The "furcation arrow". A reliable radiographic image?

When radiographs of maxillary molars are observed, a small, triangular radiographic shadow is sometimes noted over either the mesial or distal roots in the proximal furcation area. This study was undertaken to determine the reliability of using this radiographic image as an aid in diagnosing proximal furcation involvement. Sixty-six Degree 1, 53 Degree 2 and 43 Degree 3 proximal furcation involvements in maxillary molars in dry skulls were assessed visually with the Nyman and Lindhe classification. An additional 120 uninvolved furcations were included as controls. The involved maxillary molars were radiographed with standard periapical radiographic techniques. Projected radiographs were evaluated independently by six dentists who determined whether there was a triangular radiographic shadow ("furcation arrow") over the mesial and distal proximal areas. The association of the furcation arrow image with Degree 2 or 3 furcation involvement was significant when compared with uninvolved furcations. The image was equally apparent over mesial or distal furcations and was not affected by the existence of a buccal furcation involvement. The incidence of the image over both uninvolved proximal furcations and proximal furcations with Degree 1 involvement was low and did not differ significantly. Because the furcation arrow seldom appears over uninvolved furcations, the appearance of the image indicates that there is proximal bony furcation involvement. However, absence of the furcation arrow image does not necessarily mean absence of a bony furcation involvement because the arrow was not seen in a large number of furcations with Degree 2 or 3 involvement.

Biologic preparation of diseased root surfaces. An in vitro study.

The study evaluated the effect of 2% sodium desoxycholate combined with whole plasma from a single donor on gingival fibroblast attachment to diseased root surfaces. Twenty extracted periodontally involved teeth were cut into halves buccolingually and sterilized by moist heat under high pressure. The diseased root surface of each control half was rubbed with a sterile cotton pellet saturated with Dulbecco's phosphate-buffered saline (PBS). The diseased root surface of each experimental half was rubbed with a sterile cotton pellet saturated with 2% sodium desoxycholate and then rubbed with a pellet soaked in human plasma. The control and experimental halves were placed in separate petri dishes, and a fibroblast cell suspension was added to each dish. The mean number of attached cells per half tooth was calculated for each group. Tooth surfaces treated with PBS (controls) showed a mean of 307 +/- 63 attached cells for 17 tooth halves; the experimental treated surfaces exhibited a mean of 650 +/- 130 attached cells for 16 halves. The difference between these numbers was statistically significant (P less than 0.01). These findings suggest that the desoxycholate/plasma combination enhanced in vitro fibroblast attachment to diseased root surfaces.

Periodontal emergencies.

Discomfort manifesting in the gingival tissues prompts patients to seek emergency treatment. Several clinical entities should be included in the differential diagnosis. Accurate diagnosis and appropriate therapy is essential to resolving the problem.