Calibration improves observer reliability in detecting periapical pathology on panoramic radiographs

Area of Science:

• Dentistry
• Radiology
• Public Health

Background:

• Panoramic radiographs are widely used in dental diagnostics.
• Assessing dental caries (DMFT-score), root-filled teeth, and periapical lesions requires high observer reliability.
• Variability in interpretation can impact treatment decisions and epidemiological studies.

Purpose of the Study:

• To evaluate the impact of calibration on observer reliability for assessing specific dental conditions on panoramic radiographs.
• To compare the reliability of assessing DMFT-score, root-filled teeth, and periapical lesions before and after calibration.

Main Methods:

• 100 panoramic radiographs were analyzed for DMFT-score, remaining teeth, root-filled teeth, and periapical lesions.
• Two reference examiners (endodontist, radiologist) established a consensus standard.
• Three observers performed three assessments: uncalibrated, post-calibration, and blinded.
• Statistical analysis included Wilcoxon Signed Rank test, Sign test, Intraclass Correlation Coefficient (ICC), and Weighted Kappa (κ).

Main Results:

• DMFT-score, remaining teeth, and root-filled teeth demonstrated high reliability (ICC=0.88-0.98, κ=0.98-0.99) across all assessments.
• Periapical lesions showed high inter-observer variability among reference examiners (κ=0.53).
• Observer reliability for periapical lesions significantly improved after calibration (κ=0.59-0.80) compared to uncalibrated assessments (κ=0.22-0.60).

Conclusions:

• DMFT-score, remaining teeth, and root-filled teeth are reliably assessed on panoramic radiographs.
• Calibration is crucial for enhancing observer reliability in detecting periapical lesions on panoramic radiographs.
• Standardized training protocols can improve diagnostic accuracy in dental radiology.