17. Management Of Furcation-Involved Teeth

Question 1

What are some limitations of using radiographs to check for furcation involvements?

Answer 1

1. They provide info on bone but furcation involvement is not only a matter of bone, but also of connective tissue attachment
2. The furcation channel is oriented perpendicularly to the central beam for the maxillary premolars and molar furcations. The buccal furcation of the maxillary molar is also overlapped with the palatal root thus the bone in the furcation is obscured and there is limited diagnostic value
3. Reduced bone density may be due to periodontal destruction or naturally loose spongy bone. This can only be discerned through clinical probiong

Question 2

Radiographs can be used to check the furcation involvement effectively for which teeth? Why?

Answer 2

The mandibular molars. The furcation channel is located parallel to the central beam and therefore the bone in the furcation area can be assessed

Question 3

How do you determine the prognosis of furcation-involved teeth?

Answer 3

We check the vertical and horizontal involvement

• The greater the degree of the furcation, the worse the prognosis. The more severe the vertical component, the worse the prognosis too.
• Prognosis also depends on the remaining circular attachment of each root.

Question 4

What are the GOALS of furcation therapy? ***

Answer 4

1. Elimination of microbial plaque retentive factors
2. Establishment of an anatomy conducive to proper self-performed plaque control
3. Complete elimination of furcation involvement
4. Reduction in furcation involvement
5. No further progression of furcation

Question 5

What are some factors that we should consider when deciding whether to extract or retain a furcation-involved tooth?

Answer 5

• Age of the patient
• Strategic importance of the tooth
• Prognosis of the tooth
• Prognosis of the treatment selected (need for adjunctive treatment or access for long term maintenance)
• Financial considerations
• Parafunctional habits

Question 6

What are the 3 treatment approaches we can take for furcation-involved teeth? What are their objectives?

Answer 6

1. Conservative: Subgingival debridement, access-flap surgeries and tunnel preparation. Aims to remove residual bacterial infection and improve self-performed plaque control
2. Regenerative: Guided tissue regeneration. Aims to remove residual infection and eliminate furcation defect through reconstruction of the lost inter-radicular periodontal tissues
3. Resective: Root separation/resection/amputation. Aims to eliminate inter-radicular lesion by completely removing both the dental and osseous structures that make up the defect. This creates an area that is easier to clean for plaque removal

Question 7

What are the different treatment workflows for each degree of furcation involvement?

Answer 7

Degree I - Closed debridement (SRP), Furcation plasty

Degree II - Furcation plasty, tunnel preparation, root resection, Guided tissue regeneration (lower molars), tooth extraction

Degree III - Tunnel preparation, root resection, tooth extraction

Question 8

What are the main points to take note of for furcation-involved teeth?

Answer 8

• Make sure patient factors are controlled and try to keep teeth when possible!
• Always start with non-surgical treatment first to reduce bacterial load and tissue inflammation
• Degree I furcation involvement has good long-term prognosis and does not represent a higher risk of tooth loss if periodontal maintenance is carried out
• Degree II furcation involvement can benefit from GTR and surgical procedures (mainly mandibular molars for GTR)