Full Access
The periapical index: A scoring system for radiographic assessment of apical periodontitis
Dag Ørstavik,
Kasmer Kerekes,
Harald M. Eriksen,
Corresponding Author
Dag Ørstavik
NIOM – Scandinavian Institute of Dental Materials, Oslo, Norway
Dr. Dag Ørstavik, NIOM – Scandinavian Institute of Dental Materials, Forskningsveien 1, N-0371 Oslo 3, Norway.Search for more papers by this authorKasmer Kerekes
Department of Operative Dentistry. Dental Faculty, University of Oslo, Oslo, Norway
Search for more papers by this authorHarald M. Eriksen
Department of Operative Dentistry. Dental Faculty, University of Oslo, Oslo, Norway
Search for more papers by this authorDag Ørstavik,
Kasmer Kerekes,
Harald M. Eriksen,
Corresponding Author
Dag Ørstavik
NIOM – Scandinavian Institute of Dental Materials, Oslo, Norway
Dr. Dag Ørstavik, NIOM – Scandinavian Institute of Dental Materials, Forskningsveien 1, N-0371 Oslo 3, Norway.Search for more papers by this authorKasmer Kerekes
Department of Operative Dentistry. Dental Faculty, University of Oslo, Oslo, Norway
Search for more papers by this authorHarald M. Eriksen
Department of Operative Dentistry. Dental Faculty, University of Oslo, Oslo, Norway
Search for more papers by this authorAbstract
Abstract A scoring system for registration of apical periodontitis in radiographs is presented. The system is termed the periapical index (PAI) and provides an ordinal scale of 5 scores ranging from 1 (healthy) to 5 (severe periodontitis with exacerbating features). Its validity is based on the use of reference radiographs of teeth with verified histological diagnoses. Results from studies involving 11 observers and 47 selected radiographs document that the PAI system is reasonably accurate, reproducible and able to discriminate between sub-populations. It may also allow for results from different researchers to be compared. The system may be suitable for the analysis of periapical radiographs in epidemiological studies, in clinical trials and in retrospective analyses of treatment results in endodontics.
References
- 1 James PMC, Heal JF. Dental epidemiology and survey procedures. In: GL Slack, BA Hurt, eds. Dental Public Health. Bristol : John Wright & Sons, 1981; 86–118.
- 2 ØRstavik D, Mjör IA. Endodontics. In: IA Mjör, ed. Dental Materials: Biological Properties and Clinical Evaluations. Boca Raton , FL : CRC Press, 1985: in press.
- 3 Auerbach MB. Clinical approach to the problem of pulp canal therapy. J Am Dent Assoc 1938; 25: 939–42.
- 4 Holst JJ. Resultater af rodbehandling paa grundlag al en klinisk-rønigenologisk efterundersøgelse af 418 tilfælde. Tandlægebl 1941; 45: 330–48.
- 5 Castaonola L. 1000 Fälle von Garigränbehandling nach der Walkhoffschen Metode aus dem statistischen Material der Konservierenden Abteilung. Schweiz Monatssschr Zahnheilk 1950; 60: 1033–76.
- 6 Fediter B. Ergebnisse von mehreren Tausend in der freien Praxis nach wissenschaftlich anerkannten Methoden durch-gelührten Wurzelehandlungen. Deutsche Zahnärztl Zeitschr 1955; 10: 1677–84.
- 7 Strindberg LZ. The dependence of the results of pulp therapy on certain factors. Acta Odontol, Scand 1956; 14: Suppl 14.
- 8 Egli H. Wurzelfüllmaterial AH26. Röntgenologische Nach-konlrollen über Erfolge und Misserfolge. Deutsche Zahnärztl Zeitschr 1963; 18: 407–13.
- 9 Grossman LI, Shepard LI, Pearson LA. Roentgenelogic and clinical evaluation of endodontically treated teeth. Oral Surg 1964; 17: 368–74.
- 10 Storms JL. Factors that influence the success of endodontic treatment. J Canad Dent Assoc 1969; 35: 83–97.
- 11
Hartv FJ,
Parkins HJ,
Wengraf AM.
Success rate in root canal therapy: a retrospective study of conventional cases.
Br Dent J
1970; 70: 65–70.
10.1038/sj.bdj.4802429 Google Scholar
- 12 Apt H, Dyrna G, Nitzsche W, Völker J. Ergebnisse und Konsequenzen klinisch-röntgenologischer Nachuntersuchuugen Wurzelbehandelter Zähne. Stormat DDR 1976; 26: 683–8, 743–7.
- 13 Adenubi JO. Rule DC. Success rate for root fillings in young patients. Br Dent J 1976; 41: 237–41.
- 14 Jokinen MA, Kotilainen R, Poikkens P, Poikkens R, Sarkki L. Clinical and radiographic study of pulpectomy and root canal therapy. Scand J Dent Res 1978; 86: 366–73.
- 15 Achard G, Nief L, Marie MP. Étude statistique de traitements endodontiques eftectués de 1957 à 1960 et contrôlés ultéricurement. Cah Stomatol Chir Max Fac 1978; 6: 130–5.
- 16 Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod 1979; 5: 83–90.
- 17 Delessert Y, Holz J, Baume LJ. Controle radiologique a court et à long termes du traitement radiculaire de la catégorie III des pulpopathies. ScMøveiz Monstsschr Zahnheilk 1980; 90: 585–607.
- 18 Barbakow FH, Cleaton-Jones PE, Friedman D. An evaluation of 566 cases of root canal therapy in general dental practice. J Endod 1980; 6: 456–60, 485–9.
- 19 Barbakow FH, Cleaton-Jones PE, Friedman D. Endodontic treatment of teeth with periapical radiolucent areas in a general denial practice. Oral Surg 1981; 51: 552–9.
- 20 Morse DR, Esposito JV, Pike C, Furst ML. A radiographic evaluation of the periapical status of teeth treated with the gutla-percha-eueapercha endodontic method: A one-year follow-up study of 458 root canals. Oral Surg 1983; 55: 607–10; 56: 89–96, 190–7.
- 21 Hyman JJ, Cohen ME. The predictive value of endodontic diagnostic tests. Oral Surg. 1984; 58: 343–6.
- 22 Federation Dentaire Internationale, Commission on Dental Products. Recommendations for clinical research protocols for dental materials, Int Dent J 1982; 32: 403–23.
- 23 Bergenholtz G, Malmgrona E, Milthon R. Endodontisk behandling och periapikalstatus. Tandläkart 1973; 65: 64–73, 269–79.
- 24 Reit C, Hollender L. Radiographic evaluation of endodontic therapy and the influence of observer variation. Scand J Dent Res 1983; 97: 205–12.
- 25 Reit C, Gröndahl HG. Application of statistical decision theory to radiographic diagnosis of endodontically treated teeth. Scand J Dent Res 1983: 91: 213–8.
- 26 Petersson AR, Petersson K, Krasny R, Gratt BM. Observer variations in the interpretation of periapical osseous structures: a comparison between xeroradiography and conventional radiography. J Endod 1984; 10: 205–9.
- 27 Simon JHS. Pathology. In: S Cohen, RC Burns, eds. Pathways of the Pulp. St. Louis , MS : C.V Mosby, 1984, pp.. 379–404.
- 28 Barr JH, Stephens RG. Dental Radiology: Pertinent Basic Concepts and their Applications in Clinical Practice. Philadelphia , PA : WB Saunders, 1980, pp.. 307–15.
- 29 Cohen S. Diagnostic procedures. In: S Cohen, RC Burns, eds. Pathways of the Pulp. St. Louis , MS : CV Mosby 1984, pp.. 5–35.
- 30 Gelfand M, Sunderman EJ, Goldman M. Reliability of radiographical interpretations. J Endod 1983; 9: 71–5. 31.
- 31 Zakariasen KL, Scott DA, Jensen JK. Endodontic recall radiographs: How reliable is our interpretation of endodontic success or failure and what factors affect our reliability Oral Surg 1984; 57: 343–7.
- 32 Goldman M, Pearson AH, Darzenta N. Endodontic success – Who's reading the radiograph? Oral Surg 1972; 33: 432–7.
- 33 Goldman M, Pearson AH, Darzenta N. Reliability of radiographic interpretations. Oral Surg 1974; 38: 287–93.
- 34 Valderhaug J. A histologic study of experimentally induced radicular cysts. Int. J Oral Surg 1972: 1: 137–47.
- 35 Siegel S. Nonparametric Statistics for the Behavioral Sciences. Tokyo : McGraw-Hill, 1956.
- 36 Guilford JP, Fruchter B. Fundamental Statistics in Psychology and Education. New York : McGraw-Hill, 1978.
- 37 Molven O. The Frequency, Technical Standard and Remits of Endodontic Therapy. Bergen : Thesis, 1974.
- 38 Weski O. Röntgenologisch-mikroskopische Studien aus dem Gebiete der Kieferpathologie. Korresp-Bl Zalmärz 1913; 42: 244–69, 1914; 43: 82–3.
- 39 Nygaard-Østby B. Gewebsveränderungen im apikalen Paradentium des Menschen. Oslo : Del Norske Videnskaps-Akademi, 1939.
- 40 Kronfeld R. Correlation between clinical and pathological diagnosis in chronic apical periodontitis. In: Proceedings Dental Centenary Celebration. Baltimore : Waverly Press, 1940, pp.. 409–24.
- 41 Linenberg WB, Waldron CA, Delaune GF. A clinical, roentgenographic, and histopathologic evaluation of periapical lesions. Oral Surg 1964; 17: 467–72.
- 42 Rud J, Andreassen JO, Möller Jensen JE. Radiographic criteria for the assessment of healing after endodontic surgery, Int J Oral Surg 1972; 1: 195–214.
- 43 Rowe AHR, Binnie WH. Correlation between radiological and histological inflammatory changes following root canal treatment. J Br Endod Soc 1974; 7: 57–63.
- 44 Brynolf I. A histological and roentgenological study of the periapical region of human upper incisors. Odontol Revy 1967; 15: Suppl. 11.
- 45 Mattson O. A magnifying viewer for photofluorographic films. Acta Radial 1953; 39: 412–4.
- 46 Eggen S. Standardized projection technique in intraoral roentgenography. Sver Tandläkar förb Tidn 1969; 61: 867–72.
- 47 Scott WA. Reliability of content analysis. The case of nominal scale coding. Public Opin Q, 1955; 19: 321–5.
- 48 Bross IDJ. How to use ridit analysis. Biometrics 1958; 14: 18–38.
- 49 Fleiss JL, Chilton NW, Wallenstein S. Ridit analysis in dental clinical studies. J Dent Res 1979; 58: 2080–4.
- 50 Swets JA. ROG analysis applied to the evaluation of medical imaging techniques. Invest Radial 1979; 14: 109–21.
- 51 Grainger RM. Epidemiological data. In: NW Chilton, ed. Design and Analysis in Denial and Oral Research. Philadelphia , PA : Lippincott 1967, pp.. 311–53.
- 52 Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533–51.
- 53 Möller AJR, Fabricius L, Dahén G, ÖHman AE, Heyden G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scand J Dent Res 1981; 89: 475–84.
- 54 Garland LH. On the scientific evaluation of diagnostic, procedures. Radiology 1949; 52: 309–28.
- 55 Poulsen S, Holm-Pedersen P, Kelstrup J. Comparison of different measurements of development of plaque and gingiva in man. Scand J Dent Res 1979; 87: 178–83.
- 56 Lilienfeld A, Lilienfeld D. Foundations of Epidemiology. New York : Oxford Press, 1980.
- 57 Williams T. Computer Aids to Clinical Decisions, Vol. II. Boca Raton , FL : CRC Press, 1980.
- 58 Goodenough D J, Rossmann K, Lusted LB. Radiographic applications of receiver operating characteristic (ROC) curves. Radiology 1974; 110: 89–95.
- 59 Ambjørnsen E, Rise J, Haugejorden O. A study of examiner errors associated with measurement of denture plaque. Acta Odontol Scand 1984; 42: 183–91.
- 60 Clemmer BA, Bakrabano JP. Reproducibility of periodontal scores in clinical trials. J Periodontal Res 1974; 14: Suppl. 14, pp.. 108–28.
- 61 Russell AL. A system of classification and scoring for prevalence surveys of periodontal disease. J Dent Res 1956; 35: 350–9.
- 62 Silness J, Löe H. Periodontal disease in Pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121–35.
- 63
Löe H.
The gingival index, the plaque index and the retention index system.
J Periodont
1967; 38: 610–6.
10.1902/jop.1967.38.6.610 Google Scholar
- 64 Ambjørnsen E, Valderhaug J, Normeim PW, Fløystrand F. Assessment of an additive index for plaque accumulation on complete maxillary dentures. Acta Odontol Scand 1982; 40: 203–8.
- 65 Gröndahl HG. Radiographic caries diagnosis. A study of caries progression and observer performance. Swed Dent J 1979; 3: Suppl. 3.
- 66 Leinfelder KF, Mjör IA. Clinical evaluations In: IA IA Mjör, ed. Dental Materials: Biological Properties and Clinical Evaluations. Boca Raton , FL : CRC Press 1985, in press.
- 67 Mahler DB, Terkla LG, Eysden JV. Marginal fracture of amalgam restorations. J Dent Res 1973; 52: 823–7.
- 68 Holz J, Fiore-Donno G, Baume LJ. Contrôles histologiques des matériaux d'obturation: normalisation des méthodes ex-périmentales et des critères devaluation. Schweiz Monatsschr Zalmheilk 1968; 78: 307–51.
- 69 Kallus T. Evaluation of the toxicity of denture base polymers after subcutaneous implantation in guinea pigs. J Prosthet Dent 1984; 52: 126–34.
- 70 Kallus T. Enhanced tissue response to denture base polymers in formaldehyde-sensitized guinea pigs. J Prosthel Dent 1984; 52: 292–9.
- 71 Shaw L, Murray JJ. Diagnostic reproducibility of periodontal indices. J Periodontal Res 1977; 12: 141–7.
- 72
Alexander AG,
Leon AR,
Ribbons JW,
Morganstein SI.
An assessment of the inter- and intra-examiner agreement in scoring gingivitis clinically.
J Periodontal Res
1971; 6V
146–51.
10.1111/j.1600-0765.1971.tb00602.x Google Scholar
- 73 Shaw L, Murray JJ. Inter-examiner and intra-examiner reproducibility in clinical and radiological diagnosis, Int Dent J 1975; 25: 280–8.
Citing Literature
