title: Validation of a model to evaluate the role of radiographs in the diagnosis and treatment planning of periodontal diseases.
abstract: OBJECTIVE
  The purposes of this study were (i) to see if an indirect method of design (paper patients) could be developed for study of change affected by radiographs on diagnostic outcome and planned treatment of periodontal patients and (ii) to investigate the effect of the nature of clinical examination on the value of radiographs in reaching a periodontal diagnosis. Paper cases could allow the design of examiner blind studies where repeatability could be assessed.
  
  
  METHODS
  201 patients were assigned to one of four groups and clinically assessed according to group specifications. Radiographs were taken. Periodontal diagnoses and treatment plans were drawn up for each patient with and without radiographic information (real patient). Simulated paper transcriptions were made for each subject and diagnoses and treatment plans were again drawn up (paper patient).
  
  
  RESULTS
  For many diagnoses and treatment options assessments were similar for real and paper patients. There was substantial agreement between periodontal diagnoses reached from real and paper assessments (kappa=0.68). Greater differences were seen for extractions and periodontal surgery. Paper assessments better replicated real assessments when more thorough clinical examinations were undertaken. The relatively time efficient Group 2 clinical assessment appeared to perform similarly to the extensive Group 4 clinical assessment.
  
  
  CONCLUSIONS
  The model described may be useful for simulating real patients for studies of this nature. The Group 2 assessment appeared to give sufficient clinical information for patient management and may be an appropriate choice for initial diagnosis and treatment planning of periodontal patients.
authors.affiliation: Department of Periodontology, Leeds Dental Institute, Clarendon Way, Leeds LS2 9LU, UK. a.tugnait@leeds.ac.uk <a.tugnait@leeds.ac.uk>
authors.forename: A
authors.initials: A
authors.lastname: Tugnait
authors.forename: P N
authors.initials: PN
authors.lastname: Hirschmann
authors.forename: V
authors.initials: V
authors.lastname: Clerehugh
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003792:Dental Records; D012534:Dental Scaling; D018450:Disease Progression; D019214:Gingival Overgrowth / Q000175:diagnosis; D005891:Gingivitis / Q000175:diagnosis; D006801:Humans; D008487:Medical History Taking; D009910:Oral Hygiene; D010347:Patient Care Planning; D010510:Periodontal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D010518:Periodontitis / Q000175:diagnosis; D010808:Physical Examination; D016300:Radiography, Bitewing; D019252:Radiography, Dental, Digital; D011862:Radiography, Panoramic; D015203:Reproducibility of Results; D012107:Research Design; D016037:Single-Blind Method; D014081:Tooth Extraction
chemical_list: D000900:Anti-Bacterial Agents