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

Abstract

Background The 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. Methods An 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. Results The 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). Conclusion Panoramic 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 registration Patient radiographic datasets were retrospectively analyzed.

Imaging furcation defects with low-dose cone beam computed tomography

“…Although two-dimensional imaging can determine whether a furcation defect is continuous or not in mandibular molars, this is almost impossible in maxillary molars. Two-dimensional imaging of the complex anatomy and superimposition of the roots in maxillary molars agrees only slightly with that of three-dimensional imaging 3 .…”

Development and validation of an artificial intelligence software for periodontal bone loss in panoramic imaging

“…Panoramic and periapical radiographs were found to be relevant tools with high specificity in diagnosis furcation involvement. A combination of radiological findings and furcation probing was suggested as the ideal technique for inspecting furcation sites 37 . Komšić et al compared periodontal probing, intra‐surgical measurements, panoramic and CBCT‐based parameters in molar furcation assessment.…”

The Radiographic Assessment of Furcation Area in Maxillary and Mandibular First Molars while Considering the New Classification of Periodontal Disease

“…A previous study compared the different radiographic techniques in cases of furcation involvement and stated that CBCT radiographs should not be used as routine periodontal assessment unless a clear clinical indication [ 15 , 16 ]. Although there are many studies published to date to assess the reliability of various radiographic adjunctive with that of the clinical diagnosis, each study concluded and recommended further studies [ 17 , 18 , 19 ]. Hence, this current study aimed to assess the reliability of routine periapical radiographs to confirm the clinical diagnosis of furcation is well justified.…”

“…Hence, the present study would be helpful to interpret the results and considered to be more reliable than when it is involving all the furcation involvement for all molar teeth. The current study used the Hamp and co-workers’ classification for the furcation involvement followed by the previous studies [ 17 , 19 , 20 ]. Thus, categorizing the furcation based on this classification and co-relating this with the radiographic analysis for reliability seems appropriate.…”