Furcation involvement (FI) refers to a condition in which the progression of the periodontal disease process invades the bifurcation and trifurcation of multirooted teeth. Furcation involvement, present a clinical challenge due to its anatomic complexity and reduced access for adequate plaque control which may leads to further periodontal breakdown. Consequently, maintenance of adequate oral hygiene is critical in these sites.
It has been shown that poor oral hygiene, together with the persistence of periodontal risk factors, leads to further disease progression, treatment failure, and disease recurrence.
Mobile health can serve as a valuable adjunctive approach by aiding in behavioral reinforcement through real-time reminders. With widespread mobile phone usage in India, mHealth interventions are feasible. The role of mHealth in management of furcation involved sites has still not been explored. Therefore, this randomized controlled clinical trial aims to evaluate the effectiveness of mobile health reinforcements in improving plaque control efficacy at in furcation involved sites following non-surgical periodontal therapy, with the potential to enhance patient compliance and prevent further disease progression and disease recurrence.
Systemically healthy individuals with clinically visible furcation entrance in mandibular molars in Stage III periodontitis
Horizontal bone loss extent ≥ 3mm29 and vertical bone loss ( Subclass A/B)30
Access to mobile phone
Presence of systemic diseases that could influence the outcome of periodontal therapy (Diabetes mellitus, Hypertension)
Smoking/alcohol consumption
Teeth with Grade II/III mobility
History of periodontal treatment or antibiotic therapy in the last 6 months
Parallel
Behavioural text messages twice weekly
BehavioralRegular messages twice a week will be sent to the individuals reminding the individuals for standardized oral hygiene instructions and interradicular brushing in furcation involvement. Individuals will be asked to respond to the messages.
Standardized oral hygiene instructions
Other interventionAll participants will recieve standardized oral hygiene instructions including toothbrushing techniques and interdental brushes.
Plaque Index
Plaque index by Silness and Loe (1964) will be used for assessment of plaque.Score range of this index is from 0 to 3.Score 0 means good oral hygiene and score 3 means poor oral hygiene.
Bleeding on probing
It will be measured by walking the periodontal probe at 6 sites of each tooth (mesio-buccal, mid-buccal, disto-buccal, mesio- lingual, mid-lingual and disto-lingual). It will be recorded as 1 (present) if it occurred within 15 sec of probing and 0 (absent) if no bleeding occurred. It will be calculated in %.
PROBING POCKET DEPTH (PPD)
Probing pocket depth will be measured as the distance from gingival margin to the base of pocket. The probing depth measurements will be assessed using the Periodontal probe. The probe will be inserted in the bottom of pocket and maintained parallel to vertical axis of the tooth. Measurements will be noted at 6 sites of a tooth (mesio-buccal, mid-buccal, disto-buccal, mesio-lingual, mid-lingual and disto-lingual). Measurements will be rounded to the nearest whole millimeter.
HORIZONTAL PROBING DEPTH (HPD)
Horizontal probing depth will be assessed by probing the furcation in a horizontal direction using a rigid curved probe (e.g. Nabers probe) and measuring the distance from the probe tip to a virtual tangent to the root convexities adjacent to the furcation. Measuring this distance allows assessment of different degrees of FI or the amount of horizontal attachment loss in millimeters (horizontal probing/ clinical attachment level: PAL-H/HCAL).
VERTICAL PROBING DEPTH (HPD)
UNC-15 periodontal probe will be used to record the vertical depth. The probe will be inserted into the periodontal pocket up to the alveolar bone, and the distance from the roof of furcation to the vertical depth of probing (VD) will be measured. All measurements will be recorded nearest to the millimeter.
CLINICAL ATTACHMENT LEVEL(CAL)
Clinical attachment level will be measured as the distance between the cemento-enamel junction and the base of pocket. Measurements will be made at 6 sites of each tooth (mesio-buccal, mid-buccal, disto-buccal, mesio- lingual, mid-lingual and disto-lingual) using Periodontal probe. Distance of base of the pocket from gingival margin, distance of free gingival margin from CEJ will be measured. Afterwards CAL will be calculated based on following criteria. When gingival margin is located on the anatomic crown, the level of attachment is determined by subtracting from the depth of pocket, the distance from the gingival margin to the CEJ. If both are same, the loss of attachment is recorded as zero. When gingival margin coincides with CEJ, the loss of attachment equals to probing pocket depth. When gingival margin is located apical to CEJ, the loss of attachment is greater than probing depth and therefore the distance between CEJ and gingival margin is adde
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