Complete denture occlusion: intra and inter observer analysis

Abstract

Aim: The aim of this study was to investigate the accuracy, intra- and inter-observer reliability of identifying occlusal markings made by articulating paper on complete dentures intra-orally. Methods: A series of photographs of 14 tissue borne complete dentures with occlusal markings was obtained. Articulating paper was used intra-orally at the delivery visit to make the occlusal markings. The denture sets were divided into two groups. Group 1 comprised pictures of the 14 complete lower dentures on their own, and group 2 comprised pictures of the same 14 lower dentures together with their opposing upper denture. The two groups of images were loaded into a Microsoft PowerPoint presentation as well as Keynote. Two experienced observers analysed the complete dentures independently and noted the number and distribution of the markings that they felt required adjustment. They differed, but discussed these and reached consensus. These data served as the control. Three groups of observers (10 per group) were then asked to analyse the occlusal markings of the 2 groups of denture images twice, with a two-week interval between each assessment. Before each subsequent assessment, the images were randomised by means of computer-generated random number sequence. The mean number of markings was established for each group and compared with the control mean. Intra-rater reliability was established by comparing the difference of the means of sequential observations for each rater by establishing the z-value. Inter-rater reliability within each group was established by means of analysis of variance. Results: Considering all the data, in only 17 instances (of the possible 60), did observers’ mean scores not differ from the control mean scores with good intra-rater reliability. In all other 43 instances the observers’ mean scores differed from the control mean scores and/or displayed poor intra-rater reliability. Considerable variation in inter-rater reliability was also found within every group of observers. Conclusion: The results indicate that observers are generally unable to reliably identify occlusal markings warranting occlusal adjustment, made by articulating paper on a lower complete denture. Clinical significance: Articulating paper should not be used intra-orally when delivering removable complete dentures.