The Diagnostic Accuracy of Periapical Radiolucency Using Intraoral Periapical Radiograph and Orthopantomogram: The Impact of Observer Experience - A Retrospective Study

Abstract

Background: Periapical diseases involve inflammation and tissue destruction around the tooth's root, often due to bacterial infections from caries, trauma, or poor endodontic treatment. Accurate diagnosis is crucial, with Intraoral Periapical Radiograph (IOPA) and Orthopantomogram (OPG) as primary imaging tools. IOPA offers high-resolution images for small lesions, while OPG provides a panoramic view for multiple pathologies. Their diagnostic accuracy in detecting periapical radiolucency (PRLs) varies, influenced by the observer's experience.
Aim: The study aimed to evaluate the diagnostic accuracy of Periapical Radiolucency Using an Intraoral Periapical Radiograph and Orthopantomogram and the Impact of Observer Experience.
Material and methodology: A Retrospective study was conducted at a private institution of the Oral and Maxillofacial Radiology Department, involving 105 previously diagnosed cases of periapical pathology. Patients were evaluated using IOPA followed by an OPG. The diagnostic accuracy of OPG compared to IOPA was analyzed using sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Interobserver variability was also assessed using kappa statistics to determine the consistency of radiographic interpretations.
Results: The results indicated that periapical radiographs (IOPA) demonstrated higher accuracy than orthopantomograms (OPG) in detecting periapical radiolucencies. The sensitivity of IOPA was 83%, surpassing that of OPG at 52.5%. IOPA also exhibited a a specificity of 55% while OPG had a specificity of 66.5%. Furthermore, the positive predictive value (PPV) of IOPA was 78.5%, compared to 68.5% for OPG, and the negative predictive value (NPV) of IOPA was 52%, slightly higher than the 50% NPV of OPG. Interobserver agreement was high at 92.2% among certain observers; however, kappa statistics revealed no significant differences in agreement levels.
Conclusion: Overall, IOPA demonstrated superior diagnostic accuracy compared to OPG, highlighting its importance for accurate diagnosis and treatment planning in periapical conditions, IOPA is less expensive and has less radiation exposure compared to OPG