Abstract
Introduction
Periapical images are routinely made in endodontics to support diagnosis and treatment
decisions, but conventional imaging may not readily demonstrate inflammatory changes.
This study aims to quantify disagreement in the radiologic interpretation of apical
periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences
exist based on anatomic location.
Methods
We used 1717 pretreatment periapical images made before orthograde endodontic treatment
as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted
within the National Dental Practice-Based Research Network. Periapical changes were
assessed independently by 2 board-certified specialists, an oral and maxillofacial
radiologist and an endodontist, blinded to other clinical information. If the examiners
disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was
justified, an adjudication was made by a third examiner.
Results
The overall prevalence of this radiologic diagnosis in the periapical images was 55%,
and interexaminer agreement measured with the Cohen kappa statistic was calculated
to be 0.56 (95% confidence interval, 0.52–0.60). Diagnostic disagreements between
the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for
jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant.
Conclusions
The variability of diagnostic disagreements across anatomic location and tooth type
may reflect the inability of periapical images to reveal bone changes masked by the
complexity and density of overlying anatomic structures, a limitation that could potentially
be overcome with the use of 3-dimensional imaging.
Key Words
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Article info
Publication history
Published online: July 16, 2021
Identification
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© 2021 American Association of Endodontists.
