The accuracy and interobserver reliability of identification of interalveolar foramina in the mandible using dental radiography

Abstract

Background: The evaluation of periapical radiographic evidence of these foramina might be helpful to avoid hemorrhaging of the highly vascularized regions of the floor of the mouth. Accuracy and reliability of the dental radiography in depicting the interalveolar medial foramina on 28 dry mandibles was tested in this study. Materials and Methods: The 28 mandibles were radiographically examined for the presence of median and lateral foramina that were interalveolar. The foramina diameters and the distance of the foramen to the cementoenamel junction, and to the alveolar bone crest, were measured. Two radiographic images of the symphysis areas were obtained, with and without the insertion of metal wires into the foramina. On the radiographic films, the presence of the foramina was identified and marked by two periodontists. The accuracy, sensitivity, specificity, interobserver reliability and the agreement of the readings between the diagnostic films and the films with wire insertions were analyzed. Results: Two to four foramina were observed on the lingual surfaces in the symphysis areas in 27 dry skulls. Among the 52 median foramina, 22 and 21 foramina were identified by observers 1 and 2, respectively. The accuracy, sensitivity, and specificity for the identification of the foramina were 41.1%, 42.3%, and 25.0%, respectively, for observer 1, and 37.5%, 40.4%, and 0.0%, respectively, for observer 2. The interobserver reliability was 0.57 (Kappa value). The readings for the diagnostic films and those for the films with wire insertions showed no agreement, regardless of the observer. Conclusions: Dental radiography revealed the presence of interalveolar foramina in 28 skulls; nonetheless, this result should be interpreted cautiously, as the accuracy was <50%.

Keywords

• Mandible
• dental
• radiography
• anatomy
• oral radiology
• accuracy
• foramina