Evaluation of furcation involvement with diagnostic imaging methods: a systematic review

Abstract

Objective: Multirooted teeth respond less favorably to non-surgical periodontal treatment and long-term tooth prognosis is influenced by the degree of furcation involvement (FI). Therapeutic strategy for multirooted teeth is essentially based on accurate diagnosis of the FI. The aim of this systematic review is to evaluate the accuracy of the different furcation assessment methods and to determine if radiographic help is needed to determine early stage of FI. Methods: Electronic databases were searched up to March 2021. Comparative studies describing the reliability of different clinical and/or radiological furcation assessment methods were identified. Results: A total of 22 studies comparing at least 2 furcation assessment methods, among which 15 retrospective studies, 5 prospective studies, 1 randomized controlled trial and 1 case series, were included in this review. The reliability of cone beam CT (CBCT), intraoral radiographs (IOs), orthopantomograms (OPGs) and MRI to identify FI was evaluated. Using OFS as a reference for FI detection and diagnosis, agreement ranged from 43.3 to 63% for OPG, 38.7 to 83.1% for IO and 82.4 to 84% for CBCT. The validity of the measurements was mainly influenced by the location of the furcation entrance. For radiological diagnosis, CBCT displayed the closest agreement with OFS while the accuracy of IO and OPG showed modest agreement and were influenced by the examiner’s experience. Conclusion: Altogether, it appears that the use of IO, OPG or CBCT allows detection of FI but could not be considered as gold-standard techniques.

Effects of Advanced Platelet Rich Fibrin (A-PRF+), Enamel Matrix Derivative (EMD) and Open Flap Debridement on clinical and wound healing parameters in molar furcation sites: A case series from a RCT study

“…However, traditional 2-dimensional radiographs have limited effectiveness in detecting interproximal furcation reduction due to the masking effect of the cortical bone plate on infrabony defects. While incorporating cone-beam computed tomography (CBCT) to measure bone differences between different time points could be considered an ideal approach, the potential advantages of this technique in the scientific literature remain controversial (52,53). Although we did collect radiographs at baseline and re-evaluation, we acknowledge the limitations of our study design, which led us to primarily focus on clinical and wound healing parameters.…”

Correlation of clinical and radiographic severity of periodontitis with furcation involvement: Evaluation of periapical radiographs and Cone-beam Computed Tomography

“…19 Although it is very helpful in the diagnosis of periodontal disease, the determination of CBCT examination needs to be considered with the guideline, that CBCT can be performed if conventional clinical and radiographic examinations do not provide adequate information for treatment planning. 5,20 In addition, the high benefits of CBCT examination but the ALARA (As Low As Reasonably Achievable) principle should be considered, and each patient should be evaluated individually based on their specific and situational treatment needs. 21…”

Biometric analysis of furcation area of molar teeth and its relationship with instrumentation

“…Periodontal disease is characterized by the loss of connective tissue attachment induced by the presence of periodontal pathogens within the gingival sulcus [ 1 ]. Once periodontal disease has been established, it progresses and further involves the furcation of multi-rooted teeth [ 2 ]. Compared to single-rooted tooth where there is no furcation, furcation in a multi-rooted tooth poses a very different type of clinical situation in diagnosis, prognosis and treatment plan [ 3 ].…”