The bending moments of the different tested types of zirconia abutments vary with different implant-abutment connections after chewing simulation. The use of a secondary metallic component might have a beneficial influence on the stability of zirconia abutments.

The objective of the study was to evaluate the visual assessment of vaginal discharge by vaginoscopy for the diagnosis of clinical endometritis (CE) in dairy cows. In an in vivo trial, inter- and intraobserver repeatability of vaginoscopic examination (VE) was determined and the effect of transrectal palpation and experience of the investigator evaluated. Holstein-Friesian cows (n=380) were examined by vaginoscopy between 21 and 27 d in milk by 3 investigators twice. Vaginal discharge was categorized on a 4-point classification system (0=clear mucus, 1=mucus containing flecks of pus, 2=discharge containing less than 50% pus, 3=discharge containing more than 50% pus). Cows with a vaginal discharge score (VDS) of 0 were classified as healthy, whereas cows with a VDS of 1 to 3 were classified as having CE. Vaginal discharge score on a scale from 0 to 3 has moderate intra- (Cohen's kappa coefficient, κ=0.55-0.60) and interobserver (κ=0.44) repeatability. The prevalence of CE was comparable between the 3 investigators (first VE: 42.6, 34.8, and 38.7; second VE 46.8, 36.9, and 43.7%). Transrectal palpation (relative risk=0.96-1.03) or experience of the investigator (relative risk=0.9-1.1) did not affect results of VE. In an in vitro trial, sensitivity and specificity of visual assessment were determined utilizing 33 images showing yellow and pink areas in certain percentages as a reference standard. Pus was represented by yellow areas and the mucosa, including clear mucus, by pink areas. These images were visually assessed by 30 investigators via PowerPoint presentation (experiment 1) and by 23 investigators via a simulated vaginal examination (experiment 2) utilizing the same 4-point classification system. Sensitivity was 99.6 and 96.3% and specificity was 96.7 and 90.1% in experiments 1 and 2, respectively. The results provide evidence that a visual assessment conducted by vaginoscopic examination is not perfect but can be considered a reasonable measurement of vaginal discharge and is a practical tool to distinguish healthy from diseased cows.

Providing a more reliable and examiner-independent technique for measurements of the soft tissue architecture could improve data quality in periodontal research and in the analysis of different clinical treatment modalities.

The objective of the study was to evaluate the reliability of a manual assessment of cervical diameter through palpation. In an in vivo trial, 64 Holstein-Friesian cows between 2 and 5d in milk (DIM) and between 21 and 27 DIM were examined by transrectal palpation by 3 investigators. For calculation of sensitivity and specificity, ultrasound-generated measurements were used as reference standard; a cervix >7.5 cm was categorized as large. The Pearson coefficient of correlation between the results of the 3 investigators and ultrasound-generated measurements was moderate (r=0.71, 0.74, and 0.51). The estimates generated by palpation by the 3 different investigators did not differ and were similar to measurements obtained by ultrasound. The coefficient of variation (CV) between the investigators and ultrasound was high (20.9, 18.7, and 32.0%). The mean difference between the investigators and the ultrasound was 0.60 cm (95% confidence interval: -2.4 to 3.6). Sensitivity was 28.6, 42.9, and 42.9%, and specificity was 100, 96.2, and 92.6% for the ability of the 3 investigators, respectively, to detect the 7.5-cm cutoff by palpation. Overall sensitivity and specificity for all 3 investigators, considering ultrasound as the reference, were 37.5 and 96.2%, respectively. In vitro, 24 wooden cylinders were used to represent cervical diameter and to examine the reliability, as well as sensitivity and specificity, of manual assessment of different diameters. The Pearson coefficient of correlation between the results of the investigators (n=11) and the actual diameters of the cylinders was 0.78. The CV between the investigators and the cylinders was 27.8%. The variation in the results was greater for cylinders with a larger diameter (3.5-cm diameter: mean ± standard deviation = 2.6 ± 0.9 cm; 10.5-cm diameter: mean ± standard deviation = 13.2 ± 4.0 cm). The estimate obtained by palpation for the 7.5-cm cylinder was 7.4 ± 2.1cm. Sensitivity was 79.4% and specificity 92.5%. After training one group of investigators, sensitivity and specificity improved to 85.9 and 94.4%, respectively. Transrectal palpation of the cervical diameter shows moderate repeatability and correlation and high variation between the investigators and the reference standards. Variability increased with larger diameters.