Background: This cross-sectional study aimed to evaluate the diagnostic accuracy of severe periodontitis by three different case definitions.Methods: Patients aged >35 years (n = 243, mean age = 47.8 ± 9.3 years) were evaluated by periodontal examinations and classified in patients with severe periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Academy of Periodontology (AAP)-CDC/AAP, the new periodontal disease classification proposed jointly by the AAP and the European Federation of Periodontology (EFP/AAP), and the Community Periodontal Index (CPI). The primary outcome was to compare the diagnostic accuracy of severe periodontitis between the three case definitions. Sensitivity (SS), specificity (SP), and area under the receiver operating characteristic (ROC) curve were used to analyze the accuracy. Results: The proportion of subjects presenting the most severe definitions of each classification was: severe periodontitis (CDC/AAP) = 47.3%, type III and IV periodontitis (EFP/AAP) = 43.2% and CPI code 4 = 44.4%. When comparing the CDC/AAP case definitions with the EFP/AAP classification, SS, SP, and ROC of 81.7%, 91.4%, and 0.866 (CI, 95%: 0.816 to 0.916), respectively, were obtained. Similarly, when comparing CDC/AAP to CPI code 4, SS, SP, and ROC of 81.7%, 89.1%, and 0.854 (CI, 95%: 0.802 to 0.906), respectively, were obtained. When type III and IV periodontitis (EFP/AAP) was compared with CPI code 4, the values were 92.4%, 92%, and 0.922 (CI, 95%: 0.883 to 0.961), respectively. Conclusions: The EFP/AAP classification and the CPI demonstrated high diagnostic accuracy with the CDC/AAP case definition to diagnose severe periodontitis.

The periapical radiograph is used to determine the working length in endodontic treatment. However, this radiograph does not define the position of the major apical foramen. Objective: This ex vivo laboratorial study aims to determine the prevalence of the major apical foramen mismatching the root apex in human permanent teeth, because when present, this mismatch makes the radiographic method inaccurate for determining the working length. Material and methods: This study used 400 human permanent teeth: 100 incisors, 100 canines, 100 premolars, and 100 molars, totalizing 634 canals (Ethics Committee, Federal University of Ceará #263/10). The access and negotiation of the root canals were performed with K-type files #10 and #15 until the tip of the instrument were visible at the root foramen through 5-fold magnifying glass. Periapical radiographs were performed on bucco-lingual incidence for single-rooted teeth; the incidence angle was changed for multi-rooted teeth. The films were processed and then analyzed by three calibrated examiners (Kappa 80%). Descriptive statistics and chi-square test were used for analyzing of the results. Results: The prevalence of major apical foramens mismatching the root apex was 19.72% of the canals studied. The incisors showed the lowest prevalence (9%, p<0.05) while the highest prevalence was seen in canine teeth (28%). Conclusion: According to the methodology applied, the prevalence of major apical foramens mismatching the root apex foramens make necessary an adjunct method for determining the working length, because it alone was not capable of determining the foramen position.

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