Evaluation of clinical instructors performance in radiographic assessment of primary molar furcation areas: A pilot study

Abstract

Purpose and Background

This study aimed to evaluate the diagnostic performance, agreement, and consistency of pediatric dentistry instructors in radiographic diagnosis of furcation lesions. Radiographic identification of furcation lesions in primary molars is challenging due to the superimposition of anatomic features and the developing permanent tooth buds. Clinical instructors’ inconsistencies in diagnosing this lesion may compromise patient outcomes and student training.

Methods

Eight clinical instructors assessed 20 radiographs in two blinded rounds. A validated reference diagnosis dataset was established by two calibrated specialists, using paired pre-treatment and follow-up radiographs. Total and subgroup analysis was performed between instructors with and without specialty training. Diagnostic performance was measured by sensitivity, specificity, and accuracy. Agreement and consistency were evaluated using Fleiss’ and Cohen’s Kappa.

Results

Overall sensitivity, specificity, and accuracy were 0.75, 0.77, and 0.76, respectively, with no significant differences between pediatric specialists and general dentists (p = 0.79). Agreement was moderate overall (K = 0.50 - 0.59), ranging from fair to moderate in general dentists and substantial in specialists. Intra-rater consistency was substantial to almost perfect overall and in both groups (K = 0.62- 0.82).

Conclusions

Instructors demonstrated satisfactory accuracy and high intra-rater consistency in diagnosing furcation lesions, however inter-rater agreement was suboptimal. Standardized guidelines or could improve calibration and teaching reliability.