FURCATION INVOLVEMENT COMPLICATIONS IN PERIODONTICS

PERIODONTITIS AND FURCATION

1. FURCATION INVOLVEMENT

2. CONTENTS Introduction Definitions Terminologies Anatomy of multirooted teeth Classifications Etiology Clinical features Radiographic features Examination Diagnosis Prognosis Management

3. INTRODUCTION

4. DEFINITIONS Furcation is the anatomic area of a multi-rooted tooth where the roots diverge. - AAP 1992. Furcation is defined as the area between individual root cones. - Lindhe . Furcation is the area of complex anatomic morphology that is difficult to debride by routine instrumentation. - Carranza.

5. Furcation Involvement is the pathological resorption of bone within a furcation.. - AAP 1992. Furcation Involvement is the invasion of the bifurcation or trifurcation of a multirooted teeth . - Carranza.

6. TERMINOLOGIES

7. CLASSIFICATIONS

8. According to Glickman (1953) Grade I Incipient or early lesion Grade II Cul-de-sac lesion Grade III Through and through furcation involvement Grade IV Inter-radicular bone is completely lost, the gingival tissue recede apically and clinically visible.

9. ETIOLOGY Dental plaque

10. Different types of root lengths and forms Cervical enamel projections

11. CLINICAL FEATURES The mandibular molars are the most common sites and maxillary premolars are the least common. The denuded furcation may be visible clinically or covered by the wall of the pocket. Root caries, tooth mobility and periodontal abscess are common. Associated with suprabony and infrabony pockets.

12. RADIOGRAPHIC FEATURES Grade I Radiographic changes are usually not found Grade II Radiographs may or may not depict the furcation involvement Grade III Shows a radiolucent area in the crotch of the tooth, seen as furcation arrow Grade IV Seen as radiolucent area

13. EXAMINATION Max. premolar Mesial furcation to be examined Max. molars Buccal , mesial and distal furcas to be examined Mand . molars Buccal and lingual furcas to be examined

14. DIAGNOSIS Clinical Naber’s probe Transgingival probing Radiographic - Radiolucency near furcation area.

15. PROGNOSIS Furcation Prognosis Grade I Good Grade II Good-fair (initial furca ) Grade III Fair-poor Grade IV Poor

16. MANAGEMENT

17. FURCATIONPLASTY Hamp , Nyman & Lindhe (1975) Definition Furcation plasty is a resective treatment modality which should lead to the elimination of the interradicular defect. In this both odontoplasty and osteoplasty are done. Indications - It is indicated in grade I and early grade II furcation lesions.

18. TUNNELING Synonym - Tunnel preparation Definition - Tunnel preparation is a surgical procedure performed on a multi-rooted teeth, usually a mandibular molar, resulting in a completely opened furcation to provide access for hygiene. Indications - Grade II & III furcation defects. Contraindications - Lack of patient motivation to maintain oral hygiene. Factors to be considered in tunneling Low caries rate. Mandibular molars. Wide furcal entrance. Root trunk should be short with high furcation entrance & long roots The floor of pulp chamber should not be close to the roof of furcation.

19. Tunneling

20. ROOT RESECTION Synonym – Radisection Radisectomy Definition Root resection denotes the removal of one or more roots of a molar. Indications When a fractured root of an upper molar is present. When a root has been destroyed by extensive decay. When a root has been perforated and cannot be treated endodontically . When extensive loss of bone has occurred around one root of an upper molar. When endodontic treatment of one root is technically impossible or when such treatment has failed. When untreatable furcation involvement is present & removal of root will facilitate oral hygiene in that area. Contraindications When the roots are fused. When the bridge span is long and abutment tooth would lend inadequate support. When loss of bone involves more than one root & the remaining root would have in adequate support. Lack of patient motivation to properly perform homecare procedures.

21. Horizontal / oblique approach - Resection of the involved root at the point where it joins the crown. This process is known as root amputation/ resection. Vertical approach - Amputation of pathologic root & its associated portion of the crown. This procedure is known as hemisection / trisection. Approaches to root resection

22. BICUSPIDIZATION Synonyms – Bisection Seperation Hemisection Definition - Bicuspidization is the splitting of two rooted tooth into two separate portions. Indications The fracture of one root that does not involve the other. Surgical inoperable roots that are calcified contain seperated instruments or are grossly curved. Mandibular molars with advanced grade II or III furcation involvement. Existence of periodontal bone loss to the extent that a periodontal therapy and patient maintenance do not sufficiently improve the condition. Conditions that indicate surgery will be technically feasible to perform & the prognosis is reasonable. Contraindications Lack of necessary osseous support for the remaining roots. Fused roots or roots in unfavorable proximity to each other. Remaining roots or roots endodontically inoperable. Lack of patient motivation to properly perform homecare procedure.

23. GUIDED TISSUE REGENERATION (GTR)

24. S. No. Furcation Traditional procedures Regenerative procedures 1 Grade I Scaling Root planing Curettage Odontoplasty - 2 Grade II Scaling Root planing Curettage Odontoplasty Osteoplasty with limited istectomy in shallow grade II Root resection/ hemisection in severe grade II Autogenous grafting Alloplasts Guided tissue regeneration Coronally displaced flaps Combination procedures. 3 Grade III Tunnelling Root sectioning Hemisection Extraction GTR & combination procedures. 4 Grade IV Maintenance -