Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
J Endod. 2021 Jun;47(6):906-913. doi: 10.1016/j.joen.2021.02.014. Epub 2021 Mar 8.
This study analyzed intra- and interobserver agreements during radiographic assessment of the different stages of root development using the dichotomous, Moorrees, Demirjian, and Cvek classifications, as well as the effect of the observer's level of experience on the result.
Two hundred eighty-five digital periapical radiographs were examined via visual inspection by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration, determination of the presence or absence of an open apex and the assignment of a root development stage according to the different subdivisions of the 4 indexes were performed. This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver, interobserver, and global observer agreement using the kappa coefficient and a weighted kappa. Additionally, to determine the level of concordance between the visual determination of an open or closed apex and the apical foramen width measured in millimeters, a dichotomized kappa coefficient was applied.
A good level of global observer agreement was found for the dichotomous, Demirjian, and Cvek classifications. However, a significantly low percentage of total concordance and global observer agreement (6.66% and 0.498, respectively) was obtained using the Moorrees classification, which was more pronounced among nonexperienced observers (0.247). Apical foramen width measurements indicated the presence of 143 roots with an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa coefficient test revealed a good level of agreement during the visual determination of an open or closed apex (range, 0.611-0.636).
The classifications of Cvek and Demirjian provided reliable results when determining the different stages of root development. In contrast, the Moorrees classification provided the lowest agreement values, with a significant negative effect among nonexperienced observers. Finally, the visual estimation of the presence (or absence) of an open apex provided a good level of concordance with the radiographic apical foramen width.
本研究通过使用二分法、Moorrees 法、Demirjian 法和 Cvek 法以及观察者经验水平对结果的影响，分析了在严格的技术和观察条件下，不同阶段的根尖发育的放射评估中的观察者内和观察者间的一致性。
在第一轮（n = 8）中，由 3 名有经验的和 3 名无经验的观察者（n = 6）通过视觉检查对 285 张数字根尖射线照片进行检查，进行根尖发育阶段的存在或不存在以及根据 4 个指数的不同细分进行的根发育阶段的分配。在观察者校准后，进行有无开顶的确定，并根据四个指数的不同细分来分配根发育阶段。第二轮（n = 8）重复了同样的检查。每位观察者进行了 16 次检查（N = 96），以确定一致性百分比，然后使用kappa 系数和加权 kappa 进行观察者内、观察者间和整体观察者一致性的评估。此外，为了确定视觉确定开顶或闭顶与以毫米为单位测量的根尖孔宽度之间的一致性水平，应用了二分kappa 系数。
对于二分法、Demirjian 法和 Cvek 法，发现整体观察者具有很好的一致性水平。然而，使用 Moorrees 分类法，总一致性和整体观察者一致性的百分比明显较低（分别为 6.66%和 0.498），在无经验的观察者中更为明显（0.247）。根尖孔宽度测量表明有 143 个根有开顶（50.2%）和 142 个根有闭顶（49.8%），视觉确定开顶或闭顶的二分kappa 系数测试显示出良好的一致性水平（范围为 0.611-0.636）。
在确定根尖发育的不同阶段时，Cvek 和 Demirjian 的分类法提供了可靠的结果。相比之下，Moorrees 分类法提供了最低的一致性值，在无经验的观察者中存在显著的负面影响。最后，用视觉估计有无开顶与放射根尖孔宽度具有良好的一致性。
