The influence of coronal tooth tissue in the diagnosis of apical pathosis

To assess the influence of the status of the crown of the tooth on the observers' periapical radiological assessment.

Seven clinical tutors, eight postgraduate students and seven undergraduate students were recruited. Each evaluated 24 periapical radiographs comprising 12 radiographs with teeth restored with small to medium coronal restorations and 12 radiographs displaying teeth which were either heavily restored or exhibited gross caries. Two viewing sessions, separated by several weeks, were undertaken using ideal viewing conditions. In the first viewing teeth were examined in their entirety and in the second the coronal aspects of the teeth were obscured.

An analysis of variance found no significant differences between the groups of observers during the first viewing. When the crowns were masked, undergraduate students had a significantly lower sensitivity (P = 0.008) compared with postgraduates and clinical tutors. Paired t-tests found a significant increase in the sensitivity of the postgraduate students between the first and second viewing (P = 0.037). Mean sensitivity and specificity for the undergraduates decreased from 0.67 to 0.63 and 0.64 to 0.60 for the first and second viewing, respectively, whilst mean sensitivity for postgraduates and clinical tutors increased from 0.59 to 0.79 and 0.69 to 0.80, respectively. Specificity increased from 0.72 to 0.78 for the postgraduates between viewings, whilst the tutors recorded 0.80 for each viewing.

The status of coronal tooth tissue had a major impact on the diagnostic accuracy of the observers with limited radiological experience supporting the need for earlier radiological training within the undergraduate curriculum.