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Periapikal durumun değerlendirilmesinde gözlemciler arası uyumsuzluğa neden olan vakalar

Year 2006, Volume: 13 Issue: 4, 16 - 21, 29.04.2009

Abstract

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2006 Aralık; 13(4)



Periapikal durumun değerlendirilmesinde gözlemciler arası

uyumsuzluğa neden olan vakalar


Ayşe Diljin Keçeci, Bulem Üreyen Kaya, Gül Çelik Ünal, Gürhan Taç



Özet


Amaç: Bu çalışmanın amacı, periapikal indeks (PAI) skorlama sistemi kullanılarak periapikal durumun radyografik olarak değerlendirildiği seçilmiş örneklem grubunda, gözlemciler arası uyumun sağlanamadığı ve kararsız kalınan vakaların insidansı ve etiyolojisinin saptanmasıdır. Gereç ve Yöntem: 405 dişe ait 750 kökün değerlendirildiği uzlaşma çalışmasına ait radyografilerde apikal durumun değerlendirilmesinde ortaya çıkan problemler nedeni ile en az bir gözlemcinin farklı skorladığı periapikal radyografiler yeniden değerlendirildi. Gözlemciler arası uyumsuzluğa yol açan nedenler: a) anatomik oluşumlar, b) periodontal ligament boşluğu, c) mineral kaybının görüntülenmesini etkileyen trabeküler yapı ve d) kemik iliği boşlukları olarak sınıflandırılmıştır. Bulgular: Çalışmada, 45 dişe (%9,83) ait 54 kök (%6,89).te gözlemciler arası uyumsuzluk ortaya çıktı. Gözlemciler arası uyumsuzluk sebeplerin dağılımı şu şekildedir: 9 adedi (15,52%) anatomik oluşumlar, 6 adedi (10,34 %) periodontal ligament boşluğu, 33 adedi (56,90%) trabeküler yapı ve 10 adedi (17,24%) kemik iliği boşlukları. Sonuç: Apikal bölgenin farklı morfolojisi ve çevre kemiğin yoğunluğundaki farklılıklar değerlendirmeyi zorlaştırmıştır. Kararsız kalınan zor vakalar, radyografik uzlaşmada belirsizliği göstermektedir. Bu tip vakalarda, ancak etrafındaki komşu yapıların dikkatlice değerlendirilmesinden sonra bir karara varılabilir.


Anahtar kelimeler: gözlemciler arası uyumsuzluk, periapikal, radyograf











Abstract







Disagreement cases caused interobserver variations during evaluation of periapical status







Aim: The aim of this study is to determine the etiology and incidence of the disagreement and borderline cases selected for the radiographic evaluation of periapical status using the periapical index (PAI) scoring system. Material and Method: Borderline cases in the agreement study of evaluation of 405 teeth with 750 roots, which had been given different score at least by one observer were re-evaluated. The reasons of disagreement cases were classified as: a) anatomical landmarks b) periodontal ligament space c) trabecular pattern affecting the view of mineral loss d) bone marrow spaces. Results: Fourty-five disagreement cases (%9,83) with 54 root (%6,89) were observed. The distribution of observer variations according to their reasons were as follows: 9 (15,52%) anatomical landmarks, 6 (10,34 %) periodontal ligament space, 33 (56,90%) trabecular pattern affecting the view of mineral loss, 10 (17,24%) bone marrow spaces. Then, the joint discussion resulted in an agreement for all the cases. Conclusion: The varying morphology of apical areas and varying density of surrounding bone present a number of challenges. Difficult borderline cases illustrate the uncertainty involved in radiographical consensus. In such cases the decision can only be made after careful analysis of surrounding tissues of the apex.







Key words: interobserver variations, periapical, radiograph

References

  • Köhler A, Zimmer EA. Grenzen Des Normalen und Anfange Des Pathologischen in Röntgenbild Des Skelets. Stuttgart, Germany. Georg Thieme Verlag. 1967.
  • Molander A, Reit C, Dahlen G, Kvist T. Microbiological status of root-filled teeth with apical periodontitis. Int Endod J. 1998 Jan;31(1):1-7
  • Trope M, Delano EO, Orstavik D. Endodontic treatment of teeth with apical periodontitis: single vs. multivisit treatment. J Endod. 1999 May;25(5):345- 50.
  • Molven O, Halse A, Fristad I. Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease. Int Endod J. 2002 Feb;35(2):142- 7.
  • Halse A, Molven O. A strategy for the diagnosis of periapical pathosis. J Endod. 1986 Nov;12(11):534-8.
  • Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990 Oct;16(10):498-504.
  • Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol. 2000 Oct;16(5):218-21.
  • Chugal NM, Clive JM, Spangberg LS. A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Mar;91(3):342-52.
  • Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34.
  • Sidaravicius B, Aleksejuniene J, Eriksen HM. Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania. Endod Dent Traumatol. 1999 Oct;15(5):210-5.
  • Petersson K, Lewin B, Hakansson J, Olsson B, Wennberg A. Endodontic status and suggested treatment in a population requiring substantial dental care. Endod Dent Traumatol. 1989 Jun;5(3):153-8.
  • Weiger R, Hitzler S, Hermle G, Lost C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol. 1997 Apr;13(2):69- 74.
  • Kvist T, Reit C. Results of endodontic retreatment: a randomized clinical study comparing surgical and nonsurgical procedures. J Endod. 1999 Dec;25(12):814- 7.
  • Halse A, Molven O, Fristad I. Diagnosing periapical lesions--disagreement and borderline cases. Int Endod J. 2002 Aug;35(8):703-9.
  • Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34.
  • Cohen J A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960; 20: 37-46.
  • Keçeci A.D., Çelik Ünal G., Taç A.G., Üreyen Kaya B., “Intraobserver Aggreement In The Radiographic Evaluation Of The Quality Of Root Canal Obturation”, 9 th International Congress of Turkish Endodontic Society, Abst.book, p:72, Ýstanbul, 22-24 Nisan, 2004.
  • Koran LM. Increasing the reliability of clinical data and judgments. Ann Clin Res. 1976 Apr;8(2):69-73.
  • World Health Organization Oral Health Surveys, Basic Methods, 4th edn. WHO, Geneva, Switzerland.1997; 13–5, 62–3.
  • Molven O, Halse A, Grung B Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg 1987; 16: 432–9.
  • Simpson CO. The reliability of radiographs as an index of periapical disease.Dental Items.1927; 49 :709-18.
  • Coolidge ED. The thickness of the human periodontal membrane.Journal of the American Dental Association. 1937; 24:1260-70.
  • Gibilisco JA Stafnes Oral Radiographic Diagnosis.Philadel-phia,USA:W.B.Saunders Company, 1985; pp.78-81.
  • Brocklebank LV. Dental Radiology.Understanding the X-ray Image .Oxford,UK:Oxford University Press, 1997; pp.122-30.
  • Glickman GN. Preparation for treatment.In:Cohen S, Burns RC,eds.Pathways of the Pulp.St.Louis,USA:Mosby, 1998; pp.96-8.
  • Orstavik D. Radiology of apica periodontitis. In Orstavik D, Pitt Ford TR. Essential Endodontology & Prevention and Treatment of Apical Periodontitis.London,UK:Blackwell Science, 1998; pp.131-3.
  • Kaffe I, Gratt BM. Variations in the radiographic interpre-tation of the periapical dental region. Journal of Endodontics.1988 ;14 :330-5.
  • Bender IB,Seltzer S. Roentgenographic and direct obser-vation of experimental lesions in bone I.Journal of the American Dental Association 1961;62: 152-60.
  • Bender IB,Seltzer S. Roentgenographic and direct obser-vation of experimenta lesions in bone II.Journal of the American Dental Association. 1961; 62 :708- 16.
  • Bianchi SD,Roccuzzo M,Cappello N,LiberoA,Rendine S Radiologica visibi ity of smal artifcial periapical bone lesions. Dentomaxillofacial Radiology. 1991;20: 35-9.
  • Wengraf A. Radiologically occult bone cavities.An experi-mental studyand review. British Dental Journal 1964; 117: 532-6.
  • Lee S-J, Messer HH. Radiographic appearance of arti ficially prepared periapical lesions confined to cancellous bone. Int Endod J. 1986;19 :64-72.
  • Bender IB, Seltzer S, Soltanoff W. Endodontic success- -a reappraisal of criteria. 1. Oral Surg Oral Med Oral Pathol. 1966 Dec;22:780-9.
  • Shoha RR, Dowson J, Richards AG. Radiographic interpretation of experimentally produced bony lesions. Oral Surg Oral Med Oral Pathol. 1974 Aug;38(2):294- 303.
  • Kirkevang LL, Horsted-Bindslev P, Orstavik D, Wenzel A. Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J. 2001 Apr;34(3):198-205.
  • Reit C. The influence of observer calibration on radiographic periapical diagnosis. Int Endod J. 1987 Mar;20(2):75-81.
  • White SC. Decision-support systems in dentistry. J Dent Educ. 1996 Jan;60(1):47-63.
  • Mol A, van der Stelt PF. Application of computer- aided image interpretation to the diagnosis of periapical bone lesions. Dentomaxillofac Radiol. 1992 Nov;21(4):190-4.
  • Strittmatter EJ, Keller DL, LaBounty GL, Lewis DM, Graham GD.The relationship between radionuclide bone scans and dental examinations. Oral Surg Oral Med Oral Pathol. 1989 Nov;68(5):576-81.
  • Nair MK, Tyndall DA, Ludlow JB, May K. Tuned aperture computed tomography and detection of recurrent caries. Caries Res. 1998;32(1):23-30.
  • Webber RL, Horton RA, Underhill TE, Ludlow JB, Tyndall DA. Comparison of film, direct digital, and tuned-aperture computed tomography images to identify the location of crestal defects around endosseous titanium implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Apr;81(4):480-90.
  • Ruttimann UE, Webber RL, Schmidt E. A robust digital method for film contrast correction in subtraction radiography. J Periodontal Res. 1986 Sep;21(5):486- 95.
Year 2006, Volume: 13 Issue: 4, 16 - 21, 29.04.2009

Abstract

References

  • Köhler A, Zimmer EA. Grenzen Des Normalen und Anfange Des Pathologischen in Röntgenbild Des Skelets. Stuttgart, Germany. Georg Thieme Verlag. 1967.
  • Molander A, Reit C, Dahlen G, Kvist T. Microbiological status of root-filled teeth with apical periodontitis. Int Endod J. 1998 Jan;31(1):1-7
  • Trope M, Delano EO, Orstavik D. Endodontic treatment of teeth with apical periodontitis: single vs. multivisit treatment. J Endod. 1999 May;25(5):345- 50.
  • Molven O, Halse A, Fristad I. Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease. Int Endod J. 2002 Feb;35(2):142- 7.
  • Halse A, Molven O. A strategy for the diagnosis of periapical pathosis. J Endod. 1986 Nov;12(11):534-8.
  • Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990 Oct;16(10):498-504.
  • Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol. 2000 Oct;16(5):218-21.
  • Chugal NM, Clive JM, Spangberg LS. A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Mar;91(3):342-52.
  • Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34.
  • Sidaravicius B, Aleksejuniene J, Eriksen HM. Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania. Endod Dent Traumatol. 1999 Oct;15(5):210-5.
  • Petersson K, Lewin B, Hakansson J, Olsson B, Wennberg A. Endodontic status and suggested treatment in a population requiring substantial dental care. Endod Dent Traumatol. 1989 Jun;5(3):153-8.
  • Weiger R, Hitzler S, Hermle G, Lost C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol. 1997 Apr;13(2):69- 74.
  • Kvist T, Reit C. Results of endodontic retreatment: a randomized clinical study comparing surgical and nonsurgical procedures. J Endod. 1999 Dec;25(12):814- 7.
  • Halse A, Molven O, Fristad I. Diagnosing periapical lesions--disagreement and borderline cases. Int Endod J. 2002 Aug;35(8):703-9.
  • Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34.
  • Cohen J A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960; 20: 37-46.
  • Keçeci A.D., Çelik Ünal G., Taç A.G., Üreyen Kaya B., “Intraobserver Aggreement In The Radiographic Evaluation Of The Quality Of Root Canal Obturation”, 9 th International Congress of Turkish Endodontic Society, Abst.book, p:72, Ýstanbul, 22-24 Nisan, 2004.
  • Koran LM. Increasing the reliability of clinical data and judgments. Ann Clin Res. 1976 Apr;8(2):69-73.
  • World Health Organization Oral Health Surveys, Basic Methods, 4th edn. WHO, Geneva, Switzerland.1997; 13–5, 62–3.
  • Molven O, Halse A, Grung B Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg 1987; 16: 432–9.
  • Simpson CO. The reliability of radiographs as an index of periapical disease.Dental Items.1927; 49 :709-18.
  • Coolidge ED. The thickness of the human periodontal membrane.Journal of the American Dental Association. 1937; 24:1260-70.
  • Gibilisco JA Stafnes Oral Radiographic Diagnosis.Philadel-phia,USA:W.B.Saunders Company, 1985; pp.78-81.
  • Brocklebank LV. Dental Radiology.Understanding the X-ray Image .Oxford,UK:Oxford University Press, 1997; pp.122-30.
  • Glickman GN. Preparation for treatment.In:Cohen S, Burns RC,eds.Pathways of the Pulp.St.Louis,USA:Mosby, 1998; pp.96-8.
  • Orstavik D. Radiology of apica periodontitis. In Orstavik D, Pitt Ford TR. Essential Endodontology & Prevention and Treatment of Apical Periodontitis.London,UK:Blackwell Science, 1998; pp.131-3.
  • Kaffe I, Gratt BM. Variations in the radiographic interpre-tation of the periapical dental region. Journal of Endodontics.1988 ;14 :330-5.
  • Bender IB,Seltzer S. Roentgenographic and direct obser-vation of experimental lesions in bone I.Journal of the American Dental Association 1961;62: 152-60.
  • Bender IB,Seltzer S. Roentgenographic and direct obser-vation of experimenta lesions in bone II.Journal of the American Dental Association. 1961; 62 :708- 16.
  • Bianchi SD,Roccuzzo M,Cappello N,LiberoA,Rendine S Radiologica visibi ity of smal artifcial periapical bone lesions. Dentomaxillofacial Radiology. 1991;20: 35-9.
  • Wengraf A. Radiologically occult bone cavities.An experi-mental studyand review. British Dental Journal 1964; 117: 532-6.
  • Lee S-J, Messer HH. Radiographic appearance of arti ficially prepared periapical lesions confined to cancellous bone. Int Endod J. 1986;19 :64-72.
  • Bender IB, Seltzer S, Soltanoff W. Endodontic success- -a reappraisal of criteria. 1. Oral Surg Oral Med Oral Pathol. 1966 Dec;22:780-9.
  • Shoha RR, Dowson J, Richards AG. Radiographic interpretation of experimentally produced bony lesions. Oral Surg Oral Med Oral Pathol. 1974 Aug;38(2):294- 303.
  • Kirkevang LL, Horsted-Bindslev P, Orstavik D, Wenzel A. Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J. 2001 Apr;34(3):198-205.
  • Reit C. The influence of observer calibration on radiographic periapical diagnosis. Int Endod J. 1987 Mar;20(2):75-81.
  • White SC. Decision-support systems in dentistry. J Dent Educ. 1996 Jan;60(1):47-63.
  • Mol A, van der Stelt PF. Application of computer- aided image interpretation to the diagnosis of periapical bone lesions. Dentomaxillofac Radiol. 1992 Nov;21(4):190-4.
  • Strittmatter EJ, Keller DL, LaBounty GL, Lewis DM, Graham GD.The relationship between radionuclide bone scans and dental examinations. Oral Surg Oral Med Oral Pathol. 1989 Nov;68(5):576-81.
  • Nair MK, Tyndall DA, Ludlow JB, May K. Tuned aperture computed tomography and detection of recurrent caries. Caries Res. 1998;32(1):23-30.
  • Webber RL, Horton RA, Underhill TE, Ludlow JB, Tyndall DA. Comparison of film, direct digital, and tuned-aperture computed tomography images to identify the location of crestal defects around endosseous titanium implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Apr;81(4):480-90.
  • Ruttimann UE, Webber RL, Schmidt E. A robust digital method for film contrast correction in subtraction radiography. J Periodontal Res. 1986 Sep;21(5):486- 95.
There are 42 citations in total.

Details

Primary Language English
Journal Section Research Articles
Authors

Ayşe Keçeci This is me

Bulem Kaya This is me

Gül Çelik Ünal This is me

Gürhan Taç This is me

Publication Date April 29, 2009
Submission Date April 29, 2009
Published in Issue Year 2006 Volume: 13 Issue: 4

Cite

Vancouver Keçeci A, Kaya B, Çelik Ünal G, Taç G. Periapikal durumun değerlendirilmesinde gözlemciler arası uyumsuzluğa neden olan vakalar. Med J SDU. 2009;13(4):16-21.

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