Reliability and validity of the patient disability-oriented diagnostic nomenclature system for prosthetic dentistry

Purpose: The Japan Prosthodontic Society (JPS) has proposed a new diagnostic nomenclature system (DNS), based on pathogenesis and etiology, to facilitate and improve prosthodontic treatment. This systemspecifies patient disability and the causative factor (i.e. ‘‘B (disability) caused by A (causative factor)’’). The purpose of this study was to examine the reliability and validity of this DNS. Study selection: The JPS Clinical Guideline Committee assessed mock patient charts and formulated disease names using the new DNS. Fifty validators, comprising prosthodontic specialists and dental residents, made diagnoses using the same patient charts. Reliability was evaluated as the consistency of the disease names among the validators, and validity was evaluated using the concordance rate of the disease names with the reference disease names. Results: Krippendorff’s α was 0.378 among all validators, 0.370 among prosthodontic specialists, and 0.401 among dental hospital residents. Krippendorff’s α for 10 validators (3 specialists and 7 residents) with higher concordance rates was 0.524. Two validators (1 specialist and 1 resident) with the highest concordance rates had a Krippendorff’s α of 0.648. Common disease names had higher concordance rates, while uncommon disease names showed lower concordance rates. These rates did not show correlation with clinical experience of the validator or time taken to devise the disease name. Conclusions: High reliability was not found among all validators; however, validators with higher concordance rates showed better reliability. Furthermore, common disease names had higher concordance rates. These findings indicate that the new DNS for prosthodontic dentistry exhibits clinically acceptable reliability and validity

Clinical Results of Posterior Lumbar Interbody Fusion Using Titanium Intervertebral Spacers in Elderly Patients over 70 Years

Study Design : Retrospective study. Objective: To report the clinical and radiological results of posterior lumbar interbody fusion (PLIF)using titanium intervertebral spacers in elderly patients over 70 years. Summary of Background Data : PLIF with intervertebral spacers has been introduced to treat degenerative lumbar disorders. However, in the elderly patients, it is concerned that there are several possible complications that can be associated with the use of interbody support in anterior column reconstruction under weak bone quality. There were few reports about the results of PLIF using titanium intervertebral spacers in elderly patients. M ethods : Twenty-six patients with mean age of 73 years(range,70-78)underwent one or two-level PLIF using titanium intervertebral blocks combined with posterior instrumentation,with minimum 2-year follow-up (average 49 months; range, 25-88). Radiographic and clinical outcomes analysis was performed. Results : The sagittal alignment (regional lordosis) of the operative segments averaged 7.4°before surgery, 12.7°at discharge, 11.1°post-op 1-year, and 11.8°at the final follow-up. The percentage of posterior disc height was 14.1％ before surgery,and was significantly improved after the surgery to 26.9％ at discharge and 21.8％ at the final follow-up. In 18 patients with spondylolisthesis, the percentage of slip averaged 18.9％ before surgery, and was significantly improved after the surgery to 6.8％ at discharge and maintained until the final follow-up. All patients had radiographic fusion at the follow-up. The average JOA score was 12.6 points before surgery,and increased significantly to 23.1 points at the final follow-up. Conclusion : Posterior lumbar interbody fusion using titanium spacers is valuable even in the elderly patients. The preservation of bony endplate of vertebral body, and the insertion of spacers as antero-lateraly as possible in the intervertebral space, are important for successful fusion