This document discusses furcation involvement, which refers to bone loss affecting the base of the root trunk where two or more roots meet in a multi-rooted tooth. It is usually caused by periodontal disease. The document defines furcation and discusses the etiology, classifications, anatomic factors, diagnosis, and various treatment options for furcation involvement including non-surgical therapy, osseous resection, root separation and resection, hemisection, regeneration techniques, and tooth extraction. Key factors in treatment planning include the grade and size of the furcation defect, root trunk length and morphology, and amount of remaining bone support.
This document discusses furcation involvement, which refers to bone loss affecting the base of the root trunk where two or more roots meet in a multi-rooted tooth. It is usually caused by periodontal disease. The document defines furcation and discusses the etiology, classifications, anatomic factors, diagnosis, and various treatment options for furcation involvement including non-surgical therapy, osseous resection, root separation and resection, hemisection, regeneration techniques, and tooth extraction. Key factors in treatment planning include the grade and size of the furcation defect, root trunk length and morphology, and amount of remaining bone support.
This document discusses furcation involvement, which refers to bone loss affecting the base of the root trunk where two or more roots meet in a multi-rooted tooth. It is usually caused by periodontal disease. The document defines furcation and discusses the etiology, classifications, anatomic factors, diagnosis, and various treatment options for furcation involvement including non-surgical therapy, osseous resection, root separation and resection, hemisection, regeneration techniques, and tooth extraction. Key factors in treatment planning include the grade and size of the furcation defect, root trunk length and morphology, and amount of remaining bone support.
This document discusses furcation involvement, which refers to bone loss affecting the base of the root trunk where two or more roots meet in a multi-rooted tooth. It is usually caused by periodontal disease. The document defines furcation and discusses the etiology, classifications, anatomic factors, diagnosis, and various treatment options for furcation involvement including non-surgical therapy, osseous resection, root separation and resection, hemisection, regeneration techniques, and tooth extraction. Key factors in treatment planning include the grade and size of the furcation defect, root trunk length and morphology, and amount of remaining bone support.
• Role and importance of anatomic factors in etiology, prognosis and treatment
• Mention and discus the treatment option of furcation
Definition : • Furcation defect: term used to describe bone loss, usually a result of periodontal disease,
affecting the base of the root trunk of a tooth where two or more roots meet.”.
• Glossary of periodontal terms defines Furcation as "the area of a multi-rooted tooth where
the roots diverge". The mandibular first molars - most common sites and maxillary premolars
- least common. ETIOLOGY OF FURCATION INVASIONS
Primary factor - Bacterial plaque
Extent of attachment loss depends on local anatomic factors
(e.g., root trunk length, root morphology,) and local developmental anomalies (e.g. cervical enamel projections)
Prevalence and severity of furcation increases with age
Dental caries and pulpal necrosis may also affect a tooth with furcation involvement Root complex • The portion of a tooth that is located apical of the cementoenamel junction (CEJ) • the portion that normally is covered with a root cementum • It is divided into two parts: root trunk and the root cone Root Trunk length The length of the trunk is the distance from the CEJ to the opening between the roots and is variable from one surface to another .
A key factor in both the development and the
treatment of furcation involvement Root trunk length • Short trunk = the furcation will became involved early in the disease
• A tooth with a short root trunk is a good candidate for Root
separation and resection (RSR)
• Long trunk = If the root trunk is long, the furcation involvement
occurs later in the disease process, but once established the amount of periodontal tissue support left apical of the furcation may be insufficient to allow RSR.. • Furcation entrance: the transitional area between the
undivided and the divided part of the root.
• Furcation fornix: the roof of the furcation
• Divergence: is the distance between two roots; this
distance normally increase in apical direction
• Degree of separation : the angle of separation
between two roots (cones)
Cervical enamel projections • Extension of enamel beyond the normal contours of the CEJ.
• Never have connective tissue attachment
• Most likely found on buccal surfaces of mandibulary and
maxillary second molar
• Occurrence 8.6% to 28.6% % of molars
• They favor plaque accumulation and must be removed to
facilitate scaling and root planning Diagnosis of furcation defects
• Probing (Nabors probe)
• radiographic examination Hamp et all Classification (1975)
Grade I : Horizontal penetration into furcation >
3 mm
Grade II: Horizontal penetration into furcation
<3 mm BUT incomplete
Grade III: through and through
Glickman classification 1953
• Grade I: incipient, no furcal bone loss, no
radiograph evidence
• Grade II: cul-de-sac
Grade III: thru and thru; not clinically visible
• Grade IV: thru and thru, visible clinically
Tarnow & Fletcher Tarnow and Fletcher have described classification systems that consider both horizontal and vertical attachment loss in classifying the extent of furcation involvement
Grade A : vertical loss of 1-3 mm
Grade B : vertical loss of 4-6 mm
Grade C : vertical loss of 7+ mm
The aim of furcation therapy
A. Facilitate maintenance
B. Prevent further attachment loss
C. Eliminate the furcation defects as a periodontal maintenance
problem Factors to be considered before choose on a method of therapy
1. Size, shape, and divergence of roots
2. Size of the crown 3. Length of the root trunk (distance between the CEJ and the furcation area) 4. Crown-to-root ratio 5. Amount of remaining bone support Treatment option of furcation involvement 1. Odontoplasty
2. Non-surgical treatment, Scaling and root planing
3. Open surgical debridement
4. Osseous Resective Surgery
5. Root amputation/hemisection
6. Osseous grafting
7. Guided tissue regeneration with using Biological Mediators
8. (Regenerative therapy )
9. Tooth extraction & dental implant
Nonsurgical Therapy
• Oral hygiene procedures
• Scaling and root planning
• Indicated in Grade I and early grade II
Osseous resection (osteoplasty and osteoectomy) • Make the furcation areas cleansable
• To allow easier hygiene into the furcation area for the patient.
• in Grade IV from a severe Class II or III case
• in the compromised individual in whom teeth cannot be extracted or in
whom conservative therapy has failed. Odontoplasty • It is the reshaping of the tooth coronal to the furcation to improve access for plaque control
• It increases entrance to the furca and reduces its horizontal depth
• Mainly advised for grade I & II lesions
• Potential complications • Hypersensitivity
• Pulpal irritation
• Increase risk of root caries
Odontoplasty Tunnel Preparation • It is a technique used to treat deep degree II and III furcation defects in mandibular molars and short root trunks • indicated in the case in which root resection is not possible.
• During maintenance topical application of CHX and fluoride should be
done
• At mandibular molars with;
• Short root trunk • Wide separation angle • Long divergence between the mesial and distal roots Root separation and resection (RSR) Root resection involves removing one or two roots of a multiple rooted tooth
Root separation involves the sectioning the root complex and the maintenance of all root
RSR is frequently used in cases of deep II and degree III furcation involved molars
Can be done vital or endodontically treated teeth
Indication of RSR
Teeth that are critically important to overall dental treatment plan.
Teeth with furcal Grade II + III Glickman.
Teeth with long root with adequate divergence, short root trunk.
Teeth that have sufficient remaining bone for function.
In patient with good oral hygiene and low activity for caries , Hemisection • It is the splitting of two –rooted tooth into two separate portion. This process has been called bicuspidazation or separation because it changes the molar into two separate roots. Hemisection is most likely to be performed on mandibular molars with buccal and lingual class II, III or IV furcation involvement
• After sectioning of the teeth, one or both roots can be retained. This decision is based on the extent and pattern of the bony loss, root trunk and root length, ability to eliminate the osseous defect, and endontic and restorative consideration Hemisection Hemisection (tri- section) in the Maxilla- maintenance of All Roots with F3 furcation involvement Maxillary molars • Distobuccal root 1. The shortest of the three roots 2. The root trunk is comparatively long 3. It has a small quantity of bone support Regeneration of furcation
• Gottlow et al. (1986) was the first publisher that use GTR
• Using of GTR with Bone graft
• Bone replacement grafts enhance GTR treatment outcomes in furcations
• Most predictable result was in grade II furcation
• Less predictable result was in grade III and Maxillary Grade II
