A Controlled Study on the Diagnostic Accuracy of Panoramic and Peri-Apical Radiography for Detecting Furcation Involvement

Abstract

Background: The aim of this study was to determine diagnostic accuracy, sensitivity and specificity of panoramic and peri-apical radiography for detecting furcation involvement (1) and to evaluate the possible impact of clinical experience on these diagnostic parameters (2).Methods: Periodontitis patients in need of an implant were retrospectively selected. Inclusion criteria were the presence of a CBCT, panoramic and peri-apical radiograph of the site of interest within a one-year time frame. All furcation sites were classified on the basis of CBCT using Hamp’s index (1975). These data were considered gold standard. Ten experienced examiners and 10 trainees were asked to assess furcation involvement for the same defects on the basis of corresponding panoramic and peri-apical radiographs. Absolute agreement, Cohen’s weighted kappa, sensitivity and specificity were calculated. In addition, ROC-curves were constructed.Results: The study sample included 60 furcation sites in 29 multi-rooted teeth from 17 patients (10 females; mean age 62). On average 20/60 furcations were correctly classified on the basis of panoramic radiography, corresponding to weighted kappa of 0.209 indicative of slight agreement. Respective data for peri-apical radiography were 19/60 and 0.221. When recategorizing FI Grades into ‘no to limited FI’ (FI Grade 0 and I) and ‘advanced FI’ (FI Grade II and III), panoramic and peri-apical radiography showed low sensitivity (0.550 and 0.441, respectively), yet high specificity (0.791 and 0.790, respectively) for identifying advanced FI. Both showed diagnostic value given the area under the ROC-curve amounting to 0.79 and 0.69 for panoramic and peri-apical radiography, respectively. There was no significant difference between experienced periodontists and trainees.Conclusion: Panoramic and peri-apical radiography are relevant in the diagnosis of FI given high specificity. These are best combined with furcation probing showing high sensitivity. Clinical experience does not seem to improve the accuracy of a radiological diagnosis of furcation sites.Trial Registration: Patients were retrospectively registered.

Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study

“…This reflects the higher risk of tooth loss for FI degree III compared with degree I and II, 35 but potentially also the fact that in the present study furcation involvement was only estimated from a radiographic analysis, 46 so it may be subject to error 47 . Several studies have clearly reported that furcation assessment via two‐dimensional radiography has low sensitivity and should be accompanied by clinical detection for better accuracy 48,49 …”

“…47 Several studies have clearly reported that furcation assessment via twodimensional radiography has low sensitivity and should be accompanied by clinical detection for better accuracy. 48,49 The main strength of this study is the long-term followup period and analysis of a population not undergoing systematic periodontal therapy. The limitations of this study include the use of orthopantomograms, a questionable smoking definition (non-smokers included both who never smoked or smoked <10 cigarettes/day) and the lack of sample size calculation.…”

Concentrated Growth Factors in Combination with Particulate Bio-Oss Graft: A Pilot Study on Beagle Dog Alveolar Bone Deficient

“…But predictable results have been still difficult to obtain due to the complex oral environment, which limited the prognosis. Previous clinical follow-up studies declared that patients received conventional treatment, comprising various types of access flaps and/or resection, were deeply troubled by probing depth reduction, hard tissue fill or even elimination of the intrabony component [22]. Furthermore, residual pockets often persisted following nonsurgical therapy or the use of access flaps, and resective techniques were associated with chronic loss of attachment and increases in soft-tissue atrophy [23].…”