Pillai Jayasankar P, Nilendu Debesh, Thomas Namitha, Nagpal Sugandha, Sneha Nedunari Lakshmi Sai
Department of Oral and Maxillofacial Pathology, Government Dental College and Hospital, Ahmedabad, India.
Medical Officer, Health India Insurance TPA, Vadodara, Gujarat, India.
J Oral Maxillofac Pathol. 2021 Sep-Dec;25(3):554-555. doi: 10.4103/jomfp.jomfp_85_21. Epub 2022 Jan 11.
The developmental stages of the teeth in the radiographs are graded on an ordinal scale. The present study was conducted using 123 digital orthopantomograms from individuals in the age group of 5 to 22 years and to analyze and evaluate the inter-observer agreement in grading the developmental stages of second and third molars. Four observers with different levels of practical experience in age estimation participated in the study. The development stages of both the molars in the lower left quadrant (3 quadrant) were assigned based on the Demirjian's 10 stage chart. The percentage agreement and Kappa statistics were used to test the agreement between the observers. The data of the observer 1 were used as the standard for the comparison.
There was 70.0%-75.6% agreement among the observers in staging second molar and 52%-68.3% for the third molars. There was an excellent agreement ( > 080) between observer 1 and observer 2 and a good agreement ( = 060-0.79) between observer 1 and the other two observers for both the molars. The Fleiss Kappa revealed moderate to a good overall agreement for both the molars ( = 0.51-0.66). The Freidman's test revealed a significant difference in the grading of third molars between all the raters (χ= 25.02, 3, < 0.001) and for the second molar the difference was not significant (χ= 3.89, 3, > 0.05). The stage-wise overall agreement was fair for Stage 3 in the second molar and Stage 9 and Stage 4 in the third molar.
In conclusion, proper training in the radiographic interpretation of developmental stages may minimize the errors during the age estimation methods.
在X线片上，牙齿的发育阶段按顺序量表进行分级。本研究使用了123张来自5至22岁个体的数字化曲面断层片，以分析和评估在第二和第三磨牙发育阶段分级中观察者间的一致性。四名在年龄估计方面具有不同实践经验水平的观察者参与了该研究。根据德米尔坚的10阶段图表对左下象限（第3象限）两颗磨牙的发育阶段进行划分。使用百分比一致性和kappa统计量来检验观察者之间的一致性。将观察者1的数据用作比较的标准。
观察者之间对第二磨牙分期的一致性为70.0%-75.6%，对第三磨牙的一致性为52%-68.3%。观察者1和观察者2之间有极好的一致性（>0.80），观察者1与其他两名观察者对两颗磨牙均有良好的一致性（=0.60-0.79）。Fleiss kappa显示两颗磨牙的总体一致性为中等至良好（=0.51-0.66）。弗里德曼检验显示，所有评估者对第三磨牙分级存在显著差异（χ=25.02，自由度=3，P<0.001），而对第二磨牙差异不显著（χ=3.89，自由度=3，P>0.05）。第二磨牙第3阶段以及第三磨牙第9和第4阶段的逐阶段总体一致性为一般。
总之，在发育阶段的X线片解读方面进行适当培训可能会减少年龄估计方法中的误差。
