Comparison of calculus detection among dental hygienists using an explorer and ultrasonic Insert.
Calculus detection is a type of dental technology that allows dentists to detect Subgingival calculus, which refers to the calculus below the crest of the marginal gingiva which is not seen during an oral exam. On the other hand, a dental explorer is an instrument in dentistry commonly used in dental armamentarium. An ultrasonic insert is a dentistry tool formally used to cut teeth very quickly. Still, it was improved to an ultrasonic scaler used to remove deposits from hard tissues of the teeth. The purpose of this study is to understand the effectiveness of calculus detection between Thinsert® ultrasonic Insert and the ODU 11/12 explorer.
The ODU 11/12 explorer has a thin tip, which allows the dentist to feel the tactile sensitivity by transferring the vibrations from the tip to the handle. Other technologies of detecting calculus have been invented over time. They include; Endoscopy, Spectro-optical, Auto-fluorescence technology Laser technology, among others.
Endoscopy is a calculus detection system that allows the practitioner to insert optical fibers and light sources into the teeth’ periodontal pockets. It magnifies the images up to 48 times on the screen. It is also associated with some disadvantages, i.e., it is expensive. Besides, it requires a long time to learn and extra treatment when scaling and root planing.
Auto-fluorescence was initially used to detect caries, but it was later improved to suit calculus detection. Also known as Diagnodent, it uses indium gallium arsenide diode that emits light in a wavelength onto the tooth structure. It is very effective and solely used for calculus detection.
Spectro-optical technology uses a light-emitting diode with an optical fiber attached to a cordless handpiece. Further clinical experiments would determine its effectiveness.
Lasers, specifically the KEY3 laser, combines two technologies. The InGaAs diode for calculus detection and Erbium-doped yttrium garnet (Er: YAG) for calculus removal. This technology has its disadvantages, i.e., high cost, state dental board regulations that limit its use. A variety of ultrasonic instruments are invented for biofilm and calculus removal.
The Thinsert® ultrasonic Insert has a thin tip closer to the ODU 11/12 explorer. Its design facilitates enhanced periodontal access and effective subgingival adaptation. During this process, dentists alternate between explorer use for detection and other instruments for removal. The process is repeated until the desired results are achieved.
Citations;
Introduction PNG page 192 & 193
METHODS USED FOR COMPARISON.
To determine the better instrument to use in this case, an experiment has to be conducted. Consider 30 patients who have agreed to sign a written informed consent, medical history forms before the study. We’d use three faculty participants/This is made possible by making it a no-cost study. The calculus is evaluated using the Ramfjord index teeth on four possible surfaces per tooth, i.e., mesial, buccal.
The procedure is as follows; the three participants undergo calibration training using three different typodonts with different stimulated calculus surfaces. The results came back positive when we used the ODU 11/12 explorer, and we recorded the results on the standardized calculus detection chart. We divide the 30 participants into groups of three, two with 11 each and one with 8. The study was done randomly among the participants using a coin toss, and either of the two experiments tested each participant until all of them were evaluated.
Data analysis.
All statistical analysis was conducted using SPPS Version 24 (IBM Chicago, IL USA). To measure interrater reliability among many participants, two-way random effects interclass coefficient (ICC)were calculated. The values were calculated using the faculty participants using the two instruments. Values <0.29 indicate poor reliability, values between 0.30 and 0.49 suggest fair reliability, 0.50 and 0.69 indicate moderate reliability, and values >0.70 indicate strong reliability.
To measure interrater reliability, Cohen’s Kappa coefficient values were used. The values ranged from zero to one, no agreement to perfect agreement, respectively. 0.41-0.60 were in moderate agreement, 0.61-0.80 were in full agreement, and > 0.81 were in perfect agreement.
To determine the sensitivity, specificity, positive predictive value, and negative predictive value of calculus detection when using the Insert, a cross-tabulation of all surfaces evaluated for calculus was generated between the two instruments.
Results;
| Participants | 1 | 2 | 3 | 4 | 5 | 6 |
| P1 | R1E | R2T | R3E | R1T | R2E | R3T |
| P2 | R2T | R3E | R1E | R2E | R3T | R1T |
| P3 | R3T | R1T | R2E | R3E | R1E | R2T |
(R1…. Rn) = Rater Detection E=Explorer T= Thinsert®
Citations;
The method, study, and instrument PNG page 193, 194 & 195
CONCLUSION.
This study aimed to determine the effectiveness between the ODU 11/12 explorer and the Thinsert® when used by practitioners. The main aims were to determine the interrater agreement, interrater agreement and sensitivity, specificity, positive predictive value, and the negative predictive value of calculus detection among dental hygienists when using the above instruments. The results are in the table below;
| The gold standard (+) calculus present explorer | Gold standard (-) calculus present explorer | ||
| Test outcome (+) calculus present Thinsert® | 75%
n = 322(true positive) |
4%
n = 75 (false positive) |
81%
PPV TP/ (TP + FP) |
| Test outcome (+) calculus absent Thinsert® | 25%
n = 108 (false negative) |
94%
n = 1665 (true negative) |
94%
NPV TN/ (FN + TN) |
| Total | n = 430 | n = 1730 | n = 2160 |
75% sensitivity 96% sensitivity
The comparison in the table above the Thinsert® seems to be more effective at detecting the absence of calculus vs the presence of calculus. Out of the 2160 total surfaces evaluated in this study, 430 (20%) surfaces were determined to have calculus using the explorer, and 322 (15%) surfaces were determined to have calculus when using both devices. Some previous studies have shown varying levels of the above data, i.e., Pippin and Feil’s calculus evaluation. The gold standard in detecting the presence or absence of readily detectable calculus supports periodontal therapy and maintenance rationale. It involves removing readily detectable calculus and achieving and maintaining the health of the adjacent periodontal tissues, although complete removal is not achievable. Reevaluation is advised.
Citations; Discussion PNG page 196
References
Henry RK, Goldie MP. Hygiene application to clinical practice. Philadelphia, PA: F.A Davis Company; 2016.
Nield-Gehrig J. Fundamentals of periodontal Instrumentation and Advanced Root Instrumentation, 8th and. Philadelphia, PA: Lippincott William & Wilkins; 2017.
Examiners ABoD. A patient treatment clinical examination manual. 2018; http://www.cdcexams.org/documents/Manual_Dental__Hygiene_2018.pdf.Accessed March 22,2018.