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

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

[Clinical diagnosis and treatment of furcation involvement].

Furcation involvement (FI) is the lesion and destruction of periodontium that spread to the root furcation of multi-root teeth, where periodontal pockets, loss of periodontal attachment and resorption of alveolar bone are formed. Furcation involvement is a common concomitant lesion of periodontitis. The severity of furcation involvement can directly affect the prognosis of periodontitis. However, the specificity of the anatomical structure of the root furcation greatly increases the difficulty of treatment. Therefore, early detection and treatment of furcation involvement is crucial for the prevention and control of periodontitis. This paper briefly describes the pathogenesis of furcation involvement and discusses the diagnosis, classification and treatment of this disease, which is helpful to improve the clinical diagnosis and treatment of furcation involvement.

Diagnosis and Management of Furcation Lesions in Dogs - A Review.

The furcation is the anatomic area where the roots divide on a multirooted tooth. Periodontal disease causing alveolar bone loss can lead to furcation lesions of various stages. Once furcation involvement has occurred, the area can be more difficult to clean or treat due to the complex anatomy and morphology of furcations. Teeth with short root trunks, longer tooth roots, and roots with wide furcation entrance areas/degrees of separation and wide root divergence are considered better candidates for long term maintenance. Dog teeth possess many of these advantageous anatomic features compared to human teeth. Treatment options for teeth with furcation lesions include: closed debridement, open debridement, furcation plasty, tunneling, partial tooth or root resection, root separation (hemisection or trisection), regenerative therapies, or exodontia. There are many factors to consider in determining treatment options. The favorable and unfavorable characteristics for maintenance of teeth with furcation lesions are summarized. Home care and ongoing professional care are important aspects of periodontal disease control for any patient. Studies of systemic and local antibiotic therapies in human patients have not demonstrated reduction of furcation stages, and probiotic effects at furcation sites have not been specifically examined. Human review studies show that most molar teeth once deemed "hopeless" due to stage 3 furcation lesions can be maintained for at least 5 to 15 years with supportive periodontal therapy. Similar long term studies in dogs are needed to improve the evidence-based management of canine patients with furcation lesions.

A retrospective study on molar furcation assessment via clinical detection, intraoral radiography and cone beam computed tomography.

BACKGROUND: Accurate determination of bone loss at the molar furcation region by clinical detection and intraoral radiograph is challenging in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. The purpose of this study was to compare and correlate accuracy of molar furcation assessment via clinical detection, intraoral radiography and CBCT images. METHODS: Eighty-three patients with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman's classification), intraoral (periapical and/or bitewing) radiographs (recorded as presence or absence) and axial CBCT reconstructions were used to evaluate furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the three methods was evaluated by Pearson analysis. RESULTS: There were significant correlations (p < 0.05) between clinical detection and intraoral radiography, clinical detection and CBCT, as well as intraoral radiography and CBCT at all the measured sites (r values range between 0.230 to 0.644). CBCT generally exhibited higher correlation with clinical detection relative to intraoral radiography, especially at distal palatal side of maxillary first molar (p < 0.05). In addition, CBCT provided more accurate assessment, with bone loss measurement up to 2 decimals in millimeters, whereas clinical detection had 3 classes and the intraoral radiographs usually only detected the presence of furcation involvement in Glickman Class 2 and 3. CONCLUSIONS: This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical detection and intraoral radiography.

Animal models used in furcation perforation studies: A systematic review and comprehensive synthesis of model characteristics.

In order to systematise furcation perforation (FP) experimental animal models described in the literature and to determine whether there is evidence that a model is superior to others, MEDLINE/PubMed, SciELO and Cochrane Library were searched to find studies which used animal models of FP. Data were gathered concerning model characteristics, chosen groups, sample numbers, type of outcomes, journal and main area studied. Twenty-five articles were included in this systematic review, four conducted in rodent models, three in non-human primates and 18 in dogs. Medians were six animals and 34 teeth per study; 10 teeth per test group and, when performed, six teeth per control group. Twenty-four studies investigated the use of materials for FP repair; eight also tested adjuvant materials/substances. Although there is no model which can be described as ideal and superior than others for FP studies, dogs appear to possess the most suitable model characteristics.

Comparison of Two Base Materials Regarding Their Effect on Root Canal Treatment Success in Primary Molars with Furcation Lesions.

Introduction. The aim of this study was to compare MTA with another base material, IRM, which is generally used on pulpal floor after root canal treatment, regarding their effect on the success of root canal treatment of primary teeth with furcation lesions. Materials and Methods. Fifty primary teeth with furcation lesions were divided into 2 groups. Following root canal treatment, the pulpal floor was coated with MTA in the experimental group and with IRM in the control group. Teeth were followed up considering clinical (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area) criteria for 18 months. For the statistical analysis, Fisher's exact test and Pearson's chi-square tests were used and a p value of <0.05 was considered to be statistically significant. Results. Although there were no statistically significant differences between two groups in terms of treatment success, lesions healed significantly faster in the MTA group. Conclusion. In primary teeth with furcation lesions, usage of MTA on the pulpal floor following root canal treatment can be a better alternative since it induced faster healing.

Análise dos troncos radiculares, abertura das raízes e projeções cervicais de esmalte de furcas de molares superiores e inferiores. Estudo in vitro / Analysis of root trunks, opening of roots and cervical projections enamel furcas of upper and lower molars. In vitro study

O tratamento periodontal de dentes que apresentam lesão de furca, muitas vezes, tem resultados imprevisíveis devido a diversos fatores que podem dificultar a terapia ou influenciar no progresso da doença periodontal. Destes, o comprimento do tronco radicular pode contribuir para a lesão precoce das furcas ou mesmo trazer complicações para a aplicação do tratamento. A abertura das raízes pode orientar o tipo de tratamento a ser instituído e as projeções cervicais de esmalte podem dificultar a instrumentação da região, ou mesmo atuar como nicho de retenção de placa. Assim, o propósito deste estudo foi medir, por meio de um paquímetro digital, os troncos radiculares de 400 molares de banco, tanto os primeiros como os segundos, e tanto os superiores como os inferiores, assim como analisar, por meio de índice apropriado, o tipo da projeção cervical de esmalte e, por meio de classificação apropriada, a abertura das raízes, com o objetivo de orientar no diagnóstico e no plano de tratamento. Concluiu-se que há variação das medidas de tronco radicular entre as faces dos dentes avaliados e que uma maior projeção cervical de esmalte (PCE) correlaciona-se com uma diminuição do comprimento de tronco radicular na amostra avaliada, assim como os primeiros molares apresentam maior ocorrência de raízes com grau de abertura maior do que os segundos molares.

Furcation Measurements: Realities and Limitations.

Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy. For the efficient clinical management of furcation defects, it is necessary to have a reliable diagnostic tool that can accurately measure and quantify the furcation defect. This article addresses the various diagnostic methods available and assesses their limitations. Further, it also highlights some new frontiers in the field of furcation diagnosis and measurements.

Comparison of clinical and cone beam computed tomography measurements to diagnose furcation involvement.

AIM: This study aimed to determine the degree of discrepancy between clinical measurement of furcation involvement (FI) and cone beam computed tomography image analysis of multirooted teeth. METHODS: FI measurements obtained from clinical records were compared to CBCT images of the same teeth to determine the degree of discrepancy between CBCT FI grading and clinical FI grading. RESULTS: Of the hundred and fifty-four sites analysed, 22% of FI measurements from probing and CBCT were in agreement. Fifty-eight percent of clinical FI recordings were overestimated, and 20% were underestimated when compared to CBCT analysis. CONCLUSION: Clinical recording of FI is both over and underestimated compared to CBCT analysis. This was highest for probing recording grade I furcation involvement where it was highly overestimated. The occurrence of over and under estimation of FI will affect the assignment of prognosis to multirooted teeth, which can influence treatment planning for periodontal therapy and may result in inappropriate treatment.

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

UNLABELLED: 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.

Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners.

UNLABELLED: Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim. CLINICAL RELEVANCE: New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.

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 κ-coefficient (κw) = 0.588; radiographs and OFS had κw = 0.542 (OPG κw = 0.555 and I-O κw = 0.521). The interrater reliability for radiographs was dependent on the experience of the examiner (EE κw = 0.618; LE κw = 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.

Periodontal probing of dental furcations compared with diagnosis by low-dose computed tomography: a case series.

BACKGROUND: Therapeutic decisions in periodontal surgery are based on the accurate diagnosis of the furcation. Clinical probing is the basic diagnostic tool; however, the accuracy of clinical probing to distinguish Class II and Class III furcation defects is unknown. Therefore, this study compares clinical probing diagnoses to those of computed tomography (CT). METHODS: Seventy-five patients with severe periodontal disease were enrolled in this case series study. A total of 582 furcation sites in molars were assigned for the diagnosis of Class II and Class III furcation defects by clinical probing. Diagnosis based on CT served as a reference. RESULTS: The degree of furcation involvement on clinical findings was confirmed in 57% of the sites, whereas 20% were overestimated and 23% were underestimated compared with the radiologic analysis. Only 32% of Class III furcations in the CT scan were detected clinically. The best correlation of CT scan and clinical probing was found at buccal furcation sites in the mandible, with a κ-coefficient of 0.52, and buccal furcation sites in the maxilla, κ = 0.38. The κ-coefficient was 0.35 for lingual furcations, 0.29 for mesial furcations, and 0.27 for distal furcations, showing weaker correlations. CONCLUSIONS: CT scans offer more detailed information on furcation involvement than clinical probing. Especially before surgical treatment, three-dimensional radiographic imaging can be a useful tool to assess the degree of furcation involvement and optimize treatment decisions.

Anatomical landmarks of maxillary bifurcated first premolars and their influence on periodontal diagnosis and treatment.

OBJECTIVE: To assess the anatomical landmarks of the roots of bifurcated maxillary first premolars and study their effect on the diagnosis and management of periodontal disease. METHODS: One hundred sixty-five maxillary first premolars were selected. The frequency of single-, two-rooted, and three-rooted premolars was assessed, but only the dual-rooted were used for the purpose of this study. For each tooth, the following measurements were obtained using a micrometer caliper: buccal and palatal root length, mesial and distal root trunk length, crown length, and width of the furcation entrance. The types of root trunk were classified according to the ratio of root trunk height to root length into types A, B and C. Root trunk types A, B and C are defined as root trunks involving the cervical third or less, up to half of the length of the root, or greater than the apical half of the root, respectively. The presence of any root grooves and concavities, as well as bifurational ridges, was assessed. The crown to root ratio was calculated. RESULTS: Of the 165 maxillary first premolar teeth retrieved, 100 (60.6%) were two-rooted, 62 (37.57%) were single-rooted, and three (1.81%) were triple-rooted. Type A root trunks comprised only 7% of the examined teeth, while types B and C had more or less comparable results (46% and 47% respectively). Type B was more common in distal root trunks while type C was dominant in mesial root trunks. Bifurcation ridges were observed in 37% of the teeth; the mean root trunk length was greater in teeth with bifurcation ridges than in teeth without (7.41 mm vs. 5.96 mm). Root grooves and concavities were found in 96% of the mesial aspects of the root, and in 57% of the palatal aspect of the buccal root. The mean width of the furcation entrance was 0.89 +/- 0.19 mm (range 0.39-1.28). The average crown to root ratio was 0.69:1. CONCLUSION: Awareness of root surface anatomical variations may help the practitioner when assessing the diagnosis, treatment plan and prognosis of periodontally involved two-rooted maxillary premolars.

Diagnosis and management of vertical bony defects in periodontal disease.

This article discusses the diagnosis and treatment of vertical bony defects in patients with periodontitis. Defect- and tooth-related factors that impact treatment decisions and prognosis of regenerative therapy are reviewed. Etiologic and contributing factors are also discussed, as are follow-up and long-term maintenance of treated sites.

Furcation lesion in a mandibular canine.

Morphological changes can complicate dental treatment. This report presents a rare case of a furcation lesion in a mandibular canine with two roots. A 39-year-old man in general good health sought dental care for severe pain in his maxillary anterior teeth. The clinical examination showed localized swelling in the vestibular mucosa close to the mandibular left canine. Radiographic examination revealed two distinct roots and vertical bone resorption in the canine's mesial surface. Periodontal evaluation led to a diagnosis of periodontal abscess associated with furcation lesion. Despite the occurrence in an atypical location, the site of periodontal furcation received conventional therapy for initial decontamination, including tissue debridement and a combination of polyvinylpyrrolidone irrigation and antibiotics. To improve access, the decontamination was completed with surgical techniques and scaling and root planing. Early diagnosis of this rare morphological change helped to determine appropriate, timely treatment planning and optimal patient recovery.

Traumatic bone cyst suggestive of a chronic periapical abscess: a case report.

Traumatic bone cysts can mimic the signs and symptoms of an endodontic lesion. This case reports on a 19-year-old male patient who was referred for endodontic assessment of a symptomatic tooth with a gingival swelling and a draining sinus at the furcation of a mandibular second molar. Radiographically, a periradicular radiolucency is evident. A prior history of trauma as well as removal of the wisdom teeth was determined. After careful diagnosis unnecessary endodontic intervention was avoided. Surgical exploration, curettage and the generation of a blood clot resulted in healing at the 6 month review appointment. The tooth remained responsive to pulp sensibility testing at that time.

Periodontal surgery in furcation-involved maxillary molars revisited--an introduction of guidelines for comprehensive treatment.

Maxillary molars with interradicular loss of periodontal tissue have an increased risk of additional attachment loss with an impaired long-term prognosis. Since accurate clinical analysis of furcation involvement is not feasible due to limited access, morphological variations and measurement errors, additional diagnostics, e.g., with cone-beam computed tomography, may be required. Surgical treatment options have graduated from a less invasive approach, i.e., keeping as much periodontal attachment as possible, to a more invasive approach: (1) open flap debridement with/without gingivectomy or apically repositioned flap and/or tunnelling; (2) root separation; (3) amputation/trisection of a root (with/without root separation or tunnel preparation); (4) amputation/trisection of two roots; and (5) extraction of the entire tooth. Tunnelling is indicated when the degree of root separation allows for opening of the interradicular region. Alternatively, root separation is performed particularly in root-canal treated teeth with reduced coronal tooth substance requiring crown restorations. As soon as the attachment of one or two roots in maxillary molars is severely reduced, root removal is indicated and performed either as amputation or trisection including the corresponding part of the clinical crown. While the indication for regenerative measures in maxillary molars with furcation involvement is very limited, extraction and replacement with implants is restricted, particularly in sites requiring complex alveolar ridge augmentation and sinus elevation. A systematic approach for decision making in furcation-involved maxillary molars is described in this overview, including what constitutes accurate diagnosis and what indications there are for the different surgical periodontal treatment options.