title: Reproducibility of the assessment of the Fränkel manoeuvre for the evaluation of sagittal skeletal discrepancies in Class II individuals.
abstract: The Fränkel manoeuvre is a procedure by which the mandible of Class II individuals is postured forward in dental Class I relationship. The evaluation of the resulting facial profile provides information concerning the components determining the sagittal discrepancy. Data concerning the reproducibility of its assessment are not available. This study aimed to evaluate the intra-observer and inter-observer reproducibility of the assessment of the manoeuvre and to assess whether the amount of clinical experience affects its reproducibility.
  
  
  
  Two lateral photographs, one in centric occlusion, and the other with the mandible postured forward (Fränkel manoeuvre) of 100 Angle Class II individuals aged between 9 and 13 years were evaluated by six orthodontists (T0). Each examiner was asked whether the facial profile worsen or not with the manoeuvre after being trained by an expert orthodontist. The test was repeated after 2 weeks interval (T1). Intra-observer and inter-observer agreement were evaluated by computing the Cohen's K.
  
  
  
  The agreement (K values) between observations (T0 versus T1) for each examiner ranged from 0.49 to 0.72. The overall agreement was 0.65 [95% confidence interval (CI) = 0.54-0.75]. The agreement in the group with less clinical experience was 0.61 (95% CI = 0.46-0.76), while it was 0.68 (95% CI = 0.53-0.83) in the more experienced group. The amount of clinical experience did not affect intra-observer agreement (P = 0.50). The overall agreement between the examiners and the trainer was 0.74 (95% CI = 0.65-0.83) and 0.73 (95% CI = 0.64-0.83) at T0 and T1 respectively.
  
  
  
  The assessment of the Fränkel manoeuvre is reproducible and it is not influenced by the amount of clinical experience.
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martina
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy, Bambino Gesù Hospital, Division of Dentistry and Orthodontics, Rome, Italy, and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'Antò
authors.affiliation: Medical Statistics Unit - Second University of Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Casillo
authors.affiliation: Bambino Gesù Hospital, Division of Dentistry and Orthodontics, Rome, Italy, and.
authors.forename: Angela
authors.initials: A
authors.lastname: Galeotti
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Tagliaferri
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy.
authors.forename: Ambrosina
authors.initials: A
authors.lastname: Michelotti
authors.affiliation: *Department of Neuroscience, Reproductive and Oral Sciences, Section of Orthodontics, University of Naples, Federico II, Italy, Department of Orthodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada martina@unina.it.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Cioffi
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D003768:Dental Occlusion, Centric; D004955:Esthetics, Dental; D005145:Face / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000175:diagnosis* / Q000473:pathology; D008334:Mandible / Q000473:pathology; D015588:Observer Variation; D023861:Photography, Dental; D015203:Reproducibility of Results