The relative area score for sublingual varices reliability measurement: a diagnostic study.

BACKGROUND: Sublingual varices (SV) and their predictive potential for other clinical parameters is a much studied topic in oral medicine. SVs have been well studied as predictive markers for many common diseases such as arterial hypertension, cardiovascular disease, smoking, type 2 diabetes mellitus and age. Despite many prevalence studies, it is still unclear how the reliability of SV inspection affects its predictive power. The aim of this study was to quantify the inspection reliability of SV. METHODS: In a diagnostic study, the clinical inspection of 78 patients by 23 clinicians was examined for the diagnosis of SV. Digital images of the underside of the tongue were taken from each patient. The physicians were then asked to rate them for the presence of sublingual varices (0/1) in an online inspection experiment. Statistical analysis for inter-item and inter-rater reliability was performed in a τ-equivalent measurement model with Cronbach's [Formula: see text] and Fleiss κ. RESULTS: The interrater reliability for sublingual varices was relatively low with κ = 0.397. The internal consistency of image findings for SV was relatively high with α≈ 0.937. This shows that although SV inspection is possible in principle, it has a low reliability R. This means that the inspection finding (0/1) of individual images often cannot be reproduced stably. Therefore, SV inspection is a difficult task of clinical investigation. The reliability R of SV inspection also limits the maximum linear correlation [Formula: see text] of SV with an arbitrary other parameter Y. The reliability of SV inspection R = 0.847 limits the maximum correlation to [Formula: see text] (SV, Y) = 0,920-a 100% correlation was a priori not achievable in our sample. To overcome the problem of low reliability in SV inspection, we propose the RA (relative area) score as a continuous classification system for SV, which normalises the area of visible sublingual veins to the square of the length of the tongue, providing a dimensionless measure of SV. CONCLUSIONS: The reliability of the SV inspection is relatively low. This limits the maximum possible correlation of SV with other (clinical) parameters. SV inspection reliability is an important indicator for the quality of SV as a predictive marker. This should be taken into account when interpreting previous studies on SV and has implications for future studies. The RA score could help to objectify the SV examination and thus increase its reliability.

Dimensional changes of the alveolar ridge contour of the premolar extraction site in adolescents.

PURPOSE: Premolar extraction in orthodontic therapy is common in adolescent patients. Knowledge of the tissue reaction in an extraction site is mainly based on studies with animal and adults. Thus, we aim to describe the time-dependent dimensional changes of the alveolar ridge contour of the premolar extraction site in adolescents. METHODS: Clinical data were obtained from a randomized controlled clinical trial (Universal Trial Number U1111-1132-6655), comparing treatment modalities with orthodontic space closure was initiated after 2-4 weeks (group A) and ≥ 12 weeks after tooth extraction (group B). Dental casts taken before the tooth extraction (T1) and before initiation of the space closure (T2) were digitalized with a 3D scanner and superimposed to analyze the dimensional changes of the alveolar ridge in early and later stage of wound healing. Linear mixed models were used for statistical analysis. RESULTS: Plaster models of 25 patients (mean age 15.2 years, 11 male and 14 female) with 66 extraction sites were enrolled. The average atrophic changes from tooth extraction to the early stage of wound healing (group A, n = 41) were in total 27.5% ± 11.8; labially 31.3% ± 15.1 and orally 23.6% ± 13.4. In group B (n = 25) the average atrophic changes were in total 38.6% ± 12.1; labially 46.2% ± 16.7; orally 31.3% ± 18.9. The atrophic changes between the groups in total (p = 0.031) and at the labial side (p = 0.012) were significant. The jaw affiliation was a significant parameter for all examined areas in regard to all cases (labial p = 0.019; oral p = 0.020; total p = 0.001). Atrophic changes between genders were not statistically different. CONCLUSIONS: Alveolar atrophy increased over time after extraction primarily in the lower jaw at the labial side. The main atrophy occurred in the first healing phase of the extraction socket. Thus, timely coordination is important to preserve sufficient bone levels. The atrophic changes of the alveolar ridge in adolescents parallel those reported for adults.