Acta Odontol Scand. 1963;21:533–51.
Magnusson I, Fuller WW, Heins PJ, Rau CF, Gibbs CH, Marks RG, Clark WB. Correlation between electronic and visual readings of pocket depths with a newly developed constant force probe. J Clin Periodontol. 1988;15:180–4.
Mariath AA, Bressani AE, Haas AN, Araujo FB, Rösing CK. Professional flossing as a diagnostic method for gingivitis in the primary dentition. Braz Oral Res. 2008;22:316–21.
Marks RG, Magnusson I, Taylor M, Clouser B, Maruniak J, Clark WB. Evaluation of reliability and reproducibility of dental indices. J Clin Periodontol. 1993;20:54–8.
Mayfield L, Bratthall G, Attström R. Periodontal probe precision using 4 different periodontal probes. J Clin Periodontol. 1996;23:76–82.
McClanahan SF, Bartizek RD, Biesbrock AR. Identification and consequences of distinct Löe-Silness gingival index examiner styles for the clinical assessment of gingivitis. J Periodontol. 2001;72:383–92.
Mojon P, Chung J-P, Favre P, Budtz-Jorgensen E. Examiner agreement on periodontal indices during dental surveys of elders. J Clin Periodontol. 1996;23:56–9.
Mombelli A, Mühle T, Brägger U, Lang NP, Bürgin WB. Comparison of periodontal and peri-implant probing by depth-force pattern analysis. Clin Oral Implants Res. 1997;8:448–54.
Müller HP, Ulbrich M. Alveolar bone levels in adults as assessed on panoramic radiographs. (I) Prevalence, extent, and severity of even and angular bone loss. Clin Oral Investig. 2005;9(2):98–104.
Müller HP, Barrieshi-Nusair KM. Gingival bleeding on repeat probing after different time intervals in plaque-induced gingivitis. Clin Oral Investig. 2005;9:278–83.
Namgung YY, Yang MC. Outlier reduction by an option-3 measurement scheme. Biometrics. 1994;50(1):173–82.
Neto JB, Filho GR, Tramontina VA, Sallum EA, Nociti Jr FH, Sallum AW. Millimeter marks and probe tip diameter standardisation from commercially available periodontal probes. A comparative study. J Int Acad Periodontol. 2001;3:57–60.
Nield-Gehrig JS. Fundamentals of periodontal instrumentation and advanced root instrumentation. Philadelphia: Lippincott Williams & Wilkins; 2007.
Oakley C, Brunette DM. The use of diagnostic data in clinical dental practice. Dent Clin North Am. 2002;46:87–115.
Osborn J, Stoltenberg J, Huso B, Aeppli D, Pihlstrom B. Comparison of measurement variability using a standard and constant force periodontal probe. J Periodontol. 1990;61:497–503.
Osborn JB, Stoltenberg JL, Huso BA, Aeppli DM, Pihlstrom BL. Comparison of measurement variability in subjects with moderate periodontitis using a conventional and constant force periodontal probe. J Periodontol. 1992;63:283–9.
Pecoraro M, Azadivatan-le N, Janal M, Khocht A. Comparison of observer reliability in assessing alveolar bone height on direct digital and conventional radiographs. Dentomaxillofac Radiol. 2005;34:279–84.
Pierro VS, de Souza IP, Luiz RR, Barcelos R, Moraes RS. Reliability of two methods for measurement of alveolar bone level in children. Dentomaxillofac Radiol. 2008;37:34–9.
Pihlstrom BL. Measurement of attachment level in clinical trials: probing methods. J Periodontol. 1992;63:1072–7.
Polson AM. The research team, calibration, and quality assurance in clinical trials in periodontics. Ann Periodontol. 1997;2:75–82.
Preshaw PM, Kupp L, Hefti AF, Mariotti A. Measurement of clinical attachment levels using a constant force periodontal probe modified to detect the cementoenamel junction. J Clin Periodontol. 1999;26:434–40.
Quirynen M, Callens A, van Steenberghe D, Nys M. Clinical evaluation of a constant force electronic probe. J Periodontol. 1993;64:35–9.
Rae G. The equivalence of multiple rater kappa statistics and intraclass correlation coefficients. Educ Psychol Meas. 1988;48:367–74.
Ramfjord SP. Indices for prevalence and incidence of periodontal disease. J Periodontol. 1959;30:51–9.
Reddy MS, Palcanis KG, Gears NC. A comparison of manual and controlled-force attachment-level measurements. J Clin Periodontol. 1997;24:920–6.
Rise J, Tollefsen T. Reliability of plaque and periodontal measurements estimated by the internal consistency method. Acta Odontol Scand. 1984;42:293–6.
Roberts GJ. Dentists are innocent! “Everyday” bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. Pediatr Cardiol. 1999;20:317–25.
Sakka S, Al-ani Z, Kasioumis T, Worthington H, Coulthard P. Inter-examiner and intra-examiner reliability of the measurement of marginal bone loss around oral implants. Implant Dent. 2005;14:386–8.
Seabra RC, Costa FO, Costa JE, Van Dyke T, Soares RV. Impact of clinical experience on the accuracy of probing depth measurements. Quintessence Int. 2008;39:559–65.
Shaw L, Murray JJ. Diagnostic reproducibility of periodontal indices. J Periodontal Res. 1977;12:141–7.
Shi XQ, Eklund I, Tronje G, Welander U, Stamatakis HC, Engström PE, Engström GN. Comparison of observer reliability in assessing alveolar bone changes from color-coded with subtraction radiographs. Dentomaxillofac Radiol. 1999;28:31–6.
Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.
Silness J, Löe H. Periodontal disease in pregnancy. 2. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121–35.
Spolsky VW, Gornbein JA. Comparing measures of reliability for indices of gingivitis and plaque. J Periodontol. 1996;67:853–9.
Suh YI, Lundgren T, Sigurdsson T, Riggs M, Crigger M. Probing bone level measurements for determination of the depths of class II furcation defects. J Periodontol. 2002;73:637–42.
Teeuw WJ, Coelho L, Silva A, van der Palen CJNM, Lessmann FGJM, van der Velden U, Loos BG. Validation of a dental image analyzer tool to measure alveolar bone loss in periodontitis patients. J Periodontal Res. 2009;44:94–102.
Valachovic RW, Douglass CW, Berkey CS, McNeil BJ, Chauncey HH. Examiner reliability in dental radiography. J Dent Res. 1986;65:432–6.
Van der Zee E, Davies EH, Newman HN. Marking width, calibration from tip and tine diameter of periodontal probes. J Clin Periodontol. 1991;18:516–20.
Verhoeven JW, Cune MS, de Putter C. Reliability of some clinical parameters of evaluation in implant dentistry. J Oral Rehabil. 2000;27:211–6.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37:360–3.
Walsh TF, Saxby MS. Inter- and intra-examiner variability using standard and constant force periodontal probes. J Clin Periodontol. 1989;16:140–3.
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT, American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, Quality of Care and Outcomes Research Interdisciplinary Working Group, American Dental Association. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc. 2007;138(739–45):747–60.
Winter AA. Measurement of the millimeter markings of periodontal probes. J Periodontol. 1979;50:483–5.
Wolf B, Von Bethlenfalvy E, Hassfeld S, Staehle HJ, Eickholz P. Reliability of assessing interproximal bone loss by digital radiography: intrabony defects. J Clin Periodontol. 2001;28:869–78.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Dumitrescu, A.L. (2012). Measurement Reliability in Periodontal Research. In: Understanding Periodontal Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28923-1_6
Download citation
DOI: https://doi.org/10.1007/978-3-642-28923-1_6
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-28922-4
Online ISBN: 978-3-642-28923-1
eBook Packages: MedicineMedicine (R0)