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ID naloge: 146 Letnik: 2003 Predmet: stomatologija
PRIMERJAVA EISMANNOVEGA INDEKSA, EISMANN-FARCNIKOVEGA INDEKSA IN INDEKSA POTREBE PO ORTODONTSKI OBRAVNAVI
Avtor: Jasmina Primožic
Mentor: prof. dr. Franc Farcnik
Izhodišce: Ortodontska diagnostika nam s pomocjo klasifikacijskih sistemov omogoca razvrstitev posameznih vrst zobnih in celjustnih nepravilnosti (malokluzij). Za razvršcanje še vedno uporabljamo nekoliko izpopolnjen klasifikacijski sistem po Anglu (1899). Za kvantitativno vrednotenje malokluzij pa imamo razlicne okluzijske indekse. Vsak od njih ima svoje prednosti in slabosti, vendar nobeden se ni uveljavil tako, da bi ga vsesplošno uporabljali.
Namen: Z namenom, da med okuzijskimi indeksi, ki so najbolj uporabljeni v Evropi, izberemo najprimernejšega za slovenske razmere, je cilj naloge ugotoviti primerjalne prednosti oziroma slabosti Eismannovega, Eismann-Farcnikovega (EF) indeksa in Indeksa potrebe po ortodontski obravnavi (IOTN), glede na njihovo ponovljivost, zanesljivost in zamudnost pri vrednotenju malokluzije.
Hipoteze: Eismannov, Eismann-Farcnikov in IOTN indeks pri vrednotenju obsega malokluzije skladno uvršcajo preiskovance v razrede težavnosti. Ponovljivost vrednotenja malokluzije posameznega meritelja in razlicnih meriteljev je za vse tri indekse popolna. Glede na število znakov malokluzije, ki jih indeksi vrednotijo, pricakujemo najdaljši cas pri vrednotenju malokluzije z EF indeksom, najkrajši pa z IOTN indeksom.
Metode: Raziskovalna naloga je retrospektivna študija. Pri 100 preiskovancih (53 žensk, 47 moških; povprecna starost 15,4 let), ki so bili napoteni k specialistu zobne in celjustne ortopedije, sem na študijskih modelih stalnega zobovja številcno ovrednotila obseg malokluzije z Eismannovim, EF in IOTN indeksom. Skladnost pri razvršcanju v težavnostne razrede sem preverila s koeficientom korelacije ranga po Spearmanu, skladnost vrednotenja enega meritelja in razlicnih meriteljev pa s koeficientom ICC (intra-class correlation coefficient). Razlike v casu vrednotenja malokluzije sem statisticno preverila s parnim Studentovim t-testom.
Rezultati: Pri razvršcanju posameznikov v težavnostne razrede sem ugotovila srednje mocno stopnjo povezanosti med Eismannovim in EF indeksom (koeficient korelacije ranga po Spearmanu znaša 0,727), šibko stopnjo povezanosti pa med Eismannovim in IOTN (Spearmanov koef. znaša 0,316) ter EF in IOTN indeksom (Spearmanov koef. znaša 0,387). Ugotovila sem popolno ponovljivost vrednotenja enega meritelja za Eismannov (ICC je 0,914) in EF (ICC je 0,922) indeks ter odlicno ponovljivost za IOTN indeks (ICC je 0,769). Skladnost vrednotenja malokluzije za razlicne meritelje je bila za vse tri indekse popolna (ICC za Eismannov in EF indeks je 0,925, za IOTN indeks pa 0,918). Najvec casa sem porabila za ovrednotenje študijskih modelov z EF indeksom (povprecno 27,1 minut) in Eismannovim indeksom (povprecno 26,86 minut), vendar razlike v casu niso bile statisticno znacilne (p<0,05, parni, dvosmerni Studentov t-test). Najmanj casa sem porabila pri dolocanju nepravilnosti z IOTN indeksom (povprecno 1,97 minut).
Zakljucki: Indeksi razlicno razvršcajo preiskovance v težavnostne razrede. EF indeks vrednoti najvec znakov, ki dolocajo obseg malokluzije, zato je bolj natancna in zanesljiva metoda kot IOTN in Eismannov indeks. Skladnost vrednotenja malokluzije, za enega in za vec meriteljev, je za vse tri indekse popolna. Vrednotenje nepravilnosti z Eismannovim in EF indeksom je zamudnejše v primerjavi z IOTN indeksom.
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[Abstract / English version]
PRIMERJAVA EISMANNOVEGA INDEKSA, EISMANN-FARCNIKOVEGA INDEKSA IN INDEKSA POTREBE PO ORTODONTSKI OBRAVNAVI
Author: Jasmina Primožic
Mentor: prof. dr. Franc Farcnik
Background: The purpose of orthodontic diagnosis and classification systems is to record different dental and arch anomalies (malocclusions). The modified Angle's method of classifying malocclusion is still the most widely used classification system. For quantitative assessing of malocclusion different occlusal indices are used. Each of them has its advantages and disadvantages, but there is no universally accepted method for measuring malocclusion.
Aim: The purpose of this study was to select the best suitable index for the Slovene population from the most widely used indices in Europe. The aim of the study was to compare the reliability, reproducibility and the time needed for evaluating malocclusion with the Eismann, Eismann-Farcnik (EF) indices and the Index of Orthodontic Treatment Need (IOTN).
Hypothesis: The Eismann and EF indices and the IOTN do not differ in the assessment and classification of malocclusion. The intra-examiner agreement and the inter-examiner agreement for all the three methods are perfect. Taking into account the number of morphological features that each method measures, we expect the EF index to be the most time-consuming, while the IOTN to be the least.
Methods: Study models of the permanent dentition of 100 patients (53 female, 47 male, mean age = 15,4), who were randomly selected from a population of people referred to the orthodontic centre, were evaluated with the Eismann and EF indices and the IOTN. The association between the three indices was tested with the Spearman rank correlation coefficient. To evaluate the intra- and inter-examiner agreement, the ICC (intra-class correlation coefficient) was used. To compare the differences in time consumption the paired two-tailed Student t-test was used.
Results: There was a substantial correlation between the Eismann and EF indices (Spearman coefficient = 0,727) and a weak correlation between the IOTN and the other two indices. (Eismann: Spearman coeff. = 0,316) and (EF: Spearman coeff. = 0,387). The intra-examiner agreement for the Eismann (ICC = 0,914) and EF (ICC = 0,922) indices was almost perfect, while for the IOTN the intra-examiner agreement was substantial (ICC = 0,769). The inter-examiner agreement was almost perfect for all the three methods. The most time-consuming methods for assessing malocclusion were the EF (mean time = 27,1 minutes) and Eismann indices (mean time = 26,86 minutes), but there were no statistically significant differences (p<0,05, paired, two-tailed Student's t-test). The least time-consuming method was the IOTN (mean time = 1,97 minutes).
Conclusions: The three indices differ in their assessment and classification of malocclusion. The EF index is a more precise and reliable method compared to the Eismann index and the IOTN, because it measures the highest number of features that define malocclusion severity. However, evaluating malocclusion with the Eismann and EF indices is more time-consuming than using the IOTN.
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