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Perio > 40. Treatment of furcation involvement > Flashcards

40. Treatment of furcation involvement Flashcards

1
Q

Treatment of furcation involvement

Root complex

A
  • Portion of root located apical to CEJ
  • Divided into two parts: Root trunk and root cone
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2
Q

Treatment of furcation involvement

Root trunk

A
  • Undivided region of the root
  • Distance between CEJ and the furcation
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3
Q

Treatment of furcation involvement

Root cone

A

Divided region of root complex

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4
Q

Treatment of furcation involvement

Furcation entrance

A

Transition between undivided and divided part of root

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5
Q

Treatment of furcation involvement

Furcation fornix

A

Roof of furcation

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6
Q

Treatment of furcation involvement

Degree of seperation

A

Angle of seperation between the two roots

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7
Q

Treatment of furcation involvement

Divergence

A

Distance between two roots(increases in apical direction)

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8
Q

Treatment of furcation involvement

Coefficient of seperation

A

Length of root cones in relation to length of root complex

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9
Q

Treatment of furcation involvement

Maxillary first molar size compared to second

A

Larger

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10
Q

Treatment of furcation involvement

Maxillary second molar size compared to third molar

A

Larger

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11
Q

Treatment of furcation involvement

Maxillary molar roots

A
  • 3 roots
  • MB(Vertically positioned)
  • Buccal
  • Palatal(inclined, circular cross section)
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12
Q

Treatment of furcation involvement

Maxillary molar furcation entrances

A
  • 3 furcation entrances
  • Mesial(3mm from CEJ)
  • Buccal(3.5mm from CEJ)
  • Distal(5mm from CEJ)
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13
Q

Treatment of furcation involvement

Furcation fornix inclination in maxillary molars

A

Inclined

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14
Q

Treatment of furcation involvement

Degree of seperation and divergence from first to third maxillary molar

A

Decreases

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15
Q

Treatment of furcation involvement

Maxillary premolar roots

A
  • 2 roots
  • Buccal and palatal
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16
Q

Treatment of furcation involvement

Distance between CEJ and furcation entrance in maxillary premolars

A

8mm

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17
Q

Treatment of furcation involvement

Width of furcation entrance in maxillary molars

A

0.7mm

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18
Q

Treatment of furcation involvement

Roots of mandibular molars

A
  • 2 roots
  • Mesial and distal
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19
Q

Treatment of furcation involvement

Root trunk of mandibular first molar compared with second

A

Shorter root trunk

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20
Q

Treatment of furcation involvement

Mandibular molar lingual entrance compared with buccal

A

More apical to CEJ(>4mm) than buccal entrance(3mm)

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21
Q

Furcation classifications

A
  • Class 0
  • Class 1
  • Class 2
  • Class 3
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22
Q

Class 0 furcation

A

No furcation involvement

23
Q

Class 1 furcation

A

Horizontal direction, probe travels less than 3mm

through one or two entrances

24
Q

Class 2 furcation

A

Horizontal direction, probe travels more than 3mm

-Probe doesnt go through whole furcation
-Only in one entrane

25
Q

Class 3 furcation

A

Horizontal, probe travels more than 3mm making through and through lesion

two or more entrances

26
Q

Subclasses of furcation in class 3

A
  1. Less than 3mm in vertical direction
  2. 3-6mm in vertical direction
  3. More than 6mm in vertical direction
27
Q

Treatment of furcation involvement

Probe used for assessment of furcations

A
  • Nabers probe
  • 1 for upper
  • 2 for upper and lower
28
Q

Treatment of furcation involvement

Nabers probe design

A
  • Curved working end
  • Circular cross section
  • Blunt atraumatic tip
29
Q

Treatment of furcation involvement

Nabers probe markings

A

2 black bands between 3-6 and 9-12mm

30
Q

Treatment of furcation involvement

Areas of mandibular molars checked with nabers probe

A

Buccal and lingual entrances

31
Q

Treatment of furcation involvement

Areas of maxillary molars checked with nabers probe

A
  • Buccal
  • DP(Located midway)
  • MP(much closer to palatal)
32
Q

Treatment of furcation involvement

Areas of maxillary premolars checked with nabers probe

A

Mesial and distal entrances

33
Q

Treatment of furcation involvement

Radiographs used for assessment/comfirmation of furcation involvement

A
  • Periapical
  • Vertical bitewing
34
Q

Treatment of furcation involvement

Differential diagnosis of furcation involvement

A
  • Pulpal pathoses-originating from root canal
  • Occlusal overload
35
Q

Treatment of furcation involvement

Factors to consider to confirm pulpal pathosis

A
  • Vitality of tooth tested
  • If tooth vital=>plaque associated lesion supected
  • If tooth non vital=>furcation involvement w/ endodontic origin
36
Q

Treatment of furcation involvement

Factors to consider to confirm occlusal overload

A
  • Increased mobility
  • Probing fails to detect furcation
37
Q

Treatment of furcation involvement

Treatment of F1

A
  • Scaling and root planing=>
  • Furcation plasty
38
Q

Treatment of furcation involvement

Treatment of F2

A
  • Furcation plasty
  • Tunnel preparation
  • Root resection
  • Tooth extraction
  • GTR for mandibular molars
39
Q

Treatment of furcation involvement

Furcation plasty

A
  • Elimination of interradicular defect
  • Tooth substance removed(odontoplasty)
  • Alveolar crest remodelled at level of furcation entrance(osteoplasty)
  • Mainly at buccal and lingual furcations
40
Q

Treatment of furcation involvement

Furcation plasty procedure

A
  • Incision and flap retraction to access interradicular area and surrounding bone
  • Removal of inflammatory soft tissue=>scaling and root planning exposed root surfaces
  • Removal of crown and root substance in furcation area
  • Recontouring of alveolar bone crest
  • Positioning and suturing of mucosal flaps at level of alveolar crest=>cover fucation entrance w/ soft tissue
41
Q

Treatment of furcation involvement

Reason for Removal of crown and root substance in furcation area

A
  • Reduces horizontal component of defect
  • Widens furcation entrance
42
Q

Treatment of furcation involvement

Reason for recontouring of alveolar bone crest during furcation plasty

A

Reduces BL dimension of bone defect in furcation area

43
Q

Treatment of furcation involvement

Tunnel preparation

A
  • Resective therapy
  • F2 and F3 in mandibular molars(short root trunk, wide seperation angle, long divergence between mesial and distal roots)
44
Q

Treatment of furcation involvement

Tunnel preperation procedure

A
  • Incision and flap
  • Granulation tissue removed
  • Root scaling and planing
  • Furcation area widened-removal of interradicular bone
  • Alveolar bone crest recontoured
  • Flaps sutured apically
  • Topical CHX
45
Q

Treatment of furcation involvement

Reason for widening of furcation area by removal of interradicular bone in tunnel preparation

A

Allows access for cleaning devices to be inserted during plaque control

46
Q

Treatment of furcation involvement

Root seperation

A

Sectioning of root complex and maintenaince of all roots

47
Q

Treatment of furcation involvement

Root resection

A

Sectioning and removal of one or two roots of multi-rooted tooth

48
Q

Treatment of furcation involvement

Factors to consider for root seperation and resection

A
  • Length of the root trunk(shorter the better)
  • Divergence
  • Fusion between root cones
  • Remaining support around individual roots
  • Length and shape of root cones
  • stability of indivudual roots
  • Access for oral hygiene devices
49
Q

Treatment of furcation involvement

Maxillary molar treatment with RSR

A
  • DB root often removed
  • MB root preferred for retention
50
Q

Treatment of furcation involvement

Treatment of F2 and F3 in maxillary first premolar

A

Extraction

51
Q

Treatment of furcation involvement

Treatment options of mandibular molars with RSR

A
  • Seperate the two roots but maintain them both(premolarisation)
  • Seprate and extract mesial root
  • Seperate and extract distal root
52
Q

Treatment of furcation involvement

Reason for seperation and extraction of mesial root of mandibular molars during RSR

A
  • Greater surface area but ourglass shaped cross section=>
  • Difficult to clean
53
Q

Treatment of furcation involvement

Treatment sequence in RSR

A
  • Endo treatment
  • Provisional restoration
  • RSR
  • Periodontal surgery
  • Final prosthetic restoration
54
Q

Treatment of furcation involvement

Criteria for extraction

A
  • Root cant be maintained=>extensive attachment loss
  • Anatomy wont allow proper self performed plaque control
  • Poor prognosis=>endo or caries lesions

Perio (60 decks)

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