Clinical furcation diagnoses and interradicular bone defects

Abstract

The purpose of the present study was to assess associations between clinical depth of involved furcations and their bony defect depth. Twelve patients with moderate to advanced periodontitis in molars were recruited for clinical evaluation of furcation involvement by 6 dentists. Two groups of 3 dentists were assigned to the right or left half of the dentition. All dentists assessed the clinical depth of involvement of the furcations using the Ramfjord index (2 mm) in patients 1 through 6, and using the Hamp index (3 mm) in patients 7 through 12. Diagnoses were made with calibrated and uncalibrated Nabers 2 probes. After the clinical assessments the patients received full mouth scaling and root planing. After reevaluation the molars were surgically exposed. During surgery the depth of the bony furcation defects was assessed using horizontal probing and impressions. Clinically assessed depth of furcation involvement was then compared with the surgical measurements. A total of 1,180 clinical furcation diagnoses were available, of which 426 could be surgically evaluated using both the straight probe and the impressions. These evaluations were done in a total of 72 furcations using probe and impressions. For the Ramfjord index, 5% of the clinical degree 1, 40% of the degree 2, and 43% of the degree 3 readings were overestimations. For the Hamp index, 7% of degree 1, 24% of degree 2, and 0% of degree 3 readings were overestimations. These clinical diagnoses were overestimations. Forty-three percent of surgical degree 3 involvements were not recognized when using the Ramfjord index, and 27% when using the Hamp Index. These results suggest that furcation diagnosis is of limited validity.