Referral Patterns for Furcation Management among Dental Clinicians in an Academic Setting- A Preliminary Study

Introduction: A critical prognostic factor in multirooted teeth is the involvement of furcation. This can often pose challenges to the clinicians which makes them lean towards extraction and replacement rather than a comprehensive periodontal treatment.

Aim: To evaluate the choice of treatment and referral pattern for advanced Furcation Involvement (FI) among dental clinicians.

Materials and Methods: This was a cross-sectional study conducted in the Department of Periodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India from August 2018 to September 2019. In this study, two complete case details of furcation involved teeth (C1 and C2) were distributed among the dental faculty of different specialities other than periodontics from various dental colleges in Chennai, India. Both cases were complex and manageable by experienced Periodontists. A total of 414 clinicians completed a closed-ended questionnaire consisting of 15 questions. The questions were grouped under 4 domains, evaluating their diagnosing capability, treatment planning expertise, referral pattern to Periodontist and their insight on periodontal treatment outcomes. The collected data were analysed using Statistical Package for the Social Sciences (SPSS) software 23.0 version. Pearson’s Chi-square test was carried out to find association between specialties, years of experience and age with all questions regarding case scenario and periodontal disease management. The p-value of ≤0.05 was considered to be statistically significant.

Results: A total of 414 dental clinicians completed the questionnaire, the response rate being 95.2%. Of the total, 178 (43%) were males and 236 (57%) were females. The participants who opted for periodontal treatment accounted for 57.7% for C1 and 86% for C2. Total 31.2% for C1 and 5.8% for C2 opted for extraction and Fixed Partial Denture (FPD), whereas, only 8.7% for C1 and 3.9% for C2 opted for extraction and implant placement. The endodontists opted more for periodontal management. The prosthodontists, for C1 (48.1%) and oral surgeons for C2 (11.4%) showed more interest towards extraction and FPD. The clinicians with 10-20 years experience identified the defect more appropriately (82.5% for C1 and 47.5% for C2), (p-value <0.001) and suggested appropriate management {57.5% for C1 (p-value <0.001) and 65% for C2}. Of the cohort, 20.8% of the entire population and 50% with >20 years of experience constantly referred their patients for periodontal opinion and management (p-value <0.001).

Conclusion: Periodontal therapy for furcation involved molars seemed to be widely accepted by the survey respondents than extraction of the tooth followed by implants or FPD. The important factors affecting referral were the specialty of the dental clinicians and the number of years of clinical experience.