Observer Agreement in the Evaluation of Periapical Lesions Using the Periapical Index: A Comparison of Periapical and Panoramic Radiographs

Abstract

Aim: The aim of this study is to analyze the agreement between researchers with different levels of experience in assessing periapical and panoramic radiographs for determining periapical status using the periapical index, by applying two different statistical methods. Methods: This retrospective study included 180 adult patients (mean age ± SD 30.89 ± 6.84 years) who had digital panoramic and periapical radiographs taken for various reasons and treatment procedures. Two observers scored the periapical index of the teeth with periapical lesions on panoramic radiographs. One month later, the periapical radiograph of the evaluated tooth was examined. Observer agreement for the scores due to the panoramic and periapical radiographs was assessed using kappa analysis and ICC. Results: The highest level of interobserver agreement on panoramic radiographs was found in the mandibular molar region (substantial agreement; Ƙ=0.676; p=0.001) in kappa analysis and in the maxillary incisor region (almost perfect agreement; ICC=0.925; p=0.001) in ICC analysis. The highest level of interobserver agreement on periapical radiographs was observed in the mandibular molar region (substantial agreement; Ƙ=0.749; p=0.001) in kappa analysis and in the maxillary incisor region (almost perfect agreement; ICC=0.941; p=0.001) in ICC analysis. The lowest interobserver agreement on panoramic radiographs was found in the maxillary molar region in both kappa analysis (fair agreement Ƙ=0.291, p=0.005) and ICC analysis (substantial agreement ICC=0.793, p=0.001). On periapical radiographs, the lowest interobserver agreement was found in the maxillary molar region in kappa analysis (fair agreement Ƙ=0.268, p=0.013) and in the maxillary premolar region in ICC analysis (substantial agreement ICC=0.795, p=0.001). Intraobserver agreement for panoramic and periapical radiographic assessments was found to be almost perfect agreement (ICC>0.90) for both observers in ICC analysis. Conclusion: In the observer agreement of periapical lesions scored using the periapical index on panoramic and periapical radiographs, the kappa and ICC analysis results differ. It is considered that the location of the lesions and anatomical superpositions on the radiographs have an impact on radiographic evaluation.

Keywords

• periapical lesion
• interobserver agreement
• PAI
• ICC
• Kappa

Periapikal İndeks Kullanılarak Periapikal Lezyonların Değerlendirilmesinde Gözlemci Uyumu: Periapikal ve Panoramik Radyografların Karşılaştırılması

Abstract

Amaç: Periapikal durumun belirlenmesinde kullanılan periapikal ve panoramik radyografların periapikal indeks ile değerlendirilmesinde, farklı tecrübelere sahip araştırmacılar arasındaki uyumun, iki farklı istatiksel yöntem kullanılarak analizi amaçlanmıştır. Yöntem: Bu retrospektif çalışmaya, çeşitli nedenler ve tedavi prosedürleri için alınmış olan dijital panoramik ve periapikal radyografı bulunan 180 (ortalama±ss, 30.89 ± 6.84 yıl) yetişkin hasta dahil edildi. İki gözlemci tarafından periapikal lezyon bulunan dişin periapikal indeks skorlaması panoramik radyografta yapıldı. Bir ay sonra, değerlendirilen dişin periapikal radyografı incelendi. Panoramik ve periapikal radyograflarda yapılan skorlamalar için gözlemci uyumu kappa analizi ve ICC ile değerlendirildi. Bulgular: Panoramik radyografta gözlemciler arası uyumun en yüksek belirlendiği sonuçlar kappa analizinde mandibular molar bölgede (iyi düzey; Ƙ=0.676 p=0.001); ICC analizinde maksiller keser bölgede (mükemmel düzey; ICC=0.925, p=0.001) bulundu. Periapikal radyografta gözlemciler arası uyumun en yüksek belirlendiği sonuçlar kappa analizinde mandibular molar bölgede (iyi düzey; Ƙ=0.749; p=0.001); ICC analizinde maksiller keser bölgede (iyi düzey; ICC=0.941; p=0.001) bulundu. Panoramik radyografta gözlemciler arası uyum kappa analizinde (zayıf düzey Ƙ=0.291, p=0.005) ve ICC analizinde (iyi düzey ICC=0.793, p=0.001) maksiller molar bölgede en düşük olarak bulundu. Periapikal radyografta gözlemciler arası uyumun en düşük belirlendiği sonuçlar kappa analizinde maksiller molar bölgede (zayıf düzey Ƙ=0.268; p=0.013); ICC analizinde maksiller premolar bölgede (iyi düzey ICC=0.795; p=0.001) bulundu. Gözlemci içi uyum panoramik ve periapikal radyografik değerlendirmeler için ICC analizinde her iki gözlemci için mükemmel düzeyde (ICC>0.900) bulundu. Sonuç: Periapikal lezyonların panoramik ve periapikal radyograflarda periapikal indeks skorlanarak yapılan gözlemci uyumunda, kappa ve ICC analiz sonuçları farklıdır. Lezyonların yerleşim bölgesinin ve radyografdaki anatomik süperpozisyonların radyografik değerlendirmede etkisinin olduğu düşünüldü.

Keywords

• periapikal lezyon
• gözlemciler arası uyum
• PAI
• ICC
• Kappa

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