Abstract
Introduction
This study analyzed intra- and interobserver agreements during radiographic assessment
of the different stages of root development using the dichotomous, Moorrees, Demirjian,
and Cvek classifications, as well as the effect of the observer’s level of experience
on the result.
Methods
Two hundred eighty-five digital periapical radiographs were examined via visual inspection
by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration,
determination of the presence or absence of an open apex and the assignment of a root
development stage according to the different subdivisions of the 4 indexes were performed.
This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver,
interobserver, and global observer agreement using the kappa coefficient and a weighted
kappa. Additionally, to determine the level of concordance between the visual determination
of an open or closed apex and the apical foramen width measured in millimeters, a
dichotomized kappa coefficient was applied.
Results
A good level of global observer agreement was found for the dichotomous, Demirjian,
and Cvek classifications. However, a significantly low percentage of total concordance
and global observer agreement (6.66% and 0.498, respectively) was obtained using the
Moorrees classification, which was more pronounced among nonexperienced observers
(0.247). Apical foramen width measurements indicated the presence of 143 roots with
an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa
coefficient test revealed a good level of agreement during the visual determination
of an open or closed apex (range, 0.611–0.636).
Conclusions
The classifications of Cvek and Demirjian provided reliable results when determining
the different stages of root development. In contrast, the Moorrees classification
provided the lowest agreement values, with a significant negative effect among nonexperienced
observers. Finally, the visual estimation of the presence (or absence) of an open
apex provided a good level of concordance with the radiographic apical foramen width.
Key Words
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Article info
Publication history
Published online: March 07, 2021
Identification
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© 2021 American Association of Endodontists.
