,/ Cli'i I'erkiihmiui IW5.

22' Slit y/7 Cupyri^hl C>

f'liiucil ill DciDiiiiik . Alt rii;lii', n'.wrv

Clinical periodontoiogy
ISS.\ IUUJ-6979

Management of D. E. Lange^
2 TEger^and

^Department o( Operative Dentistry and

PerJodontology. University of Heidelberg,

furcation-involved teeth ^Department of Periodontology, University of

Munster, Germany

A retrospective analysis
Miilk'r H'P. Eger T. Langc DE: Maiuigeiueni of fitrcalimi-involveil teeth- A
retrospective uiutlvsis. J Cliii Periodontol 1995: -J: 911 917. © Munksgaard,
1995.

Ahsiract. In the present study, data from more than 550 pcriodontally diseased
patients with more than 1100 furcation invasions were retrospectively analysed.
There were apparent differences in the distribution of different furcation degrees
in patient populations treated by 2 differently experienced operators. However,
treatment modality patterns were rather similar. Scaling dttring periodontal flap
surgery was the tnost often performed trcattnent procedure in degree I {97-98".'ij)
and II {75-83',^.) involvements. About 44'!^. of degree III involved teeth were ex-
tracted. In order to determine the influence of degree of furcation involvement,
tooth type and operator variability on treatment modality, logistic regression
analysis was applied. Degree of furcation involvement was an important indi-
cator variable in all tiiodels, Sading as a sole measure was mainly performed in
relation to degree I of furcation involvement. With every increase in degree, the
odds of scaling decreased by factor 12,7. The odds of root resection was upper
1st molars 46x higher than in wisdom teeth or lower 2nd molars with the same
degree of involvement, but only 3.3x higher than in lower 1st molars. Tunnel
preparation as well as regenerative procedures were mainly confined to lower
molars. Operator variability was only introduced as a co\ariate in the extraction
model. Hence, despite of different operator skill and severity of periodontal disease Key words: furcation invasion: periodontai
in treated populations, decision for one or the other treatment modality seems disease; treatment modality; logistic regression
to depend essentially on degree of furcation involvement as well as tooth type.
Accepted for publication 13 December 1994

It is now well established that microbial
plaque is the main cause of chronic in-
flammatory periodontal disease. Active
disease, however, may depend on sev-
eral host factors, the presence of certain
periodontal pathogens while suspected
beneficial species are absent, as well as
a conducive environment as may be de-
tined by. e.g.. pocket temperature, iron
concentration, pocket depth, inflam-
matory status (Socransky & Haffajee
1993) and probably other circum-
stances. Furthermore, local anatomic
factors may also play a pivotal role in
the progression of periodontal disease,
i,e,. for example the palatal groove of
maxillary incisors iHou &. Tsai 1993)
or. of upmost importance, macroscopic
and microscopic structures of the fur-
cation area al multirootcd teeth fSchro-
eder & Scherlc 19S7). Actually, treat-
ment of furcation-involved teeth was in
the past and will consistently be a con-
siderable challenge in clinieal periodon-
tology (Wanget al. 1994).
Different treatment modalities (i.e..
mainly scaling and root planing, fur-
cation plasty. root resection or tunnel
preparation) of furcation-involved teeth
and respective indications have been de-
scribed in detail in several te,xtbooks on
periodontoiogy (see. e,g,. Hanip & Ny-
man (1989). Basaraba. (1990)). Basic-
ally, recommendations seem to depend
on degree of furcation involvement and.
to a lesser extent, on tooth type. How-
ever, in practice, decision for one or the
other treatment modality may be
guided by a number of other factors,
e.g., technical skill and experience of
[he therapist, strategical importance o{
the tooth lo be treated, or patient's
compliance. In recent years, several new
methods for treatment of furcation in-
volved teeth have been developed, such
as guided tissue regeneration {Pontori*
ero et al. 1988). coronally positioned
and fixed flaps (Martin et al, 1988). or
bone and synthetic grafts (Anderegg et
al. 1991. Kenney et al. 1988). The aim
of the present study was to present
data, collected retrospectively, which
may indicate the influence of (i) oper-
ator experience, (ii) degree of furcation
involvement as well as (iii) tooth type
on the decision for a certain mode of
therapy of periodontitis-affccted multi-
rooted teeth.
Material and iViethods
The restruspectivc analysis of the pres-
ent study was based on 558 patients
912 Miilter ft ui

who had been treated during I'-JSV and putation or hcmisection; (iii) tunnel model whereas the variable was re-
1994. Operator 1. a fully trained peri- preparation; (iv) regenerative measures moved from the model '\( p>Q.2. Likeli-
odontist, treated a total of 309 patients, as guided tissue regeneration with hood ratios and McEadden's g-. a
whereas the remainder of 249 patients ePTFE membranes (Pontoriero et al. transformation of the likelihood ratio
was treated by operator 2 during his 3- 19f^8) or coronally positioned and lixed intended to mimic an R-. were calcu-
year course of postgraduate peri- Haps (Martin et al. 1988); or (v) tooth lated (Hensher & Johnson \9ii\). While
odonlal training at the Department of extraction. In general, the actual degree furcation involvement was indepen-
Periodontology. University of Munster. of furcation involvement was re-evalu- dently assessed at different locations
Germany. ated inlraoperatively. This 2nd meas- (e.g.. buccal. mesiolingual and distolin-
Patienls were between 16 and 72 urement was the basis for the statistical gual in maxillary molars), a through-
years of age and siitTercd from moder- analysis. After periodontal surgery, pa- and-through involvement was generally
ately advanced or advanced peri- tients were routinely recalled every 2nd eonsidered as one furcation involve-
odontiiis. They entered an individual or 3rd month for professional tooth ment.
oral hygiene program with repeated cleaning and subgingival scaling al sites
motivation and instruction in efficient with a probing depth of ^ 5 mm and
oral hygiene which was followed by a bleeding on probing. Results
series of weekly visits for the removal of !n order to aseertain differences in In the present study, a total of 558 pa-
sub and supragingival deposits. Before patient samples treated by operators I tienls had been treated for periodontal
treatment and al the end of initial peri- and 2, contingency tables were con- disease. However, furcation involvement
odontal treatment, periodonta! con- structed and continuity corrected •/} of at least I multirooted tooth was only
ditions were routinely examined. Peri- analysis performed. Slepwise logistie found in 292 patients (52'S.). Of 309 pa-
odontal probing depth as well as gingi- regression (SYSTAT for Windows, ver- tients treated by operator 1 and 249 pa-
val recession was measured with a sion 5 and LOGIT version 2. SYSTAT tients treated by operator 2. 62.5'Vii and
standard periodontal probe (PCP 11. Evanstone, IL, USA) was applied in or- 40"A> presented with furcation involve-
Hu Friedy. Chicago. USA). Bleeding der to determine the influence of oper- ment, respectively (/)<0.001). Among
upon probing as well as presence of ator, degree of furcation involvement these 292 patients 1134 diseased fur-
supragingival plaque at the gingival and tooth type on treatment modality cations were identilied (Table I). Most
margin was recorded. Tooth mobility Each explanatory variable was entered of these furcations were found at upper
was digitally and visually assessed. In sequentially. Thereafter interactions be- 2nd molars (181. 27%. operator 1; 139.
addition, at the end of initial therapy, a tween main effects degree and tooth M)"A,. operator 2). followed by upper 1st
set 0*1 !4 standardised periapieal radio- type as well as o/wrator and looth type molars (27'Mi and 25'!^.. respectively),
graphs was obtained. These routinely were allowed to enter the model. A sig- lower 2nd molars {\6% and 17%. re-
collected diagnostics were not reported nificance level, as evidenced by the Wald spectively), lower 1st molars (15%^ op-
in the present study. /•^ statistie. of/?<0.15 was accepted for erator 1) and lower 3rd molars (H%i.
an explanatory variable to enter ihe operator 2). Table 1 indieates that simi-
In multirooted teeth, furcation in-
volvement was measured with a cali-
brated Nabers' periodontal probe
(PQ2N. Hu Friedy. Chicago, USA). A Tahle I. Disirihution of periodontally involved furcations among 55S patients
degree I involvement was diagnosed, if
the probe penetrated up lo 1/3 of the Fureation
jrivolvcmciit Operator 18/28 17/27 16/26 14/24 38/48 37/47 36/47 Others'^* Tolal
width of the tooth inlo the fureation
area. If a horizontal loss of supporting degree 1 OPI 1 75 56 12 17 36 30 3 230
tissue of more than 1/3 of a tooth's 0P2 20 86 78 7 29 43 4 289
width was assessed, but not en- degree 11 OPI 4 49 51 6 16 47 36 2 211
compassing the total width of the fur- 0P2 14 42 32 17 30 II 146
degree 111 OPI 57 72 20 9 27 36 229
cation area, a degree II involvement was 1
recorded. Degree III involvement de- 0P2 1 11 7 4 3 1 29
total OPI 13 181 179 38 42 110 102 5 670
noted a "through-and-through" destruc-
OPI 35 139 117 7 49 77 36 5 464
tion of the periodontal tissues in the
furcation area (Hamp & Nynian 1989). 6 upper 2nd premolars. 2 lower canines. 2 lower premolars.

When the personal oral hygiene had

suflicientty improved, in most patients,
periodontal surgery (subgingival curet- Tiihic 2. Slcpvvise logistie regression
tage. flap surgery or gingivectomy pro- Parameter Estimate S.E. /' Odds ratio 95'>,,C,I.
cedures) was performed. During
constant 6.895 0.405 0.000
surgery, different treatment modalities
degree -2.544 (). 157 0.000 0.08 0.06-0.11
were applied in diseased furcation areas others -3.017 0.845 0.000 0.05 0.01-0.26
of multirooted teeth: (i) scaling and toot)i 38/48 -1.090 0.342 0.001 0.34 0.17-0.66
root planing with and without furcation tooth 36/46 -0.690 0.276 0.013 0.50 0.29-0.87
plasty with sealers, curettes. Hirschfeld tooth 18/28 -1.014 0.439 0.021 0.36 0.15-0-86
periodontal hies or fine rotating flame-
Dependent viiriablc: treatment modality scaling. Response=875, reierence-259.
shaped diamond burs (40 /;m and 15 Likelihood nitio=492. 5 d.f.. /)=0.000.'
//m); (ii) resective measures as root am-
 of fiircatioiis 913

100

Fig. I. Treatment inodaliiy in relation to degree of furcation involvement and looih lype in patients treated by operator \. Sea: scaling with
and without furcation plasty: Amp: root amputation: Hem: hemiseetion: Tun: tunnel preparation: Reg: regcncralive procedure: X: tooth
extraction.

lai" numbers of degree 1, II. and III in- 16 3i'd molars, were extraeted. Regene- In order to determine the effect of
volvements were treated by operator I. rative procedures were performed in 17 degree of furcation involvement, tooth
In eontrast, in patients treated by oper- cases. In eontrast, the whole thera- type and operator on treatment modus
ator 2. there was obvious predominanee peutic spectrum was applied, if a decision, logistie regression analyses
of degree 1 involvement (/)<0.001). through-and-through Tureation involve- were performed. The respeetive models
As may be seen in Figs. 1, 2. sealing ment was diagnosed. This was es- are presented in Tables 2 through 6. De-
with or without furcation plasty as a peeially true for operator 1, who treated gree of fureation involvement strongly
sole measure was the main treatment %9"A) of all degree III furealions of the influenced whether or not sealing as a
modus (97 98'!^i>) in degree I fureation present material (Fig. I). Notably, in sole measure was performed. With
involvemenis. irrespective of tooth type 43'!^i of these cases the problem was every increase in degree, the odds for
and operator. A degree II involvement solved by tooth extraction. Root resec- scaling decreased by factor 12.7 (Table
prompted operator I in 15"Ai and oper- tion was performed in 30. tunnel prep- 2). Compared with upper 2nd and 1st
aration in 34 and regenerative measures molars. 1st premolars as well as lower
ator 2 in 83'V;i to sealing as a sole
in 12 teeth (Figs. 1. 2).
measure. A total of 28 teeth, espeeially 2nd molars, for 10 'other' teeth with
furcation involvement (mostly upper
2nd premolars). the odds of scaling as
Tahlv ,?. Stepwise logistic regression a sole measure was decreased by factor
Paraincler Estimate S.E. /' Odds ralio 95",, C.I. 20,4. For wisdom teeth and lower 1st
consKiiU 0.000
molars it was decreased by factors 2-3
-9.176 1.189
tooth 16/26 3.827 1-022 0.000 45.9 6.2 341 (Table 2).
degree 1.489 0.249 0.000 4.4 2.7-7.2 An increase in degree of one unit in-
looih 36/46 2.644 1.091 0.015 14.1 1.7 119 creased the odds of reseetive measures
loolh 17/27 1.785 1.102 0.105 6.0 0.69 51.7 for all teeth by factor 4.4. The odds of
Dependent variable: treatment modality roui resection. Response = 45, releretice-1089. root amputation was in upper 1st mo-
Likelihood ratio= 106, 4 d.f.. /) = 0.000. lars 46 times higher than root resection
in wisdom teeth or lower 2nd molars
914 Mailer et al.

Fig. 2. Trcatmcni modaliiy in relation lo degree of furciition involvemeni iitui loolli lype in patictiis ireitted by operator 2, For abbreviations,
see Fig, 1,

with the same degree of involvemeni.
but only 3,3 times higher than in lower
1st molars (Table 3). The decision for
tunnel preparation was also strongly in-
fluenced by furcation degree. In lower
molars, the odds for this treatment
modus was increased by factors 9,5 to
37.8 as compared with upper 3rd and
2nd molars, A rather weak positive as-
sociation was also found with upper I si
molars (Table 4), The odds for regene-
rative procedures were increased by fac-
tors 20-27 for lower 2nd and 1st molars
Table 4. Stcpwise logistic rcgrcssioti
Parittnctcr Estimate
constant 13.137
degree 3.062
tooth 36/46 3.632
tooth 37/47 3.067
tootli 38/4K 2.254
tooth 16/26 1.199
Dependent variable: treatment modality tunnel preparation. Respoiisc = 37. referenee= 1097.
Likelihood ratio=l34. 5d,f,. /7=0,000,
MeFaddcn's o-=0,413.
and by faclor 56 for upper 2nd molars. wisdom leeth were positively associated
However, the interaction with the de- with exlraclion. The odds of a lower
gree of furcation involvement was bor- wisdom tooth with degree I involve-
derline significant. While degree in gen- ment of being extracted was 6,2 times
eral was positively associated with re- higher than the odds of a lower 1st mo-
generative procedures, this was not true lar with degree II involvetiient. Interest-
for upper 2nd molars, where the odds ingly, operator variability was included
decreased by factor 4 with increasing into the model. The odds of extraction
furcation degree (Table 5). of a furcationally diseased tooth was
Table 6 presents the model for the de- 2,5 times higher in patienis treated by
pendent variable 'tooth extraction". It is operator 2, As ihc included interactions
obvious thai degree as well as uncotii- indicate, this was especially true for
mon multirooted teelh ("others') and upper 1st premolars. whereas the odds
of being extracted was decreased for
lower 3rd molars treated by operator 2
(Table 6).
S,E. Odds ratio 95% CM,
1.692 0,000 Discussion
0,522 0,000 21,4 7.7-59.5
0,776 0.000 37.8 8.3-172 In the present study, data from more
0.805 0.000 21,5 4.4-104 than 550 periodontally diseased pa-
1.044 0,031 9,5 1.2 73.7 tients with more than 1100 furcation in-
0.849 0.158 3.3 0,6-17,5 vasions were retrospectively analysed in
order to determine the influence of de-
gree of furcation involvement and tooth
type on personal decision for a certain
 of ftircalioiis 915

Tiihlc 5. Slcpwisc logistic regression bridement with different sonic and

Parumcicr Estimate S.t. /' Odds ralio 95"/;, C.I. ultrasonic sealers in furcations of ex-
tracted mandibular molars mounted in
eonstant -7.814 1.000 0.000
a stone model with sitnulated gingiva.
lootli 36/46 3.300 0.767 0.000 27,1 6.0 121
Although they noted large variation of
looth 37/47 3.020 0.776 0.000 20.5 4.5-93.8
degree 1.077 0.283 0.000 2.9 1.7 5.1 measurements, mean percentages of re-
looth 17/27 4.030 1.543 0.0(W 56.2 2.7-1156 maining artificial calculus of 22-33% is
degree* tooth 17/27 -1.444 0.762 0.05S 0.24 0.05 1.1 rather disappointing. In vivo experi-
ments revealed even poorer results, es-
Dependent \ariahle: treatment modality regeneraiiw piocedun: Response = 32, reterence-
pecially in ease of low experience of op-
1102.
Likelihood ratio-60.3. 5 d.i'.. /J = 0.000.
erator and/or root debridement without
surgical access. When furcation aspects
alone were assessed, it was found that
even a more experienced operator with
an open approach obtained a calculus-
Tahic 6. Stepwise logistic regression
free surface in only 68"/i of eases
Parameter Estimate S.E, P Odds ratio 95% C,!. (Fleischer et al. 1989). Similar disad-
constant -10.058 0.838 0.000 vantageous observations but a con-
degree 3.069 0.278 0.000 21,5 12.5 37.1 siderable influence of both operator
others ,5.089 0.930 0.000 162 26.2-1004 skill and open tlap access have been re-
loolh 38/48 3.850 0.557 0.000 47.0 15,8 140 ported for single- and multirooted teeth
tooth 18/28 2.460 0.498 0.000 11.7 4,4-31.1 by several investigators (Caffesse et al.
tooth 17/27 1.043 0.280 0.000 2.8 1.6 4,9 1986, Brayer et al. 1989. Parashis et al.
tooth 14/24 0.985 0.477 0.039 2.7 1.1-6,8 1993). It seems to be impossible to pre-
tooth 36/46 - 1,040 0.479 0.030 0.35 0.14 0,90 dictably retiiove mechanically all bac-
0P2 0.909 0.326 0,005 2.5 1.3 4.70 terial deposits from teeth with ad-
0P2* tooth 14/24 4.179 1.06(1 0.000 65.3 8.2-520 vanced furcation involvement. This
0P2* tooth 38/48 -3.165 0.915 0.001 0.04 0.01-0.25
should be kept in mind when planning
Dt-'pcndent variable: treatment modality loo/h cyiraciicii. Response= 145. rol'creiice = regenerative procedures where bacterial
Likelihood ratio = 364. 10 d,f.,/)-0.000, interference with healing events has
MeKaddensp--0.420. been discussed recently {Nowzari &
Slots 1994). At present, there is no
scientific information on the influence
ireatincnt tnodus. Although there is apparent with regard to relative fre- of bacteria left behind after scaling and
surprisingly little epidemiotogical inlbr- quencies of different degrees of fur- root planing in furcations (Loos et al.
niation (Larato 1970). it is well-known cation involvement, it was interesting to I98S) on the clinical success of guided
that invasion of the furcation area o\' note that similar treatment modality tissue regeneration. However, indirect
multirooted teeth is a common comph- patterns were performed by these oper- evidence may be derived when consider-
cation of advanced periodontal disease. ators. Hence, scaling with and without ing relatively limited attachment gain in
If patient populations treated by differ- furcation plasty as a sole measure was. degree II involved maxillary molars
ent operators are compared, differences by far. most often applied by all oper- (Metzler et al. 1991) and virtually no
with regard to severity of periodontal ators {70-K8'.!/i.). and teeth with a effect at all in degree I or II involved
disease are to be expected. When con- through-and-through involvement were premolars (Proestakis ct ai. 1992) as
sidering patients treated by operator 1. extracted in about 4O'%>. Root resection compared to more favorable results in
a fully trained periodontist. throiigh- was done in the present rnaterial in a presumably easier to debride lower mo-
;ind-through involvement was as fre- rather limited number of turcation-in- lars' furcations (Pontoriero et al. 1988).
quently observed as degree II involve- volved teeth (see Kigs. 1. 2). Although The result of the regenerative treatment
ment and incipient furcaiion invasion. Mutschelknauss et al, (1991) claimed model seems to reflect this information
Mutschelknauss et al. (1991). in their that, in their practice, root resection from the literature, as an association
retrospective analysis of 180 peri- had gained relative importance in re- with mandibular molars, and degree is
odontally treated patients in a special- cent years in more advanced furcation documented (Table 4). In addition, in
ised (periodontics and prosthetics) pri- involvements, they primarily performed maxiliary 2nd molars, regenerative pro-
vate practice, found 944 furcationally this procedure in their patients in only cedure was negatively associated with
diseased molars, 28'/^i with incipient in- 6.3'!'!. of diseased molars. These authors increasing severity of involvement.
volvement. 55'i^) with degree II involve- did not report on tunnel preparations
ment and \1"A> with through-and- and regenerative procedures.
through involvetiient. In contrast, in pa- An effective measure to solve the
lients treated by operator 2 of the pres- It should be stressed that, in the pres- problem of inaccessible furcations may
ent study during his postgraduate train- ent material as well as in the compar- often be root resection. In their longi-
ing program, degree III involvement able publication (Mutschelknauss et al. tudinal study. Hamp et al, (1975) per-
was diagnosed in only 6"<. of teeth with 1991). mechanical debridement during formed root resection in 87 of 175 mul-
a fiZVii predotiiinance of incipient fur- periodontal stirgery was the treatment tirooted teeth with furcation invasion.
cation invasions. Although large differ- of choice even in more advanced cases Whereas in this investigation no tooth
ences in the 3 materials reported were of furcation involvement. Patterson et was lost during the 5-years observation
al. (1989) compared eflieacy of root de- time, in subsequent investigations fail-
916 Mailer i'l al.
ure rates of up to iiiVn of resected teeth
in 10 years were reported (Langer et al.
1981. BCihler 1988). On the other hand,
whereas tunnel preparation was sus-
pected to have a poor prognosis (Hamp
et al. 1975). recent reports suggest more
favorable longterm results (Hellden et
al. 1989. Eickholz et al. 1991), Frotii
longterm studies (Hirschfeld & Wasser-
man 1978. McFall 1982) it has become
clear that, following a more conserva-
tive approach of treatment of furcation-
involved teeth (i.e.,without or virtually
without root resection), progression of
periodontal disease may be dampened
in most cases, if careful maintenance is
established. Treatment modality models
of the present investigation seem to re-
flect these changing concepts and indi-
eations.
When considering the present ap-
proach of logistic regression analysis
one has to take into account that, obvi-
ously, the decision for one or the other
treatment modus will depend, besides
tooth type and degree of involvement.
on a multitude of more complex fac-
tors, e.g.. (i) the remainder of peri-
odontal attachment apparatus around
single roots, (ii) single root mobility,
(iii) anatomical and topographical re-
lation between ditTerent roots, (iv) pres-
ence of caries, old restaurations and en-
dodontic conditions, (v) amount oi' re-
maining tooth substance, (vi) planned
new restoration and (vii) overall (stra-
tegical) importance of that particular
tooth. Patient age, general condition,
the expression of periodontal disease,
and personal oral hygiene clearly are
additional variables modulating the de-
cision of an operator for a particular
treatment modality. Probably some of
these covariates are correlated with
examined parameters (e.g.. amount of
attachment, single root mobility: de-
gree; strategic value: wisdom tooth,
mandibular 1st molar). Although it was
not possible to evaluate these covariates
in Ihis retrospective analysis, it appears
unlikely that they would have altered
the present treatment modality models
in a significant way. Also, in spite of sig-
nificant differences in patient popula-
tions treated by different experienced
operators, operator effects in treatment
modality models were not or only mar-
ginally discernible, mainly with regard
to odds of extracting 1st premolars and
lower wisdom teeth. Hence, within the
limited scope o\' the present approach.
it may be concluded that decision for
one or the other treattnent modality
seems to depend mainly on degree of
furcation involvement as well as tooth
type. Whether treatment resulted in ac-
ceptable periodonlal conditions should
be investigated in future studies.
Acknowledgements
The authors would like to express their
appreciation to Drs. R. Nienhaus and
A. Heinecke, Institute for Medical In-
formatics and Biostatistics. University
of Miinster. for discussions and com-
ments. Whereas as many as possible of
their suggestions were incorporated
into the final text, the authors alone are
responsible for errors or deficiences.
Zusammenfassung
van Ziilmcn mil Fiirkaliaiishc-
fiill. Eintf iTlioxpeklivf Aiiiilyse
In dcr vorliegenden Studie wurden Daten
von mehr als 550 parodontal erkratikten P:i-
tienten mit niehr als 1100 Furkationsdefek-
ten retrospektiv analysiert. In den Patienteii-
populationen, die von 2 iinterschiedlich cr-
lahrenen Zahniirzlen behandell wurden. gab
es offensichtliehe Unterschiede in der Vcrtci-
lung der tintcrschicdlicheii Furkationsgrade.
Das Miisier der Behandlungsartcn war jc-
doch ziemlich iihnlich. Scaling wahrend der
Lappcnopcration war die am haufigsten
diirchgcfilhrte Bchandlungsarl bci Grad I
(97-98%) und Grad II (75-83%) Furkations-
bdall. Ungdahr44%dcrGrad III befallcnen
Zahne wurde extrahiert. Um den EinfluB dcs
Grades des Furkationsbefalls. des Zahntyps
nnd der Untersuchervariabilitiit anf die Be-
handlungsarlen zn bcsiimmcn. wurde die lo-
gislische Regressionsanalyse angcwendet,
Der Grad des Furkationsbefalls war bci alien
Modelleti eine wichtige Indikatorvariable.
Sidling ats alleinige MaOnahmc wiirde
hauptsiichlich in Abhiingigkcit znm Cirad dcs
Furkationsbctalls dLirchgL-fuhrl. Mit jcdcr
Zunahme des Grades nahm die Wahrschein-
lielikeil des Sealings nm den Faktor 12.7 ab.
Die Wahrscheinlichkeit I'iir eine Wmzelrvsek-
lion war bei oberen ersten Molaren 46 mal
hoher als bei Weisheitszahnen oder unleren
zweiten Molaren mit gleichem Furkations-
grad. jedoch nur 3.3 mal hoher als bei unte-
ren ersten Molaren. Die Tuimelicniug sowie
regcncruliye Miipiiciliim-ii warcn hanptsikh-
lich atif untcre Molaren beseliriiiikl. Die Bc-
handlervariabililat wurde nur im Extrak-
lionsmodell als eine Kovariable eingefiihrt,
Deshalb sclieini. trot/ unterschiedlicher Gc-
schicklichkeit der Operalcure nnd unier-
schicdlicher Schwere der Parodontalerkran*
kung der behandelten Population, die Ent-
sehcidung fur die eine oder anderc
Behandlungsart entscheidend vom Grad des
Fnrkationsbefalls und des Zahntyps abhan-
gig zu sein.
Resume
Tniiiemciii ties Jems prescnianl une alleiiile
tic la furcaiion. Analyse retrospective
On trouvera dans la presents etude une ana-
lyse retrospeetive des donnees recueillies chez
550 paiients pre.sentant une maladie paro-
donlale avec plus de 1100 atteinles de la fur-
cation. On pOLivait constater des differences
dans !a distribution dc diiTcrents degres d'at-
tcintc dc la furcation dans des populations de
patients traites par 2 operateurs diflerem-
ment cxperimcntes. Cependant les modes de
lraitcnn;nt etaient assez semblables. Le de-
tartrage au cours d'une operation parodon-
tale a lambeau etait le proeedc Ic plus tVc-
quemmcnt employe dans les alteintes de de-
grc I (97-98'^.) ei [l (75-83"/,.|. Environ 44'!^,
des dents avec atteinle de degre III ont ete
exlraitcs. Dans Ic but dc determiner I'in-
fluence du dcgre de I'atlcinic dc la furcation,
du type de dent et de la variabilitc de Fopera-
teur sur le mode de traitenicnt. une analyse
dc regression logisiiquc a etc appliquee. Le
dcgrc d"aiteinte de la furcation etait une va-
riable indicatrice importante dans tous les
modeles. Le detartra^e seul etait pratique
principalemenl en relation avec ie degre 1
d"attcintc de la furcation. Pour chaque aug-
mentation du degre. les chances d'emploi dn
dctarlrage diminuaicnt d'un facteur 12.7. Les
chances d'emploi d'une re.scclion dc hi riici/ic
dans les I'""-"' molaires supcrieures elaicnt 46
Ibis plus clevccs qne dans les dents de sagesse
et les 2'^"^'-"' molaires infericurcs ayant le meme
degre d'atteinte. mais seulement 3.3 fois plus
elevees qne dans les I'"""' molaires inferieures.
La prcparolion d'un Itiniicl ainsi qne les n)e-
lluides de regcneraiiun etaicnt prcsque entie-
rcmcnt liniitees aux molaires interieures. La
variability de I'operalcur etait senlement in-
troduite comme covariate dans le modclc de
I'f.Mraclion. Ainsi. en depit des differences
dans I'habilete des operateurs et dans la se\e-
ritc dc la maladie parodoniale dans les popu-
lations traitecs. il scmbic quc la decision
d'exccutcr I'un ou I'autre des modes de traitc-
mcnt depende essentiellement du degre d'at-
tcinte de la furcation et du type de dent.
References
Andercgg. C. R.. Martin. S. J.. Gray. J. L.,
Mellonig. .1. T & Ghcr. M. E. (1991) Cliti-
ieai evaluation of the use of decalcified
freezc-dried bone allograft with guided
lissuc regeneration in the treatment of mo-
lar fnrcation invasions. Journal of Pcriod-
oiilohgy 61. 264 268.
Basaraba. N. (1990) Furcation invasions. In:
Peiiodiinhd diseases. 2nd edition. Schlug-
er. S,. Yuodclis. R.. Page. R. C. & Johnson.
R. H.. pp. 541 559. Philadelphia: Lea &
Febinger.
Brayer. W K.. Mellonig. J. T . Dunlap. R.
M,. Marinak. K. W. & Carson. R. E.
(1989) Scaling and root planing clTectivc-
ness; the effect of root surface access and
operator experience. Joiirmd of Pcriadon-
lohgy 60. 67-72.

Buhicr. H. (I9«8| Evaluation ofrool-rcseclcd
teelli. Results after 10 years. Journal of
Perioikmlology 59, 805-810.
CatTesse. R. G., Sweeney, R L. & Smiili. B.
A. (1986) Scaling iind rool pianing with
and without pcriodontal llap surgery.
JouriutI i>l Clinical I'criothiUolo^v 13. 205
210.
Eickholz. P. Topoll. H. H.. Hiickc, H. P. &
Lange, D. E. 119^)11 Postoperative Befunde
nach Tutinelierutig lurkationsbcteiligtcr
Untcrkiolermolarcn iGrad III). Deutsche
'/Ailmiirztliclic Zcilsilirift 46, 356 357.
Fleischer. H. C-, Mellonig, J. T. Braycr. W.
K.. Gray. J. L. & Barnelt. J. D. (19S9)
Scaling and root planing efficacy in multi-
rooted teeth. Journal of Pcrioiiontohgy 60.
402 409.
Hamp. S.-E. & Nyman, S. (1989) Treatmctii
of furcation-involved teeth. In: Tiwihaak
of clinical perioclonioUi^y 2nd edition,
Lindhe, J.. (ed).. pp. 515 533. Copen-
hagen: Munksgaard.
Hellden. L., Elliot, A.. StefH-nsen, B. &. Stel-
leiisen. J. E. M. (19^9) The prognosis o{
tunnel prepanitlons in treatment of class
III lurcations. A follou-up study. Journal
nj Periodontology (A. 182 187.
Hensher. D. & Johnson, L. W (19811 Applial
(iiscrciv choke mociclling. London: Croom
Helm.
Hou. (5.-L. & Tsai, C.-C. (1993| Relationship
between palato-radicukir grooves and lo-
eiilized periodontitis. Journal of Clinical
Pcrioiloniolo^^y 10. biy. 682.
Kenney, E. B.. Leko%ic. V. Elbaz. J. J.. Kov-
acvie. K.. Carranza Jr., E A. & Takei, H.
H. (I98S) The use of porous hydroxylapa-
lite implant in periodontal defects (II).
Treatment ol elass Ii furcation lesions in
lower molars. Journal oj Periitoniologv 59,
67-72,
Langer, H., Sicin, S. D. & Wagcnberg. B.
(1981) An evaluation of root resections. A
10 -year study. Journal of Fcriodoniology
52,719-722.
Larato, D. C. (1970) Eureation involvements:
incidence and distribution. Journal of Peri-
w/wH<j/f»t,'V 46, 499-501.
Eoos, B., Claffey, N. & Egelberg. J. (I98fi)
Clinical and mierobiotogical elTeet.s of root
debriiiement in periodonial furcation
poekets. Journal of Clinical l'eri"ilon!olo^v
15. 453 463.
Martin, M.. Gantes, B.. Garrett, S, & Egel-
berg, J. (1988) Treatment of periodontal
furcation defects. I. Review of the litera-
ture and description of a regenerative sur-
gical technique. Journal of Clinical Period-
onlology 15, 227-231.
Metzler. D. G.. Seamons, B. C , Mellonig, J.
T, Gher. M. E. & Gray. J. L. (1991) Clin-
ical evaluation of guided tissue regenera-
tion in Ihe ireaiment o\' maxillary class II
molar furcation invasions. Journal of Peri-
odoulolof^y 62, 353 360.
Mutschelknaus^. R.. Simoti, B. & Blair, W.
(1991) Langzeiiergebnissc behandetter Bi-
und Trifurkationen bei Parodontitis pro-
funda. Deutsche Zahndrziliclw Zcilschrift
46, 362-366.
Nowzari, H. & Slots, J. (1994) Microorgan-
isms in polyictrafluoethylene barrier mem-
branes for guided tissue regeneration,
Jinirual of Clinical Feri(uloi]loloi>y 21. 203
210.
Parashis. A. O.. Anagnou-Vareltzides. A. &
Demetriou. N. (1993) Calculus remo\al
from multirooted teeth with and without
surgical access (I). Efficacy on external
and furcation surfaces in relation to prob-
ing deplh. Journal ol' Clinical Pcriodonio-
loi;y 20. 63 6H.
Patterson, M., Eick, J. D., Eberhart. A. B.,
Trvaliiicn! of fiircalions 917
Gross, K. & Killoy, W. J. (1989) The effec-
tiveness of two sonic and two ultrasonic
sealer tips in furcations. Journal of Period-
o>ilolo<;i6il 325-329.
Pontoriero. R.. Lindhe, J., Nyman. S.,
Karring T, Rosenberg, E. & Sanavi. F
(1988) Guided tissue regeneration in de-
gree II fLircalion-in\ol\ed matidibular mo-
lars. A clinical study. Journal of Clinical
Periodontology 15, 247 254.
Proestakis. G.. Bratthall. G.. Soderholm, G.,
Kullendorff. B.. Grondahl. K.. Rohlin,
M. & Attstrom, R. (1992) Guided tissue
regeneration in the treatment of infrabony
defects on maxillary premolars. A pilot
study. Journal of Clinical Pcriodomology
19, 766 773.
Schroeder, H. E. & Scherle. W (1987) Warum
die Furkalion nienschlicher Ziihne so un-
vorhersehbar bizarr gestaltet ist. Schwei:cr
Monatsschrifi fi'ir Zahnniedizin 97, 1495
I5()K.
Soeransky, S. S. & Haffajee, A. D. (1993) Ef-
fect of therapy on periodontal infections.
Journal of Periodontology 84, 754-759.
Wang H.-L.. Burgelt. K G.. Shyr, Y. &
Ramljord, S. (1994) The influence of mo-
lar furcation involvement and mobility on
future clinical periodontal attachment
loss. Journal of Periodontotogy 65, 25-29.
Address:
Haii.s-Peu-r Sfiiller
DeparlmenI oj Operative !)enii,\try ami
Periodontology
Im ,\'cuenlteinier Fcid 400
D-69120 Heidelberg
Germany