The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study.

PURPOSE: To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis. MATERIALS AND METHODS: Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement. RESULTS: Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75. CONCLUSION: The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.

Intra- and inter-rater agreement of a new classification system of gingival recession defects.

PURPOSE: Several classification systems have been proposed in the literature, but none of them has been validated by means of an appropriate statistical analysis and, therefore, it is unknown whether these systems work in the same manner among different clinicians. The aim of the present study is to investigate the intra- and inter-rater agreement of a new system to classify gingival recession defects and to evaluate its agreement among different clinicians. MATERIALS AND METHODS: A new classification system was proposed and tested considering the following three factors: the amount of keratinised tissue ( <2 or ≥2 mm), the presence / absence of non carious cervical lesions and the presence/ absence of interproximal attachment loss. Kappa-statistics were performed to analyse the intra-rater and inter-rater agreement among three blinded examiners. RESULTS: A total of 120 gingival recessions were evaluated using the new classification system. The intra-rater agreement ranged from 0.74 to 0.96 for the variable keratinised tissue, from 0.67 to 0.94 for the variable non-carious cervical lesions and from 0.70 to 0.92 for the variable interproximal attachment loss. The inter-rater agreement values ranged from 0.70 to 0.85 for keratinised tissue, from 0.54 to 0.59 for non-carious cervical lesions and from 0.54 to 0.77 for the interproximal attachment loss. CONCLUSIONS: Based on the results of this study, the proposed new classification system showed moderate to substantial agreement among investigators when used in the present study population and was therefore able to diagnose the severity of gingival recession defects.

Aesthetic perception after root coverage procedure.

AIM: To investigate the aesthetic perception of the clinical outcomes of a simulated root coverage procedure in three different groups: patients, dentists, and periodontists. MATERIAL AND METHODS: 100 patients, 107 general dentists affiliated with the Dental Association of Prato, Italy, and 81 active members of the Italian Society of Periodontology were recruited for this study. The following variables: age, gender, level of education, place of residence, and years of practice (only for dentists and periodontists) were recorded by means of a questionnaire administered to each subject within the three different groups. In addition, the participants in the study were requested to assign scores to images of eight simulated clinical cases of gingival recessions: a pre- and post-treatment image for each case. RESULTS: Statistically significant differences between groups were not detected in most of the scores. Gender and residence were not significantly associated with the scores, while age was correlated for two clinical cases (p=0.0014 and 0.0017). All the cases of complete root coverage showed the highest scores among all the participants. CONCLUSIONS: These results showed that complete root coverage following root coverage procedure is perceived as the most successful outcome by patients, dentists, and periodontists.