Journal of Oral Rehabilitation 2000 27; 211 – 216 Reliability of some clinical parameters of evaluation in implant dentistry J. W. VERHOEVEN, M. S. CUNE & C. de PUTTER Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, Utrecht University, The Netherlands observations from the image on the radiograph SUMMARY Clinical tests that are commonly used to were interpreted as the ‘golden standard’ for the evaluate tissues surrounding natural teeth are also presence or absence of pathology adjacent to the used in implant dentistry. It is unclear if they are implant. Frequently, based on any clinical parame- equally valid and reflect the condition of the bone surrounding an implant reliably. This study evalu- ter, disease was not diagnosed, while the radio- ates the use of a plaque index, a gingiva index, the graph did show pathological loss of bone at the assessment of a probing depth and the Periotest bone–implant contact area. It is concluded that the aforementioned parameters are unreliable and value and relates the findings to the image on a radiograph in 16 patients, involving 32 IMZ im- unfit for clinical evaluation in implant dentistry. Radiographs are needed to evaluate critical mar- plants. All four clinical tests showed poor sensitiv- ity and, in general, only fair specificity when ginal bone changes surrounding dental implants. Introduction In order to monitor the condition of dental implants, clinical parameters for the evaluation of periodontal tissues around natural teeth, such as gingival health and plaque indices, assessment of probing depths and attachment and bone levels on radiographs, are com- monly used despite differences in morphology of muco-gingival tissues surrounding implants and natu- ral teeth (Lindhe et al., 1992; Schou et al., 1992). Therefore, one should question whether the aforemen- tioned clinical parameters are equally valid for the monitoring of teeth and dental implants and their surrounding tissues (Cox & Zarb, 1987; Bauman et al., 1992; Schou et al., 1992; van Steenberghe & Quirynen, 1993). The alveolar bone level surrounding an implant forms the ultimate and current result of treatment. In the absence of histological data, it is best detected on a radiograph (Bauman et al., 1992). However, the sys- tematic making of radiographs is undesirable and the usefulness of other clinical parameters should be investigated. An ideal clinical test will reliably detect disease — in our case changes in cervical bone – implant contact lev- els—at an early stage. It is conceivable that adequate clinical intervention may show better results at this stage. In addition, such a test should be easy to per- form, be non-invasive and be cost-effective. Reliability of a test can be expressed in terms of sensitivity and specificity, the former being the chance on a correct- positive classification by means of a test and the latter being the chance on a correct-negative classification (Table 1). This retrospective study evaluates to what degree commonly used clinical tests in implant dentistry are able to detect a critical amount of bone loss at the Table 1. Sensitivity and specificity of a clinical test Pathology present Pathology absent A (correct positive) Test positive B (false positive) D (correct negative) C (false negative) Test negative Sensitivity =(A/A+C)×100%. Specificity =(D/B+D)×100%. © 2000 Blackwell Science Ltd 211