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

Yıl 2024, Cilt: 15 Sayı: 3, 401 - 409, 25.12.2024

Hasibe Taşkın , Derya Yıldırım , Esra Seden Navruz , Elif Sena Sargın

https://doi.org/10.22312/sdusbed.1565584

Öz

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.

Anahtar Kelimeler

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

Proje Numarası

78/28

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

Öz

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.

Anahtar Kelimeler

periapical lesion, interobserver agreement, PAI, ICC, Kappa

Proje Numarası

78/28

Kaynakça

• 1. Lee L. Inflammatory diseases. In: White SS, Pharoah JM, editors. Oral Radiology Principles and Interpretation. 2017. p. 314–33.
• 2. Nair PNR. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med. 2004;15(6):348–81.
• 3. Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endod Top. 2002;1(1):3–25.
• 4. Elmas S, Odabaş ME. Geniş periapikal lezyonlu dişlerin cerrahi olmayan endodontik tedavisi: Olgu sunumu. Ata Diş Hek Fak Derg. 2021;31(1):100–3.
• 5. Lee L. Inflammatory diseases. In: White S, Pharoah M, editors. Oral Radiology: Principles and Interpretation. 7th ed. New York: Elsevier Inc.; 2014. p. 315–7.
• 6. Venskutonis T, Plotino G, Juodzbalys G, Mickevičienė L. The importance of cone-beam computed tomography in the management of endodontic problems: A review of the literature. J Endod. 2014;40(12):1895–901.
• 7. Ørstavik D, Kerekes K, Eriksen HM. The periapical index: A scoring system for radiographic assessment of apical periodontitis. Dent Traumatol. 1986;2(1):20–4.
• 8. Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endod Top. 2002;1:3–25.
• 9. Cotti E, Campisi G. Advanced radiographic techniques for the detection of lesions in bone. Endod Top. 2004;7:52–72.
• 10. De Moor RJ, Hommez GM, De Boever JG, Delme KI, Martens GE. Periapical health related to the quality of root canal treatment in a Belgian population. Int Endod J. 2000;33(3):113–20.
• 11. Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J. 2002;35(3):229–38.
• 12. Kirkevang LL, Hörsted-Bindslev P, Ørstavik D, Wenzel A. Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J. 2001;34(3):198–205.
• 13. Segura-Egea JJ, Jiménez-Pinzón A, Poyato-Ferrera MM, Velasco-Ortega E, Ríos-Santos JV. Periapical status and quality of root fillings and coronal restorations in an adult Spanish population. Int Endod J. 2004;37(8):524–30.
• 14. Lupi-Pegurier L, Bertrand MF, Muller-Bolla M, Rocca JP, Bolla M. Periapical status, prevalence and quality of endodontic treatment in an adult French population. Int Endod J. 2002;35(8):690–7.
• 15. Marques MD, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult Portuguese population. Int Endod J. 1998;31(3):161–5.
• 16. Ödesjö B, Hellden L, Salonen L, Langeland K. Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population. Endod Dent Traumatol. 1990;6(6):265–72.
• 17. De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK. Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J. 1993;26(2):112–9.
• 18. Halse A, Molven O, Fristad I. Diagnosing periapical lesions: Disagreement and borderline cases. Int Endod J. 2002;35(8):703–9.
• 19. Alpar R. Performance tests of validity and reliability. Spor Bilimlerinde Uygulamalı İstatistik. 2nd ed. İstanbul: Nobel Yayın Dağıtım; 2001. p. 261.
• 20. Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.
• 21. Kılıç S. Kappa testi. Journal of Mood Disorders. 2015;5(3):142–4.
• 22. Bryington AA, Palmer DJ, Watkins MW. The estimation of interobserver agreement in behavioral assessment. Behav Anal Today. 2002;3(3):323–8.
• 23. Berry KJ, Mielke PW. A generalization of Cohen’s kappa agreement measure to interval measurement and multiple raters. Educ Psychol Meas. 1988;48(4):921–33.
• 24. Aydın G, Kaya H. İnkontinans ile ilişkili dermatiti değerlendirme ölçeği: Gözlemciler arası uyum çalışması. Florence Nightingale Journal of Nursing. 2017;25(2).
• 25. Toklu E. Çocuklarda, abdominal solid organların US ölçümlerinin BT veya MR organ hacimleri ile korelasyonu ve gözlemciler arası uyumu. Proquest Dissertations & Theses Global. 2017;Order No. 28737923.
• 26. Özdemir S, Turkay R, Atasoy B. Diagnostic performance and reproducibility of the Radiological Society of North America Expert Consensus Statement on COVID-19 pneumonia. J Amer. 2024;9(1):14–8.
• 27. Yılmaz A, Çakmak Özlü F. Sefalometrik radyografilerin analizlerinde kullanılan dijital ve manuel metotların karşılaştırılması. J Turkish Dent Res. 2024;2(3):241–50.
• 28. Alagöz E, Ünver T, Tak AY, Özdemir Ş. Effect of delayed scanning and scanning resolution using photostimulable phosphor plates on detection of vertical root fracture: In vitro study. Turkiye Klinikleri J Dent Sci. 2024;30(1):1–16.
• 29. Cortegoso Valdivia P, Deding U, Bjørsum-Meyer T, Baatrup G, Fernández-Urién I, Dray X, et al. Inter/intra-observer agreement in video-capsule endoscopy: Are we getting it all wrong? A systematic review and meta-analysis. Diagnostics (Basel). 2022;12(10):2400:1–15.
• 30. Marques M, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult Portuguese population. Int Endod J. 1998;31(3):161–5.
• 31. Ridao-Sacie C, Segura-Egea JJ, Fernández-Palacín A, Bullón-Fernández P, Ríos-Santos JV. Radiological assessment of periapical status using the periapical index: Comparison of periapical radiography and digital panoramic radiography. Int Endod J. 2007;40(6):433–40.
• 32. Nardi C, Calistri L, Grazzini G, Desideri I, Lorini C, Occhipinti M, et al. Is panoramic radiography an accurate imaging technique for the detection of endodontically treated asymptomatic apical periodontitis? J Endod. 2018;44(10):1500–8.
• 33. Sebring D, Kvist T, Buhlin K, Jonasson P, Lund H. Calibration improves observer reliability in detecting periapical pathology on panoramic radiographs. Acta Odontol Scand. 2021;79(7):554–61.