Desenvolvimento e validação de critério para avaliação de restaurações indiretas

Abstract

The objectives of this study were: 1) to propose and validate a criteria developed specifically for the evaluation of the clinical performance of indirect restorations (UERJ), which does not yet exist in the scientific literature. 2) create a form and an association table, which will be used together, to identify the variables related to the operator, material and/or patient that can influence the longevity and classification of this type of restoration. The UERJ criteria allows classifying restorations according to the need for intervention: Maintenance (M) for success; Repair (B) for survival; Replacement (S) for failure; and does not apply (NA) in cases where the replacement of the restoration does not solve the identified problem (others variables involved). In this new criteria, a new form was developed, created to assist in the investigation of possible issues related to the operator, material and patient that could influence the restorations outcome. The parameters analyzed were: structural integrity (material, tooth and restauration margin), anatomical shape (contours, contacts and surface roughness), pulp health and aesthetic harmony. The Content validation was qualitative (Literature search and expert opinion) and technical (content validation index- IVC). The criterion validity was investigated comparing the new criterion with the most used criteria for the evaluation of indirect restorations, the CDA. Two dental surgeons, specialists in Dental Prosthesis, evaluated 196 indirect restorations at the Dental Prosthesis clinic of Odontoclínica Central da Marinha. These were trained and calibrated through a clinical and photographic examination, in order to achieve a double intrarater and interrater confidence level ≥ 85% and, thus, enable the validation of the UERJ criterion. Cohen's Kappa statistic test registered for both intra and interexaminer agreements a coefficient > 0.91 with p-value < 0.0001. The UERJ Criteria was validated trough sensitivity tests (0,96), specificity tests (0,91) and predictive values (VPP 0,84 and VPN 0,98) with confidence interval (CI) of 95%. Due to the current lack of standardization in clinical studies on the performance of indirect restorations, this study proposed a simple, specific and reproducible evaluation protocol, not yet available in the literature, through the creation and validation of this new criterion, the UERJ criterion. Within the limits of this study, the UERJ criterion is a valid instrument for evaluating the clinical performance of indirect restorations. It showed excellent inter- and intra-examiner agreement and statistical tests that confirmed these statements.