Reliability and agreement of root length measurements during orthodontic treatment in images from different CBCT machines using multiplanar reconstruction

Kristina Johansson; Liselotte Paulsson; Helena Christell

doi:10.2340/biid.v11.41161

Authors

Kristina Johansson Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Orthodontics, Östersund Hospital, Östersund, Sweden
Liselotte Paulsson Faculty of Odontology, Malmö University, Malmö, Sweden
Helena Christell Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Diagnostics, Helsingborg Hospital, Helsingborg, Sweden

DOI:

https://doi.org/10.2340/biid.v11.41161

Keywords:

Cone-beam computed tomography, root resorption, orthodontic appliances, fixed, reproducibility of results, observer variation

Abstract

Objectives: To assess inter- and intrarater reliability and agreement for measurements of root lengths using multiplanar reconstruction (MPR) in cone beam computed tomography (CBCT) examinations.

Furthermore, to determine whether using MPR from different CBCT machines was a reliable and reproducible method for assessment of root length during orthodontic treatment of adolescents.

Materials and methods: A total of 40 CBCT examinations obtained before, during and after orthodontic treatment of 14 adolescents, with fixed appliances from a multicentre randomised controlled trial, were used. All roots from the incisors to the first molars were measured by two independent raters and in accordance with a protocol preceded by a multi-step calibration. Reliability was assessed by intra class correlation (ICC). Agreement was assessed by measurement error according to the Dahlberg formula and Bland–Altman plot.

Results: The number of repeated measurements varied from 436 to 474 for the different timepoints. Good to excellent inter- and intrarater reliability for different tooth groups and timepoints were shown. Measurement error for inter- and intrarater agreement varied between 0.41 mm and 0.77 mm. The Bland–Altman plot with 95% limits of agreement varied between +1.43 mm and −2.01 mm for different tooth groups and timepoints.

Conclusions: The results of this study indicate that CBCT using MPR from different machines is a reproducible method for measuring root length during different phases of orthodontic treatment. When interpreting root shortening measurements in CBCT using MPR for clinical or research purposes, values below 2 mm should be approached with caution, as they may contain measurement errors.

Downloads

Download data is not yet available.

References

Peryer G, Golder S, Junqueira D, Vohra S, Loke YK. Chapter 19: adverse effects. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions. 2nd ed. Chichester, UK: John Wiley & Sons; 2019. pp 493–506. DOI: https://doi.org/10.1002/9781119536604.ch19

Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE. Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop. 2010;137(4):462-12A. https://doi.org/10.1016/j.ajodo.2009.06.021 DOI: https://doi.org/10.1016/j.ajodo.2009.06.021

Yi J, Li M, Li Y, Li X, Zhao Z. Root resorption during orthodontic treatment with self-ligating or conventional brackets: a systematic review and meta-analysis. BMC Oral Health. 2016;16(1):125. https://doi.org/10.1186/s12903-016-0320-y DOI: https://doi.org/10.1186/s12903-016-0320-y

Samandara A, Papageorgiou SN, Ioannidou-Marathiotou I, Kavvadia-Tsatala S, Papadopoulos MA. Evaluation of orthodontically induced external root resorption following orthodontic treatment using cone beam computed tomography (CBCT): a systematic review and meta-analysis. Eur J Orthod. 2019;41(1):67–79. https://doi.org/10.1093/ejo/cjy027 DOI: https://doi.org/10.1093/ejo/cjy027

Makedonas D, Lund H, Hansen K. Root resorption diagnosed with cone beam computed tomography after 6 months and at the end of orthodontic treatment with fixed appliances. Angle Orthod. 2013;83(3):389–393. https://doi.org/10.2319/042012-332.1 DOI: https://doi.org/10.2319/042012-332.1

Artun J, Van ‘t Hullenaar R, Doppel D, Kuijpers-Jagtman AM. Identification of orthodontic patients at risk of severe apical root resorption. Am J Orthod Dentofacial Orthop. 2009;135(4):448–455. https://doi.org/10.1016/j.ajodo.2007.06.012 DOI: https://doi.org/10.1016/j.ajodo.2007.06.012

Johansson K, Lindh C, Paulsson L, Rohlin M. A tool for assessment of risk of bias in studies of adverse effects of orthodontic treatment applied in a systematic review on external root resorption. Eur J Orthod. 2021;43(4):457–466. https://doi.org/10.1093/ejo/cjaa072 DOI: https://doi.org/10.1093/ejo/cjaa072

Levander E, Malmgren O, Eliasson S. Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study. Eur J Orthod. 1994;16(3):223–228. https://doi.org/10.1093/ejo/16.3.223 DOI: https://doi.org/10.1093/ejo/16.3.223

Sondeijker CFW, Lamberts AA, Beckmann SH, Kuitert RB, van Westing K, Persoon S, et al. Development of a clinical practice guideline for orthodontically induced external apical root resorption. Eur J Orthod. 2020;42(2):115–124. https://doi.org/10.1093/ejo/cjz034 DOI: https://doi.org/10.1093/ejo/cjz034

Bland JM, Altman DG. A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comput Biol Med. 1990;20(5):337–340. https://doi.org/10.1016/0010-4825(90)90013-f DOI: https://doi.org/10.1016/0010-4825(90)90013-F

Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud. 2011;48(6):661–671. https://doi.org/10.1016/j.ijnurstu.2011.01.016 DOI: https://doi.org/10.1016/j.ijnurstu.2011.01.016

Springate SD. The effect of sample size and bias on the reliability of estimates of error: a comparative study of Dahlberg’s formula. Eur J Orthod. 2012;34(2):158–163. https://doi.org/10.1093/ejo/cjr010 DOI: https://doi.org/10.1093/ejo/cjr010

Yassir YA, McIntyre GT, Bearn DR. Orthodontic treatment and root resorption: an overview of systematic reviews. Eur J Orthod. 2021;43(4):442–456. https://doi.org/10.1093/ejo/cjaa058 DOI: https://doi.org/10.1093/ejo/cjaa058

Lund H, Gröndahl K, Gröndahl HG. Cone beam computed tomography for assessment of root length and marginal bone level during orthodontic treatment. Angle Orthod. 2010;80(3):466–473. https://doi.org/10.2319/072909-427.1 DOI: https://doi.org/10.2319/072909-427.1

Meesters AML, Ten Duis K, Banierink H, Stirler VMA, Wouters PCR, Kraeima J, et al. What are the interobserver and intraobserver variability of gap and Stepoff measurements in acetabular fractures? Clin Orthop Relat Res. 2020;478(12):2801–2808. https://doi.org/10.1097/CORR.0000000000001398 DOI: https://doi.org/10.1097/CORR.0000000000001398

Baena-de la Iglesia T, Yañez-Vico RM, Iglesias-Linares A. Diagnostic performance of cone-beam computed tomography to diagnose in vivo/in vitro root resorption: a systematic review and meta-analysis. J Evid Based Dent Pract. 2023;23(1):101803. https://doi.org/10.1016/j.jebdp.2022.101803 DOI: https://doi.org/10.1016/j.jebdp.2022.101803

Deng Y, Sun Y, Xu T. Evaluation of root resorption after comprehensive orthodontic treatment using cone beam computed tomography (CBCT): a meta-analysis. BMC Oral Health. 2018;18(1):116. https://doi.org/10.1186/s12903-018-0579-2 DOI: https://doi.org/10.1186/s12903-018-0579-2

National Council on Radiation Protection and Measurements. NCRP: achievements of the past 50 years and addressing the needs of the future. Fiftieth annual meeting program. Bethesda: NCRP; 2014.

Pauwels R, Araki K, Siewerdsen JH, Thongvigitmanee SS. Technical aspects of dental CBCT: state of the art. Dentomaxillofac Radiol. 2015;44(1):20140224. https://doi.org/10.1259/dmfr.20140224 DOI: https://doi.org/10.1259/dmfr.20140224

Borg DN, Bach AJE, O’Brien JL, Sainani KL. Calculating sample size for reliability studies. PM R. 2022;14(8):1018-1025. https://doi.org/10.1002/pmrj.12850 DOI: https://doi.org/10.1002/pmrj.12850

Dahlberg G. Statistical methods for medical and biological students. London: Allen and Unwin; 1940. p. 122–132.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–310. DOI: https://doi.org/10.1016/S0140-6736(86)90837-8

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012 DOI: https://doi.org/10.1016/j.jcm.2016.02.012

Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root resorption after orthodontic treatment of traumatized teeth. Am J Orthod. 1982;82(6):487–491. https://doi.org/10.1016/0002-9416(82)90317-7 DOI: https://doi.org/10.1016/0002-9416(82)90317-7

Obuchowski NA. How many observers are needed in clinical studies of medical imaging? Am J Roentgenol. 2004;182(4):867–869. https://doi.org/10.2214/ajr.182.4.1820867 DOI: https://doi.org/10.2214/ajr.182.4.1820867

Cocchetti DV. Sample size requirements for increasing the precision of reliability estimates: problems and proposed solutions. J Clin Exp Neuropsychol. 1999;21(4):567–570. https://doi.org/10.1076/jcen.21.4.567.886 DOI: https://doi.org/10.5555/jcen.21.4.567.886

Al-Okshi A, Paulsson L, Rohlin M, Ebrahim E, Lindh C. Measurability and reliability of assessments of root length and marginal bone level in cone beam CT and intraoral radiography: a study of adolescents. Dentomaxillofac Radiol. 2019;48(5):20180368. https://doi.org/10.1259/dmfr.20180368 DOI: https://doi.org/10.1259/dmfr.20180368

Lago GV, Fernandes TMF, Oltramari-Navarro PVP, Almeida MR, Ladewig VdeM, Conti ACdeCF. Reliability of CBCT and periapical radiography methods to evaluate external apical root resorption during early phase of orthodontic treatment. J Health Sci. 2018;20:2–7. https://doi.org/10.17921/2447-8938.2018v20n1p2-7 DOI: https://doi.org/10.17921/2447-8938.2018v20n1p2-7

Sherrard JF, Rossouw PE, Benson BW, Carrillo R, Buschang PH. Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl):S100–S108. https://doi.org/10.1016/j.ajodo.2009.03.040 DOI: https://doi.org/10.1016/j.ajodo.2009.03.040

Spin-Neto R, Costa C, Salgado DM, Zambrana NR, Gotfredsen E, Wenzel A. Patient movement characteristics and the impact on CBCT image quality and interpretability. Dentomaxillofac Radiol. 2018;47(1):20170216. https://doi.org/10.1259/dmfr.20170216 DOI: https://doi.org/10.1259/dmfr.20170216