不同显示终端观察数字根尖片中根管锉尖端位置准确性的研究

Diagnostic consistency for observing endodontic files in digital radiographs displayed on different electronic devices

目的探讨不同显示终端诊断数字根尖片中根管锉尖端位置的准确性,为确定智能手机辅助诊断根管工作长度的可行性提供参考。方法将10号或15号K锉分别插入脱水人头颅骨(北京大学口腔医学院·口腔医院医学影像科提供)上下颌第二前磨牙和第一磨牙的根管中,分别拍摄100张数字根尖片。上下颌牙齿根尖片中共150个根管,其中75个根管内插入的10号或15号K锉到达工作长度,75个根管内插入的10号或15号K锉距离根尖1.5 mm。由5名观察者(3名牙体牙髓医师、2名放射医师,均工作5年以上)分别对200张数字根尖片在笔记本电脑(Lenovo Thinkpad E480)、平板电脑(Apple iPad 2018)、智能手机A(HUAWEI P9 Plus)和智能手机B(Apple iPhone 7)上根据5级评分标准进行读片观察,以根管预备后插入20号K锉到达X线根尖后的工作长度作为金标准,得出受试者工作特征(receiver operating characteristic,ROC)曲线,并对曲线下面积(area under curve,AUC)进行单因素方差分析和独立样本t检验。结果利用笔记本电脑、平板电脑和智能手机A、B观察数字根尖片中同一型号根管锉尖端位置获得的AUC值(10号K锉组分别为:0.891±0.037、0.869±0.037、0.870±0.017、0.849±0.037;15号K锉组分别为:0.957±0.02、0.961±0.02、0.961±0.01、0.961±0.02)差异均无统计学意义(10号K锉:F=1.39,P=0.281;15号K锉:F=0.05,P=0.985);针对不同型号根管锉,不同显示终端中15号K锉组的AUC值显著高于10号K锉组(t=-10.65,P<0.001)。结论本研究中4种显示终端观察数字根尖片中根管锉尖端位置的准确性差异无统计学意义,借助智能手机诊断数字根尖片中根管锉尖端位置确定根管工作长度的方法可行。

Objectives To evaluate the diagnostic consistency of working lengths by observing endodontic files in root canals and periapical subtle structures in digital intraoral radiographs presented in two smartphones,a tablet and a laptop computer.Methods A dried human skull embedded in an acrylic compound was used for exposing radiographs of the upper and lower second premolars and first molars with two endodontic files(Kerr files size 10 and 15)positioned to the full length of the roots or 1.5 mm short of apexes.A total of 100 radiographs were taken for each of the file sizes.Five observers were asked to assess all the 200 digital radiographs according to a 5-category scale in smartphone A(HUAWEI P9 Plus),smartphjone B(Apple iPhone 7),tablet(Apple iPad 2018)and laptop computer(Lenovo Thinkpad E480),respectively.The gold standard for receiver operating characteristic curve(ROC)analysis was determined with the endodontic Kerr file size 20.A total of 150 roots with files were radiographed,75 of which with files reaching the radiographic apexes of the respective roots and 75 of which with files 1.5 mm short of the radiographic apexes for each endodontic file size.Results from ROC analysis was analyzed with one-way ANOVA and independent sample t test.Results For the Kerr file size 10,the area under the ROC curve for laptop,tablet and two smartphones were 0.891±0.037,0.869±0.037,0.870±0.017 and 0.849±0.037,while for the Kerr file size 15 the ROC values were 0.957±0.02,0.961±0.02,0.961±0.01 and 0.961±0.02,respectively.There were no significant differences for diagnostic accuracy for observing endodontic file positions among digital radiographs presented in the two smartphones,one tablet and one laptop devices(endodontic file size 10:F=1.39,P=0.281;endodontic file size 15:F=0.05,P=0.985).A significant difference was found in the diagnostic accuracy of endodontic file positions between size 10 and 15 files in different display devices(t=-10.65,P<0.001).Conclusions There was a high diagnostic consistency in the determination of working length and periapical subtle structures of roots by observing digital radiographs displayed on smartphones,tablet and laptop computer.