INTRODUCTION: The diagnosis and treatment of endodontic infections is a multi-step fact gathering process, with the gold standard of periapical lesion diagnosis being histological biopsy. With common diagnoses, such as periapical granulomas and radicular cysts, representing the bulk of biopsies, the possibility of a less invasive method of lesion identification ought to be examined. In recent years Cone Beam Computed Tomography (CBCT) imaging has been proposed as a potential diagnostic tool for periapical diagnosis, but this theory requires further testing and data in order to verify its appropriateness.
OBJECTIVE: The aim of this study was to evaluate six criteria used for assessing periapical lesions of teeth seen on CBCT scan from the textbook Oral Radiology White and Pharoah.
MATERIAL AND METHODS: Three blinded endodontists observed radiographic features of oral periapical lesions of teeth previously diagnosed as either radicular cysts or periapical granulomas via histological biopsy. All lesions had previously been scanned via CBCT, and endodontic apical surgery was performed allowing for a pathology sample of the lesion. The observers viewed 40 CBCT and 40 corresponding periapical (PA) radiographic images, all randomized, and reported which of the six criteria (Location- apex of tooth, periphery- corticated border, shape- curved or circular, internal structure- radiolucent, effects on surrounding structures- displace or resorb roots, corticated plate perforation- present) were present in the scans. Data was analyzed using a Logistical Regression Fleiss Kappa statistic with a 95% confidence level.
RESULTS: CBCT cyst showed no agreement between examiners criteria selected to statistical significance. The most selected criteria by all examiners were shape and internal structure.
PA radiographic Cyst showed moderate agreement for ‘Location’ and ‘Periphery’ and substantial agreement on ‘none’ criteria. The most selected criteria by all examiners were internal structure and location.
CBCT Granuloma showed moderate agreement for ‘location’ and perfect agreement for ‘none’. The most selected criteria by all examiners were shape, location, and internal structure.
PA radiographic Granuloma showed substantial agreement for ‘periphery’ and moderate agreement for internal structure (radiolucency). The most selected criteria by all examiners were location, and occasionally shape and internal structure.
Logistic regression of selected criteria shows with each additional criteria present on each lesion the chance of the lesion being a granuloma decreases 24.9% on PA radiographs and 33.9% on CBCT images.
CONCLUSION: The current study shows an inter-examiner agreement of moderate to perfect kappa statistic does not align with the most commonly selected criteria among examiners, showing poor examiner agreement among lesions. / 2024-06-21T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/44804 |
| Date | 21 June 2022 |
| Creators | Penberthy, Skylar Montana Grizzly |
| Contributors | Chogle, Sami |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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