Reliability of Two Methods of Evaluation of the Apical Limit of Obturation of Root Canals of Primary Teeth: A Pilot Study

Duarte, Maysa Lannes; Pepino, Julia Cocchiarale; Sancas, Mariana Coutinho; Moreira, Jéssica Pronestino de Lima; Neves, Aline de Almeida; Pintor, Andréa Vaz Braga; Primo, Laura Guimarães

doi:10.1590/pboci.2020.058

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 20 • 2020 • https://doi.org/10.1590/pboci.2020.058 copy

Reliability of Two Methods of Evaluation of the Apical Limit of Obturation of Root Canals of Primary Teeth: A Pilot Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To verify the concordance in the evaluation of the apical limit of obturation (ALO) in filled root canals of primary teeth between digital and visual methods.

Material and Methods:

Twenty periapical radiographs of endodontically treated primary teeth were digitalized and evaluated by an endodontics specialist (E1), a PhD pediatric dentist (E2), and a MSc general dentist (E3). Calibrated evaluators (Kappa = 1.00) analysed the images in a light-isolated environment two times (D1 and D2) with a one-week interval between evaluations. ALO scores were categorized as overfilled, flush-filled and underfilled.

Results:

The intra-rater reliability between methods was 0.82 (D1) and 0.75 (D2) for E1, 0.93 (D1 and D2) for E2, and 0.94 (D1 and D2) for E3. Inter-rater reliability ranged from 0.71 (E1 × E3) and 1.00 (E1 × E2) for the visual method to 0.76 (E1 × E3) and 0.88 (E1 × E2) for the digital method. Spearman correlation coefficients showed a similar ranking among the evaluators. There was greater disagreement among the underfilled and ideal scores. For all evaluators, the digital method favoured the identification of the ideal score.

Conclusion:

Both methods are suitable for the determination of the ALO of filled primary teeth and can be used in clinical practice.

Keywords:
Dimensional Measurement Accuracy; Radiography, Dental; Root Canal Obturation

Author	Method	Score	Description
Barcelos et al. [⁴[4] Barcelos R, Tannure PN, Gleiser R, Luiz RR, Primo LG. The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation. Int J Paediatr Dent 2012; 22(5):369-81. https://doi.org/10.1111/j.1365-263X.2011.01210.x https://doi.org/10.1111/j.1365-263X.2011... ]	Visual	Underfilled	Sealer at 1 mm or more short of radiographic apex.
		Ideal	Sealer paste at radiographic apex level.
		Overfilled	Sealer paste extruded beyond radiographic apex.
Adaptation of Dovigo et al. [⁸[8] Dovigo LN, Campos JADB, Pappen FG, Leonardo RT. The apical limit of filling and the clinical and radiographic success of teeth with dental pulp necrosis and periapical lesions. RGO 2006; 54(3):249-53.]	Digital	Underfilled	Limit of 1.1 mm or more below the radiographic apex.
		Ideal	Limit from 0.0 to 1.0 mm below the radiographic apex.
		Overfilled	Extruded filling material in the periapice.

Evaluator	Score	Visual				Kappa	Digital				Kappa	Kappa between Methods
		Day 1		Day 2			Day 1		Day 2
		N	%	N	%		N	%	N	%
E1	Underfilled	5	25	6	30	0.87	5	25	4	20	0.81	0.82 (D1^* * D1: Day One; )
	Ideal	0	0	0	0		3	15	2	10		0.75 (D2^† † D2: Day Two. )
	Overfilled	15	75	14	70		12	60	14	70
E2	Underfilled	5	25	5	25	1.00	5	25	5	25	1.00	0.93
	Ideal	0	0	0	0		1	5	1	5
	Overfilled	15	75	15	75		14	70	14	70
E3	Underfilled	5	25	5	25	1.00	5	25	5	25	1.00	0.94
	Ideal	3	15	3	15		4	20	4	20
	Overfilled	12	60	12	60		11	55	11	55

Evaluators	Visual		Digital
	Day 1	Day 2	Day 1	Day 2
E1 x E2	1.00	0.87	0.88	0.80
E1 x E3	0.82	0.71	0.87	0.76
E2 x E3	0.82	0.82	0.82	0.82

	E1				E2				E3
	Visual		Digital		Visual		Digital		Visual		Digital
	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.	D1^† † D1: Day One;	D2^‡ ‡ D2: Day Two.
Visual D1^† † D1: Day One;	1.00	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);
Visual D2^‡ ‡ D2: Day Two.	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.89^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	0.81^* * The correlation is significant at the 0.01 level (2 extremities);	0.81^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.85^* * The correlation is significant at the 0.01 level (2 extremities);	0.85^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D1^† † D1: Day One;	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.89^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.82^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D2^‡ ‡ D2: Day Two.	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.82^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.69^* * The correlation is significant at the 0.01 level (2 extremities);	0.69^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);
Visual D1^† † D1: Day One;	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);
Visual D2^‡ ‡ D2: Day Two.	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.88^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D1^† † D1: Day One;	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.81^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D2^‡ ‡ D2: Day Two.	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.81^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.80^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	0.94^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);
Visual D1^† † D1: Day One;	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.69^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);
Visual D2^‡ ‡ D2: Day Two.	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.72^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.69^* * The correlation is significant at the 0.01 level (2 extremities);	0.86^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	0.90^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D1^† † D1: Day One;	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.85^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	1.00	1.00^* * The correlation is significant at the 0.01 level (2 extremities);
Digital D2^‡ ‡ D2: Day Two.	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.85^* * The correlation is significant at the 0.01 level (2 extremities);	0.84^* * The correlation is significant at the 0.01 level (2 extremities);	0.78^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.83^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.87^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	0.95^* * The correlation is significant at the 0.01 level (2 extremities);	1.00^* * The correlation is significant at the 0.01 level (2 extremities);	1.00

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[1] Author to whom correspondence should be addressed: Professor Laura Guimarães Primo, Disciplina de Odontopediatria da FO-UFRJ, Av. Prof. Rodolpho Paulo Rocco, 325, Cidade Universitária, CCS, Rio de Janeiro, RJ, Brazil. 21941-913. Phone: +55 21 3938-2098. E-mail: lprimo@pobox.com.