Classification of furcation involvement of endodontically treated mandibular first permanent molars based on cone beam CT / 口腔疾病防治

Objective @#To classify the furcation involvement (FI) of endodontically treated mandibular first permanent molars based on cone beam computed tomography (CBCT), provide reference for individualized treatment of FI. @*Methods@#CBCT images of the FI of 164 endodontically treated mandibular first permanent molars from 163 patients in Nanjing Stomatological Hospital, Medical School of Nanjing University were collected retrospectively. On the CBCT images, the shape and extent of periapical and periodontitis bone resorption, the thickness of residual dentin in the pulp floor and root canal wall, and the periodontal bone resorption of the complete dentition were evaluated. The FI was classified into periodontal, periapical, perforated and mixed types.@* Results@#Among the 164 FIs of endodontically treated mandibular first permanent molars, the periapical type was the most common (41.5%), followed by the mixed type (26.2%), perforated type (18.3%), and periodontal type (14.0%). Among the 68 periapical-type FIs of endodontically treated mandibular first permanent molars, 48.5% were proper root canal filling, 44.1% were insufficient filling and 7.4% were overfilling. Among the 43 mixed-type FIs, the periodontal mixed periapical type was the most common (72.1%).@*Conclusion @#Detailed evaluation and classification of furcation involvement could be performed using CBCT images; therefore, the study has guiding significance for clinical treatment.

Periodontal treatment of furcation involvement at the mandibular first molar with a follow-up of 27 years / 华西口腔医学杂志

Due to the complicated anatomical structures in the furcation area of multirooted mandibular first molars, dental hygiene is greatly compromised once the furcation is involved in the periodontitis, leading to the unfavorable prognosis of teeth with furcation involvement. A patient came to a dental office with the chief complaint of "mobile mandibular posterior tooth" 27 years ago. The periapical film showed alveolar bone resorption at the root furcation of the right mandibular first molar. Flap surgery and fine supportive therapy were conducted. The patient was diagnosed with "furcation involvement Class Ⅲ" during a revisit three years ago. Satisfactory and healthy periodontal statuses were observed 2, 9, 24, and 33 months after the periodontal flap surgery plus tunneling procedures. A follow-up of 27 years in the present case demonstrated that a favorable prognosis of furcation involvement can be achieved after adequate periodontal treatment.

Accuracy of cone beam computed tomography in assessing maxillary molar furcation involvement / 华西口腔医学杂志

OBJECTIVE@#This study aimed to assess the accuracy of cone beam computed tomography (CBCT) in detecting furcation involvement (FI) in maxillary molars.@*METHODS@#Thirty-one maxillary molars of 15 patients with generalized chronic periodontitis considered for furcation surgery were assessed. Clinical examination and CBCT were performed, and the FI degree was evaluated. Clinical and CBCT-based FI assessments were compared with intrasurgical data.@*RESULTS@#The agreement between clinical and intrasurgical assessments was weak in all sites, with a kappa of less than 0.4; the complete, overestimated, and underestimated agreement percentages were 42.0%, 24.7%, and 33.3%, respectively. The agreement between the CBCT and intrasurgical assessments was strong, with a ka ppa of 0.831; the complete, overestimated, and underestimated agreement percentages were 88.2%, 3.2%, and 8.6%, respectively. The agreement between both assessments was the highest in the buccal furcation entrance (κ=0.896), followed by that in the distopalatal (κ=0.822) and mesiopalatal (κ=0.767) furcation entrances.@*CONCLUSIONS@#CBCT images demonstrated high accuracy in assessing the horizontal bone loss of FI in maxillary molars.

Evaluation of Dental CBCT in Assessing the Furcation Involvement in Mandibular Molars

Furcation involvement (FI) refers to the invasion of the bifurcation and trifurcation areas of multi-rooted teeth by periodontal disease. Diagnosis of FI by 2D radiographs can be overcome by the use of cone-beam computed tomography (CBCT) imaging technique. Objective: To compare the measurements of furcation depth by clinical method and CBCT in assessing the FI. Methods: The present study comprised of 60 furcation involved mandibular molars from 45 patients suffering from Chronic Generalized Severe Periodontitis. Teeth having probing pocket depth of ≥6mm were considered for the study. Clinical measurements of furcation depth were made on buccal or lingual sides of mandibular molars by using endodontic file with stopper which was done by two clinicians. The CBCT measurements were performed by measuring the deepest vertical and horizontal furcation defects at each furcation entrance. These measurements were then recorded, compiled and statistically analysed. Results: The comparison of furcation involvement clinically by clinician 1 and CBCT measurements in buccal side was statistically significant (p=0.0255*), while it was statistically not significant (p=0.3696 NS) on lingual side. Similarly, the comparison of furcation involvement clinically by clinician 2 and CBCT measurements in buccal side was statistically significant (p=0.0278*), while it was statistically not significant (p=0.4951 NS) on lingual side. Conclusion: CBCT technique can be considered a reliable tool for detecting FI as CBCT imaging showed high accuracy and moderate reproducibility in the assessment of furcation depth.

Clinical application of non-surgical treatment under periodontal endoscope in patients with moderate-to-severe periodontitis of multirooted teeth / 吉林大学学报(医学版)

Objective: To observe the curative effect of non-surgical treatment under periodontal endoscope in the patients with moderate-to-severe periodontal pockets of multirooted teeth after scaling and root planning (SRP), and to expound the clinical significance of periodontal endoscope in assisting periodontal non-surgical treatment. Methods: After SRP, there were still more than 127 multirooted teeth with moderate-to-severe periodontal pockets in 24 patients with periodontitis. The above multirooted teeth received non-surgical treatment under periodontal endoscope, the control of periodontal risk factors was evaluated by the periodontal risk assessment (PRA) model; the probing depth (PD), bleeding on probing (BOP), attachment loss (AL), calculus residual rate of the patients after treatment were detected by Florida Probe system; the percentage of furcation defect was detected. Results: After 3 months of periodontal endoscope-assisted periodontal non-surgical treatment, the risk factors of the patients after treatment were reduced and the patients had good prognosis. The PD value and percentage of BOP positive sites of the teeth of the patients after treatment were significantly decreased compared with before treatment (P0. 05). The percentage of teeth with Class I furcation involvement among the multirooted teeth after treatment was significantly lower than before treatment (P 0. 05). Conclusion: The effect of periodontal endoscope-assisted non-surgical treatment for the multirooted teeth with residual moderate-to-sever periodontal pockets after SRP, and it can avoid periodontal operation to some extent.

Correlation of radiovisuographic analysis of interdental and interradicular bone loss in furcation involvement of mandibular first molars: A retrospective study

The presence of furcation involvement represents a formidable problem in the treatment of periodontal disease. Advances in radiographic analysis such as radiovisuographic (RVG) aid in the early diagnosis and treatment planning, which is critical for long-term success. The present investigation aims to correlate the interdental and interradicular bone loss in chronic periodontitis patients so as to explore the potential of interdental bone loss as a rough approximate screening tool for early furcation diagnosis in mandibular first molar. Materials and Methods: RVG radiographs with furcation radiolucency in mandibular first molars were selected. The morphometric measurements of mesial, distal interdental bone loss, and interradicular bone loss in mandibular first molars were recorded using RVG. The correlation between mesial and distal interdental bone loss and interradicular bone loss was analyzed. Results: In this retrospective investigation, it was observed that distal interdental bone loss was not significantly different when compared with mesial interdental bone loss. The interradicular bone loss was significantly different when compared with mesial interdental bone loss, whereas on analysis between distal interdental bone loss and interradicular bone loss was also found to be statistically significant. Interpretation and Conclusion: Interdental bone loss was found to be associated with progressive bone destruction in furcation area which suggests that early detection of interdental bone loss can be helpful in predicting future interradicular bone loss.

Correlation between clinical and radiographic findings on the occurrence of furcation involvement in patients with periodontitis.

Aim : The aim of the present study was to determine the occurrence of furcation involvement in the molars of patients with chronic periodontitis and correlate clinical and radiographic findings. Materials and Methods: Seventy subjects aged 35-69 years enrolled for treatment at a periodontics specialization program in Pernambuco, Brazil (EAP-SCDP-ABO/PE) participated in the study, comprising a total of 350 molars examined. The clinical diagnosis of furcation involvement was performed with a horizontal Nabers probe, whereas the radiographic examination was performed with periapical and bite-wing radiographs. The images were analyzed with an X-ray viewer at 3× magnification. The Chi-square test was used, with the level of significance set at 5%. Results: A total of 64.5% individuals presented with furcation involvement, 43.1% of whom had degree II furcation. A significant association (P = 0.0060) was found between tooth type and frequency of furcation involvement. The first lower and upper molars were affected in 64.5 and 58.5% of cases, respectively. Adequate agreement (0.65) was observed between the clinical and radiographic findings. Conclusion: Taking into consideration the method employed and the results obtained, it may be concluded that the clinical and radiographic examinations performed are effective tools for diagnosing furcation involvement in teeth affected with periodontal disease.

A Clinical Study On Management of Mandibular Molar With Large Periapical Abscess And Furcation Involvement : A Conservative Approach.

Treatment of the damaged molar often presents a set of challenges unique to the posterior dentition. Traditional dental treatments continue to be refined to improve the prognosis when treating the posterior dentition. Daily treatment-planning decisions involve consideration of local host factors as well as limitations in specific therapeutic approaches. Objectives: The aim of this article is to present a case report of management of periapical abscess of mandibular right first molar associated with furcation involvement utilizing metapex followed by conventional root canal treatment. Results: Patient was evaluated after filling of canals with metapex every three months for one year. Radiographic examination showed healing of furcation defect as well as resolution of periapical radiolucencies. Clinical evaluation revealed reduction of tooth mobility. Discussion: The case was diagnosed as periapical abscess with furcation involvement. The suggested treatment of periapical abscess with furcation involvement by placement of metapex followed by conventional root canal treatment of the involved tooth could result in complete healing of tooth which was considered hopeless.

Treatment of Endo - Perio Lesion With Syringeable Bio Active Alloplastic Bone Graft Material : A Case Report.

Endodontic–periodontal lesions present challenges to the clinician as far as diagnosis andprognosis of the involved teeth are concerned. Etiologic factors such as bacteria, fungi,and viruses as well as various contributing factors such as trauma, root resorptions,perforations, and dental malformations play an important role in the development andprogression of such lesions. The relationship between the pulp and periodontium has been extensively studied. The pathways for the spread of bacteria between pulpal and periodontal tissues have been discussed with controversy. This case report presents a successful treatment of a 43 year old systemically healthy male suffering with endoperio lesions of upper right first and second molar teeth.

Use of periosteal membrane as a barrier membrane for the treatment of buccal Grade II furcation defects in lower molars: A novel technique.

Objective : To use the periosteum as a barrier in treatment of buccal Grade II furcation defects of lower molars. Materials and Methods : This technique was performed on 12 patients with bilateral buccal Grade II furcation defects of lower molars. On a random basis, one furcation defect of each pair was selected for the control group and other for the experimental group. Debridement was done in the defect area in both groups. In the control group, after debridement, mucoperiosteal flap was sutured back. In the experimental group, after reflection of the mucoperiosteal flap, a portion of the periosteum along with a layer of connective tissue (periosteal membrane) was incised and mobilized in the defect area for defect coverage as a barrier, and then the periosteal membrane and mucoperiosteal flap were fixed with suture, respectively. Horizontal dimension of the furcation defect was the primary outcome measure. Gingival index, probing attachment level (PAL), and vertical dimension of furcation defect were the secondary outcome measures. Clinical parameters were registered at baseline and at 6 months. Results : Every clinical parameter was improved by surgery. Significant gain in PAL as well as horizontal and vertical dimensions of the furcation defects was found. Conclusion: This periosteum displacement technique is effective for the treatment of buccal Grade II furcation defects of lower molars.

Multidiciplinary Approach For Management Of Mandibular Molar With Furcation Involvement - A Case Report.

The aim of modern dentistry is to conserve the natural dentition. Advances in dentistry and increased patient’s desire to retain their teeth allowed us to carry out this present day mandate. Periodontally compromised teeth involving furcation and one of the root may well be retained by removal of the diseased root. Case report describes the procedure of radi-section in mandibular right first molar (46) and its subsequent prosthetic rehabilitation.

Root resection of compromised molars / 대한치주과학회지

PURPOSE: Studies reported controversial results about prognosis of root resection with 0%-38% failure rate. The purpose of this study is to consider clinical efficacy of root resection. MATERIALS AND METHODS: This study reported three cases of root resection which were performed on different sites. In first case, lower right first molar showed pus discharge and 7 mm of probing pocket depth. It was diagnosed as fracture of mesial root. Hemisection of mesial root was performed In second case, upper right first molar showed severe bone loss on disto-buccal root and 7 mm of probing pocket. Resection of disto-buccal root was performed In third case, lower left second molar showed severe bone loss on distal root including apex and 15mm of probing pocket depth. Hemisection of distal root was performed. RESULT: In these three cases of root resection, compromised molars were treated successfully and conserved. CONCLUSION: Root resection is a successful procedure treating compromised multi-rooted teeth and conserving teeth when proper case selection is performed.

Clinical study on therpeutic effects of Guided tissue regeneration by Nanogide-C(R) and Biomesh(R) in furcation defects / 대한치주과학회지

This study was designed to compare the effects of treatment using chitosan membrane (Nanogide-C(R)) resorbable barrier with control treated by polylactic acid/polylacticglycolic acid membrane(PLA/PLGA membrane, Biomesh(R)). 44 furcation defecs from 44 patients with class 2 furcation degree were used for this study, 22 sites of them were treated by chitosan membrane as experimental group and 22 site were treated by PLA/PLGA membrane as control group. Clinical parameters including probing depth, gingival recession, attachment level and radiographic examination were evlauated at base line, 1 month, 2 month and 3 month. after surgery. Statistical test used to analyze these data included paired t-test, one way ANOVA. The results are as follows : 1. Probing depth was significanlly decreased in the two group and there were significant differences between groups(p<0.05). 2. Gingival recession was not significanlly increased in the two group and there were no significant differences between groups(p<0.05). 3. Loss of attachment was statistically decreased in the two group and there were no significant differences between groups(p<0.05). 4. Horizontal bone level was significanlly increased in the two group and there were significant differences between groups(p<0.05). On the basis of these results, chitoans resorbable membrane has similar potential to PLA/PLGA membrane in GTR for furcation defect.

The influence of periapical lesion on furcation involvement in mandibular molars / 대한치주과학회지

The purpose of the study was to investigate the influence of an endodontic infection on presence of furcation involvement in periodontally-involved mandibular molars. All first and second mandibualr molars in 45 patients were selected if at least one was root-filled or had a possible periapical radiolucency. The sample consisted of patients from a referral population at a periodotnal clinic which represented an adult population with a mean age of 47.5 years (range 31 to 63) For mandibular molars with periapical destruction at both roots, frequency of horizontal furcation depth > or = 3 mm was significantly more compared to teeth without periapical destruction. Mean periodontal probing depth was significantly greater at mandibular molars with periapical destruction. It is suggested that a root canal infection in periodontitis-involved molars may potentiate periodontitis progression by spreading of endodontic pathgens through patent accessory canals and dentinal tubules. In conclusion, an endodontic infection in mandibular molars was found to be associated with additional attachment loss in the furcation area, and may thus be considered to be one of several risk factors influencing the prognosis of molars in periodontitis-prone patients.

A comparative study of the clinical effects of PRP and non-absorbable membrane in the treatment of mandibular class II furcations / 대한치주과학회지

This study was performed to compare the clinical effectiveness of two regenerative techniques for class II furcation involvements in human: a combination of bone grafts with PRP vs. GTR with bone grafts. The e-PTFE group was treated with non-absorbable membrane and bone grafts, the PRP group was treated with PRP and bone grafts Pocket depth, clinical attachment level, and gingival recession were measured at baseline and postoperative 6 months. Vertical and horizontal furcation depth were measured by re-entry surgeries at 6 months post-treatment Both groups were statistically analyzed by Wilcoxon signed Ranks Test & Mann-whitney Test using SPSS program (5% significance level). The results were as follows: 1. The change of pocket depth, clinical attachment level, vertical furcation depth and horizontal furcation depth in both groups was decreased significantly at 6 months than at baseline. (p<0.05) 2. The change of gingival recession in both groups was increased significantly at 6 months than at baseline. (p<0.05) 3. The change of alveolar crest absorption in both groups was increased at 6 months than at baseline but there were no statistically significant differences. 4. The change of pocket depth, clinical attachment level, vertical furcation depth and horizontal furcation depth in both groups was increased significantly at 6 months, but there were no statistically or clinically significant differences with both groups. 5. The change of gingival recession and alveolar crest absorption in both groups was increased at 6 months, but there were no statistically or clinically significant differences with both groups. In conclusion, the use of bone graft with PRP or GTR technique improved clinical index of the soft and hard tissue in mandibular class II furcation involvement but there were no statistically or clinically significant differences between bone graft with PRP and GTR technique.

Effects of the Guided Tissue Regeneration Using Polylactic/Polyglycolic Copolymer Membrane in the Furcation Involvement / 대한치주과학회지

The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were 2.2+/-1.6mm and 2.4+/-1.1mm respectively in the control group, while they were 2.4+/-1.3mm and 3.0+/- 1.2mm respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.

A Retrospective Anaylsis of Root-Resected Teeth / 대한치주과학회지

The purpose of this study was to evaluate the clinical validity of multi-rooted teeth subjected to root-resection treatment. Over a period of 1-7 years, 60 root-resected molars in 59 patients were examined clinically and radiographically. All patients were periodically recalled once or twice a year. Root-resections were due to periodontal, more specifically furcal bone loss or marginal bone loss, in 34 cases and extensive dental carious destruction in 10 cases. In other cases, root-resections resulted from 6 cases of root fracture, 6 cases of periodontal-endodontic combined lesion, and 1 case of endodontic problem. Root-resection was carried out on 26 maxillary molars and 34 mandibular molars. The results are as follows; 1. 14 cases(23.3%) were considered failures. 8 cases(13.3%) of them occurred within the first year(8 cases, 13.3%), 4 cases(6.7%) between 1-3 years, and 2 cases(3.3%) between 4-7 years. 2. 8 cases(13.3%) were considered failures due to periodontal reasons, 3 cases(5%) due to root fracture, 2 cases(3.3%) due to endodontic problem, and 1 case(1.7%) due to prosthetic problem. 3. 37 cases(61.7%) showed up for the recall appointments, and the percentage of failures(13.5%) was lower compared with that of all patients(23.3%). The results of the present study indicate that the prognosis of root-resected teeth is favourable if attention is paid to the selection of proper case and to achieving optimal oral hygiene and periodic check up.

Clinical Evaluation of Dental CT and Three-dimensional Reconstruction Compared with Conventional Radiography in the Diagnosis of Molar Furcation Involvement / 中国医师杂志

Objective To evaluate the clinical diagnostic role of dental computed tomography (CT) and three-dimensional reconstruction (3DR) compared with conventional dental periapical radiography (DPR) in the diagnosis of molar furcation involvement (FI). Methods Dental CT and 3DR were performed about a maxillary first molar and its alveolar bone diagnosed as FI II? by conventional probe technique, and the images were compared with that of DPR. Results The images of dental CT scans and 3DR showed not only the area, type and quantity of periodontal destruction, but also the complex stereoscopic anatomical vision and ambient spatial relationship around the molar. Especially, the images displayed the alveolar destructions of the dental buccal and palate site that could not always be demonstrated by DPR. The degree of the molar FI was defined as III? in fact. Conclusion Dental CT and 3DR have many superiorities and value, which can not be replaced by DPR, in the clinical diagnosis and prognostic judgment of molar furcation involvement.