title: Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis.
abstract: OBJECTIVE
  The aims of this study were to evaluate whether the use of CT facilitates agreement among endodontists in selecting treatments for root-filled maxillary molars with apical periodontitis and to assess the efficacy of CT in choosing a treatment for such teeth.
  
  
  METHODS
  39 root-filled maxillary molars from 34 patients with suspected apical periodontitis were independently evaluated by 4 endodontists and 1 postgraduate student (decision-makers). Treatment decisions were made based on intra-oral radiographs and a fictive clinical history. After 1-3 months, the same decision-makers repeated the examination of the same teeth but with additional information from a CT examination. Agreement between decision-makers with or without the availability of the CT results was measured with Cohen's kappa coefficient. Differences in selected treatments with or without accessibility to the CT results were plotted for the same endodontists using descriptive statistics.
  
  
  RESULTS
  The agreement in assessments among endodontists was slight or fair before the CT results were available (range: 0.081-0.535). No increase was observed after reviewing the CT results (range: 0.116-0.379). After the use of CT, the treatment plan was changed 38-76% of the time by all decision-makers, and the changes affected 57.8% of the cases in the study.
  
  
  CONCLUSIONS
  The endodontists in this study exhibited a low degree of agreement when choosing a treatment for root-filled maxillary molars with apical periodontitis. A CT examination of the investigated teeth did not result in a significantly higher degree of agreement, and CT frequently contributed to a shift in the selected therapy.
authors.affiliation: 1 Department of Endodontics, Tandvårdens Kompetenscentrum, Norrbotten's County Council, Luleå, Sweden.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Mota de Almeida
authors.affiliation: 2 Institute of Dentistry, University of Turku, Turku, Finland.|3 Department of Diagnostic Imaging, Turku University Hospital, Turku, Finland.
authors.forename: Sisko
authors.initials: S
authors.lastname: Huumonen
authors.affiliation: 4 Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Molander
authors.affiliation: 5 Department of Radiology, Sunderby Hospital, Norrbottens County Council, Luleå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Öhman
authors.affiliation: 4 Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D008963:Molar / Q000000981:diagnostic imaging*; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: decision-making; endodontics; tomography