Reliability Assessment of the Clinical and Radiographic Diagnosis of Furcation Involvement

The aim of the present study was to compare and assess the relationship and agreement between the clinical and radiographic detection of Furcation Involvement (FI) in the mandibular molars of patients with periodontitis.

The sample size included 360 molars from 283 participants with a total of 180 molars involved with furcation clinically and 180 without. The inclusion criteria involved records of patients in the age range 35-76 years, diagnosed with generalized periodontitis, Stage II to IV, Grade B and C, and existing periapical radiographs/dental panoramic radiographs. The periodontal charts (Hamp’s classification) and radiographs were used to evaluate furcation on the buccal and lingual sites of first and second mandibular molars.

Of the 360 molars, half of the molars (50%, n=180) had clinical FI. Of the clinical FI group, the majority (73%, n=131) demonstrated FI in the radiological assessment with the periapical radiographs. In the not-clinically detected FI group, just less than half (49%, n=89) demonstrated FI in the radiological assessment. The sensitivity of the radiographic detection of FI as a diagnostic marker was 50.6%, and the specificity was 72.8%. Of the 180 sites analyzed with FI clinically, a slight agreement was found between the clinical assessment and radiographic findings using the kappa analysis (k=0.18). The first mandibular molars showed a fair agreement (k= 0.21) compared to the second mandibular molars (k=0.15). In terms of the individual sites, the lingual sites (k=0.24) had a fair agreement compared to the buccal sites with a slight agreement. The Spearman Correlation analysis for the first mandibular molar showed a moderate positive correlation (r=0.4, p<0.001) compared to the second mandibular molar with no or negligible relationship (r=0.19, p<0.001). Comparatively, the DPT radiograph showed a weak correlation and poor agreement.

Both diagnostic tools, intraoral radiography and clinical assessment should be used for diagnosing FI in mandibular molars.