A RETROSPECTIVE STUDY ON MOLAR FURCATION ASSESSMENT VIA CLINICAL DETECTION, INTRAORAL RADIOGRAPHY, AND CONE BEAM COMPUTED TOMOGRAPHY

W Zhang,K Foss,B Wang

doi:10.1016/j.oooo.2019.01.063

Abstract

Background It is challenging to assess molar furcation bone loss by clinical detection and intraoral radiographs in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. Objective(s) The aim of this study was to compare and correlate molar furcation assessment via clinical detection, intraoral radiography, and CBCT. Study Design Eighty-three patients, seen at the University of Texas School of Dentistry (UTSD), with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman classification), intraoral (periapical and/or bitewing) radiographs, and sagittal and axial CBCT reconstructions were used to identify furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the 3 methods was evaluated by Pearson's analysis. Results There were significant correlations (P < .05) between clinical detection and intraoral radiography, clinical detection and CBCT, and intraoral radiography and CBCT at all the measured sites (r values ranged from 0.230 to 0.644). CBCT exhibited generally higher correlation with clinical detection compared with intraoral radiography, especially at the distal–palatal side of the maxillary first molar (P < .05). In addition, CBCT provided more accurate furcation assessment, because it measured 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. Discussion/Conclusions This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical examination and intraoral radiography. It is challenging to assess molar furcation bone loss by clinical detection and intraoral radiographs in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. The aim of this study was to compare and correlate molar furcation assessment via clinical detection, intraoral radiography, and CBCT. Eighty-three patients, seen at the University of Texas School of Dentistry (UTSD), with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman classification), intraoral (periapical and/or bitewing) radiographs, and sagittal and axial CBCT reconstructions were used to identify furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the 3 methods was evaluated by Pearson's analysis. There were significant correlations (P < .05) between clinical detection and intraoral radiography, clinical detection and CBCT, and intraoral radiography and CBCT at all the measured sites (r values ranged from 0.230 to 0.644). CBCT exhibited generally higher correlation with clinical detection compared with intraoral radiography, especially at the distal–palatal side of the maxillary first molar (P < .05). In addition, CBCT provided more accurate furcation assessment, because it measured 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. This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical examination and intraoral radiography.

Highlights

Accurate determination of bone loss at the molar furcation region by clinical detection and intraoral radiograph is challenging in many instances
Based on a previous study conducted by Qiao et al [13] who compared molar furcation assessment between clinical probing and Cone beam computed tomography (CBCT), a power analysis was performed which demonstrated that a sample size of 51 subjects would achieve 80% power to detect the association between these two evaluation methods on a significance level of 0.05
First molar Furcation involvement (FI) assessed by clinical detection, BW/PA and CBCT were illustrated in Tables 1, 2 and 3, respectively

Summary

Introduction

Accurate determination of bone loss at the molar furcation region by clinical detection and intraoral radiograph is challenging in many instances. The purpose of this study was to compare and correlate accuracy of molar furcation assessment via clinical detection, intraoral radiography and CBCT images. Zhang et al BMC Oral Health (2018) 18:75 bony defect [11] Factors such as tooth position, inclination, root morphology, length of root trunk, degree of root separation and configuration of residual inter-radicular bone, all affect accuracy of clinical furcation assessment [12, 13]. Periapical (PA) or bitewing (BW) radiographs are commonly used intraoral projections to supplement clinical detection for furcation assessment [8, 14]. Detectability of early FI by intraoral radiographs is especially limited and inconsistent [16]

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