The relationship between radiologic interpretation and root tip fracture during tooth extraction performed by junior...

The purpose of this study was to analyze the relationship between root tip fracture and radiologic interpretation of root morphology on periapical radiographs during third molar extraction performed by junior clinicians.

Before tooth extraction, periapical radiographs of 107 patients with 116 third molars were evaluated by junior clinicians, all with less than 5 years of clinical experience. Radiologic interpretations of root morphology-including number, curvature, fusion, and accessory root-were recorded before each extraction. The clinicians were also asked to estimate the possibility of root fracture on a Visual Analogue Scale before the procedure. The exact morphology of the extracted teeth was recorded after the extraction for the purpose of comparison.

Twenty-nine of 116 teeth extracted were not correctly interpreted in at least 1 of the morphologic categories surveyed. The average expected fracture rate of nonfractured teeth was 23.1%, whereas the average expected fracture rate of fractured teeth was a significantly higher 50.3%. Misinterpretation of root morphology on radiographs decreased with increased clinical experience. Senior residents had the lowest misinterpretation and fracture rate. Logistic regression analysis showed that fracture is most closely related to the estimated fracture rate (4.95) and is also significantly related to underestimation of root curvature (0.95; 24.56 with 2 df of chi-square, P = .0001).

Misinterpretation of root morphology on radiographs occurred in 25% of the teeth. Root curvature was the most misinterpreted item studied. Fracture was most closely related to the estimated fracture rate. Junior clinicians in this study expected that only 50% of the fractured teeth would fracture, reflecting a general underestimation of root tip fracture. Further study should be performed to evaluate how to increase the accuracy of root curvature interpretation.