Resumen de Periodontal Probing Versus Radiographs for the Diagnosis of Furcation Involvement
Background: Decisions in periodontal therapy for multirooted teeth are essentially based on accurate diagnosis of the furcation involvement (FI). Furcation probing (FP) is still the basic diagnostic measure, although the assessment may be difficult. The aim of this study is to evaluate the validity of FP and radiographic assessment of FI compared with visual assessment during open flap surgery (OFS).
Methods: In this retrospective clinical cohort study, 215 participants with periodontal disease and at least one molar treated with OFS were enrolled, and a total of 834 molars were assigned for FI by FP and in radiographs analyzed by an experienced (EE) and less experienced examiner (LE). For the investigation, 143 panoramic radiographs (OPGs) and 77 intra-oral radiographs (I-Os) were evaluated.
Results: The Class of FI by FP was confirmed in 56%, whereas 15% were overestimated and 29% underestimated. FI Class 0 and I had been detected with high probability (74% and 54%, respectively). Of all FI Class III, 57% were detected correctly by radiographs and 32% by FP. FP and OFS revealed a weighted ?-coefficient (?w) = 0.588; radiographs and OFS had ?w = 0.542 (OPG ?w = 0.555 and I-O ?w = 0.521). The interrater reliability for radiographs was dependent on the experience of the examiner (EE ?w = 0.618; LE ?w = 0.426).
Conclusions: Experience in analyzing conventional radiographs increases the potential of correct diagnosis of advanced FI. The reliability of FP compared with radiographic assessment depends on the anatomy and location of the tooth. Both diagnostic tools should be used in cases of suspected FI.
The management of molars with furcation involvement (FI) represents one of the major challenges in clinical periodontology.1,2 Treatment of periodontally diseased molars with no FI or FI Class I1 may be managed by root debridement alone,3 whereas advanced FI (Class II or III1) requires invasive, in some cases resective, techniques.4-6 FI Class II1 of mandibular molars as well as of buccal furcations in maxillary molars may be successfully treated by regenerative procedures.7 Therefore, accurate presurgical diagnosis of FI is fundamental for decision making and assessing the prognosis of diseased molars. Previous investigations of the validity of various assessment techniques of FI were performed in vitro8 or prospectively.9-13 Prospective studies have some advantages because the data might be more reproducible, e.g., standardized radiographs with a receptor holder, strict parallel-right-angle x-ray technique, or examination by one well-instructed examiner. However, this does not reflect real treatment conditions. The present study, therefore, is designed as a retrospective investigation over a long observation period with dentists of different experience to determine the validity of assessing FI by clinical furcation probing (FP) as well as conventional radiographs in comparison to the true situation during open flap surgery (OFS). In addition, the influence of parameters such as diagnostic experience of the examiner or type of radiograph was investigated.
