Le Tina, Nassery Khash, Kahlert Bill, Heithersay Geoffrey
School of Dentistry, The University of Adelaide, Adelaide Australia.
Aust Orthod J. 2011 Nov;27(2):162-8.
The aim of the present study was to compare diagnostic assessments of anterior tooth and bone status in a randomised cohort of pre-orthodontic patients using panoramic and periapical radiographs.
Four hundred and forty-four cases with matched periapical and panoramic radiographs were examined by three observers. Two were final-year postgraduate endodontic students and the other, a final-year Honours degree dental student. Multi-rater Kappa values were used to assess the reliability of the observers, with a value of 1 equating to complete agreement.
With the exception of endodontic Class 1 and 2 palatal invaginations, reliability exceeded 0.95 for all three observers. An assessment of the graduate endodontic students revealed only a marginal increase in the kappa values. Statistical analysis (p < 0.05) determined that developmental anomalies or tooth/bone pathoses were more reliably detected by observers using periapical radiographs compared with panoramic films. This finding has relevance given the likelihood of anterior dental trauma among young children.
While there have been considerable improvements in the quality of dental panoramic radiography, the present study indicated that a reliable pre-orthodontic or post-trauma diagnostic assessment should include both panoramic and intra-oral radiographs.
本研究旨在比较在一组随机选取的正畸治疗前患者中，使用全景片和根尖片对前牙及牙槽骨状况进行诊断评估的结果。
由三名观察者对444例同时具备根尖片和全景片的病例进行检查。其中两名是牙髓病学专业的研究生，另一名是牙科荣誉学位的本科最后一年学生。采用多评分者卡帕值来评估观察者的可靠性，卡帕值为1表示完全一致。
除牙髓病学分类1和2型腭侧内陷外，三名观察者的可靠性均超过0.95。对牙髓病学专业研究生的评估显示卡帕值仅略有增加。统计分析（p < 0.05）表明，与全景片相比，观察者使用根尖片能更可靠地检测出发育异常或牙齿/牙槽骨病变。鉴于幼儿发生前牙外伤的可能性，这一发现具有重要意义。
尽管牙科全景摄影的质量有了显著提高，但本研究表明，可靠的正畸治疗前或外伤后诊断评估应同时包括全景片和口内片。
