Furcation Involvement and its Therapy.pptx

Furcation involvement and it's therapy

1. By Dr. Seema Abid 1 FURCATION Involvement & its THERAPY

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7. 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.” OR “Invasion of bifurcation and trifurcation of multi-rooted teeth by periodontal Disease” 7

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13. Hamp et al. (1975) classification Degree I: Horizontal loss of periodontal support not exceeding 1/3 of the width of the tooth Degree II: Horizontal loss of periodontal support exceeding 1/3 of the width of the tooth, but not encompassing the total width of the furcation area Degree III: Horizontal "through and through" de- struction of the periodontal tissues in the furcation area 13

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16. Glickman`s Classification Grade I: early stage of furcation involvement supra bony pocket increase probing depth due to early bone loss radiographic changes not found Grade II: cul-de-sac with definitely horizantal component portion of bone remain in the furcation region vertical bone loss may or may not be present. 16

17. Glickman`s Classification Grade III: bone is not attached to dome of furcation Complete loss of interadicular bone appearance of radiolucent area with pocket formation Grade IV: loss of attachment and gingival recession furcation is clinically visible Probe passes easily through and through. 17

18. Glickman`s Classification 18

19. Diagnosis The following parameters should be recorded to evaluate the amount of tissue loss in periodontal disease and also to identify the apical extension of the inflammatory lesion pocket depth (probing depth) attachment level (probing attachment level) furcation involvement ( measured with nabers probe ) Radiographs 19

20. Pocket Depth 20

21. Nabers probe for furcation areas 21

22. Technique of Nabers Probe 22

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28. Furcation plasty Tooth substance is removed (odontoplasty) and the alveolar bone crest is remodeled (osteoplasty) at the level of the furcation entrance 28

29. Furcation plasty procedure Reflection of soft tissue flap. Removal of the inflammatory soft tissue scaling and root planning of the exposed root surfaces. The removal of crown and root substance in the furcation area (odontoplasty) The recontouring of the alveolar bone crest (osteoplasty) positioning and the suturing of the mucosal flaps at the level of the alveolar crest in order to cover the furcation entrance with soft tissue. 29

30. Tunnel preparation Technique used to treat deep degree II and degree III furcation defects in mandibular molars Following hard and soft tissue resection enough space has been established in the furcation region to allow access for cleaning devices to be used during self performed plaque control The flaps are apically positioned The exposed root surfaces should be treated by topical application of chlorhexidine digluconate and fluoride varnish. Because of pronounced risk for root sensitivity and for carious lesions developing on the denuded root surfaces within artificially prepared tunnels 30

31. Tunnel preparation 31

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34. Root separation and resection (RSR) Root separation involves the sectioning of the root complex and the maintenance of all roots. Root resection involves the sectioning and the removal of one or two roots of a multirooted tooth. RSR is frequently used in cases of deep degree II and degree III furcation involved molars. 34

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38. Criteria for RSR The length of the root trunk A tooth with a short root trunk is a good candidate for RSR; The divergence between the root cones Roots with a short divergence are technically more difficult to separate than roots which are wide apart The length and the shape of the root cones Short and small root cones following separation tend to exhibit an increased mobility Amount of remaining support around individual roots This should be determined by probing the entire circumference of the separated roots Stability of individual roots Access for oral hygiene devices 38

39. Regeneration of furcation defects "guided tissue regeneration" (GTR) therapy is provided GTR is more successful in degree II furcation involvements then in degree III involvements 39

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41. GTR limits The morphology of the periodontal defect  Horizantal bone loss The anatomy of the Furcation with complex morphology  more in maxillary than mandibular tooth The varying and changing location of the soft tissue margins during the early phase of healing with a possible recession of the flap margin and early exposure of both the membrane material and the fornix of the Furcation 41

42. GTR feasibility improves if Adequate debridement area of exposed root surface The membrane material is properly placed A plaque control program is put in place. This should include daily rinsing with a chlorhexidine solution and professional toothcleaning once a week for the first month, and once every 2-3 weeks for at least another 6 months of healing following the surgical procedure 42

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45. Extraction option Through and through Furcation defects (degree III and IV) Advance attachment loss Un-adequate plaque control High caries activity Non compliance of the patient 45

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