Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study

Abstract

AIM: The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars. MATERIAL AND METHODS: Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD). RESULTS: The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having 6 mm and almost 60% having only 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of 4 mm was given when residual PPD of 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11). CONCLUSIONS: The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Material and methods: 17 dentate patients, who received CBCT for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips and to the clinical probing pocket depth (PPD). Results:The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤6 mm and almost 60% having only ≤4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤4mm was given when residual PPD of ≥6 mm were remaining at 2 or more tooth sites. Conclusions:The majority of periodontally involved maxillary molars had a significantly substantially reduced interfurcal bone height, particularly with at least 2 sites with residual PPD ≥6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired.

Cone‐Beam Computed Tomography for Detection of Intrabony and Furcation Defects: A Systematic Review Based on a Hierarchical Model for Diagnostic Efficacy

“…The search strategy yielded a total of 1,989 publications in MEDLINE (PubMed), EMBASE, and Cochrane Library (see http://www.joponline.org/doi/suppl/10.1902/jop.2016.150636/suppl_file/150636_supapp1.pdf in online Journal of Periodontology ). The initial screening of the papers was performed using the abstracts and key words and yielded 17 papers 16,17,20‐23,39‐49 that potentially met the inclusion criteria. This was supplemented by four hand‐searched papers 18,19,30,50 .…”

“…This was supplemented by four hand‐searched papers 18,19,30,50 . After full‐text reading, five of these papers were excluded because they did not fulfill the inclusion criteria 39,43,44,48,49 . Excluded studies and reasons for exclusion are presented in Table 2.…”

Impact of CBCT image quality on the confidence of furcation measurements

“…From a patient`s perspective, a straight forward tooth extraction may be indicated and suggested, when the tooth is not maintainable. In case the morphological appearance is compatible with a reasonable long‐term prognosis, unnecessary tooth extractions are avoided (Walter et al., 2011, 2014). While doing so, a sinus floor augmentation, implant placement and advanced prosthetic reconstruction may be postponed.…”

“…In addition, several other relevant aspects, including periapical diseases and/or root perforations, or anatomical features, including fenestrations or root proximities, are detectable using these timely radiographic measures (Walter et al., 2009; Walter, Weiger, & Zitzmann, 2011). The data from a series of CBCT research papers also provide some information on the amount of residual alveolar bone in the furcation area of the severely destroyed periodontal attachment in maxillary molars (Walter et al., 2009, 2010, 2011, 2014; Walter, Weiger, Dietrich, Lang, & Zitzmann, 2012). With respect to implant placement in the distal maxillary area, it needs to be considered that a relevant number of maxillary molars in need for furcation treatment had a reduced inter‐furcal bone height less or equal 4mm (Walter et al., 2014).…”

“…The data from a series of CBCT research papers also provide some information on the amount of residual alveolar bone in the furcation area of the severely destroyed periodontal attachment in maxillary molars (Walter et al., 2009, 2010, 2011, 2014; Walter, Weiger, Dietrich, Lang, & Zitzmann, 2012). With respect to implant placement in the distal maxillary area, it needs to be considered that a relevant number of maxillary molars in need for furcation treatment had a reduced inter‐furcal bone height less or equal 4mm (Walter et al., 2014). Such a reduced amount of bone probably leads to the need for more invasive surgical treatments, for example bone augmentation, in advance of implant placement.…”