Furcation Sites Research Articles

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Effects of Advanced Platelet Rich Fibrin (A-PRF+), Enamel Matrix Derivative (EMD) and Open Flap Debridement on clinical and wound healing parameters in molar furcation sites: A case series from a RCT study

AimTo study effects of advanced platelet rich Fibrin (A-PRF+) and enamel matrix derivative (EMD) compared to open flap debridement (OFD) alone in molar furcation sites grade II on clinical and wound healing parameters.Materials and methodsA randomized controlled trial was designed. Eligible patients were randomly allocated in one of three treatment groups: A-PRF+, EMD or OFD. The patients and clinical examiners were blinded for the treatment received. A minimally invasive microsurgical approach was performed for the three modalities. Clinical measurements were scored at baseline and 6 months postoperatively. The clinical healing of each furcation was scored via Early Wound Healing Index on day 3, 1 week, 2 weeks and 6 weeks.Results17 patients (A-PRF+ n = 6, EMD n = 5, OFD n = 6) completed the 6 months follow-up. The further completion of the trial had to be cancelled due to the COVID-19 pandemic. In three patients in the A-PRF+ group, the grade II of the treated furcation regressed to grade I; the corresponding number in the EMD and OFD groups were zero and one respectively. Further, 3, 1 and 4 patients in the PRF, EMD and OFD groups respectively, showed a gain of bone level ≥1 mm. The defects in the A-PRF+ group showed delayed early healing compared to EMD and OFD groups.ConclusionThe case series (RCT design) suggest a slight advantage for A-PRF+ over EMD and OFD, regarding the regressing of a furcation II to grade I, however this treatment showed delayed early wound healing compared to EMD or OFD.Clinical Trial Registrationhttps://www.isrctn.com/, identifier ISRCTN13520922.

Periodontal regeneration after third molar extraction causing attachment loss in distal and furcation sites of the second molar: a case report with 12 months follow-up

Introduction: The periodontal support apparatus is extremely important due to guarantee insertion to the tooth. It helps with the maintenance of the structural resistance and reconstructive property, and its loss may contribute to root exposure and the possibility to obtain an augmentation of the sensitivity. Thereby, this paper aimed to describe a case report, using regenerative techniques in a bone loss involving distal and furcation regions of the mandibular second molar, which was associated with the extraction of the adjacent impacted third molar without bone interposing. Case presentation: The patient was referred to a private dental clinic reporting an unpleasant odor while using dental floss in the distal region of the mandibular left second molar, during the three years. In addition, reported a history of extraction of the wisdom tooth six years ago. Periapical examination and periodontal index were performed and an extensive radiolucent image involving distal and furcation regions, with a 12 mm probing depth involving the distal root at tooth (2nd molar). No other region showed probing depth greater than 3mm. Thus, after rigorous scaling and root planing, periodontal guided tissue regeneration was performed as an attempt to fill the bone defect. Conclusion: The regenerative process is a predictable way to treat vital mandibular second molar after extraction of the adjacent third molar. Clinicians must give special attention to extraction involving the mandibular third molars, mainly when there is no bone interposed between the second and third molars.

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.

Relationship Between Root Trunk Types and Periodontal Attachment Loss in Taiwanese’s Molars Affected with Class III Furcation Involvements

The purpose of the present study was to investigate the relationship between root trunk types (RTT) and periodontal attachment loss (PAL) on molars affected with Class III furcation involvement (FI). The extracted teeth (169) of maxillary (103) and mandibular (66) molars in individuals affected severe advanced periodontitis were diagnosed as molars with Class III FI and alveolar bone loss ≧70%. The clinical records include patient’s age, gender, degree of FIs and vertical dimensions of root trunk types (RTT), molar location, furcation site, and number of extracted molars. The assessments of the PAL and RTT of the extracted molars were taken under a stereomicroscope equipped with micrometer scale. Collected data were analysed using the chi-square test and one-way ANOVA. Results showed that significant relationships between PALs and 1) prevalence of molar location (p&lt;0.001); 2) RTTs (f=4.32, p&lt;0.05); 3) molar types; and 4) furcation surfaces (p&lt;0.05). It was concluded that the prevalence of the molar extraction affected with the Class III molar FI is associated with increasing length of root trunk and PAL.

CBCT Visualization of Furcation Perforation Repair Materials Using Different Voxel Sizes

Background: Three-dimensional cone-beam computed tomography is gaining popularity as an imaging modality aiding the performance of difficult endodontic treatment procedures. For this reason, we assessed the visualization of bioactive furcal perforation repair materials in an ex vivo study using CBCT with different voxel sizes and determined which voxel size yielding the best images with least artefacts. Visualization of endodontic restorative material is affected by the appearance of various artifacts. This study was conducted to evaluate the CBCT visualization of three perforation repair materials using five different voxel sizes.&#x0D; Methods: This study was performed with 84 mandibular molars that had been extracted for various reasons. All samples were measured with a digital caliper (Digimess, São Paulo, Brazil), marked at 3 mm above the cementoenamel junction, and decoronized at this line. The root segments were amputated at 3 mm below the furcation site using diamond discs under water cooling. Endodontic access cavities were then created, and the perforations were formed. Biodentine, MTA, and EndoSequence were mixed following the manufacturers’ instructions and applied to the perforation sites. Five image sets were obtained: 0.075 mm3; 0.1 mm3; 0.15 mm3; 0.2 mm3; and 0.4 mm3. Each scan was evaluated by 2 observers with 8 to 12 years of experience in CBCT imaging.&#x0D; Results: The best image quality for repair all materials was achieved with a voxel size of 0.1 mm3. Image clarity of repair materials was no statistically difference between voxel sizes of 0.075 mm3 and 0.15 mm3. Image quality was significantly reduced at voxel sizes of 0.2 mm3 and 0.4 mm3, and was the worst quality at 0.4 mm3 voxels in all groups.&#x0D; Conclusions: CBCT imaging can be used to examine endodontic repair materials with adjustment of the effective radiation dose rate and selection of the appropriate voxel size.

A controlled study on the diagnostic accuracy of panoramic and peri-apical radiography for detecting furcation involvement

BackgroundThe aims of this study were (1) to determine the accuracy, sensitivity, and specificity of panoramic and peri-apical radiographs in diagnosing furcation involvement, as well as (2) to evaluate the possible impact of clinical experience on these diagnostic parameters.MethodsAn existing radiographic dataset of periodontitis patients requiring implant surgery was retrospectively examined for furcation involvement. Criteria for inclusion were the presence of a CBCT, panoramic and peri-apical radiograph of the site of interest within a one-year time frame. All furcation sites were classified using the CBCT, which was considered as the gold standard, according to Hamp’s index (1975). Ten experienced examiners and 10 trainees were asked to assess furcation involvement for the same defects using only the corresponding panoramic and peri-apical radiographs. Absolute agreement, Cohen’s weighted kappa, sensitivity, specificity and ROC-curves were analyzed.ResultsThe study sample included 60 furcation sites in 29 multi-rooted teeth from 17 patients. On average, 20/60 furcations were correctly classified according to the panoramic radiographs, corresponding to a weighted kappa score of 0.209, indicating slight agreement. Similarly, an average of 19/60 furcations were correctly classified according to the peri-apical radiographs, corresponding to a weighted kappa score of 0.211, also indicating slight agreement. No significant difference between panoramic and peri-apical radiography was found (P = 0.903). When recategorizing FI Grades into ‘no to limited FI’ (FI Grade 0 and I) and ‘advanced FI’ (FI Grade II and III), the panoramic and peri-apical radiography showed low sensitivity (0.558 and 0.441, respectively), yet high specificity (0.791 and 0.790, respectively) for identifying advanced FI. The ROC-curves for the panoramic and peri-apical radiographs were 0.79 and 0.69 respectively. No significant difference was found between experienced periodontists and trainees (P = 0.257 versus P = 0.880).ConclusionPanoramic and peri-apical radiography are relevant tools in the diagnosis of FI and provide high specificity. Ideally, they are best used in combination with furcation probing, which shows high sensitivity. Furthermore, clinical experience does not seem to improve the accuracy of a radiological diagnosis of furcation sites.Trial registrationPatient radiographic datasets were retrospectively analyzed.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

BackgroundDue to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.MethodsTwenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).ResultsA significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).ConclusionsThe 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Assessment of Most Common Furcation Site among Smokers with Chronic Periodontitis

Assessment of Most Common Furcation Site among Smokers with Chronic Periodontitis

Impact of Molar Furcations on Photodynamic Therapy Outcomes: A 6-Month Split-Mouth Randomized Clinical Trial.

The effectiveness of adjunctive photodynamic treatment (PDT) to non-surgical periodontal therapy has been shown to depend on initial periodontal status. As molar furcation involvement impairs healing response to non-surgical periodontal therapy, the aim of this study was to evaluate the impact of furcation involvement on PDT outcomes. Thirty-six patients suffering from severe chronic periodontitis were included in a 6-month split-mouth randomized clinical trial. PDT applications used the toluidine blue O and a light-emitting diode (LED) with a red spectrum. Repeated PDT applications were performed in addition to non-surgical periodontal treatment at baseline and at 3-months. Pocket probing depth (PPD), plaque index, bleeding on probing, and clinical attachment level were recorded at baseline, and again at 3- and 6-months. Furcation sites of molars were compared to other sites of molars and non-molars. Multilevel analysis showed no PDT effect in molar furcation sites while an additional significant reduction (odds ratio = 0.67) of pockets with PPD > 5 mm in other sites at 3-months was measured. PPD reduction appeared delayed in molar furcation sites treated with PDT. There is no additional apparent benefit to use PDT in molar furcation sites for the reduction of pockets with PPD > 5 mm contrary to other sites.

A Comparison of Clinical and Radiological Parameters in the Evaluation of Molar Furcation Involvement in Periodontitis.

ObjectiveThe aim of this study was to compare clinical, intra-surgical, 2D (panoramic) and 3D (CBCT)-based parameters in assessing molar furcation involvement (FI).Materials and MethodsSix patients with generalized periodontitis Stage II to IV, Grade B and C who were scheduled for the periodontal flap surgical treatment were recruited in the study. In total, 38 molar teeth with 93 furcation sites were analysed. All subjects had comprehensive periodontal examination, which included an assessment of molar FI using Naber’s probe according to modified Glickman’s classification. Periodontal surgery was performed in patients with at least one maxillary molar with probing depth of ≥6 mm. This probing demonstrated lower grade of FI compared with intra-surgical findings.ResultsPeriodontal probing, intra-surgical measurement and measurements based on CBCT significantly correlated with each other regarding the assessment of FI, with r values ranging between 0.81 to 1.00 (p<0.01). The correlation of panoramic radiograph with periodontal probing is 0.49, with CBCT 0.39 and with intra-surgical measurements 0.36. The results showed an excellent agreement and higher accuracy between intra-surgical measurements and CBCT (0.96), in contrast to clinical examination and panoramic radiography- 0.87 and 0.63 respectively. Different clinical and radiological modalities showed a correlation among each other. They are accurate and have their own benefits, which makes (renders) them useful in establishing periodontal diagnosis and treatment planning.ConclusionHowever, CBCT offers significant advantages including excellent agreement and higher accuracy and can be used as justified as excellent diagnostic tool in detecting and locating FI to provide a more reliable diagnosis and basis for treatment decisions.

Use of antimicrobial agents in periodontology

With mechanical cleaning, it is never possible to remove all bacteria from tooth surfaces, in, for example, furcation sites and at the bottom of the pocket. Supporting non-surgical periodontal treatment with the use of antimicrobial agents is, therefore, an obvious approach in order to achieve a better treatment outcome.. The combination of amoxicillin and metronidazole has been thoroughly investigated as a support in periodontal treatment and deserves a place among the tools the dental care professional has for effective treatment. However, there is at present no strict indication in which clinical situations antibiotics can be successfully prescribed. Considering responsible use of antimicrobials by healthcare professionals (antimicrobial stewardship) the decision to support periodontal treatment with antibiotics should be in the hands of those authorised to provide a prescription. Additional rinsing with chlorhexidine twice daily during periodontal treatment and the subsequent two weeks (6-8 weeks) can be considered in order to enhance the effect of clinical treatment.

Comparison of the Furcation Involvement by Clinical Probing and Cone Beam Computed Tomography with True Level of Involvement during Flap Surgery

ABSTRACT Aim The aim of the study was to evaluate and compare the clinical probing and cone beam computed tomography (CBCT) imaging technique for examination of the furcation involvement with the true level of involvement seen during open flap surgery (OFS). Materials and methods The study included 22 patients (50 molar teeth) who met the inclusion and exclusion criteria with at least one molar tooth with grade II or III furcation involvement. After phase I therapy, furcation involvement was measured using both clinical probing and CBCT imaging technique. The measurements obtained during the OFS were then compared with those obtained by clinical probing and CBCT. To avoid bias, the assessments of furcation involvement by all three techniques were done by three different examiners. Results The agreement in the furcation gradings between clinical and CBCT findings gave a Cohen Kappa value of 0.03 [statistically insignificant (p = 0.80)] and between clinical and open surgical measurements gave a Cohen Kappa value of 0.11 [statistically insignificant (p = 0.38)]. However, agreement in the furcation gradings between CBCT and open surgical measurements gave a Cohen Kappa value of 0.89 and it was statistically significant (p = 0.001). Conclusion Thus, the results indicated that there was the highest agreement between measurements obtained using CBCT imaging technique and true level of involvement seen during OFS (89%) when compared to clinical and OFS measurements (11%) and clinical and CBCT measurements (3%). Clinical significance Thus, CBCT can be considered as an efficient diagnostic tool to accurately assess osseous defects at furcation sites when compared to clinical probing. How to cite this article Aghanashini S, Jayachandran C, Mundinamane DB, Nadiger S, Bhat D, Andavarapu S. Comparison of the Furcation Involvement by Clinical Probing and Cone Beam Computed Tomography with True Level of Involvement during Flap Surgery. World J Dent 2017;8(4):267-272.

Comparative Evaluation of Cone-beam Computed Tomography versus Direct Surgical Measurements in the Diagnosis of Mandibular Molar Furcation Involvement.

Aim:Periodontists frequently experience inconvenience in accurate assessment and treatment of furcation areas affected by periodontal disease. Furcation involvement (FI) most commonly affects the mandibular molars. Diagnosis of furcation-involved teeth is mainly by the assessment of probing pocket depth, clinical attachment level, furcation entrance probing, and intraoral periapical radiographs. Three-dimensional imaging has provided advantage to the clinician in assessment of bone morphology. Thus, the present study aimed to compare the diagnostic efficacy of cone-beam computed tomography (CBCT) as against direct intrasurgical measurements of furcation defects in mandibular molars.Subjects and Methods:Study population included 14 patients with 25 mandibular molar furcation sites. CBCT was performed to measure height, width, and depth of furcation defects of mandibular molars with Grade II and Grade III FI. Intrasurgical measurements of the FI were assessed during periodontal flap surgery in indicated teeth which were compared with CBCT measurements. Statistical analysis was done using paired t-test and Bland–Altman plot.Results:The CBCT versus intrasurgical furcation measurements were 2.18 ± 0.86 mm and 2.30 ± 0.89 mm for furcation height, 1.87 ± 0.52 mm and 1.84 ± 0.49 mm for furcation width, and 3.81 ± 1.37 mm and 4.05 ± 1.49 mm for furcation depth, respectively. Results showed that there was no statistical significance between the measured parameters, indicating that the two methods were statistically similar.Conclusion:Accuracy of assessment of mandibular molar FI by CBCT was comparable to that of direct surgical measurements. These findings indicate that CBCT is an excellent adjunctive diagnostic tool in periodontal treatment planning.

Is furcation involvement affected by adjunctive systemic amoxicillin plus metronidazole? A clinical trials exploratory subanalysis

Evaluation of the clinical effect of systemic amoxicillin and metronidazole adjunctively to mechanical debridement at furcation sites. This is an exploratory per-protocol collective subanalysis from a prospective, randomized, double-blind, multi-centre trial (ClinicalTrials.gov NCT00707369) on the effect of adjunctive systemic amoxicillin 500mg plus metronidazole 400mg (3×/day, 7days) use on furcation involvement in moderate to severe periodontitis. Outcome was the change in frequency of classes of furcation involvement after 27.5months. Therapy comprised mechanical debridement in conjunction with antibiotic or placebo administration, and maintenance therapy at three months intervals. Three hundred and forty-five patients (175 placebo, 170 antibiotics) with 6576 furcation sites (class 0 2956; class I 2370; class II 886; class III 364) were examined (3472 placebo, 3104 antibiotics). Pocket reduction/attachment gain at the furcation sites was noticeably better after antibiotics (1.2/0.6mm) than after placebo (0.7/0.2mm) 27.5months after therapy. However, most furcation degrees were unchanged (placebo 61.5%/antibiotics 62.2%), more sites improved than deteriorated (20.3%/18.2%, 22.1%/15.7% respectively) and no differences in the change of furcation degrees between treatments could be detected. Compared to placebo, prescription of adjunctive systemic antibiotics failed to show clinically relevant benefit with regard to furcation class involvement.

The use of cone-beam computed tomography in furcation defects diagnosis

Background: The use of cone-beam computed tomography (CBCT), as an additional diagnostic tool in daily dental practice, has expanded rapidly in recent years. Since CBCT allows assessment of dento-maxillofacial structures in three-dimensional manner, its use may be very tempting in alveolar bone furcation defects (FDs) diagnosis. Aim: The aim of this study was to determine the impact of clinical experience and experience with CBCT on FD detection in patients with periodontitis. Material and Methods: Fifteen patients with chronic generalized severe periodontitis were included in the study. In total, 168 furcation sites were analyzed on CBCT images by a previously trained senior year undergraduate student (O1) and a PhD student with three years of CBCT experience (O2), and compared to clinical findings (probing). CBCT images were analyzed on two separate occasions, within a 7-day interval. FDs were assessed both clinically and on CBCT images, using a dichotomous scale (present/absent). Intraobserver agreement for each observer was calculated by using Kappa coefficient (k). Interobserver agreement and agreement between CBCT and clinical findings for both observers were calculated. Results: Kappa coefficient value for both observers indicated a high intraobserver agreement (k1=0.75; k2=0.94). Interobserver agreement of CBCT image analyses was present in 72.6% (73.0% in maxilla, 71.7% in mandible). Agreement between CBCT image analyses and clinical findings for O1 was 48.8% and 51.2% for O2. Conclusion: It can be assumed that clinical experience and CBCT proficiency do not have an impact on FD detection on CBCT images, if an appropriate training was previously performed.

Clinical and CBCT-based diagnosis of furcation involvement in patients with severe periodontitis.

The aim of this study was to compare the use of periodontal probing and cone beam computed tomography (CBCT) images in the diagnosis of furcation involvement (FI) in patients with chronic generalized severe periodontitis. Fifteen patients with chronic generalized severe periodontitis were included in this study. In total, 174 furcation sites (all in molar teeth) were analyzed. FI was assessed at three sites (buccal, mesiopalatal, and distopalatal) of maxillary molars, and at two sites (buccal and oral) of mandibular molars. FI was assessed both clinically (periodontal probing) and on CBCT images, using a dichotomous scale (present/absent). The agreement between clinical and CBCT-based findings was calculated. FI were more often detected by means of CBCT than by means of clinical examination. Agreement between the evaluation methods was present in 46.9% of cases (63.3% in maxilla, 45.0% in mandible). FI detected clinically was confirmed by means of CBCT in 24% of the evaluated sites. The largest agreement (73.7%) in FI detection was found in the distopalatal maxillary sites between CBCT and clinical probing. The smallest agreement (36.6%) was found in the buccal sites of the mandibular molars, in which 63.3% of FI were detected using CBCT only, but not clinically. The number of FI detected by means of CBCT was larger than by means of periodontal probing. In those cases in which chronic generalized severe periodontitis is clinically diagnosed, and surgical treatment is necessary, CBCT may be suggested as an adjunct tool for FI assessment.

Effects of Locally Administered Tiludronic Acid on Experimental Periodontitis in Rats

It appears there are no studies evaluating the influence of the bisphosphonate tiludronic acid (TIL) on periodontitis. The purpose of this study is to evaluate via microtomographic, histopathologic, histometric, and immunohistochemical analyses the effects of local administration of TIL on ligature-induced periodontitis in rats. Forty-eight rats were divided into six groups: C (control), EP (experimental periodontitis), EP-Saline, EP-TIL0.1, EP-TIL0.3, and EP-TIL1. In EP, a ligature was placed around maxillary second molars. In EP-TIL0.1, EP-TIL0.3, and EP-TIL1, TIL solutions of 0.1, 0.3, and 1 mg/kg body weight, respectively, were injected into the subperiosteal palatal area adjacent to maxillary second molars every other day. EP-Saline received 0.9% NaCl solution instead. Animals were euthanized at day 11. Bone changes were evaluated by microtomographic and histometric analyses. Histopathologic analysis and immunohistochemical detection of tartrate-resistant acid phosphatase (TRAP) were also performed. Data were statistically analyzed (analysis of variance or Kruskal-Wallis, P <0.05). Histometric and microtomographic analyses (at buccal, interproximal, and furcation sites) demonstrated that EP-TIL1 presented less alveolar bone loss (ABL) than EP (P <0.05), whereas EP-TIL0.1 and EP-TIL0.3 did not demonstrate significant differences in alveolar bone level compared to EP (P >0.05). Also, EP-TIL1 showed significantly fewer TRAP-positive multinucleated osteoclasts than EP and EP-Saline (P <0.05). It can be concluded that locally administered TIL solution (1 mg/kg body weight) reduced alveolar bone loss in experimental periodontitis and the dosage of TIL may influence its anti-inflammatory and antiresorptive properties.

Evaluation of Alveolar Bone Density at Furcation Sites Using Computer Tomography in Patients with Horizontal Bone Loss

Objectives: The aim of the current study was to evaluate quantitatively bone density in the maxillary and mandibular interradicular sites and to establish his determinants as assessed on computer tomography images. Methods: Sections of 0.5 mm thickness horizontal CT sections were selected to measure bone density of the interradicular and interdentally septum in CTs from 29 individuals (17 females, mean age 40.44 years). Results: There were statistically significant differences of mean value and of bone density at specific bone depth levels in the furcation area according to age, gender, tooth type and between the maxilla and mandible (P &lt; 0.05). The multiple linear regression analyses showed, for both mean furcation alveolar bone density value as well as particular values at different bone level as dependent variable, a strong association with gender, distance from the furcation roof to the alveolar bone septum, presence of restorative treatment of caries, presence of endodontic treatment and mean alveolar bone density of the mesial and distal alveolar septum (P &lt; 0.0001). Conclusions: Using the CT in periodontology has demonstrated to be a valid support to diagnose the changes in the alveolar bone, to monitor the treatment results with a higher precision and to point out possible error sources.

Evaluation of bioactive glass and autogenous bone in the treatment of Grade II furcation involvement: A randomized controlled trial

Introduction: Furcation involvement is an inflammatory process that results in a breakdown of the supporting connective tissue and bone as a result of extension of periodontal destruction between the roots of multi-rooted teeth. Class II furcation lesions are a challenging scenario for periodontal therapy and a serious threat for tooth prognosis where the teeth mortality has been reported to occur more frequently in furcated teeth than in similar teeth without furcation defects. Aims and Objectives: The aim of this study was to compare the efficacy of bioactive glass (BG) grafting material versus autogenous bone grafting in the treatment of Grade II furcation involvement clinically and radiographically. Materials and Methods: A total of 30 patients with buccal mandibular Grade II furcation involvement were divided- by a split-mouth design- into three groups; group (Gp) I involved 30 sites grafted with BG; Gp II involved 30 sites grafted with autogenous bone and Gp III involved 10 sites treated with scaling and root planing only after flap reflection. Results: The postoperative healing periods were, generally uneventful with no postoperative complications. At the last follow-up period, the previous furcation sites were covered with healthy gingiva and there was a great reduction in the surface area of the furcation defects with a marked increase in the gray level in both Gp I and II with no significant difference, while there was a statistically significant difference between Gp I and Gp III and between Gp II and Gp III at 3 months and at 6 months of follow-up periods. Conclusion: The use of BG and autogenous bone grafts has better outcomes in the treatment of Grade II furcation involvement when compared with open debridement alone. The use of bony glass has nearly the same successful outcomes of the autogenous bone graft; however, it is less traumatic to the patient. Clinical Relevance to Interdisciplinary Dentistry Periodontal regenerative procedure using bioactive glass material can be performed to enhance bone formation Class II furcation lesions are a challenging scenario for periodontal therapy and a serious threat for tooth prognosis.