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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 2  »  Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease
Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease
Introduction - Materials and methods.



Introduction.
A strategy for the radiographic diagnosis of periapical pathosis was presented by Halse & Molven (1986) and used in follow-up studies, and they were later adopted by others (Halse & Molven 1987, Molven & Halse 1988, Sjögren et al . 1990, Saunders et al . 2000, Tronstad et al . 2000). This strategy involved two experienced observers, an endodontist and a radiologist. Cases were grouped either with no periapical pathological finding, with increased width of the periodontal ligament space, or with pathological finding. Agreement was studied on three levels: percentage agreement between scores, agreement by calculation of Cohen’s kappa, and discussed agreement, that is agreement after joint evaluation of disagreement and difficult, borderline cases. The use of this strategy indicated that: (a) the variation between the observers was reduced to an acceptable level; (b) obvious false recordings were few; and (c) diagnoses could be made which were directly related to the choice of treatment (Halse & Molven 1986).
The strategy has been reapplied by the same observers (OM and AH) in successive studies of treatment results now for the same root fillings 20–27 years postoperatively (Molven et al . 2002, unpublished observations). Another more recently qualified endodontist (IF) was introduced to the method, and it was decided to compare his observations with those made by the endodontist (OM) and the radiologist (AH). This was done in the present methodological study which primarily aimed at analyses of the long-term reliability of the original observers. The purposes of this paper therefore are: (1) to present findings related to the long-term stability of two experienced observers and (2) to compare their observations with evaluations made by an observer with recent scientific and clinical training in endodontics.

Materials and methods.
The material consisted of 60 full-mouth series of intraoral radiographs. The series, containing 257 endodonticallytreated roots, had been taken at follow-up examinations 10–17 years after completion of the endodontic treatment in a teaching clinic, and had formerly been evaluated by two of the observers (OM, A and AH, B). The material was divided into three groups, each consisting of 20 full-mouth series of radiographs, with 79, 93 and 85 endodontically filled roots, respectively.
The radiographic techniques and diagnostic procedures have been presented previously (Halse & Molven 1986). Three standard groups of findings were used (Figs 1–3). The evaluations were made by the two original observers and the new endodontist (IF, C) on three separate occasions. Each observer first evaluated one group containing 20 series of radiographs. Thereafter, a session of calibration and joint evaluation and decision (see later) followed before another group of radiographs was evaluated. A joint session also followed after evaluation of the third group of radiographs.

Normal periapical findings after endodontic treatment, schematically illustrated (left) and as observed in different regions of the jaws
Figure 1. Normal periapical findings after endodontic treatment, schematically illustrated (left) and as observed in different regions of the jaws.

Widened periodontal spaces illustrated schematically (left) and as observed in different regions of the jaws
Figure 2. Widened periodontal spaces illustrated schematically (left) and as observed in different regions of the jaws.
Note: The structure of the bone around the apex in the left radiograph was judged to be part of the normal trabecular system.

Pathological findings (illustrated schematically and as observed in different regions of the jaws
Figure 3. Pathological findings (periapical radiolucency) illustrated schematically (left) and as observed in different regions of the jaws.

Calibration and decision procedure.
Two observers’ agreement was recorded as the radiographic result.  Cases evaluated differently by the three observers were scheduled for joint discussion with an aim of consensus or majority decision. In addition to the calibration as a function of the joint evaluation of disagreement cases, some cases, suited for discussion, were selected by one of the endodontists (OM). They were also discussed and re-interpreted jointly immediately after each evaluating occasion at a meeting between the observers. Selectional guidelines were:

  1. each observer should be represented with deviations from the two others;
  2. each classification group should be represented as a deviating diagnosis;
  3. special attention should be given to difficulties encountered with the
  4. diagnosis of apical periodontitis;
  5. different tooth groups and both jaws should be included.

Rejection of radiographs.
Radiographs rejected by the radiologist and one of the endodontists were omitted from the study. Radiographs rejected by the two endodontists were reevaluated by the radiologist to make a final decision about rejection.
Radiographs rejected only by the radiologist were subjected to joint evaluation.