Diagnosis of periapical lesions of the front teeth using the internet

Objective. New information technologies not only raise the degree of quality of patient health care but also enable their partial or complete management over the distances of thousands of kilometers away from the health care centers or dentists. The need for distance diagnosis and planning of interventions is especially important when caring for soldiers, bed-ridden individuals, those with special needs and other patient subpopulations. Our aim here was to investigate the practical usefulness of teledentistry methods in the diagnosis and routine management of endodontic/oral surgery patients in the sense of reliability of teledentistry diagnosis and assessment of the most appropriate therapy in an endodontic or oral surgery treatment of the front teeth. Methods. In our experimental randomized study performed from June to December 2009, there were 250 enrolled patients of both genders, aged 9 to 67 years, visiting our department because of the symptoms related to the problems with periapical regions of their front teeth. The teeth observed constituted permanent dentition, and for each of the teeth producing complaints, photographs and radiographs were taken and uploaded to XPA3 Online application server on the Internet, from where they were downloaded and reviewed by distant consultants. Diagnostic agreement was studied by way of Cohen's kappa coefficient, as well as diagnostic sensitivity (SE), specificity (SP), and efficacy (EFF), and z-test and McNemmar X2 test were applied for the significance threshold of p=0.05. Results. The results obtained (k=0.97%, SE=0,99%, SP=0,99%, EFF=0,99 za 95% IP) indicate an almost complete diagnostic agreement. Diagnostic differences were not statistically significant. Conclusion. Teledentistry based on the Internet as a telecommunication medium can be successfully utilized in the diagnosis of periapical lesions of the front teeth, reducing the costs associated with distant visits and making urgent help available.