COMPARISON BETWEEN INTRAORAL RADIOGRAPHY (IOR) AND CONE BEAM COMPUTED TOMOGRAPHY (CBCT) FOR THE ASSESSMENT OF MOLAR FURCATION INVOLVEMENT

Abstract

Background: Furcation bone loss is often obscured in intraoral radiograph (IOR). Cone beam computed tomography (CBCT) provides three-dimensional data, which may be beneficial for furcation assessment. The aim of this study was to compare the assessment of molar with furcation bone loss and furcation treatment by IOR and CBCT. In addition, the reliability of the furcation arrow as a predictor of furcation bone loss was evaluated. Method: There were twenty-five subjects with moderate to advanced periodontitis. All patients received complete clinical examination, full-mouth intraoral radiographs, as well as CBCT. Three periodontists assessed the degree of furcation bone loss and the presence of furcation arrows, based on radiographic data. The treatment of furcation-involved teeth was determined, based on radiographic and clinical data. The examiner agreement on the assessment was also evaluated. Results: One-hundred and sixty-eight molars (81 upper molars, 87 lower molars) were included in the analysis. The concordance between IOR and CBCT for the presence of furcation bone loss (77.3-80.5%) and furcation treatment (80.3%) were good, with a trend towards under-estimation. IOR and CBCT had excellent agreement on non-surgical treatment (94.6%). The agreement on tooth extraction was fair (71.9%) whereas the agreement on surgical treatment was low (56.8%). The inter-examiner agreement (Fleiss’s kappa) and percentage of complete agreement of CBCT was excellent and higher than IOR for all categories of assessment. The presence of furcation arrow was significantly associated furcation bone loss with the sensitivity, specificity, positive predictive value and negative predictive value of 0.42, 0.86, 0.76 and 0.60, respectively. Conclusions: IOR is a reasonable tool to identify whether there is furcation bone loss or not. However, CBCT is superior to IOR for assessing the extent of furcation bone loss and surgical planning of furcation treatment. CBCT provides excellent agreement among examiners on furcation assessments. A furcation arrow may be used to predict furcation bone loss.