Furcation involvement

furcation involvement

1. Furcation : Involvement
and Treatment

2. Furcationisanareaorzoneofdivisionofrootsinamulti
rootedtooth
Furcationinvolvementreferstotheinvasionofthe
bifurcationandtrifurcationofmultirootedteethby
periodontaldisease.
Definition :

3. Anatomy of Furcation:

4. Etiological factors :
Longterm-bacterialplaqueandinflammatoryconsequenses.
Localanatomicalfactors(roottrunklength,rootmorphology
proximityofthefurcationtothecemento-enameljunction,
presenceofaccessorypulpalcanals)
Localdevelopmentalanomalies(cervicalenamelprojections
andenamelpearls),
Traumafromocclusion

5. Local Anatomical Factors :
Root Trunk length
Root length
Root form
Inter-radicular dimension
Anatomy of furcation
Cervical enamel projection

6. Root Trunk length :
Short root trunk early involvement but more accessible.
Longer root trunk late invasion but less accessible.
Root length :
Itisdirectlyrelatedtoquantityofattachmentsuppotingthe
tooth
Teethwithlongrootsandshorttomoderateroottrunk
lengtharemorereadilytreatedbecausesufficient
attachmentremainstomeetfunctionaldemands.

7. Root form :
The mesial root of most mandibular first and second molars
and the mesiofacialroot of the maxillary first molar are
typically curved to the distal side in the apical thirdand the
distal aspect of this root is usually heavily fluted.
Interradiculardimension :
Teeth with widely separated roots present more treatment
options and are readily treated

8. Anatomy of furcation :
Presence of bifurcation ridges, concavity domes, accessory
canals complicate treatment.
Cervical enamel projections :
Should be removed because they facilitate plaque
accumulation and complicate treatment.

9. Classification
GLICKMAN’S CLASSIFICATION (1953)
Grade I-
Incipient or early lesion.
Pocket is suprabonywith slight bone
loss in loss in furcation area.
No radiographic changes

10. Grade II-
Lesion is cul-de-sac.
Bone is destroyed in one or more aspects but portion of
PDL and portion of alvolarbone are intact permitting only
partial probe penetration.
Radiographic changes may or may not be present.

11. Grade III-
Interradicularbone is lost completely but occluded by gingival
tissues hence not seen clinically.
Though and through penetration of probe.
Radiologicallya radiolucency is seen between roots.

12. GradeIV-
Completeinteradicularbonelosswithapicalrecessionof
tissuessoclinicallyvisible.
RadiologicalchangessameasgradeIII.

13. TARNOW & FLETCHER (1984)
(Sub-classification based on the degree of vertical involvement)
Subclass A. 1–3 mm
Subclass B. 4–6 mm
Subclass C. >7 mm

14. Diagnosis :
Probing with the specially designed probes (Nabers
probe) or No.23 explorer.
Transgingival sounding.

15. Radiographic Appearance
Three diagnostic criteria are
suggested:
1.The slightest radiographic
change in the furcation area
should be investigated
clinically, especially if there is
bone loss on adjacent roots.

16. 2.Diminished radiodensityin the
furcation area in which
outlines of bony trabeculaeare
visible suggestsfurcation
involvement.

17. 3)Whenever there is marked
bone loss in relation to a
single molar root, it may be
assumed that the furcation is
also involved

18. Management
GRADEI-
Intialpreparationforscalingandrootplaning.
Curettageorgigivectomytoexposefurcationarea.
Odontoplasty–toreshapeoreliminatelocalfactors
whichcauseplaqueaccumulation.

19. GRADE II-
Early (non invasive):
Scaling, rootplaning, curettage.
Furcationplastyosteoplasty+odontoplasty
Advanced :
Tunneling
Autogenousor allogenousbone grafts can be given
along with GTR

20. Grade III :
Early -Periodontal regeneration
Advanced -Resectiveprocedures.
Grade IV :
Treated mostly by resectiveprocedures.
Extraction -with advanced attachment loss

21. Resectiveprocedures :
1)Root resection
2)Hemisection
3)Bicuspidization

22. Root Resection:
The removal of a root without the removal of any portion of
the crown

23. Which tooth to remove ?
1)Remove the roots that will eliminate the furcation and allow
the production of a maintainable architecture on the remaining
roots.
2)Remove the root with the greatest amount of bone and
attachment loss.
3)Remove the root that best contributes to the elimination of
periodontal problems on adjacent teeth.

24. 4)Removetherootwiththegreatestnumberofanatomic
problems,suchasseverecurvature,developmentalgrooves,
rootflutings,oraccessoryandmultiplerootcanals.
5)Removetherootthatleastcomplicatesfutureperiodontal
maintenance.

25. Hemisection
Surgical removal of a root with associated part of the crown.
Hemisection is most likely to be performed on mandibular
molars with buccal and lingual class II or III furcation
involvements

26. Bicuspidization
Sectioningofrootcomplexand
maintainenceofallroots.
Decisionisbasedontheextentandpattern
ofbonyloss,roottrunkandrootlength,
abilitytoeliminatetheosseousdefect,and
endodonticandrestorativeconsiderations.

27. Thank you