| Abstract|| |
Background and Objectives: 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.
Keywords: Furcation involvement, interradicular bone loss, radiovisuographic analysis
|How to cite this article:|
Batra P, Das S, Jain S. Correlation of radiovisuographic analysis of interdental and interradicular bone loss in furcation involvement of mandibular first molars: A retrospective study. Indian J Dent Res 2018;29:329-32
|How to cite this URL:|
Batra P, Das S, Jain S. Correlation of radiovisuographic analysis of interdental and interradicular bone loss in furcation involvement of mandibular first molars: A retrospective study. Indian J Dent Res [serial online] 2018 [cited 2021 Aug 1];29:329-32. Available from: https://www.ijdr.in/text.asp?2018/29/3/329/234357
| Introduction|| |
Periodontitis is an infectious disease which most often leads to progressive attachment loss and bone loss. The presence of furcation involvement or interradicular bone loss is one of the clinical findings that can lead to a diagnosis of advanced periodontitis. Higher morbidity and compromised prognosis for molars with furcation involvement have been reported in several retrospective studies of tooth loss.,
It is observed that the frequency of furcation defects increases with age and its existence increases the risk of tooth loss.
Several morphological factors such as furcation entrance width, root trunk length and the presence of root concavities, cervical enamel projections, bifurcation ridges, and enamel pearls contribute to the etiology and compromised prognosis of furcation involved teeth.
Furcation involvement most often affects the mandibular first molars, followed by mesial furcation of the maxillary first molars, whereas the maxillary premolars are the least frequently involved. The buccal furcation entrance of the maxillary molars and buccal and lingual furcation entrance of the mandibular molars are normally accessible for examination. The difficult access to distal furcation of maxillary molars presents a formidable problem in clinical diagnosis.
Ross and Thompson reported that clinical examination alone detected furcation involvement in only 3% of maxillary and 9% of mandibular molars. The combination of radiographic and clinical examinations improved detection to 65% in maxillary molars but only 23% in mandibular molars.
The inherent limitations associated with conventional diagnostic procedures further limit the sensitivity and reliability of furcation diagnosis.,,,,,,, Clinical probing is dependent on a multitude of technical factors, for example, the probing force and angulations, while radiographs may over or underestimate the amount of bone loss due to projection errors and lack of three-dimensional (3D) information.
Furcation areas present some of the greatest challenges to the success of periodontal therapy. It is known that with the progression of periodontal destruction and the involvement of furcation areas, the severity of periodontitis increases and treatment is less effective because of limited access.
Therefore, furcation defects represent formidable problem in the treatment of periodontal disease thus necessitating an early diagnosis and treatment.
The need of a simple, less elaborate, time and cost-efficient diagnostic tool is required for careful comprehensive examination, diagnosis, and timely intervention of furcation lesions at their earliest, so that the best clinic outcomes can be achieved. The present investigation aims to correlate the interdental and interradicular bone loss in chronic periodontitis patients using radiovisuography, 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|| |
This is a retrospective study where a total of 70 RVGs of Mandibular right and left first molars with furcation involvement were evaluated from database of outpatient Department of Periodontics, The Oxford Dental College, Bengaluru. Out of the 70 RVG radiographs, 15 were excluded because of radiographic errors. Based on the clinical and radiographic records, the radiographs of patients diagnosed with chronic generalized moderate-to-severe periodontitis were selected.
The criteria for radiograph selection were:
- RVG radiographs of mandibular first molars with furcation radiolucency.
- Molars with fused roots
- Subjects with endo-perio lesion/periapical lesion according to clinical records
- Open contacts with respect to mandibular molars
- Crowding with respect to mandibular molars.
RVGs procured were subjected to morphometric measurements defining the interdental and furcation areas.
The length of the tooth was measured from cusp tip of the crown (C) to apex of the root (A) and calibrated with the standard value using Kodak dental imaging software.
The mesial interdental bone loss, the distal interdental bone loss, and the interradicular bone loss were calculated [Figure 1].
|Figure 1: Morphometric measurement of mesial, distal interdental bone loss, and interradicular bone loss. Mesial interdental bone loss was calculated from cementoenamel junction (CEJ) to the apical extension of the bony defect (M). Distal interdental bone loss was calculated from cemento enamel junction (CEJ) to the apical extension of the bony defect (D). The inter radicular bone loss was measured from the furcation fornix to the crest of the intact interradicular bone level (B)|
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Differences among means were compared. The correlation for the mesial and the distal interdental bone loss to the interradicular bone loss were analyzed.
These were measured by a single examiner to avoid error due to interobserver variation using the digital software, the 'Kodak dental imaging software' installed within the RVG.
The mean values for the mesial interdental bone loss, the distal interdental bone loss, and the interradicular bone loss were calculated. Differences among means were compared using the two-tailed t-test. The correlation for the mesial and the distal interdental bone loss to the interradicular bone loss were analyzed using the Pearson correlation coefficient.
| Results|| |
In this retrospective investigation, it was observed that distal bone loss was not significantly different when compared with mesial bone loss whereas interradicular bone loss was significantly different when compared with mesial bone loss. The analysis between distal bone loss and interradicular bone loss was also statistically significant [Figure 2] and [Table 1].
It was observed that mean interdental bone loss was significantly different when compared with interradicular bone loss [Figure 3] and [Table 1]. However, there was no significant difference seen in between mandibular right first molar and left first molar.
According to the results of the present investigation, when the bone loss at interdental area was equal or exceeding 3.1 mm, a minimum interradicular bone loss of 1.3 mm was evident.
| Discussion|| |
The prevalence of involvement of the furcation area in the maxillary and mandibular molars ranges from 25% to 52% and from 16% to 35%, respectively.,,,,
Teeth with furcation involvement are 2.5 times more likely to lose attachment as compared with teeth without furcation involvement.
The aim of our study was to correlate the interdental and interradicular bone loss in RVGs of chronic periodontitis patients and to explore the potential of interdental bone loss as a landmark for screening of early furcation diagnosis.
As a general rule, bone loss is always greater than its appearance in the radiograph. Therefore, it is possible for furcation involvement to be present without radiographic changes. Variations in the radiographic technique may obscure the presence and extent of furcation involvement. A tooth may present marked bifurcation involvement in one film but appear to be uninvolved in another.
With regard to methodology, digital radiography was used in the present study for the evaluation of bone loss, whereas earlier studies used intraoral periapical radiographs and bitewing radiographs for the analysis of bone loss.,,
RVGs were taken from 39 male and 16 female individuals. Based on the gender, there was no statistical significant difference in the correlation between the interradicular to the interdental bone loss. This is supported in a longitudinal study by Rohner et al.
The comparison between the interradicular and interdental bone loss in males and females were found to be significant in both the genders.
In the present study, it was seen that values ranging from 1.20 to 16.70 mm for the mesial and those ranging from 2.70 to 13.60 mm for the distal interdental bone loss were associated with interradicular bone loss in the range of 1.30–9.10 mm, and both were significantly correlated with each other.
The results of the present investigation revealed that the smallest amount of interradicular bone loss of approximately 1.3 mm and above was observed only when the bone loss at the interdental area was equal to or exceeding 3.1 mm. The findings of the present investigation are consistent with the results of the study conducted by Grover et al., where the furcation bone loss with the range of 0.80 mm and above were in correlation with interdental bone loss of above 3.70 mm.
The present study demonstrated that interradicular bone loss associated with the progression of bone destruction in multi-rooted teeth of patients with chronic periodontitis had a significant correlation to the loss of bone in the interdental area.
The assessment of the interdental bone loss can be used as a screening tool to detect the periodontal disease in the earliest stage. Because treatment of furcation involvement in its advanced stage is complex, expensive, time-consuming and requires an interdisciplinary approach.
Therefore, to detect the earliest lesions of furcations, the interdental bone loss can be kept as an approximate guide for the comprehensive management of such patients. This correlation suggests that if the disease progression can be halted with approximate periodontal therapy when the interdental bone destruction has just ensued, it may lead to an improved prognosis for the interradicular areas.
Within the limitation of the present study, root trunk length is not considered. Furthermore, radiographs may underestimate the amount of bone loss due to projection errors or lack of 3D information.
Further clinical studies should aim to confirm these results and to identify further influencing factors.
| Conclusion|| |
Interradicular bone loss was associated with the progression of bone destruction in multi-rooted teeth in patients with chronic periodontitis. Interdental bone loss was also 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. Future studies with root trunk length consideration can precisely mark the limits of bone loss in chronic periodontitis when the involvement of the furcation is present.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ramfjord SP, Caffesse RG, Morrison EC, Hill RW, Kerry GJ, Appleberry EA, et al.
4 modalities of periodontal treatment compared over 5 years. J Clin Periodontol 1987;14:445-52.
Matthews DC, Smith CG, Hanscom SL. Tooth loss in periodontal patients. J Can Dent Assoc 2001;67:207-10.
Carranza FA, Henry HT. Carranza's Clinical Periodontology. 10th
ed. Philadelphia: W.B. Saunders Company; 2006.
Bower RC. Furcation morphology relative to periodontal treatment. Furcation root surface anatomy. J Periodontol 1979;50:366-74.
Ross IF, Thompson RH Jr. Furcation involvement in maxillary and mandibular molars. J Periodontol 1980;51:450-4.
Eickholz P, Hausmann E. Accuracy of radiographic assessment of interproximal bone loss in intrabony defects using linear measurements. Eur J Oral Sci 2000;108:70-3.
Schliephake H, Wichmann M, Donnerstag F, Vogt S. Imaging of periimplant bone levels of implants with buccal bone defects. Clin Oral Implants Res 2003;14:193-200.
Zulqarnain BJ, Almas K. Effect of X-ray beam vertical angulation on radiographic assessment of alveolar crest level. Indian J Dent Res 1998;9:132-8.
Brägger U. Radiographic parameters: Biological significance and clinical use. Periodontol 2000 2005;39:73-90.
Mol A. Imaging methods in periodontology. Periodontol 2000 2004;34:34-48.
Benn DK. A review of the reliability of radiographic measurements in estimating alveolar bone changes. J Clin Periodontol 1990;17:14-21.
Jeffcoat MK, Reddy MS. Advances in measurements of periodontal bone and attachment loss. Monogr Oral Sci 2000;17:56-72.
Hefti AF. Periodontal probing. Crit Rev Oral Biol Med 1997;8:336-56.
Vandenberghe B, Jacobs R, Yang J. Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images: An in vitro
assessment of bony and/or infrabony defects. Dentomaxillofac Radiol 2008;37:252-60.
Popova C, Mlachkova A, Emilov D. Correlation of interdental and interradicular bone loss radiographic assessment. J IMAB Ann Proc (Scientific Papers) 2008;2:35-7.
Rohner F, Cimasoni G, Vuagnat P. Longitudinal radiographical study on the rate of alveolar bone loss in patients of a dental school. J Clin Periodontol 1983;10:643-51.
Goldman MJ, Ross IF, Goteiner D. Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study. J Periodontol 1986;57:347-53.
Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol 1978;49:225-37.
McFall WT Jr. Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol 1982;53:539-49.
Wood WR, Greco GW, McFall WT Jr. Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care. J Periodontol 1989;60:516-20.
Wang HL, Burgett FG, Shyr Y, Ramfjord S. The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss. J Periodontol 1994;65:25-9.
Björn AL, Hjort P. Bone loss of furcated mandibular molars. A longitudinal study. J Clin Periodontol 1982;9:402-8.
Grover V, Malhotra R, Kapoor A, Mankotia CS, Bither R. Correlation of the interdental and the interradicular bone loss: A radiovisuographic analysis. J Indian Soc Periodontol 2014;18:482-7.
] [Full text]
Dr. Parichaya Batra
Department of Periodontics, The Oxford Dental College, Bommanahalli, Hosur Road, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]